The Effect of 12-week Aerobic and Lower Extremity Resistance Exercises on Healing of Plantar Ulcers in Type 2 Diabetic Patients

Inclusion criteria:

Type II DM according to ADA criteria for less than 20 years Receiving medical care (diet, oral agents, insulin) throughout the disease course Stable hypoglycemic medications (type & dosage) within the last 2 months Existence of at least one plantar ulcer that has not healed during the last 4 weeks despite receiving standard medical care 1 cm2 ≤ Wound Surface Area ≤ 16 cm2 The ulcer must be classified as grade 1 or 2, stage A or C under the UTCS At least 18 years of age BMI < 35 0.7 ≤ ABI ≤ 1.2 6.5% ≤ HbA1C ≤ 9.5% 100 ≤ FBS ≤ 250 mg/dl Sedentary lifestyle for the last 6 months Receiving at least 8 years of education within the IRI educational system

Exclusion criteria:

Cognitive or mental deficit Wound treatments other than standard care (deemed to be required by the physician) such as growth factors, NPWT, hyperbaric oxygen, special dressings, etc. Ulcer requiring surgical operations other than debridement Non-diabetic ulcers such as electrical, chemical or radiation burns, etc. Pregnancy or breast feeding Infection or OM Critical limb ischemia or lower extremity gangrene Proliferative retinopathy or history of retinal detachment Macroalbuminuria History of major lower extremity amputation Severe liver disease Uncontrolled HTN or BP higher than 160/95 mmHg Life-threatening disease such as malignancy History of DVT during the last 6 months Active cellulitis or collagen vascular disease Active Charcot Present history of smoking or alcoholism Dialysis Immunodeficiency caused by immunosuppressant usage or chemotherapy during the past 2 months, radiotherapy within the last 4 months or systemic diseases Presence of any overt cardiovascular condition diagnosed by cardiologist that prevents the patient from performing vigorous activities Any kind of disease or condition (orthopedic, neurologic, pulmonary, arthritis, etc.) that limits or contraindicates physical activity Presence of any condition considered as absolute contraindication for physical activity by the ACSM’s guideline Participating in any experimental or non-experimental program that requires regular physical activity Missing 3 consecutive or 4 non-consecutive sessions during the study

Target sample size: 46