Intervention in the form of a PA (physical activity) program combining aerobic, resistance, and flexibility exercises adapted for wearing a lower limb offloading device and limiting weight-bearing on the feet, with a duration of twelve (12) weeks, consisting of two supervised sessions and one unsupervised home session per week.
Objectives: 1. Evaluate the acceptability of a non-weight bearing physical activity (PA) program; 2. Assess the feasibility of the PA program and the data collection procedure; 3. Evaluate the feasibility of a submaximal exercise test for cardiorespiratory capacity; and 4. Verify the sensitivity of dependent variables to respond to a physical activity program (e.g., cardiorespiratory capacity, cardiovascular and metabolic risk factors, quality of life, PA level). Type of study: Feasibility and acceptability study with a pre-post evaluative design. Intervention: Intervention in the form of a PA (physical activity) program combining aerobic, resistance, and flexibility exercises adapted for wearing a lower limb offloading device and limiting weight-bearing on the feet, with a duration of twelve (12) weeks, consisting of two supervised sessions and one unsupervised home session per week. Subjects: * 10-12 persons with an active diabetic foot ulcer * 2-3 kinesiologists Data collection: * Sociodemographic and health questionnaire (age, sex, gender, marital status, education level, employment status, average annual family income, medical and health history, pharmacological and non-pharmacological treatments); * Feasibility assessment: PA (physical activity) logbook including 1) the number of supervised and unsupervised sessions completed, 2) the duration of each session, 3) participation rate (number of patients recruited/number of eligible patients), 4) attrition rate (number of participants who completed the follow-ups/number of participants recruited), and 5) perceived facilitators and barriers; * Acceptability assessment: 1) Treatment Acceptability and Preference (TAP) Questionnaire, seven to nine additional questions to assess the use of provided material resources and required safety checks (capillary blood glucose and wound inspection) and collection of participants' feedback, and 2) Client Satisfaction Questionnaire (CSQ-8); * Assessment of the sensitivity of dependent variables to respond to the PA program\*: 1) estimation of VO2max by a submaximal exercise test on a stationary bike (Aerobic Power Index submaximal exercise test), 2) average daily step count over seven days at the waist and in the offloading boot at times 0, 4, 8, and 12 weeks, 3) Global Physical Activity Questionnaire (GPAQ), 3) clinical examination (height, weight, body mass index, waist circumference, body fat percentage, blood pressure, resting heart rate, characteristics of the DFU and classification (SINBAD), 4) paraclinical examinations (venous blood glucose, glycated hemoglobin, lipid profile), 5) neuropathic pain questionnaire (DN4), 6) Epworth sleepiness scale, quality of life questionnaire (EQ-5D-5L), 7) questionnaire on motivation to practice PA. * Health and safety parameter measurements: electrocardiogram, oxygen saturation, estimated glomerular filtration rate, urine albumin/creatinine ratio, complete blood count. * Data collection at 24 and 36 weeks is also planned for participants who agree to be contacted after completing the 12-week PA program.
12-week duration, 2 supervised trainings/week, 1 unsupervised home-based training/week Aerobic, resistance and flexibility exercises
Universite du Quebec à Trois-Rivieres
Trois-Rivières, Quebec, Canada
Feasibility of physical activity intervention
Physical activity logbook, number of sessions completed with higher number meaning a greater feasibility
Time frame: At time 12 weeks
Acceptability of physical activity intervention
Treatment Acceptability and Preference (TAP) Questionnaire, minimum score 0/maximum score 16 with higher score meaning a greater acceptability
Time frame: At time 12 weeks
Satisfaction towards physical activity intervention
Client Satisfaction Questionnaire (CSQ-8), minimum score 8/maximum score 32 with higher score meaning a higher satisfaction
Time frame: At time 12 weeks
Estimated VO2max
submaximal exercise test on a stationary bike (Aerobic Power Index submaximal exercise test), mL/kg/min
Time frame: At times 0 and 12 weeks
Average daily step count over seven days
At the waist and in the offloading boot using a FitBit Zip, number of steps
Time frame: At times 0, 4, 8, and 12 weeks
Physical activity level
Global Physical Activity Questionnaire (GPAQ), no minimum/maximum, details number of minutes/number of days per week of physical activity according to type of activity (work, leisures, commute, sedentary time)
Time frame: At times 0 and 12 weeks
Height
Standing with rigid measuring rod, cm
Time frame: At time 0
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Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
12
Weight
Standing on beam balance scale, kg
Time frame: At times 0 and 12 weeks
Waist circumference
With flexible measuring tape above ombilic, cm
Time frame: At times 0 and 12 weeks
Body fat percentage
With bio-impedance balance, %
Time frame: At times 0 and 12 weeks
Arterial blood pressure
With automatic blood pressure monitor, mm Hg
Time frame: At times 0 and 12 weeks
Resting heart rate
With automatic blood pressure monitor, bpm
Time frame: At times 0 and 12 weeks
Wound measurements (width, length, depth)
With flexible ruler
Time frame: At times 0, 4, 8 and 12 weeks
Classification of the ulcer
Using SINBAD system, 6 categories graded 0 or 1 for a minimum of 0 and maximum of 6, with higher score meaning a more complicated ulcer
Time frame: At times 0, 4, 8 and 12 weeks
Non fasting venous blood glucose
With venipuncture, mmol/L
Time frame: At times 0 and 12 weeks
Glycated hemoglobin
With venipuncture, %
Time frame: At times 0 and 12 weeks
Lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, non-HDL cholesterol)
Venipuncture, g/L
Time frame: At times 0 and 12 weeks
Neuropathic pain (if present)
Neuropathic pain (DN4) Questionnaire, 10 yes/no questions, higher number of yes indicates more severe neuropathic pain
Time frame: At times 0 and 12 weeks
Sleep apnea symptoms
Epworth sleepiness scale, minimum score of 0/maximum score of 24, higher score makes sleep apnea more likely
Time frame: At times 0 and 12 weeks
Reported quality of life
Quality of life questionnaire (EQ-5D-5L), minimum score of 5/maximum of 25 + 10cm visual analog scale, higher score represents a lower quality of life + 10cm being the best health condition possible
Time frame: At times 0 and 12 weeks
Questionnaire on motivation to practice physical activity
With the Behavioural Regulation in Exercise revised Questionnaire (BREQ-2), 5 motivation categories graded from 0 to 4, Intrinsic (4 questions), Identified (3 questions), Introjected (3 questions), External (4 questions) and Amotivation (4 questions), with lower scores meaning lesser motivation for each category
Time frame: At times 0 and 12 weeks