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Aims Diabetic foot disease is associated with both macro- and microvascular disease. Exercise has both positive and negative effects on the perfusion of lower limbs with peripheral arterial occlusive disease (PAOD). We aimed to measure changes in foot perfusion following a brief period of lower-limb exercise in individuals with and without Type 2 diabetes and non-critical PAOD.
Methods Subjects were allocated to groups according to the presence or absence of diabetes, PAOD on colour duplex imaging and clinically detectable peripheral neuropaÍthy. Transcutaneous oxygen tension (TcPO2), transcutaneous carbon dioxide tension (TcPCO2), ankle-brachial pressure indices, toe pressures and toe-brachial pressure indices (TBI) were measured.
Results One hundred and sixteen limbs were studied in 61 subjects. Post-exercise, toe pressure and TBI increased in the non-diabetic group with arterial disease, but not in the groups with diabetes. Foot TcPO2 values increased in groups with diabetes and TcPCO2 decreased in all groups with arterial disease. Increased chest TcPO2 and decreased TcPCO2 were demonstrated in the groups with diabetes.
Conclusions Elevations in foot TcPO2 and reductions in TcPCO2 indicate improved cutaneous perfusion response to local heating post-exercise. Elevated toe pressures in the non-diabetes group suggest that improved perfusion may be associated with enhanced lower limb macrovascular haemodynamics. However, improvements in TcPO2 and TcPCO2 at foot and chest sites in diabetes imply a global change in cutaneous perfusion. The results suggest that brief exercise results in an improvement in cutaneous perfusion in non-critical PAOD, particularly in individuals with diabetes
The influence of exercise on foot perfusion in diabetes
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