To Train or not to Train: Exercise in Diabetic Foot Ulceration. A Brief Narrative Review

Diabetic foot ulcers (DFUs) are a serious and common complication of diabetes mellitus, contributing substantially to patient morbidity, reduced quality of life, and healthcare costs. Accumulating evidence highlights the potential benefits of exercise across various stages of DFUs. This review summarises current evidence on the role of exercise in DFUs management and emphasises the need for well-designed clinical trials to inform future rehabilitation guidelines. Exercise has been shown to improve glycaemic control, promote cardiovascular health, ameliorate neuropathic symptoms, and improve well-being. Importantly, appropriately selected and supervised physical activity may be safely implemented before ulcer onset, during the active ulceration phase, and following wound healing. Data show that exercise provides stage-specific benefits in DFUs by improving risk factors, reducing plantar pressures and foot pain prior to ulceration; enhancing wound healing as adjunctive therapy during ulceration; and lowering the risk of recurrence in the post-healing period. However, current research is limited by heterogeneity in exercise protocols, lack of consensus on training parameters, and exclusion of high-risk populations from trials.