Diabetes/metabolism research and reviews
July 1, 2026 · via Europe PMC
Less Is More? Physical Inactivity and Increased Risk of Diabetes-Related Foot Ulceration-A Systematic Review.
Jones PJ, Armstrong DG, Rowlands AV, Sourij H, Noormandi A, Theodorakopoulos G.
AI summary — for doctors, generated from the abstract only
Physical inactivity was associated with roughly doubled risk of diabetes-related foot ulceration in an exploratory meta-analysis, though the evidence is of poor to fair quality.
What was studied
Systematic review of 16 studies assessing physical inactivity and/or sedentary behaviour and diabetic foot ulcer outcomes, with exploratory meta-analysis.
Key findings
- 11 of 16 studies reported greater DFU likelihood in inactive participants
- Exploratory meta-analysis: inactivity OR 2.09 (95% CI 1.32-3.32)
- Sedentary behaviour OR 2.95 from a single poor-quality cohort (n=175)
- Heterogeneous definitions and mostly self-reported activity
Clinical relevance
This suggests inactivity should not be assumed protective for feet in diabetes and supports research into safe activity thresholds; reverse causation cannot be excluded.
Who should care
Limitations
Heterogeneous, mostly observational studies of poor to fair quality with self-reported activity; possible reverse causation.
Being inactive may raise, not lower, the risk of diabetic foot ulcers.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Aims
Those at risk of diabetes-related foot ulceration (DFU) must balance sufficient physical activity to maintain glycaemic control and cardiovascular health whilst avoiding excessive trauma to their feet. Our systematic review aimed to assess whether physical inactivity and/or sedentary behaviour affect DFU outcomes.
Materials and methods
Embase, Medline, and Scopus were searched for peer-reviewed studies using the criteria: ('diabetes' OR 'diabetic') AND ('physical*' OR 'activ*' OR 'inactiv*' OR 'sedentary') AND 'foot' AND 'ulcer', returning 4650 results excluding duplicates. 16 studies were included and assessed for risk of bias using the Newcastle-Ottawa Scale (NOS).
Results
Fifteen studies assessed physical inactivity and 1 assessed both inactivity and sedentary behaviour and DFU outcomes. Eleven of 16 (69%) studies reported significantly greater likelihood of DFU in inactive participants. Exploratory meta-analysis suggested physical inactivity to be associated with doubled DFU risk (OR 2.09, 95% CI 1.32-3.32, p = 0.002). Evidence that sedentary behaviour was associated with tripled DFU risk was based on a single prospective cohort and had a high risk of bias (OR 2.95, 95% CI: 1.5-6.4, p = 0.008; n = 175, NOS: poor). Study methodologies were heterogenous (e.g., inconsistent definitions of inactive), with habitual physical activity measured through interviews, patient records, or questionnaires in 14 of 16 studies (NOS rating: poor to fair).
Conclusions
Available evidence suggested that physical inactivity and sedentary behaviour were associated with an increased risk of DFU. Further research is needed to develop thresholds for physical inactivity and sedentary behaviour to reduce DFU risk.
DOI
10.1002/dmrr.70198
PMID
42411004
PMCID
PMC13338649
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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