Home-Based Lower Limb Exercises for Individuals with Diabetes: A Scoping Review

Background: Diabetic foot ulcers (DFUs) affect millions worldwide, significantly increasing the risk of amputation, mortality, and reduced quality of life. While conventional interventions such as specialized footwear and podiatric care can mitigate ulceration risks, they do not address the biomechanical factors contributing to ulcer recurrence. Emerging evidence suggests that lower limb exercises may play a role in secondary DFU prevention. This scoping review aims to synthesize available research on home-based lower limb exercise programs for individuals with diabetes mellitus, focusing on feasibility, adherence, and their impact on foot biomechanics and ulcer prevention. Methods: A search was conducted across six electronic databases (PubMed, Web of Science, Cochrane Library, EBSCO, Scopus, and ScienceDirect) for studies published between January 2014 and December 2024. Eligible studies included those assessing home-based lower limb exercises in diabetic individuals, with interventions lasting at least four weeks. Studies focusing on supervised exercises, pharmacological interventions, or non-diabetic populations were excluded. Results: Nine studies met the inclusion criteria, featuring a range of home-based exercise interventions, such as muscle strengthening, stretching routines, proprioceptive training, functional mobility exercises, and range-of-motion activities. These interventions demonstrated notable effectiveness, leading to improved foot biomechanics, more even plantar pressure distribution, enhanced balance, and reduced ulcer recurrence (in some cases). One study, for instance, reported a significant decrease in ulcer recurrence, with only 16% of participants in the intervention group experiencing relapse compared to 72% in the control group after 24 weeks. Adherence rates varied across studies but were generally higher when programs included structured guidance through educational booklets, mobile applications, or consistent phone follow-ups ranging from 41% to 92.5%. Nonetheless, the findings tend to be tempered by methodological differences between studies and a lack of robust long-term follow-up data. Conclusions: Home-based lower limb exercises show promise in improving foot function and preventing DFU recurrence. Further research is needed to standardize protocols, enhance adherence, and confirm long-term effectiveness.