The Effects Of Mixed Exercises On The Prevention Of Diabetic Foot Among Risk Population Of Diabetic Foot In Community

ObjectiveTo explore the effects of mixed exercises on the prevention of diabetic foot among risk population of diabetic foot in community.MethodsThere were two stages included in the study.The first stage:A cross-sectional study design was conducted in this stage.210 diabetic patients living in Jiangsu Road community in Shanghai were enrolled by the non-probability sampling. The participants were interviewed by questionnaires including social demographic questionnaire, information related disease questionnaire, knowledge of diabetic foot questionnaire, health belief of exercises related to diabetic foot questionnaire and behavior of exercises related to diabetic foot questionnaire. ES-100V3 Doppler blood stream detector produced by Japan Hadeco was used to examine the patients’parameters of lower limb blood flow. Screen the risk population of diabetic foot in community. The data was analyzed by the SPSS 16.0.The second stage:A quasi-experimental study design was conducted in this stage.74 patients with diabetic foot risk factors in accordance with the inclusion criteria were enrolled and assigned to intervention group (n=37) and control group (n=37) according to the community health service station. The intervention group patients received the program of mixed exercises for 6 months, while the control group patients received routine exercises program in community. The changes of knowledge, health belief, behavior, parameters of lower limb blood flow, the incidence of foot ulcers and biochemical test results were compared by the SPSS 16.0.Results1. Baseline survey:①The total score of knowledge of DF questionnaire was 23.27±6.91 (range from 0 to 35), among that the knowledge of risk factors of DF was 4.38±3.23 (range from 0 to 10), the knowledge of choosing shoes and socks was 8.30±1.89 (range from 0 to 10), the knowledge of self-care for foot was 7.29±2.69 (range from 0 to 11) and knowledge of exercises was 3.30±0.98 (range from 0 to 4). Duration of diabetes, educational level and per capita monthly income of family were the main influencing factors of knowledge related to DF (P< 0.05).②The total score of health belief of exercises related to DF questionnaire was 137.39±15.06 (range from 38 to 190), among that the perceived susceptibility of DF was 17.74±2.94 (range from 5 to 25), the perceived severity of DF was 23,27±3,26 (range from 6 to 30), the motivation of exercises was 21.02±3.70 (range from 6 to 30), the perceived benefits of exercises was 23.42±3.15 (range from 6 to 30), the perceived barriers of exercises was 22.22±3.11 (range from 7 to 35) and self-efficacy was 29.72±5.02 (range from 8 to 40). Knowledge of DF was the main influencing factors of health belief of exercises related to DF (P< 0.05).③The total score of behavior of exercises related to DF questionnaire was 68.32±11.53 (range from 21 to 105), among that the behavior of choosing shoes and socks was 35.03±4.63 (range from 10 to 50), the method, intensity, progress and matters needing attention of exercises was 33.29±8.75 (range from 11 to 55). Knowledge and health belief of exercises related to DF were the main influencing factors of behavior of exercises related to DF (P<0.05).④The status of screening for risk population of diabetic foot:according to Gavin’s weighted risk scale of diabetic foot, there were 36 patients in normal group (17.1%),112 patients in low risk group (53.4%),59 patients in medium risk group (28.1%) and 3 patients in high risk group(1.4%). The composition of risk factors from high to low were number of years with diabetes (> 10) (46.2%), loss of protective sensation(37.1%), heart disease or smoking history (35.2%), vasculopathy (23.3%), nephropathy or retinopathy (19.5%), structural deformity (12.4%) and previous ulceration or amputation (1.4%). Logistic stepwise regression analysis showed that age and LDL-C not up to the standard were risk factors of PAD and the peak of foot dorsal artery flow was a protective factor of PAD.2. The total score and four dimensions scores of knowledge of DF questionnaire between the intervention group and the control group had no statistic difference at the beginning of the intervention (P>0.05). T test showed that the differences of the two groups of total score and four dimensions scores of knowledge of DF questionnaire were significantly different between post-intervention at the 3rd month and 6th month and pre-intervention (P<0.05),3. The total score and six dimensions scores of health belief of exercises related to DF questionnaire between the intervention group and the control group had no statistic difference at the beginning of the intervention (P>0.05). The results of repeated measures ANOVA showed that the total score and six dimensions scores of the questionnaire existed the group effect and the interaction effect between time factor and group factor (P<0.05). T test showed that the differences of the two groups of the total score and five dimensions scores except for the perceived barriers of exercises score were significantly different between post-intervention at the 3rd month and pre-intervention (P<0.05). And the differences of the two groups of the total score and six dimensions scores were significantly different between post-intervention at 6th month and pre-intervention (P<0.05).4. The total score and two dimensions scores of behavior of exercises related to DF questionnaire between the intervention group and the control group had no statistic difference at the beginning of the intervention (P>0.05). The results of repeated measures ANOVA showed that the total score and two dimensions scores of the questionnaire existed the group effect and the interaction effect between time factor and group factor (P<0.001). T test showed that the differences of the two groups of the total score and two dimensions scores were significantly different between post-intervention at the 3rd month and 6th month and pre-intervention (P<0.001).5. The values of bilateral ABI and the peak of foot artery flow between the intervention group and the control group had no statistic difference at the beginning of the intervention (P>0.05). T test showed that the differences of the two groups of the values of right peak flow of posterior tibial artery and foot dorsal artery were significantly different between post-intervention at the 3rd month and pre-intervention (P<0.05). And the differences of the two groups of the values of bilateral ABI and peak flow of posterior tibial artery and foot dorsal artery were significantly different between post-intervention at the 6th month and pre-intervention (P<0.05),6. The two groups of patients were both without foot ulcers at the beginning of the intervention. The incidence of foot ulcers had no statistic difference at the 3rd month after intervention (P>0.05), while the incidence of foot ulcers of the intervention group was significantly lower than the control group at the 6th month after intervention (P<0.05).7. The FPG, 2h PBG, HbA,c, HDL-C, LDL-C between the intervention group and the control group had no statistic difference at the beginning of the intervention (P>0.05). T test showed that the differences of the two groups of the FPG were significantly different between post-intervention at the 3rd month and pre-intervention (P<0.05). And the differences of the two groups of the FPG,2h PBG, HbA1c, HDL-C, LDL-C were significantly different between post-intervention at the 6th month and pre-intervention (P<0.05).8. The values of BMI, waistline and WHR between the intervention group and the control group had no statistic difference at the beginning of the intervention (P>0.05). T test showed that the differences of the two groups of the BMI were significantly different between post-intervention at the 3rd month and the 6th month and pre-intervention (P<0.05).Conclusions1. Diabetic patients in community were short of knowledge of DF, whose health belief and behavior of exercises related to DF should be improved.2. The results of screening for risk population of diabetic foot in community were not optimistic.3. The health education of exercises based on the Health Belief Model as a theoretical guidance could effectively improve the level of knowledge of DF, health belief and behavior of exercises related to DF among the risk population’s of DF in community.4. Mixed exercises combining weight bearing and non-weight bearing exercises could effectively improve the risk population’s of DF the values of ABI and the peak of foot artery flow, the incidence of foot ulcers, the values of BMI and related biochemical test results.5. The health education of exercises based on the Health Belief Model as a theoretical guidance was feasible and provided support for preventing DF in community, which was worth to further study and popularize.