Evidence mapPaperPMID 42411004Full record

SynthesisDiabetes/metabolism research and reviews2026

Less Is More? Physical Inactivity and Increased Risk of Diabetes-Related Foot Ulceration-A Systematic Review.

Petra J Jones, David G Armstrong, Alex V Rowlands, Harald Sourij, Afsaneh Noormandi, George Theodorakopoulos

Abstract readSystematic Review
In one paragraph

Synthesis in Diabetes/metabolism research and reviews, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Petra J JonesLeicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK.ORCID https://orcid.org/0000-0002-9340-9168
David G ArmstrongKeck School of Medicine, University of Southern California, Los Angeles, California, USA.ORCID https://orcid.org/0000-0003-1887-9175
Alex V RowlandsDiabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.ORCID https://orcid.org/0000-0002-1463-697X
Harald SourijCardiometabolic Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.ORCID https://orcid.org/0000-0003-3510-9594
Afsaneh NoormandiCardiometabolic Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.ORCID https://orcid.org/0000-0002-8479-0497
George TheodorakopoulosKeck School of Medicine, University of Southern California, Los Angeles, California, USA.ORCID https://orcid.org/0009-0008-1196-539X

Funding

Anglo-Austrian Society Otto Harpner fundNational Institute for Health and Care Research BRC Leicester NIHR203327National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases 1R01124789-01A1NIHR Applied Research Collaboration East MidlandsNIHR Leicester Biomedical Research Centre
6 · The paper itself

Abstract

aimsThose 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

methodsEmbase, 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).

resultsFifteen 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).

conclusionsAvailable 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.

Indexed as

Diabetic FootExerciseSedentary BehaviorHumansRisk Factorsdiabetesfootinactivityphysical activitysedentaryulcer

Identifiers

PMID42411004
PMCPMC13338649

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.