Effect of physical activity on tissue perfusion in patients with diabetes mellitus: Systematic review and meta-analysis

Abstract

Aims

The objective of this systematic review and meta-analysis is to identify and assess the literature exploring the impact of physical activity on enhancing tissue perfusion in the feet of patients with diabetes mellitus (DM).

Materials and methods

All the selected studies were evaluated using the Cochrane risk of bias tool, to assess the risk of bias for randomized controlled trials. A thorough search was conducted in April 2024 through PubMed and Web of Science to identify randomized clinical trials (RCTs) and comparative studies that assessed the effect of physical activity enhancing tissue perfusion. Data analysis was performed using RevMan v5.4., employing the Mantel-Haenszel method for dichotomous outcomes.

Results

A total of nine studies compared changes in microcirculation before and after physical exercise in patients with DM. A meta-analysis of the data collected from seven studies estimated a mean difference of 4.87 (95 % CI 2.37–7.38) favouring the improvement of microvascular parameters post-exercise, with a minor level of heterogeneity (x² = 10.54, df = 6, p = 0.1, I² = 43 %) and a statistically significant difference between the two groups (p ≤ 0.001). However, a second evaluation, which included four studies involving patients with and without DM, indicated high heterogeneity (x² = 661.32, df = 3, p ≤ 0.00001, I² = 100 %) with no observable statistically significant differences between the two groups (p = 0.62).

Conclusion

Physical activity in patients with DM may be effective in improving blood microcirculation in the lower limbs.