Fifteen-minute walk improves microcirculation in people with diabetes mellitus

Abstract

Introduction

Skin perfusion is a key marker for detecting microcirculatory disorders in the lower extremity and predicting complications in patients with diabetes mellitus. This study aimed to evaluate microcirculation before and after an external stimulus—characterised by tissue hypoxia, increased temperature, and pressure—to assess its effect on tissue perfusion.

Material and methods

A pre–post analytical study was conducted in 30 participants. Baseline measurements included skin perfusion pressure, digital, ankle, and toe pressures, and transcutaneous oxygen pressure, obtained using a combined sphygmomanometry and laser Doppler flowmetry system. Sensors were placed on the dorsum of the foot, pads of both great toes, and the third finger of the hand, with pneumatic cuffs on the upper arm, ankles, and toes. Ankle–brachial and toe–brachial indices were calculated. Participants then completed a supervised 15-minute treadmill walk at 2.5 km/h, after which all measurements were repeated. Notable changes in participants with compromised vascular status prompted an exploratory subgroup analysis. Risk of ulceration was defined according to the International Working Group on the Diabetic Foot classification, based on loss of protective sensation, peripheral arterial disease, foot deformity, and any prior ulceration or amputation. Ischaemia was classified using the Wound, Ischaemia and Foot Infection system, which grades severity according to ankle–brachial index, toe pressure, and transcutaneous oxygen pressure. Stratification using these internationally recognised classifications provided a standardised framework to interpret the responses in a clinically meaningful context. Effects across subgroups were analysed using one-factor analysis of variance, evaluating both absolute and relative changes to account for baseline heterogeneity.

Results

Overall, microvascular parameters, particularly skin perfusion pressure, increased significantly by 15 % (p = 0.035, d = −0.412) after the intervention, whereas macrovascular parameters remained unchanged. Subgroup analyses revealed no statistically significant differences, but potentially relevant increases of up to 33 % in tissue perfusion were observed, especially in participants with compromised vascular status.

Conclusion

This simple, non-pharmacological stimulus may effectively enhance tissue perfusion in patients with diabetes mellitus, particularly in those at high risk of ulceration or with moderate to severe ischaemia, offering clinically feasible intervention.