Feasibility and Exploratory Outcomes of Foot‐Ankle and Walking Exercises for Diabetic Neuropathy, Stress, and Quality of Life: A Pilot Randomized Controlled Trial

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Abstract
Foot–ankle and walking exercises have been proposed as potential strategies for managing symptoms in people with diabetic peripheral neuropathy (DPN), yet evidence from primary care remains limited. This pilot study assessed the feasibility and acceptability of these interventions and explored preliminary outcome patterns in DPN, stress, and quality of life (QoL). A three‐arm pilot randomized controlled trial was conducted in three public health centers in Yogyakarta, Indonesia ( n = 108; 36 per group). The control group received usual care and health education. The foot‐ankle group received education, leaflets, demonstrations, and guided practice, while the walking group received education and leaflets supporting a structured walking routine. Participants in the intervention groups then performed the exercises independently for 12 weeks. Outcomes were assessed at baseline, week 6, and week 12. Feasibility included recruitment, retention, data completeness, adherence, and adverse events. Adherence to the ≥ 150 min/week activity target was assessed using participant‐reported exercise logs. Acceptability was explored through open‐ended questions. Exploratory outcomes were analyzed using generalized estimating equations under an intention‐to‐treat approach. Feasibility indicators were favorable, with retention > 90%, minimal adverse events, and ≥ 80% adherence. Exploratory analyses suggested possible trends toward changes in DPN indicators, diabetes‐related distress, QoL barriers, fasting blood glucose, blood pressure, and ankle–brachial index in the intervention groups compared with controls. These findings suggest that the interventions are feasible and acceptable in primary care and provide preliminary estimates to inform a future fully powered randomized trial.

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