Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Do foot ulcers affect physical activity, energy expenditure and sleep?  Diabetic foot activity sleep study (#364)

Helen Sheahan 1 , Peter Lazzarini 1 2 3 , James Walsh 4 5 , Greg Jorgenson 6 7 , Ewan Kinnear 2 3 , Kimberley Canning 1 , Nishka Refausse 1
  1. Queensland Health, Chermside, QLD, Australia
  2. Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, QLD, Australia
  3. Department of Podiatry , Metro North Hospital and Health Service, Queensland Health, Chermside, QLD, Australia
  4. Physiotherapy Department , Queensland Health, Chermside, QLD, Australia
  5. Heart Lung Institute, The Prince Charles Hospital, Chermside, QLD, Australia
  6. Department of Sleep Studies , The Prince Charles Hospital, Chermside, QLD, Australia
  7. School of Medicince, University of Queensland, Brisbane, QLD, Australia


Diabetic foot ulcers (DFU) mainly occur due to repetitive stress on the foot from daily activity in the presence of peripheral neuropathy.  Very few studies have investigated daily activity and energy expenditure in people with DFU.  The aim of this case-control study was to investigate daily activity, energy expenditure and sleep in diabetes patients with DFU compared to those without DFU.


Participants with type 2 diabetes were recruited into three groups, those with: i) current neuropathic foot ulcers (DFU), ii) peripheral neuropathy without DFU history (DPN), and, iii) nil neuropathy or DFU history (NIL).  Exclusion criteria included peripheral arterial disease and mobility aid use.  Participants wore a SenseWear Pro 3 Armband continuously for 7 days and completed an Epworth Sleepiness Scale.  The Armband is a validated automated measure of activity (steps, Metabolic Equivalent Tasks (MET), physical activity (>3 METs) duration), energy expenditure(kJ) and sleep (duration).  Data on age, sex, BMI, diabetes duration and HbA1c were also collected.


Sixty-three (30 DFU; 21 DPN; 12 NIL) participants were recruited; 71% males, mean±SD age of 61±11 years, diabetes duration 13±9 years, HbA1c 8.3±2.8, BMI 33±6, average METs 1.2±0.2.  No demographic differences between groups were reported, except mean age (57±11 DFU; 68±10 DPN; 60±9 NIL, p = 0.003).   Significant differences were reported in mean±SD steps/day (3,271±2,417 DFU; 5,211±3,290 DPN; 6,052±2,521 NIL, p = 0.002) and daily energy expenditure(kJ) (13,0006±3,559 DFU; 11,074±1,962 DPN; 10,959±1,351 NIL, p = 0.006).  No significant differences were reported for average METs, physical activity, sleep time or Epworth score (p > 0.1).

Conclusion and Clinical Relevance   

Findings suggest people with diabetes foot ulcers are much less active, however, expend much more energy in doing so than those without a history of foot ulcers.  Sleep parameters showed no differences.  Further research is required to investigate the disproportionate daily activity and energy expenditure balance in people with diabetes foot ulcers. 

Key Words

Foot, ulcers, activity, energy, sleep