# Home-Based Lower Limb Exercises for Individuals with Diabetes: A Scoping Review
## 4 Discussion
### Feasibility, Acceptability, and Adherence to Home-Based Exercise Programs  
The effectiveness of home-based and remotely supervised exercise programs for individuals with diabetes has been demonstrated in various studies. [PERSON] et al. [30] conducted an RCT comparing supervised group exercises with internet-based home programs. Both interventions significantly improved glycemic control, functional capacity, and quality of life, with no major differences in effectiveness between the two methods. Similarly, [PERSON] et al. [31] assessed supervised versus home-based exercise interventions for women with T2 DM. Their findings indicated that while supervised training led to better health-related quality of life outcomes, home-based exercises were still effective in improving glycemic control, body composition, and lipid profiles. These studies confirm the potential of structured home exercise programs to enhance health outcomes in individuals with T2 DM.  
Despite these benefits, adherence to remote exercise interventions remains a challenge. Some studies incorporated adherence-enhancing strategies, such as checking exercise logbooks every three weeks or conducting weekly follow-up phone calls [18; 22]. In contrast, others provided no interim supervision, even in long-term interventions spanning up to 10 months [28]. Lack of ongoing support can hinder engagement and reduce the effectiveness of these interventions. Research suggests that structured guidance, including exercise booklets, mobile applications, and telehealth support, can improve adherence and ensure program continuity [17; 18; 19].  
Technology use in diabetes care is emerging as a promising tool to support remote exercise programs. Mobile health (mHealth) applications have been shown to enhance motivation and patient engagement by providing interactive guidance and real-time monitoring [32]. Web-based recruitment methods for digital exercise programs also demonstrate the potential to increase access to high-risk populations, enabling better participation in clinical trials and structured interventions. Moreover, the inclusion of self-determined motivation strategies can help patients overcome perceived barriers to exercise, further supporting long-term adherence [33].  
In addition to digital solutions, qualitative research highlights the importance of addressing practical barriers to exercise participation. [PERSON] et al. [34] identified key factors influencing non-participation in diabetes self-care programs, including accessibility, quality of education, and the need for flexible, distance-learning options. By offering modern training methods that combine virtual education with individualized support, adherence to exercise programs can be improved.  
Several studies have employed expert validation methods, such as the Delphi technique, to refine remote exercise therapy programs before implementation. This approach has been used to develop educational booklets and web-based software applications that ensure the safety, feasibility, and acceptability of home-based interventions [18; 22]. Although certain feasibility studies on internet-based foot and ankle exercise programs, such as SOPeD, were excluded from this review, they provide valuable insights into scalable intervention models for future research [28; 29].  
Overall, home-based exercise programs for individuals with diabetes show promise in improving glycemic control and functional outcomes. However, adherence remains a critical factor in their long-term success. Future interventions should incorporate structured supervision, technological support, and tailored motivational strategies to enhance patient engagement and ensure sustainable benefits.