# Home-Based Lower Limb Exercises for Individuals with Diabetes: A Scoping Review
## 4 Discussion
### Types of Home-Based Exercises Included in the Review  
The studies included in this review primarily focused on structured lower limb exercise programs designed to prevent DFUs. While most research on exercise therapy for individuals with diabetes emphasizes general physical activity, such as aerobic and resistance training to enhance insulin sensitivity and cardiovascular health, this review specifically examined interventions targeting foot biomechanics, muscle strength, and proprioception. Exercise programs varied in duration, ranging from a minimum of 4 weeks [15] to a maximum of 12 months [16], with follow-up assessments conducted between 4 weeks and 24 months to evaluate both short- and long-term effects. Exercise sessions typically lasted between 20 and 60 min and were performed two or three times per week at a time and place convenient for participants. In addition to exercise prescriptions, most studies incorporated self-care education through written or verbal instructions, aiming to increase awareness of potential complications and encourage early reporting of symptoms. Some participants also received exercise kits containing materials such as cotton balls, pencils, and massage balls to help them perform the exercises correctly [17; 20; 21]. Among the nine studies analyzed, six provided detailed exercise protocols that included a warm-up and a structured exercise regimen, and two studies introduced a cool-down phase. The warm-up phase, lasting between five and ten minutes, consisted of one to three exercises, such as walking, seated foot tapping, leg stretching, massaging the sole in circular motions, rolling a ball underfoot, or gently twisting toes [15; 17; 18; 19; 20; 21]. The main exercise component incorporated various movements to improve mobility, strength, proprioception, and balance. Ankle mobility exercises included passive and active dorsiflexion and plantarflexion; aversion and inversion; subtalar joint pronation and supination; and walking on different foot surfaces, such as the heel, forefoot, and lateral or medial borders of the foot [14; 15; 18; 20; 21]. Toe and intrinsic foot muscle-strengthening activities included grasping objects with the toes, moving a cloth underfoot, toe extensions and raises, spreading, and walking with toe-gripping motions [13; 14; 18; 20; 21]. Some exercises focused on proprioception training, such as double-leg support on a rubber disc, and rolling a curly ball under the foot to enhance sensory feedback and stability [13; 14]. Calf muscle-strengthening exercises included standing on tiptoes and lowering slowly, as well as self-stretching techniques for the triceps surae muscle, such as standing with one foot forward, the knee bent, and the opposite leg extended back with the heel in contact with the ground [13; 15; 18; 20; 21]. Balance and coordination exercises involved isometric knee extension, one-leg stance, forefoot stamping, tandem walking, and controlled heel-to-toe foot rollover during gait to promote functional stability [14; 16]. Some studies (three out of nine) also included additional movements, such as foot circumduction, drawing the alphabet with the feet, and sliding feet on the floor [13; 15; 17]. Others (two out of nine) incorporated hip exercises, including flexion, extension, abduction, and circular hip motions in a standing position to support overall lower limb function [13; 17]. The cool-down phase, lasting around five minutes, consisted of relaxation techniques such as deep-breathing exercises and slow foot movements, aimed at reducing muscle tension and promoting circulation [17; 19]. Although specific exercise variations and progressions differed across studies, the reviewed interventions consistently emphasized simplicity, accessibility, and ease of adherence. Some studies allowed exercise difficulty to be tailored to individual capabilities, ensuring that participants could gradually increase intensity based on their functional status [18; 20; 21].