# Home-Based Lower Limb Exercises for Individuals with Diabetes: A Scoping Review
## 4 Discussion
### Gaps in the Literature and Future Research Directions  
The field of home-based lower limb exercises for individuals with diabetes, particularly in secondary prevention of DFUs, remains underexplored. While there is a growing interest in exercise interventions, few studies specifically focus on their effectiveness in preventing DFU recurrence, a critical concern given the chronic and progressive nature of diabetes-related foot complications. Home-based exercise programs, particularly those targeting RoM improvement and reducing peak plantar pressures, are essential components for secondary DFU prevention. However, the literature reveals a distinct gap in examining the long-term benefits and effectiveness of these exercises. One notable gap is the absence of standardized protocols for home-based lower limb exercises in diabetic populations. Existing studies employ varied exercise regimens, from basic mobility exercises to complex resistance training. This diversity complicates comparisons and makes it difficult to draw firm conclusions regarding the optimal exercise intervention. Future research must focus on developing and validating standardized exercise protocols tailored to individuals with diabetes, accounting for varying levels of DPN severity. Establishing such protocols would allow for more robust comparisons and a clearer understanding of the most effective exercise interventions for DFU prevention. Another significant gap is the short duration of most studies in this area. While some studies have demonstrated benefits from home-based exercises over 4-12-week periods, very few extend follow-up beyond six months. Given the chronic nature of diabetes and its associated complications, longer-term follow-up is essential to assess whether exercise interventions yield sustainable benefits in terms of preventing DFU recurrence. Research that examines long-term outcomes, ideally over 12 months or more, would provide more valuable insights into the lasting impact of home-based exercises on foot health and overall diabetes management. Furthermore, while many studies focus on functional and biomechanical outcomes, few specifically investigate the impact of home-based exercise interventions on ulcer recurrence as a primary outcome. Only a limited number of studies, such as [PERSON] et al. [19], have directly assessed ulcer recurrence rates in response to exercise interventions, and they reported significantly lower recurrence in the intervention group. Expanding this line of inquiry is essential for understanding how exercise affects not only functional and biomechanical measures but also clinically relevant outcomes like DFU recurrence. Future research should prioritize ulcer recurrence as a primary outcome to better assess the direct impact of exercise interventions on preventing foot complications in individuals with diabetes. Technological advancements also present an important opportunity to enhance the effectiveness and engagement of home-based exercise programs. Mobile health (mHealth) applications, wearable sensors, and real-time feedback mechanisms are underutilized in the current literature but have great potential to support patients' self-management behaviors. Integrating these technologies into home-based exercise interventions could significantly improve adherence, provide personalized recommendations, and facilitate remote monitoring by healthcare providers. The incorporation of AI-driven exercise monitoring could also offer tailored exercise adjustments, ensuring safety and efficacy for individuals with varying levels of physical ability and disease severity. As such, future research should explore the integration of these technologies to enhance patient engagement and optimize clinical outcomes. Additionally, there is a growing trend toward remotely delivered exercise programs, which gained momentum during the COVID-19 pandemic.