Journal of Population Therapeutics

& Clinical Pharmacology

RESEARCH ARTICLE
DOI: 10.53555/jptcp.v31i2.4653

EFFICACY OF BUERGER’S EXERCISE ON LOWER

EXTREMITY PERFUSION AND THEIR QUALITY OF LIFE
AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS – A
SYSTEMATIC REVIEW
Poonam Negi1*, Dr. Renu Sharma2, Hemchandra Pandey3
1*
Ph.D. Nursing Research Scholar, Hemwati Nandan Bahuguna, Uttrakhand Medical Education
University, Dehradun, India.
2
Principal, Government College of Nursing Bajpur, Uttarakhand
3
Professor Cum Vice Chancellor, Hemwati Nandan Bahuguna, Uttrakhand Medical Education
University, Dehradun, India

*Corresponding Author: Poonam Negi

*Ph.D. Nursing Research Scholar, Hemwati Nandan Bahuguna, Uttrakhand Medical Education
University, Dehradun, India.
Email: negipoonam11@gmail.com

Abstract- Diabetes mellitus is a metabolic condition characterized by elevated blood sugar levels
caused by defects in insulin secretion, activity, or both. Polyuria, polyphagia, and polydipsia have
traditionally been associated with high blood sugar levels. Diabetes is the most common metabolic
illness and affects people all over the world. Diabetes prevalence is determined by social, racial, and
genetic variables. The World Health Organization (WHO) expects that diabetes will become a
pandemic in emerging countries. India has the world's greatest concentration of diabetics. Diabetes
mellitus impairs endothelial and smooth muscle cell activity in the arteries, raising the risk of
peripheral vascular disease. Peripheral vascular disease in the lower limbs is more likely to develop
in those with severe and longstanding diabetes. Most of the problems can be avoided. To remain
healthy, you must commit to maintaining your weight, exercising, and taking the appropriate
medications for the rest of your life.

Keywords- Buerger’s Exercise, Lower Extremity Perfusion & Diabetes mellitus

Aim- This literature review aimed to check the efficacy of Buerger’s’ Exercise on Lower Extremity
Perfusion and Their Quality Of Life among Patients with Type 2 Diabetes Mellitus

Method – An extensive search and numerous evaluation of the peer-reviewed literature was
conducted for narrative review. Journal article were retrieved from three database (PubMed, Medline,
Embase & Research gate) using the search terms ‘Buerger’s Exercise’, ‘Lower Extremity Perfusion’
and ‘Diabetes Mellitus’.

Result-The search yielded ten studies related to efficacy of Buerger’s Exercise on Lower Extremity
Perfusion and Their Quality Of Life among Patients with Type 2 Diabetes Mellitus

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Efficacy Of Buerger’s Exercise On Lower Extremity Perfusion And Their Quality Of Life Among Patients With Type 2
Diabetes Mellitus – A Systematic Review

Introduction- A healthy life is a priceless gift, and if someone is in good enough shape, they are the
wealthiest people in their own universe. Because mental and physical health are usually intertwined,
every change—good or bad—in one has a direct impact on both. Exercise and physical exercise are
crucial components of a healthy lifestyle since humans are designed to use their bodies, and living
without them leads to illness. Diabetes mellitus is a metabolic condition characterized by elevated
blood sugar levels caused by defects in insulin secretion, activity, or both. iabetes severity and
duration increase the risk of developing lower extremity peripheral vascular disease. The majority of
the complications are avoidable. It necessitates a lifelong commitment to staying healthy, maintaining
weight, exercising, and taking prescribed medications. Burger Allen Exercise (BAE) promote Lower
Extremity Perfusion (LEP) via the wound healing process and reduce Peripheral Neuropathy
Symptoms (PNS) among Diabetes Mellitus (DM) patients.

Search strategy for identification of studies

The search strategy was designed to access published and were comprise three stages:
• A limited search of PubMed Medline, Google Scholar and Research Gate to identify relevant
keywords contained in and subject the title, abstract descriptors.
• Terms identified in this way, and the synonyms used by respective databases, was used in an
extensive search of the literature.
• Reference lists and bibliographies of the articles collected from those identified in stage two above
was searched.

Table No. 1 Literature search details table.

Search Strategy List of databases and e-journals
searched
• Scopus
• Keywords used: Buerger’s Exercise, • Pub Med
Lower Extremity Perfusion, Diabetes • Research Gate
mellitus & quality of life • Indian Journal of Public Health
• International Journal of Health Sciences &
• Used with MESH terms OR , AND Research
• Google scholar
• Search was limited to publication year • Medline
2019 – 2023

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Efficacy Of Buerger’s Exercise On Lower Extremity Perfusion And Their Quality Of Life Among Patients With Type 2
Diabetes Mellitus – A Systematic Review

Table No.2 Studies Related To Efficacy of Buerger’s Exercise on Lower Extremity Perfusion and
Their Quality Of Life among Patients with Type 2 Diabetes Mellitus
Author Country Study Design/ Sample Result Conclusion
Method

Prajnya India Quasi experimental 30 Statistical value revealed The study concluded
Elinlar research design patients that on post-intervention that Buerger’s Allen
Digal with type the mean lower extremity exercise is a non-
(2023) 2 perfusion in right leg in invasive cost effective
Diabetes experimental group was method to improve the
Mellitus 0.84 which is higher than lower extremity
the mean lower extremity perfusion
perfusion of control group
0.65 with p value 0.000
which is extremely
significant at pd0.001 level
of significance.

Anna Indonesia Quasi-experiment 43 The findings demonstrated Most ABI values in

Martiana with a pretest and patients a statistically significant LKD patients with the
Afida et al, post-test without a with type relationship between the category of venous
(2022) control strategy 2 average ABI in LKD disorders showed a
Diabetes patients before and after decrease. In contrast,
Mellitus 0.85 (P-value = 0.000). the type of normal veins
showed an increase
based on the circulation
of the lower extremity
legs after the Buerger’s
Allen exercise.
Muh. Indonesia Pre-experimental 60 The Wilcoxon Signed Rank Burger Allen Exercise
Anwar design a pre- patients Test results of the ABI is effective in
Hafid et al, posttest only control with type value in the right limb are improving peripheral
(2021) group 2 0.043 or p <0.05 and the circulation of the
Diabetes ABI value on the left limb lower extremities and
Mellitus are 0.025 or p <0.05. is an alternative for
repairing impaired
tissue perfusion in
diabetic feet.
Jenyfer India Quasi Experimental 60 The mean pre-test scores of The results of the study
Renu Non- equivalent pre- patients level of lower extremity concluded that
Margret W test and post-test with type perfusion in experimental practicing Buerger’s
at el, control group 2 group is 0.77(SD + 0.015) Allen exercises
(2021) research design Diabetes and post-test mean score is improved the lower
Mellitus 0.85(SD + 0.016) and mean extremity perfusion
difference is 0.08. The among patients with
paired ‘t’ value was 17.12 type II Diabetes
which was significant at mellitus
p<0.05 level.

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Efficacy Of Buerger’s Exercise On Lower Extremity Perfusion And Their Quality Of Life Among Patients With Type 2
Diabetes Mellitus – A Systematic Review

Pritam V. India Quasi experimental 60 All the p-values were large Buerger’s Allen
Gavit research design samples (greater than 0.05), none of Exercise is
(2021) with type the demographic variables significantly effective
2 was found to have on Lower Extremity
Diabetes significant association with Perfusion among
Mellitus the lower extremity Patients with type 2
perfusion among patients Diabetes Mellitus
with type 2 diabetes admitted at selected
mellitus. hospitals of city
Reham Adel Egypt quasiexperimental 70 There were a statistically Buerger’s Allen
Ebada El design patients significant differences Exercise
Sayed et al, between post 1 and post 2 implementation is
(2021) after Buerger’s- Allen effective method for
exercise implementation decreasing capillary
mean scores in both legs (t= refill time, increasing
2.756, p= 0.007& t= 3.699, ankle brachial index
p= 0.002), respectively (ABI) score and
improving peripheral
pulses, temperature,
skin color and sensation
Mulia Indonesia quasi-experimental 45 The mean result is that the In conclusion,
Mayangsari design with one patients change in ABI value in the Buerger’s allen
et al, group pre-test- intervention group is better exercise was effective
(2021) posttest than the control group with in increasing the value
a significant p value (0.000) of the Ankle Brachial
which means that there is a Index (ABI)
significant difference in the
effect of changes in the ABI
value in the intervention
group and the control
group.
Jinna India quasi-experimental 100 A significant difference in BAE has to be taught to
Radhika et study patients PNS was seen after the the patients with DM in
el, implementation of BAE in improving the level of
(2020) both right LEP (t48 = 6.81, LEP and can be
p < 0.001) and left LEP t48 encouraged to practice
= 5.21, p < 0.001). in the hospital and
home care setup.
Anju Kumar India quasi-experimental 60 The study findings revealed The use of Buerger’s
et al, design with one patients that the post intervention Allen Exercise is
(2019) group pre-test- mean ABI score in effective in improving
posttest experimental group (Right the foot perfusion in
Mean=0.95, Left terms of ABI score,
Mean=0.94) was reducing the capillary
significantly higher than refill time. Therefore, it
control group (Right is recommended that
Mean=0.86, Left „Buerger’s Allen
Mean=0.85) (p=0.001***). Exercise‟ can be used
The post intervention CRT to improve the foot
was lower in experimental perfusion of diabetes
group than control group mellitus patients.
(p=0.001***) respectively.
(47%) patients were treated
conservatively, whereas 32
(53%) participants had
surgical care.

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Efficacy Of Buerger’s Exercise On Lower Extremity Perfusion And Their Quality Of Life Among Patients With Type 2
Diabetes Mellitus – A Systematic Review

Sathya. K India quasi-experimenta 60 Study showed that in Study concluded that

et al, research design patients experimental group the post
(2019) test mean score was 0.921
with S.D of 0.083 and in the
control group, post test
mean value is 0.734 with
SD is 0.063.The calculated
paired „t‟ test value 4.97.
that the Buerger’s Allen
exercises is an effective
intervention in
improving lower leg
perfusion among
clients with Type II DM

Fig 1: Flow diagram of screening and selection of reviews

Conclusion- The current systematic review examined the effect of Buerger’s Allen Exercise on the
levels of LEP and PNS in people with type 2 Diabetes Mellitus. The exercise that the patients
underwent was clearly effective in improving their LEP and lowering their PNS. Nurses should be
able to inspect and teach BAE to patients with diabetes mellitus (DM) in both hospital and home care
settings in order to prevent further complications such as peripheral artery disease and diabetic foot
ulcers..
In terms of ABI score and CRT, the Buerger’s Allen Exercise is an effective strategy for enhancing
foot perfusion in diabetic patients. As a result, it is recommended that people with diabetes mellitus
perform the "Buerger’s Allen Exercise" to improve their foot circulation.

Conflicts of Interest
The author declares that they have no conflicts of interest
Funding
The author declares that there was no funding source

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Efficacy Of Buerger’s Exercise On Lower Extremity Perfusion And Their Quality Of Life Among Patients With Type 2
Diabetes Mellitus – A Systematic Review

REFERENCES
1. Kumari A, Rai K, Kumari V et.al. A study to assess the effectiveness of Buerger’s Allen exercise
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2. Sathya K, Karthi. A study to assess the effectiveness of Buerger’s Allen exercise to prevent risk of
diabetic foot by improving lower extremity perfusion among clients with type-2 diabetes mellitus
in selected hospitals at Villupuram district, Tamilnadu. International Journal of Research and
Review. 2019; 6(3):83-88
3. Hafid, M. A., Ilhamsyah, I., Saputra, L. O. A., & Sari, M. (2021). The Effect of Buerger’s Allen
Exercise on The Lower Extremity Peripheral Circulation in Type 2 Diabetic Patients. STRADA
Jurnal Ilmiah Kesehatan, 10(1), 612–621.
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