Abstract
BACKGROUND: Evidence for wearable-guided physiotherapy in diabetic kidney disease (DKD) is limited. This study evaluated the effects of physiotherapist-supervised exercise supported by wearable device feedback in patients with type 2 diabetes, including those with DKD. METHODS: In this single-center, prospective study, 58 outpatients were allocated to an intervention group (IG) or non-intervention group (NIG). The per-protocol set included 45 participants completing six months (IG = 25, NIG = 20). IG wore a wrist-worn device and received monthly physiotherapist-led guidance; NIG received standard care. The primary endpoint was 6-min walk distance (6MWD); secondary outcomes included weight-bearing index (WBI), phase angle (PhA), HbA1c, and eGFR. Analyses used linear mixed-effects models adjusted for covariates. RESULTS: IG improved 6MWD from 512.0 m to 551.0 m (+ 38.7 m), while NIG changed from 410.0 m to 407.0 m (- 3.7 m). The group × time interaction was significant (p < 0.001); adjusted between-group difference was + 42.4 m (95% CI: 20.3-64.5). IG showed greater reductions in HbA1c (- 0.89%, 95% CI: - 1.53 to - 0.25; p = 0.008) and improvements in WBI and PhA (p < 0.01). Changes in eGFR were not significant (0.65 mL/min/1.73m(2), 95% CI: -3.84 to 5.14; p = 0.78). CONCLUSIONS: Monthly physiotherapist-led exercise supported by wearable feedback improved functional capacity and glycemic control in patients with DKD. This pragmatic, scalable model may enhance outpatient rehabilitation strategies. GRAPHICAL ABSTRACT: Values represent adjusted between-group differences in change from baseline to six months, estimated using linear mixed-effects models with group, time, and group × time interaction, adjusted for age, baseline 6-min walk distance, HbA1c, eGFR, cardiovascular disease, and smoking status. Error ranges indicate 95% confidence intervals. Arrows indicate direction of change favoring the intervention group. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13340-026-00900-x.