Join us   Log in  

FRONTIERS IN MEDICAL CASE REPORTS - Volume 2; Issue 1, (Jan-Jun,2022), Archives of Medical and Clinical Research

Pages: 01-03
Print Article   Download XML  Download PDF

Benefits of Buerger-Allen Exercises for Diabetic people: A Mini-Review

Author: Ahmad Mahdi Ahmad, Akram Abdel-Aziz, Walaa Anwar Mohamed Khalifa, Alaa Abulfotouh Mohammed

Category: Medical and Clinical Research


Diabetics suffer from serious micro- and macrovascular complications of the disease with negative effects on blood flow and lower extremity sensation. Drug therapy alone might be insufficient to prevent or treat these health problems, and patients may need complementary therapy. Exercise therapy is an essential part of the treatment plan for diabetes mellitus and can complement drug treatment. Buerger-Allen exercises have recently become an evidence-based form of exercise to improve peripheral blood flow in diabetics. This short report briefly mentions the clinical benefits of Buerger-Allen exercises.

Keywords: Buerger-Allen Exercise, Diabetes Mellitus, Clinical Benefits


Full Text:


Patients with diabetes mellitus, particularly those with poor glycemic control, often have impaired blood flow in the lower extremities and an increased risk of foot ulcers, gangrene, or amputations. Buerger-Allen exercise can improve peripheral blood flow in patients with diabetes mellitus (Thakur et al., 2022). The Buerger-Allen exercise was first described by Leo Buerger in 1926 and later modified by Arthur Allen in 1930 (Chang et al., 2015). Buerger-Allen exercises are active postural exercises in which gravity alternately deflates and fills blood vessels to increase blood flow to the lower limbs (John and Rathiga, 2015). The Buerger-Allen exercise includes several stages as follows: (a) The patient lies supine with the leg raised 45 and 60 using a pillow and performs ankle motion for 3 minutes or until the feet become pale; (b) Then, the patient sits on the edge of the bed with his/her feet dangling over and performs dorsiflexion and plantar flexion and moves legs in and out for 3 minutes; (c) Finally, the patient lies supine, covered with a blanket, for 3 minutes (Trisnawati et al., 2020). The entire cycle can be repeated 3 to 6 times per session and each session can be repeated 3 times per day (Trisnawati et al., 2020). Impaired blood flow in the lower extremities can be identified by measuring the ankle-brachial index (ABI), a standard non-invasive method of assessing blood flow to the lower extremities, which is the ratio of the higher of the two systolic blood pressures of either dorsalis pedis artery or posterior tibial artery, and the higher of the two systolic blood pressure values of the upper extremities (Rac-Albu et al., 2014). A circulatory disorder can be identified with an ABI value below 0.90 and a severe circulatory disorder can be identified with an ABI value below 0.4 (Rac-Albu et al., 2014). However, in patients with diabetes and those on dialysis, the ABI may be an invalid method due to the presence of arterial calcification, and in such case, the toe-arm index should be used instead.


The clinical benefits of Buerger-Allen exercises can be listed as follows: (a) A reduction in the risk of neuropathy in diabetics (Widia and Hidayat, 2021); (b) a reduction in symptoms of peripheral neuropathy in patients with diabetes mellitus (Radhika et al., 2020); (c) An increased ankle-brachial index (ABI) in diabetics (Zahran et al., 2018); (d) a reduction in capillary filling time in the lower extremities of diabetics (El Sayed et al., 2021); (e) improvements in peripheral pulse, temperature and skin color in patients with type 2 diabetes mellitus (El Sayed et al., 2021); (f) an increase in peripheral blood flow in patients with diabetic foot ulceration as evidenced by increased skin perfusion pressure (Chang et al, 2016); (g) an improvement in wound status in diabetics with foot ulcers (Lin et al., 2018); (h) Elevated peripheral oxyhemoglobin, required for proper healing in patients with diabetic foot ulcers (Chen et al., 2017). The mechanism of Buerger-Allen exercises involves the use of gravity to alternately empty and fill the columns of blood through the blood vessels of the lower extremity (Chang et al., 2015). Benefits of Buerger-Allen exercises can include ease of use and learnability, safety, no cost, suitability for home care programs, less physical stress, and time efficiency.


Buerger-Allen exercises have numerous advantages and benefits and may be of clinical importance for diabetics who have impaired blood flow to the lower extremities and/or peripheral neuropathy. Clinicians and other health care professionals who deal with people with diabetes may consider implementing Buerger-Allen exercises into the treatment plan for diabetes mellitus.

Conflict of Interest

The authors declare no conflict of interest


Chang C, Chang C, Chen, M. Effect of Buerger’s Exercises on Improving Peripheral Circulation: A Systematic Review. Open J Nurs 2015; 5: 120-128.

Chang CC, Chen MY, Shen JH, Lin Y Bin, Hsu WW, Lin BS. A quantitative realtime assessment of Buerger exercise on dorsal foot peripheral skin circulation in patients with diabetes foot. Medicine (Baltim) 2016; 95:46(e5334).

Chen ML, Lin BS, Su CW, Lin YB, Chen MY, Shen JH, Chang CC. The application of wireless near infrared spectroscopy on detecting peripheral circulation in patients with diabetes foot ulcer when doing Buerger's exercise. Laser Surg Med 2017; 49:652e7.

El Sayed RAE, Abd Elsalam SN, Elmetwaly RM. Effect of Buerger- Allen Exercise on Lower Extremities Perfusion among Patients with Type 2 Diabetes Mellitus. Egyptian Journal of Health Care 2021; 12: 555-572.

John J and Rathiga A. Effectiveness of buergerallen exercise to improve the lower extremity perfusion among patients with type 2 diabetes mellitus. Int J Curr Res Acad Rev 2015; 3:252-63.

Lin BS, Chang CC, Su CL, Li JR, Chen ML, Chen MY, Huang YK. The assessment of Buerger's exercise on dorsal foot skin circulation in patients with vasculopathic diabetic foot ulcer by using wireless near-infrared spectroscope: a cohort prospective study. Laser Med Sci 2018; 33: 977e82.

Rac-Albu M, Iliuta L, Guberna SM, Sinescu C. The role of ankle-brachial index for predicting peripheral arterial disease. Maedica (Buchar) 2014; 9:295e302.

Radhika J, Poomalai G, Nalini S, Revathi R. Effectiveness of Buerger-Allen Exercise on Lower Extremity Perfusion and Peripheral Neuropathy Symptoms among Patients with Diabetes Mellitus. Iran J Nurs Midwifery Res 2020; 25:291-295.

Thakur A, Sharma R, Sharma SK, Thakur K, Jelly P. Effect of buerger allen exercise on foot perfusion among patient with diabetes mellitus: A systematic review & meta-analysis, Diabetes & Metabolic Syndrome. Diabetes Metab Syndr 2022; 16: 102393.

Trisnawati I, Sudiana IK, Supriyanto S. Effect of Leg Exercise on the Lower Limb Circulation of Patients with Diabetes Mellitus: A Systematic Review. Jurnal Ners 2020 7; 15: 497-507.

Widia C and Hidayat R. Literature Review: Foot Exercise Prevents the Risk of Neuropathy on Diabetes Mellitus Patient: Foot Exercise Prevents the Risk of Neuropathy on Type 2 Diabetes Mellitus Patient. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) 2021; 7.

Zahran W, Hassanen A, Nabih M, Kyrillos F. Effect of Buerger Allen exercise on lower limb perfusion among patients with type 2 diabetes mellitus. Mansoura Nursing Journal 2018; 5: 101-111.