Effect of type 2 diabetes on energy cost and preferred speed of walking

Effects of minute oscillation stretching training on muscle and tendon stiffness and walking capability in people with type 2 diabetes

AIM

we investigated the effects of a 10 week training program (i.e., minute oscillatory stretching; MOS) on the mechanical responses and walking capability in people with type 2 diabetes (T2D).

METHODS

seventeen T2D patients performed maximum voluntary contractions of the plantar flexor muscles during which Achilles tendon stiffness (kT) and muscle-tendon stiffness (kM) were evaluated at different percentages of the maximum voluntary force (MVC). In addition, each participant was requested to walk at different walking speeds (i.e. 2, 3, 4, 5, and 6 kmh-1) while their net energy cost of walking (Cnet), cumulative EMG activity per distance travelled (CMAPD) and kinematic parameters (step length, step frequency, the ankle/knee range of motion) were evaluated.

RESULTS

maximum tendon elongation increased after MOS training, and kT significantly decreased (between 0 and 20% of MVC). No differences were observed for muscle elongation or kM after training. Cnet decreased after training (at the slowest tested speeds) while no changes in CMAPD were observed. Step length and ankle ROM during walking increased after training at the slowest tested speeds, while step frequency decreased; no significant effects were observed for knee ROM.

CONCLUSION

these results indicate the effectiveness of 10 weeks of MOS training in reducing tendon stiffness and the energy cost during walking in people with T2D. This training protocol requires no specific instrumentation, can be easily performed at home, and has a high adherence (92 ± 9%). It could, thus, be useful to mitigate mechanical tendon deterioration and improve physical behaviour in this population.

Hand Grip Strength Relative to Waist Circumference as a Means to Identify Men and Women Possessing Intact Mobility in a Cohort of Older Adults with Type 2 Diabetes

Possessing intact mobility in older adults assures their continued independence. The early identification of reduced mobility in older adults with type 2 diabetes (T2DM) is paramount for preventing their future physical deterioration. Hand grip strength (HGS), relative to body size, is associated with mobility in older T2DM patients. This study aims to identify an HGS index that best identifies mobilityintact older T2DM patients, along with its optimal cut-off point. The baseline data are from a cohort of 122 older T2DM patients (59% women) (mean age of 70.2 ± 4.4 years). Three mobility tests encompassing three main mobility domains were measured, including usual gait speed (UGS), timed up and go (TUG), and a two-minute walk test (2MWT). Passing scores were defined as those either above the established cut-off points or above the 25th percentile of population norms. Passing all three tests was considered as possessing intact mobility. Receiver operating characteristic (ROC) curves of the most relevant HGS indices were constructed to determine the area under the curve (AUC) that best identifies patients with intact mobility. In a sample of 122 older adults with T2DM, 63.9% of women and 60% of men were found to possess intact mobility. HGS relative to waist circumference (WC) was found to have the strongest association with intact mobility, presenting the highest AUC in both men (0.78) and women (0.72) for discriminating mobility status, with an optimal cut-off of 0.355 (kg/cm) and 0.245 (kg/cm) in men and women, respectively. HGS relative to WC best differentiated between mobility-intact older adults with T2DM and those with mobility limitations, especially in men. Using HGS/WC as a simple and safe screening mode for mobility in a clinical setting could potentially identify older patients with T2DM that require therapeutic interventions.

Wearable Sensor for Assessing Gait and Postural Alterations in Patients with Diabetes: A Scoping Review

Background and Objectives: Diabetes mellitus is considered a serious public health problem due to its high prevalence and related complications, including gait and posture impairments due to neuropathy and vascular alterations and the subsequent increased risk of falls. The gait of patients with diabetes is characterized by alterations of the main spatiotemporal gait parameters such as gait velocity, cadence, stride time and length, which are also known to worsen with disease course. Wearable sensor systems can be used for gait analysis by providing spatiotemporal parameters and postural control (evaluated from the perspective of body sway), useful for investigating the disease progression. Thanks to their small size and low cost of their components, inertial measurement units (IMUs) are easy to wear and are cheap tools for movement analysis. Materials and Methods: The aim of this study is to review articles published in the last 21 years (from 2000 to 2021) concerning the application of wearable sensors to assess spatiotemporal parameters of gait and body postural alterations in patients with diabetes mellitus. Relevant articles were searched in the Medline database using PubMed, Ovid and Cochrane libraries. Results: One hundred and four articles were initially identified while searching the scientific literature on this topic. Thirteen were selected and analysed in this review. Wearable motion sensors are useful, noninvasive, low-cost, and objective tools for performing gait and posture analysis in diabetic patients. The IMUs can be worn at the lumber levels, tibias or feet, and different spatiotemporal parameters of movement and static posture can be assessed. Conclusions: Future research should focus on standardizing the measurement setup and selecting the most informative spatiotemporal parameters for gait and posture analysis.

Factors associated with relative muscle strength in patients with type 2 diabetes mellitus

OBJECTIVES

Some patients with type 2 diabetes mellitus (T2DM) experience decreased mobility associated with lower relative muscle strength (normalized with muscle mass). This study aimed to identify factors predicting relative muscle strength of patients with T2DM assessed at regular clinical visits.

METHODS

A total of 144 T2DM patients underwent fasting blood drawing (determining white blood cell count [WBC], diabetic kidney disease [DKD], and glycated hemoglobin [HbA1c]) and the assessment of body composition, diabetic peripheral neuropathy (DPN), activity level, and muscle strength (grip, knee extensor, and ankle plantar flexor strength). One-way ANOVA and multiple regression models were used to identify factors associated with the relative muscle strength.

RESULTS

Our data showed that age, diabetes duration, fat percentage, WBC, DPN, and DKD were negatively associated with the relative muscle strength. Specifically, a greater WBC was associated with lower relative muscle strength of both distal and proximal muscle groups of extremities after the adjustment of other associated factors. DPN was associated with lower relative strength of the distal muscle groups of extremities.

CONCLUSIONS

WBC may be used as a marker of inflammation, and greater count, even within the normal range, is negatively associated with the relative muscle strength in patients with T2DM.

Effect of Walking on Sand with Dietary Intervention in OverweightType 2 DiabetesMellitusPatients: A Randomized Controlled Trial

(1) Background: The primary goal of this study was to assess the effect of sand walking on Hemoglobin A1c (HbA1c), Body Mass Index (BMI), waist circumference, and quality of life among individuals with Type-2 Diabetes Mellitus (T2DM). (2) Methods: A randomized-controlled design was conducted on 66 overweight participants suffering from T2DM. Participants were randomly allocated to sand walking (SW) (n = 33) and normal walking (NW) (n = 33) groups. Participants performed moderate-intensity walking for 30 min, 3 times a week for 4 months. Participants walking on sand had statistically significant mean scores for HbA1c, BMI, waist circumference and quality of life((M = 7.32, SD = 0.47),(M = 25.77, SD = 1.366),(M = 92.94, SD = 2.59), (M = 91.48, SD = 34.08)) than those walking on leveled surface ((M = 8.38, SD = 0.77),t(52.8) = −6.73, p = 0.003, (M = 26.80, SD = 1.38), t(64) = −3.05, p = 0.001,(M = 98.12, SD = 2.16.3), t(64) = −3.75, p = 0.001, (M = 112, SD = 33.7), t(64) = −2.45, p = 0.017)respectively. (3) Conclusions: Regular SW with a healthy dietary regime for 4 months led to a statistically significant difference in HbA1c, BMI, waist circumference, and quality of life as compared to NW group.

Estimating energy expenditure from accelerometer data in healthy adults and patients with type 2 diabetes

OBJECTIVE

The aim of this study was to develop specific prediction equations based on acceleration data measured at three body sites for estimating energy expenditure (EE) during static and active conditions in middle-aged and older adults with and without type 2 diabetes (T2D).

RESEARCH METHODS

Forty patients with T2D (age: 40-74 yr, body mass index (BMI): 21-29.4 kg·m-2) and healthy participants (age: 47-79 yr, BMI: 20.2-29.8 kg·m-2) completed trials in both static conditions and treadmill walking. For all trials, gas exchange was monitored using indirect calorimetry and vector magnitude was calculated from acceleration data measured using inertial measurement units placed to the participant's center of mass (CM), hip and ankle. Stepwise multiple regression analyses were conducted to select relevant variables to include in the three EE prediction equations, and three Monte Carlo cross-validation procedures were used to evaluate each separate equation.

RESULTS

Vector magnitude (p < 0.0001) and personal data (gender, diabetes status and BMI; p < 0.0001) were used to develop three linear prediction equations to estimate EE during static conditions and walking. Cross-validation revealed similar robust coefficients of determination (R2: 0.81 to 0.85) and small bias (mean bias: 0.008 to -0.005 kcal·min-1) for all three equations. However, the equation based on CM acceleration exhibited the lowest root mean square error (0.60 kcal·min-1 vs. 0.65 and 0.69 kcal·min-1 for the hip and ankle equations, respectively; p < 0.001).

CONCLUSION

The three equations based on acceleration data and participant characteristics accurately estimated EE during sedentary conditions and walking in middle-aged and older adults, with or without diabetes.

Accelerometry-based method for assessing energy expenditure in patients with diabetes during walking

BACKGROUND

Monitoring activity-related energy expenditure (EE) is essential in the management of daily activity and the dietary programme in patients with type 2 diabetes (T2D) and must be estimated accurately. Accelerometry-based equations have frequently used to estimate EE, although the validity of these methods has not been confirmed in patients with T2D. The present study aimed to test the validity of an accelerometry-based method (Bouten's method) to assess EE during walking in patients with T2D.

METHODS

The study included 20 patients with controlled T2D [mean (SD) duration: 10.6 (6.1) years; age: 57.5 (8.4) years; body mass index: 26.4 (2.6) kg m- ²]. All participants performed five 6-min periods of walking at different speeds (0.5-1.5 m s-1 ) on a treadmill. Mechanical data were recorded using an inertial measurement unit placed on the lower back with gas exchange being simultaneously monitored.

RESULTS

Values of EE during walking estimated by the accelerometer method did not differ significantly from those measured by indirect calorimetry. Bias and root mean square error were -1.17 and 2.93 kJ min-1 , respectively, on average across speeds.

CONCLUSIONS

Our results suggest that EE during walking may be accurately estimated in patients with diabetes mellitus using an accelerometer.