Evaluation of physical fitness in patients with Type 2 diabetes mellitus

The Impact of Diabetes Complications on the Physical Function of Maintenance Hemodialysis Patients

This study investigated the impact of diabetes on the physical function of patients undergoing dialysis. This study included 22 patients undergoing outpatient dialysis with continued exercise therapy during dialysis at our hospital between January 2021 and August 2021. The participants were divided into two groups based on the presence or absence of diabetes, and various parameters were compared between the groups. To compare each physical function assessment and measurement of anterior thigh muscle thickness, repeated-measures analysis of variance was conducted to test for the presence of interactions and main effects. Significant differences were observed in the absence of dyslipidemia (p < 0.01), high-density lipoprotein cholesterol level (p < 0.01), and foot sole skin perfusion pressure (p < 0.02). In terms of physical function, a main effect between the groups was observed in the five-time sit-to-stand test, and anterior thigh muscle thickness showed a main effect over time. Significant differences in the anterior thigh muscle thickness were observed between three and six months after the intervention (p < 0.05). In patients undergoing dialysis with diabetes complications, a decrease in physical activity and lack of exercise can lead to a reduction in overall physical activity levels. Additionally, impairments such as peripheral neuropathy may contribute to an accelerated decrease in skeletal muscle mass.

Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

Objective

To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes.

Materials and methods

The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2 max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software.

Results

Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2 max (-5.84 mL.kg-1.min-1, 95% CI -6.93, -4.76 mL.kg-1.min-1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (-93.30 meters, 95% CI -141.2, -45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001).

Conclusion

Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2 max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.

Operational Modal Analysis of Near-Infrared Spectroscopy Measure of 2-Month Exercise Intervention Effects in Sedentary Older Adults with Diabetes and Cognitive Impairment

The Global Burden of Disease Study (GBD 2019 Diseases and Injuries Collaborators) found that diabetes significantly increases the overall burden of disease, leading to a 24.4% increase in disability-adjusted life years. Persistently high glucose levels in diabetes can cause structural and functional changes in proteins throughout the body, and the accumulation of protein aggregates in the brain that can be associated with the progression of Alzheimer's Disease (AD). To address this burden in type 2 diabetes mellitus (T2DM), a combined aerobic and resistance exercise program was developed based on the recommendations of the American College of Sports Medicine. The prospectively registered clinical trials (NCT04626453, NCT04812288) involved two groups: an Intervention group of older sedentary adults with T2DM and a Control group of healthy older adults who could be either active or sedentary. The completion rate for the 2-month exercise program was high, with participants completing on an average of 89.14% of the exercise sessions. This indicated that the program was practical, feasible, and well tolerated, even during the COVID-19 pandemic. It was also safe, requiring minimal equipment and no supervision. Our paper presents portable near-infrared spectroscopy (NIRS) based measures that showed muscle oxygen saturation (SmO2), i.e., the balance between oxygen delivery and oxygen consumption in muscle, drop during bilateral heel rise task (BHR) and the 6 min walk task (6MWT) significantly (p < 0.05) changed at the post-intervention follow-up from the pre-intervention baseline in the T2DM Intervention group participants. Moreover, post-intervention changes from pre-intervention baseline for the prefrontal activation (both oxyhemoglobin and deoxyhemoglobin) showed statistically significant (p < 0.05, q < 0.05) effect at the right superior frontal gyrus, dorsolateral, during the Mini-Cog task. Here, operational modal analysis provided further insights into the 2-month exercise intervention effects on the very-low-frequency oscillations (<0.05 Hz) during the Mini-Cog task that improved post-intervention in the sedentary T2DM Intervention group from their pre-intervention baseline when compared to active healthy Control group. Then, the 6MWT distance significantly (p < 0.01) improved in the T2DM Intervention group at post-intervention follow-up from pre-intervention baseline that showed improved aerobic capacity and endurance. Our portable NIRS based measures have practical implications at the point of care for the therapists as they can monitor muscle and brain oxygenation changes during physical and cognitive tests to prescribe personalized physical exercise doses without triggering individual stress response, thereby, enhancing vascular health in T2DM.

Mechanisms underlying altered neuromuscular function in people with DPN

Diabetes alters numerous physiological functions and can lead to disastrous consequences in the long term. Neuromuscular function is particularly affected and is impacted early, offering an opportunity to detect the onset of diabetes-related dysfunctions and follow the advancement of the disease. The role of physical training for counteracting the deleterious effects of diabetes is well accepted but at the same time, it appears difficult to reliably assess the effects of exercise on functional capacity in patients with diabetic peripheral neuropathy (DPN). In this paper, we will review the specific characteristics of various neuromuscular dysfunctions associated with diabetes according to the DPN presence or not, and their changes over time. We present several propositions regarding the onset of neuromuscular alterations in people with diabetes compared to people with DPN. It appears that motor unit loss and neuromuscular transmission impairment are among the main mechanisms explaining the considerable degradation of neuromuscular function in the transition from a diabetic to neuropathic state. Rate of force development and contractile properties could start to decrease with the onset of preferential type II fiber atrophy, commonly reported in people with DPN. Finally, M_max amplitude could decrease with neuromuscular fatigue only in people with DPN, reflecting the fatigue-related neuromuscular transmission impairment reported in people with DPN. In this review, we show that the different neuromuscular parameters are altered at different stages of diabetes, according to the presence of DPN or not. The precise evaluation of these parameters might participate in adapting the physical training prescription.

Tele-Assessment of Functional Capacity through the Six-Minute Walk Test in Patients with Diabetes Mellitus Type 2: Validity and Reliability of Repeated Measurements

A tele-assessed 6MWT (TL 6MWT) could be an alternative method of evaluating functional capacity in patients with diabetes mellitus type 2 (DM2). This study aimed to assess the validity and reliability of a TL 6MWT. The functional capacity of 28 patients with DM2 (75% men) aged 61 ± 13 years was evaluated twice via an indoor, center-based 6MWT (CB 6MWT) and twice outside each patient's home via a web-based platform TL 6MWT. The study showed a high statistically significant correlation between the CB and TL 6MWT (Pearson's r = 0.76, p < 0.001). Reliability testing showed no statistically significant differences in the distance covered (CB1: 492 ± 84 m and CB2: 506 ± 86 m versus TL1: 534 ± 87 m and TL2: 542 ± 93 m, respectively) and in the best distance of the TL 6MWT (545 ± 93 m) compared to the best CB distance (521 ± 83 m). Strong internal reliability for both the CB (intraclass correlation coefficient (ICC) = 0.93) and the TL 6MWT (ICC = 0.98) was found. The results indicate that a TL 6MWT performed outdoors can be a highly valid and reliable tool to assess functional capacity in patients with DM2. No learning effect between the TL and CB assessment was found, minimizing the need for repetition.

Handgrip strength is inversely associated with augmentation index in patients with type 2 diabetes

Handgrip strength (HGS) is a measure of overall skeletal muscle strength and is used to identify risks for cardiovascular disease and mortality. Furthermore, HGS is an indicator of arterial stiffness that leads to atherosclerotic cardiovascular disease. This study aimed to examine the relationship between HGS and augmentation index (AIx) in patients with type 2 diabetes. A cross-sectional study was conducted to examine patients with type 2 diabetes whose HGS and AIx were measured in our hospital. AIx was measured noninvasively using an applanation tonometer, and multiple regression analyses were conducted to assess the independent relationship between HGS and AIx. This study included 404 patients. After adjusting for age, gender, body mass index, duration of diabetes, smoking and exercise habit, biochemical parameters, and physiological parameters related to arterial stiffness, HGS was found to be independently and inversely associated with AIx (β = - 0.270, p = 0.006). HGS was independently and inversely associated with AIx in patients with type 2 diabetes. Patients with diminished HGS should be subjected to intensive exercise therapy for reducing the risk of arterial stiffness and cardiovascular disease.Trial registration: UMIN000023010.

The Physical Activity Assessment of Adults With Type 2 Diabetes Using Accelerometer-Based Cut Points: Scoping Review

Background

Incorporating physical activity into lifestyle routines is recommended for individuals with type 2 diabetes. Accelerometers offer a promising method for objectively measuring physical activity and for assessing interventions. However, the existing literature for accelerometer-measured physical activity among middle-aged and older adults with type 2 diabetes is lacking.

Objective

This study aims to identify research studies in which accelerometer-based cut points were used to classify the physical activity intensity of middle-aged to older adults with type 2 diabetes as sedentary, light, moderate, vigorous, and very vigorous, and to determine if validated accelerometer cut points specifically for this population exist.

Methods

We followed the Joanna Briggs Institute methodology for scoping reviews. Between June 23 and July 12, 2020, two reviewers independently screened records from four databases (PubMed, Web of Science, Embase, Engineering Village) and the ActiGraph Corp web site for eligible studies that included patients with type 2 diabetes with a sample mean age ≥50 years, used research-grade accelerometers, applied cut points to categorize objectively measured physical activity, and were available in English. We excluded studies reporting exclusively steps or step counts measured by accelerometers or pedometers and conference abstracts or other sources that did not have a full text available. Data extraction was completed using Microsoft Excel. Data for the following variables were tabulated based on frequency distributions: study design, accelerometer type, device placement, epoch length, total wear time, and cut points used. Study aims and participant demographic data were summarized.

Results

A total of 748 records were screened at the abstract level, and 88 full-text articles were assessed for eligibility. Ultimately, 46 articles were retained and analyzed. Participants’ mean ages ranged from 50 to 79.9 years. The ActiGraph accelerometer and the Freedson et al and Troiano et al counts-per-minute cut points were the most frequently used across the literature. Freedson et al and Troiano et al counts-per-minute cut points for light, moderate, and vigorous activity correspond to <1952, 1952-5724, and ≥5725, and 100-2019, 2020-5998, and ≥5999, respectively. The Lopes et al cut points were developed by calibrating the ActiGraph in middle-aged and older adults with overweight/obesity and type 2 diabetes. These counts-per-minute thresholds are ≥200 (light), ≥1240 (moderate), and ≥2400 (vigorous), and were applied in 1 interventional study.

Conclusions

An assortment of accelerometer cut points have been used by researchers to categorize physical activity intensity for middle-aged and older adults with diabetes. Only one set of cut points was validated and calibrated in our population of interest. Additional research is warranted to address the need for diabetes-specific cut points to inform public health recommendations. This includes confirmation that the Lopes et al cut points reflect clinically meaningful changes in physical activity for adults with diabetes who have comorbidities other than overweight/obesity and the development of relative intensity cut points that may be more suitable for those with suboptimal physical functioning.

The effect of diabetes on functional outcomes among individuals with distal radial fractures

STUDY DESIGN

Prospective cohort study.

INTRODUCTION

Diabetes is reported to adversely affect outcomes; however, its effect on distal radial fractures (DRF) is not well examined.

PURPOSE OF THE STUDY

This study investigated the effect of diabetes on pain, hand function, physical health status, grip strength, and wrist and forearm range of motion among patients with DRF.

METHODS

A total of 479 patients with DRF were classified into patients with and without diabetes based on self-report. Patient-Rated Wrist Evaluation assessed pain and hand function. The Short Form-12 assessed physical health status. Both questionnaires examined DRF recovery at baseline, 3 month, and 1 year.

RESULTS

There was a significant improvement in Patient-Rated Wrist Evaluation scores over time (69 [19] to 25 [22]; 76 [15] to 20 [20] for patients with and without diabetes respectively, P < .01) with a significant interaction between time and diabetes (P < .01), indicating that patients with diabetes recovered more slowly than the rest of the cohort. There was an improvement over time on physical status (36 [12] to 45 [12]; 39 [9] to 50 [9], P < .01), grip strength (16 [7] to 24 [10]; 15 [9] to 24 [10], P < .01), and range of motion (flexion [42 {14} to 49 {15}; 43 {15} to 54 {14}, P < .01], extension [45 {11} to 52 {11}; 46 {13} to 53 {12}, P < .01], pronation [73 {10} to 77 {9}; 73 {11} to 78 {9}, P < .01], and supination [58 {17} to 65 {14}; 61 {17} to 70 {12}, P < .01]) for patients with and without diabetes, respectively. Patients with diabetes did not differ significantly in these secondary outcomes compared to the rest of the cohort.

DISCUSSION AND CONCLUSION

Although individuals with diabetes had good outcomes, their recovery was slower than the rest of the cohort. This may be due to the adverse effect of hyperglycemia on bone tissues and small blood vessels. Future studies are required to assess how severity and duration of diabetes affect outcomes after DRF.

Factors Associated with Meeting Current Recommendation for Physical Activity in Scottish Adults with Diabetes

It remains unclear which factors are instrumental in meeting the recommended physical activity in people with diabetes. We, therefore, aimed to determine the sociodemographic, health-related behavior and clinical factors associated with meeting the recommended levels of physical activity in Scottish adults with diabetes. The study was based on the nationally-representative cross-sectional Scottish Health Surveys (2014–2017). The study participants included a sub-sample of 1259 adults (≥16 years old) with diabetes. Physical activity was evaluated using international guidelines. Overall, 34.1% of the subjects met the recommended levels of physical activity. Independent determinants of meeting the recommended levels of physical activity include male gender (odds ratio (OR) 1.47; 95% confidence interval (CI) 1.07–2.00) and being a non-smoker (OR 1.62; 95% CI 1.02–2.56). Furthermore, meeting the recommended physical activity levels decreased with age (OR 0.96; 95% CI 0.95–0.97), having a longstanding illness (OR 0.56; 95% CI 0.34–0.93) and body mass index (OR 0.94; 95% CI 0.92–0.97), but increased with higher fruit and vegetable intake (OR 1.16; 95% CI 1.07–1.25) and mental wellbeing (OR 1.04; 95% CI 1.02–1.06). Implementation of health promotion programs that target the identified determinants is needed to improve the recommended levels of physical activity among adults with diabetes.

Influence of Complications of Diabetes Mellitus on Exercise Tolerance of Patients with Heart Failure: Focusing on autonomic nervous activity and heart rate response during cardiopulmonary exercise tests

PURPOSE

The purpose of this study was to clarify the influence of complications of diabetes on the exercise tolerance of patients with heart failure.

METHODS

The subjects of this study were 69 patients (44 men; mean age: 62.2 ± 13.4 years) who were hospitalized and diagnosed with heart failure between November 2016 and November 2017. The subjects all took part in a cardiopulmonary exercise test. The patients' medical background, indexes obtained from lower-limb muscle strength and the cardiopulmonary exercise test, heart rate response indexes [Δ heart rate (ΔHR)], and autonomic nervous activities were measured, and these individual indexes were compared between the diabetic group and the non-diabetic group.

RESULTS

Compared with the non-diabetic group, the peak oxygen uptake (peak V̇O₂) and ΔHR in the diabetic group were significantly lower (13.0 ± 2.2 vs. 14.9 ± 4.4 ml/kg/min and 27.2 ± 11.7 vs. 36.7 ± 14.7 bpm, respectively) (p<0.05). Regarding the autonomic nervous activity during the cardiopulmonary exercise test in the diabetic group, there was a significant decrease of parasympathetic nerve activity and a significant lack of increase in sympathetic nerve activity (p<0.05).

CONCLUSIONS

Patients with heart failure and diabetes had lower levels of exercise tolerance, as compared with patients without complications. It was suggested that the decrease in heart rate response was due to the decrease of autonomic nervous activity and that this may play a role in reduced exercise tolerance.

Aerobic exercise training at maximal fat oxidation intensity improves body composition, glycemic control, and physical capacity in older people with type 2 diabetes

Background

Aerobic training has been used as one of the common treatments for type 2 diabetes; however, further research on the individualized exercise program with the optimal intensity is still necessary. The purpose of this study was to investigate the effects of supervised exercise training at the maximal fat oxidation (FATmax) intensity on body composition, glycemic control, lipid profile, and physical capacity in older people with type 2 diabetes.

Methods

Twenty-four women and 25 men with type 2 diabetes, aged 60–69 years. The exercise groups trained at the individualized FATmax intensity for 1 h/day for 3 days/week over 16 weeks. No dietary intervention was introduced during the experimental period. Whole body fat, abdominal fat, oral glucose tolerance test, lipid profile, and physical capacity were measured before and after the interventions.

Results

FATmax intensity was at 41.3 ± 3.2% VO₂max for women and 46.1 ± 10.3% VO₂max for men. Exercise groups obtained significant improvements in body composition, with a special decrease in abdominal obesity; decreased resting blood glucose concentration and HbA1c; and increased VO₂max, walking ability, and lower body strength, compared to the non-exercising controls. Daily energy intake and medication remained unchanged for all participants during the experimental period.

Conclusion

Beside the improvements in the laboratory variables, the individualized FATmax training can also benefit daily physical capacity of older people with type 2 diabetes.

Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors: A Clinician's Guide

This comprehensive review covers the historical background, physiology, application in type 2 diabetes, novel uses, cardiovascular benefits, side effects and contraindications of sodium-glucose cotransporter-2 (SGLT2) inhibitors. SGLT2 inhibitors are an insulin-independent class of oral antihyperglycemic medication that clinicians use in the treatment of type 2 diabetes. Multiple landmark clinical trials support the effectiveness of SGLT2 inhibitors in reducing blood glucose levels, but it is important to understand when to properly utilize them. SGLT2 inhibitors are the most beneficial as an adjunct medication in addition to metformin in patients with a history of cardiovascular or renal disease who need further hemoglobin A1c reduction. The novel mechanism of action also demands clinicians be aware of the side effects not typically experienced with other oral antihyperglycemic drugs, such as genital tract infections, lower leg amputations, electrolyte disturbances and bone fractures. On top of their benefits in type 2 diabetes, novel uses for SGLT2 inhibitors are being uncovered. Diabetic patients with non-alcoholic fatty liver disease, who are at an increased risk of cirrhosis and hepatocellular carcinoma, experience a clinically significant reduction in serum alanine aminotransferase levels. SGLT2 inhibitors are also effective at lowering body weight in obese individuals and decreasing systolic blood pressure. Dual SGLT1/SGLT2 inhibitors are currently being investigated as possibly the first oral medication for type 1 diabetes.

Effects of glucose-lowering agents on cardiorespiratory fitness

Exercise therapy is essential for the management of type 2 diabetes (T2D). However, patients with T2D show lower physical activity and reduced cardiorespiratory fitness than healthy individuals. It would be ideal for clinicians to co-prescribe glucose-lowering agents that improve cardiorespiratory fitness or exercise capacity in conjunction with exercise therapy. Metformin does not improve cardiorespiratory fitness and may attenuate any beneficial effect of exercise in patients with T2D. In contrast, thiazolidinediones appear to improve cardiorespiratory fitness in patients with T2D. Although evidence is limited, sodium-glucose cotransporter 2 (SGLT2) inhibitors may improve cardiorespiratory fitness in patients with heart failure, and the effect of glucagon-like peptide-1 (GLP-1) receptor agonists on cardiorespiratory fitness is controversial. Recent clinical trials have shown that both SGLT2 inhibitors and GLP-1 receptor agonists exert a favorable effect on cardiovascular disease. It becomes more important to choose drugs that have beneficial effects on the cardiovascular system beyond glucose-lowering effects. Further studies are warranted to determine an ideal glucose-lowering agent combined with exercise therapy for the treatment of T2D.

Dynamical Coordination of Hand Intrinsic Muscles for Precision Grip in Diabetes Mellitus

This study investigated the effects of diabetes mellitus (DM) on dynamical coordination of hand intrinsic muscles during precision grip. Precision grip was tested using a custom designed apparatus with stable and unstable loads, during which the surface electromyographic (sEMG) signals of the abductor pollicis brevis (APB) and first dorsal interosseous (FDI) were recorded simultaneously. Recurrence quantification analysis (RQA) was applied to quantify the dynamical structure of sEMG signals of the APB and FDI; and cross recurrence quantification analysis (CRQA) was used to assess the intermuscular coupling between the two intrinsic muscles. This study revealed that the DM altered the dynamical structure of muscle activation for the FDI and the dynamical intermuscular coordination between the APB and FDI during precision grip. A reinforced feedforward mechanism that compensates the loss of sensory feedbacks in DM may be responsible for the stronger intermuscular coupling between the APB and FDI muscles. Sensory deficits in DM remarkably decreased the capacity of online motor adjustment based on sensory feedback, rendering a lower adaptability to the uncertainty of environment. This study shed light on inherent dynamical properties underlying the intrinsic muscle activation and intermuscular coordination for precision grip and the effects of DM on hand sensorimotor function.

Association of handgrip strength with hospitalization, cardiovascular events, and mortality in Japanese patients with type 2 diabetes

Handgrip strength is useful for the diagnosis of sarcopenia. We examined the associations of handgrip strength with all-cause mortality, cardiovascular events, and hospitalization in patients with type 2 diabetes. From April 2013 to December 2015, we conducted a retrospective cohort study to examine patients with type 2 diabetes whose handgrip strength was measured at our hospital. All patients were followed up until May 2016. A total of 1,282 patients (63.8 ± 13.9 years) were enrolled and followed up for 2.36 ± 0.73 years. During the follow-up period, 20 patients (1.6%) died, 14 (1.1%) experienced cardiovascular events, and 556 (43.4%) were admitted to our hospital for any diseases. Multiple regression analyses revealed that handgrip strength was favorably associated with abdominal obesity and renal function. Moreover, Cox proportional hazard analyses with adjustment for potential confounding variables revealed that handgrip strength was significantly associated with occurrence of CVD events and hospitalization in all subjects. In addition, handgrip strength was significantly associated with mortality and hospitalization in men and with hospitalization in women. Handgrip strength could be a prognostic indicator for health as well as a diagnostic marker of skeletal muscle mass loss in Japanese patients with type 2 diabetes.

Relationships among exercise capacity, dynamic balance and gait characteristics of Nigerian patients with type-2 diabetes: an indication for fall prevention

This study investigated the relationships among exercise capacity (EC), dynamic balance (DB), and gait characteristics (GCs) of patients with type-2 diabetes (T2D) and healthy controls (HCs). This observational controlled study involved 125 patients with T2D receiving treatment at a Nigerian university teaching hospital and 125 apparently healthy patients' relatives and hospital staff recruited as controls. EC maximum oxygen consumption (VO2max) was estimated following a 6-min walk test. DB and GC were assessed using the Time Up to Go Test and an accelerometer (BTS G-Walk) assessing gait speed, step length, stride length, and cadence respectively during a self-selected walk. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. The mean ages of patients with T2D and HCs were 57.6±6.6 and 60.0±7.0 years, respectively. All physical characteristics were comparable (P>0.05). There were significant differences in the VO2max and DB between patients with T2D and HCs; 7.6±0.6 mL/kg/min vs. 9.6±0.6 mL/kg/min (t=-16.6, P=0.001) and 14.2±2.1 sec vs. 10.4±1.5 sec (t=-6.37, P=0.001), respectively. Furthermore, significant differences were found in GC between patients with T2D and HCs; gait speed: 0.7±0.1 m/sec vs. 1.2±0.1 m/sec (t=-16.60, P=0.001), step length: 0.6±0.2 m vs. 0.9±0.3 m (t=-7.56, P=0.001) and stride length: 0.9±0.1 m vs. 1.1±0.5 m (t=-6.09, P=0.001). There were significant correlations between EC and gait speed in both groups (T2D: r=-0.26, P=0.032 and HCs: r=0.51, P=0.003). In conclusion, patients with T2D demonstrated lower EC, unstable DB, and altered GCs compared with HCs. Exercise interventions to improve EC and gait balance are recommended.

Daily physical activity and type 2 diabetes: A review

Physical activity improves glycemic control and reduces the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes (T2D). Moderate to vigorous physical activity is recommended to manage T2D; however, patients with T2D can be physically weak, making it difficult to engage in the recommended levels of physical activity. Daily physical activity includes various activities performed during both occupational and leisure time such as walking, gardening, and housework that type 2 diabetic patients should be able to perform without considerable physical burden. This review focuses on the association between daily physical activity and T2D. Walking was the most common form of daily physical activity, with numerous studies demonstrating its beneficial effects on reducing the risk of T2D, CVD, and mortality. Walking for at least 30 min per day was shown to reduce the risk of T2D by approximately 50%. Additionally, walking was associated with a reduction in mortality. In contrast, evidence was extremely limited regarding other daily physical activities such as gardening and housework in patients with T2D. Recent studies have suggested daily physical activity, including non-exercise activity thermogenesis, to be favorably associated with metabolic risks and mortality. However, well-designed longitudinal studies are warranted to elucidate its effects on overall health.

Sensorimotor Peripheral Nerve Function and the Longitudinal Relationship With Endurance Walking in the Health, Aging and Body Composition Study

OBJECTIVES

To determine whether lower extremity sensorimotor peripheral nerve deficits are associated with reduced walking endurance in older adults.

DESIGN

Prospective cohort study with 6 years of follow-up.

SETTING

Two university research clinics.

PARTICIPANTS

Community-dwelling older adults enrolled in the Health, Aging and Body Composition Study from the 2000-2001 annual clinical examination (N=2393; mean age ± SD, 76.5±2.9y; 48.2% men; 38.2% black) and a subset with longitudinal data (n=1178).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants underwent peripheral nerve function examination in 2000-2001, including peroneal motor nerve conduction amplitude and velocity, vibration perception threshold, and monofilament testing. Symptoms of lower extremity peripheral neuropathy included numbness or tingling and sudden stabbing, burning, pain, or aches in the feet or legs. The Long Distance Corridor Walk (LDCW) (400 m) was administered in 2000-2001 and every 2 years afterward for 6 years to assess endurance walking performance over time.

RESULTS

In separate, fully adjusted linear mixed models, poor vibration threshold (>130 μm), 10-g and 1.4-g monofilament insensitivity were each associated with a slower 400-m walk completion time (16.0 s, 14.4s, and 6.9 s slower, respectively; P<.05 for each). Poor motor amplitude (<1 mV), poor vibration perception threshold, and 10-g monofilament insensitivity were related to greater slowing per year (4.7, 4.2, and 3.8 additional seconds per year, respectively; P<.05), although poor motor amplitude was not associated with initial completion time.

CONCLUSIONS

Poorer sensorimotor peripheral nerve function is related to slower endurance walking and greater slowing longitudinally. Interventions to reduce the burden of sensorimotor peripheral nerve function impairments should be considered to help older adults maintain walking endurance-a critical component for remaining independent in the community.

Neuromuscular dysfunction in type 2 diabetes: underlying mechanisms and effect of resistance training

Diabetic patients are at higher risk of developing physical disabilities than non-diabetic subjects. Physical disability appears to be related, at least in part, to muscle dysfunction. Several studies have reported reduced muscle strength and power under dynamic and static conditions in both the upper and lower limbs of patients with type 2 diabetes. Additional effects of diabetes include a reduction in muscle mass, quality, endurance and an alteration in muscle fibre composition, though the available data on these parameters are conflicting. The impact of diabetes on neuromuscular function has been related to the co-existence of long-term complications. Peripheral neuropathy has been shown to affect muscle by impairing motor nerve conduction. Also, vascular complications may contribute to the decline in muscle strength. However, muscle dysfunction occurs early in the course of diabetes and affects also the upper limbs, thus suggesting that it may develop independently of micro and macrovascular disease. A growing body of evidence indicates that hyperglycaemia may cause an alteration of the intrinsic properties of the muscle to generate force, via several mechanisms. Recently, resistance exercise has been shown to be an effective strategy to counteract the deterioration of muscular performance. High-intensity exercise seems to provide greater benefits than moderate-intensity training, whereas the effect of a power training is yet unknown. This article reviews the available literature on the impairment of muscle function induced by diabetes, the underlying mechanisms, and the effect of resistance training on this defect. Copyright © 2015 John Wiley & Sons, Ltd.

Influência do nível de atividade física sobre a aptidão física e qualidade de vida relacionada à saúde em idosos portadores ou não de diabetes mellitus tipo 2

INTRODUÇÃO: O exercício físico é considerado um dos componentes para melhoria das condições de saúde em diabéticos tipo 2. Além disso, alguns estudos têm sugerido que níveis mais elevados de aptidão física também podem melhorar a qualidade de vida relacionada à saúde (QVRS). No entanto, não existem estudos publicados que sejam especificamente concebidos para examinar esta relação. OBJETIVO: O objetivo do presente estudo foi avaliar o efeito do nível de atividade física sobre a aptidão física e QVRS e determinar se existem diferenças quando indivíduos com e sem diabetes mellitus tipo 2 são comparados. MÉTODO: Cinquenta e quatro participantes com diabetes tipo 2 e 54 participantes pareados por idade sem diabetes foram voluntários para participar deste estudo. A aptidão física (teste de levantar da cadeira de 30 segundos, teste de caminhada de seis minutos e teste de sentar e alcançar) e QVRS (VC-36) foram avaliadas. RESULTADOS: Os participantes com diabetes tipo 2 apresentaram menores escores médios para o teste de sentar e alcançar e uma maior pontuação em relação ao escore do componente mental do que os controles. Quando os dois grupos foram classificados quanto ao nível de atividade física, foram encontradas diferenças significativas em relação a função social, saúde mental, saúde geral e vitalidade, entre os pacientes insuficiente e minimamente ativos. CONCLUSÃO: Os participantes com maiores níveis de prática de atividade física também relataram melhor aptidão física, a qual, juntamente com as melhorias na QVRS, pode ter implicações clínicas na prevenção e tratamento do diabetes mellitus tipo 2.

Test-retest reliability and minimal detectable change scores for fitness assessment in older adults with type 2 diabetes

PURPOSE

To assess the intraclass correlation coefficients (ICCs) and to determine the minimal detectable change (MDC95 ) scores of the data for the Hand Grip Strength Test, the Chair Sit and Reach Test (CSRT), the Timed "Up and Go" (TUG) test, the 6-Minute Walk Test (6MWT) and 30 seconds Sit to Stand Test (30s-STS) test in older adults with type 2 NIDDM.

DESIGN

Test-retest reliability.

METHODS

Eighteen subject participated in two sessions (1 week apart), which included the different tests.

FINDINGS

High ICCs (≥ 0.92) were found for all tests. The MDC₉₅ scores were as follows: 4.0 kg for Hand Grip Strength Tests, 7.5 cm for the right leg-CSRT, 9.0 cm for the left leg-CSRT, 1.0 second for the TUG test, 27 m for the 6MWT, and 3.3 repetitions for the 30s-STS test.

CONCLUSIONS

All tests evaluated are reliable outcome measures for type 2 NIDDM patients.

CLINICAL RELEVANCE

This study has generated novel MCD₉₅ data, which will assist nursing practitioners in both prescribing the most beneficial exercise and interpreting posttreatment changes after rehabilitation in patients with T2DM.

The relationship between nutritional status, functional capacity, and health-related quality of life in older adults with type 2 diabetes: a pilot explanatory study

OBJECTIVE

To explore the relationship between nutritional status, functional capacity and health-related quality of life (HRQoL) in older adults with type 2 diabetes (T2DM).

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Forty two non-insulin dependent older adults from a primary care center in Seville, Spain.

MEASUREMENTS

Function was assessed with a battery of standardized physical fitness tests. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and the European Quality of Life Questionnaire (EQ-5D-3L) was used to assess HRQoL.

RESULTS

There was an association between MNA-nutritional status and lower body strength as assessed by the chair sit-stand test (rho= .451; p= .037) and between MNA-nutritional status and EQ-5D-3L-HRQoL (EQ-5D-3Lutility, rho= .553; p<.001 and EQ-5D-3LVAS rho= .402; p<.001). An MNA item by item correlation analysis with HRQoL and lower limb strength demonstrated that HRQoL appears to be related to functional capacity (principally lower body strength, motor agility and cardiorespiratory fitness) among participants. These results were maintained when correlations were adjusted for co-morbidity.

CONCLUSION

Our results demonstrated that nutritional status is moderately associated with HRQoL and lower limb strength in patients with T2DM. Our data suggest that more emphasis should be placed on interventions to encourage a correct diet and stress the needed to improve lower body strength to reinforce better mobility in T2DM population.

Depressed mood, glycaemic control and functional capacity in overweight/obese men with and without type 2 diabetes

OBJECTIVE

To determine whether there were differences in depressed mood between overweight/obese men with and without type 2 diabetes (T2DM) and to examine any associations between depressed mood, physical functioning, and glycaemic control in overweight/obese men with and without T2DM.

METHODS

Fifty seven overweight/obese men with (n = 19, age = 54.2 ± 7.4 yrs, BMI = 32.3 ± 6.7 kg⋅m-2) and without T2DM (n = 38, age = 51.1 ± 6.8 yrs, BMI = 29.9 ± 4.5kg⋅m-2, p > 0.05 between groups) participated. The men completed measures of depressed mood and health-related quality of life (HRQL) and underwent the following assessments: fasting blood lipids and glucose, HbA1c, anthropometric measurements, VO2peak, muscle strength, and physical function.

RESULTS

Compared to men without T2DM, men with T2DM had higher depressed mood (p = 0.05, η2 = 0.07), as well as lower perceived general health (p < .01, η2 = 0.24) and social functioning (p = .01, η2 = 0.10). Men with T2DM also had lower VO2peak (21.8 ± 5.3 versus 25.8 ± 5.4 ml⋅kg-1⋅min-1, p < .01, η2 = 0.11) and muscle strength (3.3 ± 0.8 versus 3.7 ± 0.7 kg⋅kg-1, p = 0.08, η2 = 0.06), as well as being slower to complete physical performance tasks (27.2 ± 5.2 versus 24.2 ± 2.8 sec, p < 0.01, η2 = 0.13). In those with T2DM, depressed mood was highly correlated with most HRQL subscales. For the combined cohort, depressed mood was correlated with fasting glucose (r = 0.31, p = 0.012) but not the functional measures.

CONCLUSIONS

Men with T2DM have higher levels of depressed mood compared to men without T2DM. Glycaemic control, but not functional capacities, is associated with depressed mood in the study cohort.

Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies

BACKGROUND

Diabetes is the most common cause of peripheral neuropathies. No definitive treatment for diabetic neuropathies has been reported, and very few studies have been published on the role of exercise in reducing either the symptoms or incidence of diabetic neuropathies.

METHODS

This study assessed the effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies. Thirty-eight patients with diabetes having peripheral neuropathies were enrolled, randomized, and subdivided in two groups: an experimental group of 19 participants with diabetes (72.9 ± 5.6 years old) and a control group of 19 participants with diabetes (73.2 ± 5.4 years old). Both groups received health education on diabetes for 50 min/week for 8 weeks. The experimental group practiced an additional balance exercise program for 60 min, two times a week. The exercise training was performed two times per week for 8 weeks. Results were evaluated by both static and dynamic balance and trunk proprioception.

RESULTS

Postural sway significantly decreased (P < 0.05), the one-leg stance test significantly increased (P < 0.05), and dynamic balance from the Berg Balance Scale, Functional Reach Test, Timed Up and Go test, and 10-m walking time improved significantly after balance exercise (P < 0.05). Trunk repositioning errors also decreased with training (P < 0.05).

CONCLUSION

The balance exercise program improved balance and trunk proprioception. These results suggested that a balance exercise is suitable for individuals with diabetic neuropathy.

The impact of diabetes on the outcomes of surgical and nonsurgical treatment of patients in the spine patient outcomes research trial

STUDY DESIGN

A secondary analysis comparing diabetic patients with nondiabetic patients enrolled in the Spine Patient Outcomes Research Trial (SPORT).

OBJECTIVE

To compare surgical outcomes and complications between diabetic and nondiabetic spine patients.

SUMMARY OF BACKGROUND DATA

Patients with diabetes are predisposed to comorbidities that may confound the diagnosis and treatment of patients with spinal disorders.

METHODS

Baseline characteristics and outcomes of 199 patients with diabetes were compared with those of the nondiabetic population in a total of 2405 patients enrolled in the Spine Patient Outcomes Research Trial for the diagnoses of intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS). Primary outcome measures include the 36-Item Short Form Health Survey (SF-36) Health Status questionnaire and the Oswestry Disability Index.

RESULTS

Patients with diabetes were significantly older and had a higher body mass index than nondiabetic patients. Comorbidities, including hypertension, stroke, cardiovascular disease, and joint disease, were significantly more frequent in diabetic patients than in nondiabetic patients. Patients with diabetes and IDH did not make significant gains in pain and function with surgical intervention relative to diabetic patients who underwent nonoperative treatment. Diabetic patients with SpS and DS experienced significantly greater improvements in pain and function with surgical intervention when compared with nonoperative treatment. Among those who had surgery, nondiabetic patients with SpS achieved marginally significantly greater gains in function than their diabetic counterparts (SF-36 physical function, P = 0.062). Among patients who had surgery for DS, diabetic patients did not have as much improvement in pain or function as did the nondiabetic population (SF-36 bodily pain, P = 0.003; physical function, P = 0.002). Postoperative complications were more prevalent in patients with diabetes than in nondiabetic patients with SpS (P = 0.002). There was an increase in postoperative (P = 0.028) and intraoperative (P = 0.029) blood replacement in DS patients with diabetes.

CONCLUSION

Diabetic patients with SpS and DS benefited from surgery, though older SpS patients with diabetes have more postoperative complications. IDH patients with diabetes did not benefit from surgical intervention.

An original field evaluation test for chronic obstructive pulmonary disease population: the six-minute stepper test

PURPOSE

The aim of this study was to evaluate a new field test, the six-minute stepper test (6-MST), by studying its reproducibility, sensitivity and validity.

METHODS

After a familiarization test, 16 patients with chronic obstructive pulmonary disease (COPD) and 15 healthy subjects performed two six-minute stepper tests per day over three evaluation days. Ten of the 16 patients with COPD also performed a six-minute walking test (6-MWT) with an analysis of gas exchange to compare the metabolic requirements of the two tests. Dyspnoea Borg values were evaluated with Borg's CR-10 scale.

RESULTS

The mean (SD) scores for the COPD group for the first and second six-minute stepper tests were 382.49 (106.01) and 412.45 (118.39) strokes/6 minutes, respectively. Crossed comparison between the first or the second six-minute stepper tests of each evaluation day revealed no significant difference, indicating the reproducibility of the test. The sensitivity was demonstrated by a significantly higher performance in the healthy group (P < 0.001), demonstrating the ability of the test to detect two groups with different fitness levels. Finally, mean dyspnoea Borg values (SD) were significantly lower (P < 0.05) during the six-minute stepper test than during 6-MWT (2.5 (1.5) versus 3.1 (1.2)).

CONCLUSIONS

This study demonstrated that the six-minute stepper test is a reproducible, sensitive, secure, well-tolerated and feasible test for patients with COPD. The reproducibility and sensitivity of the six-minute stepper test suggests that this test could be used in the evaluation of exercise tolerance in patients with COPD.

The diabetic hand: a forgotten complication?

The manifestations of diabetes in the hand were much discussed in the 1970s and 1980s. The present review aims to revisit the diabetic hand and to discuss the pathology of the hand that may be clinically important in diabetic patients. In the strict sense of the term, the "diabetic hand" encompasses the three most widely studied conditions which have traditionally been associated with diabetes, namely limited joint mobility, Dupuytren's contracture and trigger finger. There is evidence that these entities are significantly more frequent in patients with diabetes and also that they may be associated with diabetes duration, poor metabolic control and presence of microvascular complications. In a more general sense, though, there are other conditions affecting the hands, which also occur more frequently in diabetes. From a practical point of view, increased alertness both for neuropathic hand ulcers in patients with profound neuropathy and for diabetic hand infections is absolutely necessary. Recently, reduced hand strength is beginning to be recognized as a further complication of diabetes. Thus, the hand may reveal substantial pathology in diabetes, and ideally, clinical examination should not ignore it.

Intermittent versus continuous exercise: effects of perceptually lower exercise in obese women

INTRODUCTION

Exercise has beneficial effects on obesity and diabetes treatments. However, obese subjects do not closely adhere to training programs probably because of the monotony of the continuous exercise that is frequently proposed. To increase adherence to training programs, intermittent exercise, which is less monotonous, may be more appropriate.

PURPOSE

The purposes of this study were to determine the perceptually less hard exercise (continuous vs intermittent exercise) and to analyze the impact of a training program on the basis of this exercise in obese women with and without type 2 diabetes.

METHODS

Twenty type 2 diabetic obese women and 20 obese women without diabetes were recruited. In each group, 10 patients integrated a training program (i.e., training groups), whereas the remaining patients were untrained (i.e., control groups). The training groups performed a continuous exercise and an intermittent exercise to determine the perceptually less hard exercise thanks to lower ratings of perceived exertion (RPE). Then, a training program that included 32 min (3 d x wk(-1) x 10 wk(-1)) of the perceptually less hard exercise was proposed to training groups.

RESULTS

RPE were significantly lower during the intermittent exercise compared to the continuous exercise in the obese women with or without diabetes (RPE = 12.3 +/- 2.3 vs 13.7 +/- 2.3 and RPE = 11.9 +/- 1.1 vs 13.2 +/- 1.6, respectively). After the training program, significant beneficial effects on the glycosylated hemoglobin (6.8 +/- 1.4% vs 6.5 +/- 1.2%), body mass (97.1 +/- 16.9 vs 95.2 +/- 16.2 kg), body mass index (37.6 +/- 6.1 vs 36.8 +/- 6.0 kg x m(-2)), and on the HR and the walked distance limit were noticed in the training groups.

CONCLUSION

The obese women with or without diabetes perceived the intermittent exercise as being less hard than the continuous exercise, and a training program based on intermittent exercises produced beneficial effects on obesity and type 2 diabetes.

Walking: a matter of quantity and quality physical activity for type 2 diabetes management

Walking is often prescribed as a mode of physical activity for people with type 2 diabetes (T2D). We and others have found that although people with T2D may increase the amount that they walk (e.g., more steps per day), improvements in key health outcomes are rarely achieved. We agree that walking is an acceptable approach for people with T2D to meet current clinical practice guidelines, but consideration of both the total number of daily steps and the walking speed of a portion of those total daily steps are necessary to gain health benefit.

Relationship between skin resistance level and static balance in type II diabetic subjects

Diabetes mellitus is major cause leading to pathological changes in skin foot plantar area (SFPA) and affected the static standing balance duration (SSBD). Skin resistance level (SRL) is related to skin conductance which changes in the presence of sweat. This study aims to find out the relationship between the SRL and SSBD in type II diabetic patients. Sixty-eight voluntary students, 30 type II diabetic patients and 30 healthy non-diabetic subjects, were participated to the study. The SSBD was measured on dominant and non-dominant legs. SRLs were recorded with two surface electrodes over the metatarsus heads and heel. The SSBD of the healthy young group was found to be higher than the other groups (P<0.001). The SRL values of the non-dominant leg in the diabetic group was found to be lower than the others (P=0.014). For dominant and non-dominant legs within each group, only the healthy young group has statistically difference (P=0.012). A significant correlation was seen to be between the SRL and SSBD for only healthy non-diabetic group for the non-dominant leg. The relation between the SRL and SSBD is poor but very promising. Measurement of the SRL can be used in evaluating the inflammation of the diabetic foot.

Circadian variability of blood pressure in obese children

BACKGROUND AND AIMS

The aim of the present study was to evaluate the circadian rhythm of blood pressure pattern in obese children, and to investigate if the lack of normal diurnal rhythm of blood pressure is associated with cardiovascular risk factors.

METHODS AND RESULTS

73 obese children (body weight [mean+/-SD]: 89.0+/-17.8 kg; age [mean+/-SD]: 14.2+/-2.3 years), 42 dippers and 31 non-dippers were investigated. Following ambulatory blood pressure monitoring (ABPM), physical fitness testing was performed on a treadmill. Physical working capacity at 130, -150, -170 beat/min (PWC-130, -150, -170), resting and peak oxygen consumption (VO(2)rest, VO(2)peak) were determined. Forty-two percent of obese children were non-dipper. PWC-130 (74.8+/-48.8 watts; 48.0+/-38.5 watts), PWC-150 (132.9+/-52.1 watts; 104.2+/-49.3 watts), PWC-170 (185.9+/-49.5 watts; 154.9+/-53.4 watts) and VO(2)rest, ([mean+/-SD]: 0.29+/-0.08 L/min; 0.26+/-0.07 L/min), and VO(2) peak (2.77+/-0.61 L/min; 2.44+/-0.62 L/min) were significantly lower in the non-dipper group, as compared to dippers (p<0.05). The prevalence of hypertension, on the basis of ABPM, was significantly higher in the non-dipper group (45.2% vs 83.9%, p<0.001). This is due to increased prevalence of masked hypertension in the non-dipper group (19.0% vs 32.3%, p<0.001).

CONCLUSION

The normal circadian variation of the blood pressure is frequently absent in obese children. Most of the non-dipper obese children are hypertensive, and their physical fitness is decreased.

Hand span influences optimal grip span in boys and girls aged 6 to 12 years

PURPOSE

The first aim was to determine whether there is an optimal grip span for determining the maximum hand grip strength in boys and girls aged 6 to 12 years and whether the optimal grip span was related to hand span. If so, the second aim was to derive a mathematical equation relating hand span and optimal grip span.

METHODS

A total of 123 boys (9 y +/- 2) and 70 girls (8 y +/- 2) were evaluated. Each hand was randomly tested on 10 occasions using 5 different grip spans, allowing a 1-minute rest between attempts. The hand span was measured from the tip of the thumb to the tip of the little finger with the hand opened widely.

RESULTS

An optimal grip span to determine maximum hand grip strength was identified for both genders. Hand span and optimal grip span showed a significant linear association in the studied children. The equation relating grip span as a function of hand span in boys is formulated as y = x/4 + 0.44 and in girls as y = 0.3x - 0.52, where x is the hand span (maximal width between first and fifth fingers) and y is the optimal grip span.

CONCLUSIONS

The results suggest that there is an optimal grip span to which the dynamometer should be adjusted when measuring hand grip strength in children. The optimal grip span was influenced by hand span in both genders.

Assessment of health-related fitness in the patients with end-stage renal disease on hemodialysis: using Eurofit Test Battery

The main objectives of this study were to evaluate the health-related physical fitness for the patients with end-stage renal disease on hemodialysis and determine the suitability of Eurofit Test Battery for adults to decide their health-related physical fitness level. Eighteen patients with end-stage renal disease (ESRD) on hemodialysis (age 49.7+17.9, 10 female / 8 male) was evaluated and compared with 22 age-matched healthy subjects (age 50.5 + 9.4 years, 13 female / 9 male) for this purposes. Eurofit Test Battery for Adults is composed of aerobic fitness, musculoskeletal fitness, motor fitness, and anthropometry components. Aerobic fitness, which was assessed by six minutes walking distance, was lower in the patient group than controls (p < 0.05). Hemodialysis patients had lower motor fitness (0.000) and musculoskeletal fitness including vertical jump and handgrip tests (0.047, 0.002). Percentage of body fat and skinfold thickness values measured from triceps, subscapular, abdominal, and thigh were also lower in patient group (p < 0.05). Additionally no complication was seen during and/or after the tests. In conclusion, the Eurofit for adults may be considered a useful test battery to evaluate the physical fitness and design the health-related physical fitness program based on the Eurofit results in this population.

The effects of the diabetes related soft tissue hand lesions and the reduced hand strength on functional disability of hand in type 2 diabetic patients

OBJECTIVES

The aim of the present study is to examine the effects of diabetes related soft tissue hand lesions such as Dupuytren's disease, trigger finger and limited joint mobility (LJM) and the reduced hand strength on the functional disability of the hand in type 2 diabetic patients.

METHODS

Forty-four type 2 diabetic patients and 60 age and sex matched controls were included in the study. Subjects were examined for the presence of Dupuytren's disease, trigger finger and LJM. Grip strength was tested first with Jamar dynamometer followed by pinch strength measurements using by a manual pinchmeter. Electrophysiological studies were performed in both groups. Duruöz Hand Index (DHI) was used to assess the functional hand disability.

RESULTS

The mean DHI score of the diabetics was significantly higher than controls (p<0.0001). Dupuytren's disease, trigger finger or LJM was not correlated with DHI in diabetic patients (p>0.05). The grip and pinch strengths were significantly lower in diabetic patients than the non-diabetic controls (p<0.05) and the grip and pinch strengths were negatively correlated with DHI in type 2 diabetic patients (p<0.001).

CONCLUSION

Dupuytren's disease, trigger finger and LJM did not cause to functional disability of hand but low hand strength was found to cause functional disability of hand in our type 2 diabetic patients.

Hand grip strength in patients with type 2 diabetes mellitus

AIM

The aim of the present study was to compare hand grip strength and pinch power, which are important parameters of hand function, in 76 patients with type 2 diabetes mellitus (T2DM) (mean age: 50.11+/-7.6) with 47 non-diabetic control subjects (mean age: 46.93+/-10.2).

METHODS

Grip strength was assessed with a Jamar dynamometer and pinch power was measured with a pinch gauge. Body composition was measured using a Tanita body composition analyzer. Mann-Whitney test, chi-square test, Fisher's exact test, T-test, Kruskal-Wallis variance analysis, Wilcoxon's signed rank test and Pearson's correlation coefficients were used to determine the differences and relations between groups. A p-value <0.05 was taken as statistically significant.

RESULTS

Hand grip strength test values were significantly lower in the diabetic group compared with the control group. Key pinch power value for the right hand was significantly lower in the diabetic group than in the control group whereas the left hand value was similar.

CONCLUSION

Hand grip strength and key pinch power values were found to be lower in patients with T2DM than in age-matched control subjects. Hands, as well as feet, are also affected by diabetes and physicians should be aware of this.

Evaluation of balance and physical fitness in diabetic neuropathic patients

AIM

The main aim was to evaluate balance and physical fitness in diabetic neuropathic patients.

METHODS

Sixty voluntary adults of both sexes from Kutahya, Turkey, were divided into two groups: a Type 2 diabetic neuropathic group (DG), mean age 57.6+/-3.9 (50-65; n=30); and a nondiabetic control group (CG), mean age 55.6+/-6.1 (51-64; n=30). The CG was selected to match the diabetic group characteristics, such as age, body mass, and sex. Standing on dominant and nondominant leg, functional reach and physical fitness tests were used for assessment.

RESULTS

Static and dynamic standings on one leg test were significantly lower in DG (P<.01). Considering CG results, maximal balance reduction in DG was found in the dynamic test on the dominant leg with the eyes open and head rotation (63.1%) and the lowest was on the static test on dominant leg with eyes open (19.7%). The result of the functional reach test was determined to be significantly lower in DG, with 21.3% balance reduction (P<.01). In all physical fitness tests, DG made significantly lower repetitions in 1 min (P<.01). Functional reach (34 cm) and one-leg standing (42 s) test results had shown our participants' low-risk falling, considering literature studies (15 cm and 30 s).

CONCLUSION

The data show that the diabetic neuropathy disturbed especially the balance on the dominant leg and decrease physical fitness. In this situation, further studies that show the difference between dominant and nondominant leg balance and new risk of falling profile in diabetic neuropathic participants are needed.

The acute effects of in-patient physiotherapy program on functional capacity in type II diabetes mellitus

PURPOSE

This study was planned to evaluate the acute effects of a short-term in-patient physiotherapy program on functional capacity in hospitalised type II diabetic patients.

METHODS

Forty four hospitalised type II diabetic patients in continuing medical care at Dokuz Eylül University Hospital were included in this study. Twenty three of the 44 patients were randomised to an exercise rehabilitation group and 21 to a control group. Patients in the exercise group were assigned to an average 12.0+/-2.4 days low-intensity exercise rehabilitation program during hospitalisation. The control group did not receive any exercise advice. Before and after the exercise rehabilitation program all patients' functional capacity was evaluated by the 6 min walking test.

RESULTS

There were no significant differences in the main measured parameters among groups and in the 6 min walking test at baseline. At the end of the rehabilitation program, the resting heart rate (HR) decreased by 4.1% (P<0.05) in the exercise group by and 2.1% in control group. Resting systolic (SBP) and diastolic blood pressure (DBP) decreased (6.2 and 2.6%) significantly in the exercise group but there were no significant changes in the control group (0.9 and 0.7%). The distance walked in the 6 min test increased significantly more in the exercise group than in the control group ( 18.0% versus 10.2%; P<0.05). Estimated VO2 max also increased more (28.6% versus 3.5%, P<0.05). Moreover, the exercise group described the 6 min walk test as easier than before exercise rehabilitation. The Borg scale did not change in the control group.

CONCLUSION

Supervised in-patient exercise rehabilitation is a safe and effective intervention in type II diabetic patients, which reduces physical impairment and improves functional ability.