Effects of Power Training on Physical Activity, Sitting Time, Disability, and Quality of Life in Older Patients With Type 2 Diabetes During the COVID-19 Confinement

Interventions to reduce sedentary behaviour in adults with type 2 diabetes: A systematic review and meta-analysis

Treatment and management of Type 2 Diabetes (T2D) includes physical activity, nutrition, and pharmacological management. Recently, the importance of reducing and breaking up sedentary behaviour has become recognized. This review aimed to summarize and synthesize the effectiveness of interventions in reducing and/or breaking up sedentary behaviour and cardiometabolic biomarkers in adults with T2D. A study protocol was preregistered on PROSPERO (CRD42022357281) and a database search (PubMed, EMBASE, Scopus, Web of Science, PsycINFO, SPORTDiscus, CINAHL, and Cochrane Library) was conducted on 16/09/2022 and updated on 03/01/2024. This review followed PRISMA guidelines and study quality was assessed with the Cochrane risk of Bias Tools. Twenty-eight articles were included in the review. The meta-analysis of short-term (Range: 3 hours- 4 days) sedentary behaviour interventions found significant improvement in continuous interstitial glucose measured for 24 hours after the sedentary behaviour intervention compared to control (SMD:-0.819,95%CI:-1.255,-0.383,p<0.001). Similarly, there was a significant improvement in postprandial interstitial glucose after the sedentary behaviour intervention compared to control (SMD:-0.347,95%CI:-0.584,-0.110,p = 0.004). Ten out of eleven longer-term (Range: 5 weeks- 3 years) sedentary behaviour interventions improved at least one measure of sedentary behaviour compared to control. Eight out of eight longer-term sedentary behaviour interventions improved at least one cardiometabolic biomarker compared to control. Reducing sedentary behaviour, independent of physical activity, can improve glycemic control in adults with T2D. Further, sedentary behaviour may be a feasible/ sustainable behaviour change.

Exercise interventions for frail older adults with diabetes: A scoping review

There is a paucity of evidence on exercise interventions for frail older adults with diabetes. This scoping review aims to identify the scope of the current literature on the characteristics and effects of exercise interventions for frail older adults with diabetes. A search without time limitation was conducted in eight databases. 14 studies were finally included. Resistance exercise and multicomponent exercise were the most common types of exercise. There was considerable variation in the frequency, duration and intensity of exercise interventions. Studies reported improvements in frailty status, physical function, blood glucose and lipid levels and economic effectiveness. The most frequent combined interventions involved nutrition and education. Although evidence was limited, the potential benefits of exercise interventions for frail older adults with diabetes were substantial. Further high-quality studies are needed to explore the most effective and cost-saving exercise interventions for frail older adults with diabetes.

Analysis and prediction of older adult sports participation in South Korea using artificial neural networks and logistic regression models

BACKGROUND

Korea's aging population and the lack of older adult participation in sports are increasing medical expenses.

AIMS

This study aimed to segment older adult sports participants based on their demographic characteristics and exercise practice behavior and applied artificial neural network and logistic regression models to these segments to best predict the effect of medical cost reduction. It presents strategies for older adult sports participation.

METHODS

A sample comprising data on 1,770 older adults aged 50 years and above was drawn from the 2019 National Sports Survey. The data were analyzed through frequency analysis, hierarchical and K-means clustering, artificial neural network, logistic regression, cross-tabulation analyses, and one-way ANOVA using SPSS 23 and Modeler 14.2.

RESULTS

The participants were divided into five clusters. The artificial neural network and logistic analysis models showed that the cluster comprising married women in their 60s who participated in active exercise had the highest possibility of reducing medical expenses.

DISCUSSION

Targeting women in their 60s who actively participate in sports, the government should expand the supply of local gymnasiums, community centers, and sports programs. If local gymnasiums and community centers run sports programs and appoint appropriate sports instructors, the most effective medical cost reduction effect can be obtained.

CONCLUSIONS

This study contributes to the field by providing insights into the specific demographic segments to focus on for measures to reduce medical costs through sports participation.

Burden of disability in type 2 diabetes mellitus and the moderating effects of physical activity

The growing diabetic epidemic has created a substantial burden, not only on the people with diabetes but also on society at large. This mini-review discussed the limitations and patterns of disability in type 2 diabetes mellitus and put forward a case for the moderating effects of physical activity (PA) in the management of diabetes. The limitations and impairments associated with diabetes include vascular, neurological, cardiac, and renal impairments. Moreover, individuals participate less in their daily lives and in their instrumental activities of daily living, which negatively impacts the quality of life of individuals with diabetes. This often leads to a loss of quality of life due to disabilities, resulting in an increased rate of disability-adjusted life years among people with type 2 diabetes mellitus. Moreover, there are psychosocial sequelae of diabetes mellitus. This necessitates looking for moderating factors that may reduce the burden of the disease. PA has been shown to be one of the factors that can mitigate these burdens. PA does this in several ways, including through the benefits it confers, such as a reduction of hemoglobin A1c, a reduction of excess fat in the liver and pancreas, and the reduction of cardiovascular risk factors, all of which favorably affect glycemic parameters. Specifically, PA regulates or moderates diabetes disability through two mechanisms: The regulation of glucolipid metabolism disorders and the optimization of body mass index and systemic conditions. Therefore, efforts should be directed at PA uptake through identified strategies. This will not only prevent diabetes or diabetes complications but will reduce its burden.

Circulating Sestrins and Force Velocity Profiling in Older Adults with Type 2 Diabetes

ABSTRACTType 2 diabetes mellitus (T2DM) in old age affects the musculoskeletal system causing loss of muscle mass, strength, and physical function. Stress-inducible proteins named sestrins are potential novel biomarkers of muscle function due to their ability to suppress oxidative stress and prevent muscle degeneration. Our aim was to determine the association between different force-velocity (F-V) profiles with body composition, physical performance, and glucose control in older adults with T2DM. We also intended to determine the potential utility of sestrin 1 (Sesn1) and 2 (Sesn2) as biomarkers of physical functionality. Fifty-nine participants (69-79 years) were classified in 3 groups according to their F-V profile based on the leg press exercise: nondeficit (N_DEF= 40.7%), force deficit (F_DEF= 28.8%), and velocity deficit (V_DEF= 30.5%). Both V_DEF and F_DEF groups showed lower muscle power than N_DEF (Cohen's d 0.87 and 0.75 for effect size, respectively). Serum Sesn2 levels, maximal dynamic strength, arms and legs fat-free mass were reduced in F_DEF compared to the N_DEF group (p < 0.05), whereas glycated hemoglobin (HbA1c) and fasting glucose levels were similar among groups. ROC analysis revealed the distinction between the N_DEF and F_DEF group based on Sesn2 concentrations (<0.72 ng/mL), suggesting their potential use as functional biomarkers for early intervention through exercise. Older adults with T2DM show different F-V profiles, related to low levels of Sesn2, impaired body composition and physical performance, and may be taken into consideration to target exercise training in this specific population.

Exercise Intervention as a Therapy in Patients with Diabetes Mellitus and Sarcopenia: A Meta-Analysis

INTRODUCTION

Sarcopenia is defined as a progressive and generalized muscle disorder that involves accelerated loss of muscle mass and impaired function. It is believed to influence the ability to carry out daily activities, muscle strength, and physical capacity in the elderly. Studies have shown that sarcopenia has been implicated as both a cause and a consequence of diabetes mellitus. In this analysis, we aimed to systematically show the impact of exercise intervention as a therapy for patients with diabetes mellitus and sarcopenia.

METHODS

Electronic databases, including PubMed, EMBASE, Web of Science, and the Cochrane database, were searched from November to December 2021 for publications based on exercise intervention in patients with sarcopenia. After the selection of studies for this analysis, patients with diabetes mellitus were retrieved. Since dichotomous data including mean and standard deviation were reported, weighted mean difference (MD) with 95% confidence intervals (CI) were used to represent the data following analysis.

RESULTS

A total of 431 participants with diabetes mellitus and sarcopenia were included in this meta-analysis. A statistical analysis was carried out on patients with diabetes mellitus who were assigned to the exercise intervention group. Our analysis showed that "sit-to-stand test" and "timed up and go" were significantly in favor of exercise intervention: MD -1.57, 95% confidence interval (CI) -2.26 to -0.87 (P = 0.0001) versus MD -0.61, 95% CI -1.21 to -0.01 (P = 0.05), respectively. Handgrip strength, walking speed and leg strength were also assessed. Another statistical analysis was carried out, this time on patients with diabetes mellitus and sarcopenia who were not assigned to an exercise intervention. The results showed no significant difference among sit-to-stand test, timed up and go, handgrip strength, and leg strength.

CONCLUSION

Exercise intervention significantly improved the time taken to stand up from a sitting position, and to "stand up and go" in patients with diabetes mellitus and sarcopenia. Therefore, exercise intervention should be considered a relevant therapy for such patients.

Telerehabilitation program for older adults on a waiting list for physical therapy after hospital discharge: study protocol for a pragmatic randomized trial protocol

BACKGROUND

Delays in starting physical therapy after hospital discharge worsen deconditioning in older adults. Intervening quickly can minimize the negative effects of deconditioning. Telerehabilitation is a strategy that increases access to rehabilitation, improves clinical outcomes, and reduces costs. This paper presents the protocol for a pragmatic clinical trial that aims to determine the effectiveness and cost-effectiveness of a multi-component intervention offered by telerehabilitation for discharged older adults awaiting physical therapy for any specific medical condition.

METHODS

This is a pragmatic randomized controlled clinical trial with two groups: telerehabilitation and control. Participants (n=230) will be recruited among individuals discharged from hospitals who are in the public healthcare system physical therapy waiting lists. The telerehabilitation group will receive a smartphone app with a personalized program (based on individual's functional ability) of resistance, balance, and daily activity training exercises. The intervention will be implemented at the individuals' homes. This group will be monitored weekly by phone and monthly through a face-to-face meeting until they start physical therapy. The control group will adhere to the public healthcare system's usual flow and will be monitored weekly by telephone until they start physical therapy. The primary outcome will be a physical function (Timed Up and Go and 30-s Chair Stand Test). The measurements will take place in baseline, start, and discharge of outpatient physical therapy. The economic evaluations will be performed from the perspective of society and the Brazilian public healthcare system.

DISCUSSION

The study will produce evidence on the effectiveness and cost-effectiveness of multi-component telerehabilitation intervention for discharged older adult patients awaiting physical therapy, providing input that can aid the implementation of similar proposals in other patient groups.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials (ReBEC), RBR-9243v7 . Registered on 24 August 2020.