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Thomson AM, Rioux BV, Hrubeniuk TJ, Bouchard DR, Sénéchal M. Does type 2 diabetes duration influence the effectiveness of an aerobic exercise intervention: Results from the INTENSITY study. PLoS One 2024; 19:e0304341. [PMID: 38843234 PMCID: PMC11156316 DOI: 10.1371/journal.pone.0304341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Studies suggest that longer durations of T2DM increase the risk of T2DM complications and premature mortality. However, whether T2DM duration impacts the efficacy of an aerobic exercise intervention is unclear. OBJECTIVE The purpose of this study was: 1) to compare changes in body composition, cardiorespiratory fitness, and glycemia between individuals with short- and long-duration T2DM after aerobic exercise and 2) to determine whether these changes were associated with changes in glycemia by T2DM duration. METHODS A secondary analysis of the INTENSITY study (NCT03787836), including thirty-four adults (≥19 years) with T2DM who participated in 28 weeks of aerobic exercise training for 150 minutes per week at a moderate-to-vigorous intensity (4.5 to 6.0 metabolic equivalents (METs)). Using pre-established cut-points, participants were categorized into two groups 1) short-duration T2DM (<5 years) or 2) long-duration T2DM (≥5 years). Glycemia was measured by glycated hemoglobin (HbA1c), body composition by BodPod, and cardiorespiratory fitness by a measure of peak oxygen consumption (VO2peak). All measurements were performed at baseline, 16 weeks, and 28 weeks. RESULTS Participants in the short-duration T2DM group experienced decreases in fat mass (kg) (p = 0.03), HbA1c (p = 0.05), and an increased relative VO2peak (p = 0.01). Those with long-duration T2DM experienced decreases in fat mass (kg) (p = 0.02) and HbA1c (p <0.001) and increased fat-free mass (p = 0.02). No significant differences were observed between groups in any outcomes. Changes in fat mass (r = 0.54, p = 0.02), and body fat percentage (r = 0.50, p = 0.02) were significantly associated with the change in HbA1c in those with a long-duration T2DM only. CONCLUSION Our results suggest T2DM duration did not differently impact the efficacy of a 28-week aerobic exercise intervention. However, changes in body composition were associated with better glycemia in individuals with longer T2DM duration only.
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Affiliation(s)
- Amy M. Thomson
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Brittany V. Rioux
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Travis J. Hrubeniuk
- CancerCare Manitoba, Canada
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Danielle R. Bouchard
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Martin Sénéchal
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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Argyropoulou D, Nomikos T, Terzis G, Karakosta M, Aphamis G, Geladas ND, Paschalis V. The Effect of Chronic Dietary Protein Manipulation on Amino Acids' Profile and Position Sense in the Elderly Suffering from Type 2 Diabetes Mellitus. J Funct Morphol Kinesiol 2024; 9:62. [PMID: 38651420 PMCID: PMC11036287 DOI: 10.3390/jfmk9020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
Dietary protein with adequate essential amino acids effectively stimulates protein synthesis and improves muscle mass. Musculoskeletal disorders in lower or upper limbs are not uncommon among patients with type II diabetes mellitus (T2DM). Therefore, this study primarily examines the effects of chronic dietary protein manipulation on amino acids' profile and position sense in the elderly suffering from T2DM. A total of 26 individuals suffering from non-insulin-dependent T2DM (age > 55 years old) participated in a 12 week nutritional intervention. The subjects were randomly assigned and the control group received 0.8-1.0 g protein/kg/day, while the intervention group received 1.2-1.5 g protein/kg/day. Lean body mass, muscle strength, and position sense were assessed at baseline, as well as at the 6th and 12th week of the intervention. Only in the intervention group, the essential amino acids intake met the current nutritional recommendations (p < 0.05), while, by the 12th week, only the intervention group showed significant improvement in the muscle strength of knee (p < 0.05) and shoulder (p < 0.05) extension. On the contrary, in the control group, a significant decline in appendicular lean mass (p < 0.05) was observed by the 12th week. Position sense at the knee joint revealed a tendency for improvement in the intervention group by the 12th week (main effect of time p = 0.072). In the present investigation, it was revealed that the higher protein intake in the intervention group seemed to have positive effects on muscle strength and nearly positive effects on position sense.
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Affiliation(s)
- Dionysia Argyropoulou
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (D.A.); (G.T.); (N.D.G.)
| | - Tzortzis Nomikos
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece; (T.N.); (M.K.)
| | - Gerasimos Terzis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (D.A.); (G.T.); (N.D.G.)
| | - Myrto Karakosta
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece; (T.N.); (M.K.)
| | - George Aphamis
- Department of Life Sciences, University of Nicosia, Nicosia 1700, Cyprus;
| | - Nickos D. Geladas
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (D.A.); (G.T.); (N.D.G.)
| | - Vassilis Paschalis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (D.A.); (G.T.); (N.D.G.)
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Shahrjerdi S, Bahrpeyma F, Bagherian SA. Acute short term effects of endurance and resistance training on balance control in patients with diabetic peripheral neuropathy. Int J Neurosci 2023; 133:1017-1023. [PMID: 35109765 DOI: 10.1080/00207454.2022.2033739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/08/2020] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Exercise training have numerous beneficial effects on the complications of diabetic peripheral neuropathy. Exercise training may cause immediate effects on balance control in DPN patients. This study aims to assess the Acute Short Term effects of endurance and resistance exercise training on balance control in DPN patients. METHODS In this study, 11 patients with DPN and 11 healthy subjects participated. Patients and healthy subjects did endurance and resistance training in two separate exercise sessions. Dynamic balance and functional balance test were assessed before and after the interventions. Independent t-test was used to compare balance indices before and after training, the intervention effects were examined using ANOVA repeated measure test. The statistical significance level was set at p < 0.05. RESULTS The results showed that dynamic and functional balance in DPN patients were significantly lower than in healthy subjects. Anterior-posterior stability and total stability indices and functional balance test deteriorated significantly after training. CONCLUSION Endurance or resistance training may lead to acute disturbance of dynamic and functional balance in DPN patients. Hence, immediately after exercise, patients with diabetes are at an increased risk of falling, therefore, preventive considerations are necessary.
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Affiliation(s)
- Samira Shahrjerdi
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Seyed Ahmad Bagherian
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Le Corre A, Caron N, Turpin NA, Dalleau G. Mechanisms underlying altered neuromuscular function in people with DPN. Eur J Appl Physiol 2023:10.1007/s00421-023-05150-2. [PMID: 36763123 DOI: 10.1007/s00421-023-05150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
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, Mmax 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.
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Affiliation(s)
- Antonin Le Corre
- IRISSE (EA 4075), UFR SHE, University of La Réunion, 117 Rue du Général Ailleret, 97430, Le Tampon, France.
| | - Nathan Caron
- IRISSE (EA 4075), UFR SHE, University of La Réunion, 117 Rue du Général Ailleret, 97430, Le Tampon, France
| | - Nicolas A Turpin
- IRISSE (EA 4075), UFR SHE, University of La Réunion, 117 Rue du Général Ailleret, 97430, Le Tampon, France
| | - Georges Dalleau
- IRISSE (EA 4075), UFR SHE, University of La Réunion, 117 Rue du Général Ailleret, 97430, Le Tampon, France
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Bahrpeyma F, Shahrjerdi S, C. M. Savelberg H, Bagherian S, Jamshidpour B. Force generation and muscle activation of knee extensor and flexor muscles in type 2 diabetes mellitus patients. JOURNAL OF MEDICAL SIGNALS & SENSORS 2023. [DOI: 10.4103/jmss.jmss_129_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Filgueiras JR, Sales CP, da Silva IG, Dos Santos CM, Neto EDCM, da Rocha RB, Cardoso VS. Morphological and functional changes in skeletal muscle in type 2 diabetes mellitus: A systematic review and meta-analysis. Physiother Theory Pract 2022:1-27. [PMID: 35345979 DOI: 10.1080/09593985.2022.2057375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Changes in the skeletal muscle are common in patients with type 2 diabetes mellitus (T2DM). These changes impair your motor skills. OBJECTIVE This systematic review aimed to investigate changes in skeletal muscle in patients with T2DM. METHODS The search was carried out in the PubMed, Scopus, and Web of Science databases until December 1, 2021. Observational studies that evaluated musculoskeletal changes in people with T2DM were included. The review was based on PRISMA recommendations. The primary parameters analyzed were muscle strength, muscle mass, muscle power, and muscle endurance. RESULTS Forty-eight studies were included, with a total of 26,042 participants. The results revealed that T2DM is associated with a reduction in handgrip [-2.64 (CI 95% = -3.33 to -1.95, Z = -7.50, p < .0001], and knee extension muscle strength [-0.56 (CI 95% = -0.76 to -0.36, Z = -5.64, p < .0001)], a higher percentage of type II fibers [11.74 (CI 95% = 6.24 to 17.25, Z = 4.18, p < .0001)], and a lower percentage of type I fibers [-15.69 (CI 95% = -18.22 to -13.16, Z = -12.16, p < .0001], in addition to a greater thickness of the calcaneus tendon (p < .0001). CONCLUSION Individuals with T2DM present skeletal muscle impairments, mainly reduced muscle strength, mass, and endurance; increase in the thickness of the calcaneus tendon, and alteration in the proportion of type I and II fibers, even in the initial stage of the disease.
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Affiliation(s)
- Jardeson Rocha Filgueiras
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil
| | - Cleudiane Pereira Sales
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil
| | - Ivanilson Gomes da Silva
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil
| | - Cristiana Maria Dos Santos
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil.,Postgraduate Program in Biomedical Sciences, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil
| | | | | | - Vinicius Saura Cardoso
- BioSignal Laboratory, School of Physical Therapy, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil.,Postgraduate Program in Biomedical Sciences, Parnaiba Delta Federal University (UFDPar). Av. São Sebastião, Parnaíba-Piauí, Brazil.,Center of Medical Specialties. Av. Capitão Claro, Parnaíba-Piauí, Brazil
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Gelman R, Berg M, Ilan Y. A Subject-Tailored Variability-Based Platform for Overcoming the Plateau Effect in Sports Training: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031722. [PMID: 35162745 PMCID: PMC8834821 DOI: 10.3390/ijerph19031722] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 12/16/2022]
Abstract
The plateau effect in training is a significant obstacle for professional athletes and average subjects. It evolves from both the muscle-nerve-axis-associated performance and various cardiorespiratory parameters. Compensatory adaptation mechanisms contribute to a lack of continuous improvement with most exercise regimens. Attempts to overcome this plateau in exercise have been only partially successful, and it remains a significant unmet need in both healthy subjects and those suffering from chronic neuromuscular, cardiopulmonary, and metabolic diseases. Variability patterns characterize many biological processes, from cellular to organ levels. The present review discusses the significant obstacles in overcoming the plateau in training and establishes a platform to implement subject-tailored variability patterns to prevent and overcome this plateau in muscle and cardiorespiratory performance.
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Affiliation(s)
- Ram Gelman
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem 9103401, Israel;
| | - Marc Berg
- Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA 94304, USA;
| | - Yaron Ilan
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem 9103401, Israel;
- Correspondence: ; Tel.: +972-2-6778231; Fax: +972-2-6431021
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8
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HIRASAWA Y, MATSUKI R, TANINA H. Relationship between Echo Intensity of Vastus Lateralis and Knee Extension Strength in Patients with Type 2 Diabetes Mellitus. Phys Ther Res 2022; 25:113-119. [PMID: 36819918 PMCID: PMC9910353 DOI: 10.1298/ptr.e10172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to determine the association between echo intensity (EI) of vastus lateralis and knee extension strength (KES) in patients with type 2 diabetes mellitus (T2DM). METHODS This retrospective study included a total of 304 patients (189 males and 115 females) with T2DM who were hospitalized for treatment or care. EI and muscle thickness (MT) of the right vastus lateralis were assessed from transverse ultrasound images. Maximal isometric KES was evaluated using a dynamometer and normalized for body weight (%KES). RESULTS %KES was significantly positively correlated with MT and stages of change for exercise behavior, and significantly negatively correlated with age, T2DM duration, and EI. %KES was significantly higher in male than in female. %KES was significantly higher in non-diabetic peripheral neuropathy (DPN) than in DPN. Stepwise multiple regression analysis showed that sex, age, T2DM duration, EI, and stages of change for exercise behavior were significant determinants of %KES. CONCLUSION The study results suggest that EI is associated with %KES in patients with T2DM.
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Affiliation(s)
| | - Ryosuke MATSUKI
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Hideaki TANINA
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
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Bhati P, Singla D, Masood S, Hussain ME. Type 2 Diabetes Mellitus Patients Manifest Greater Muscle Fatigability Than Healthy Individuals During Dynamic Fatigue Protocol. J Manipulative Physiol Ther 2021; 44:205-220. [PMID: 33902943 DOI: 10.1016/j.jmpt.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/11/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study aimed to investigate the electromyographic (EMG) indices of muscle fatigue along with biochemical marker of fatigue-that is, blood lactate-during a dynamic fatigue protocol in individuals with type 2 diabetes mellitus (T2DM) vs a healthy control group. Secondarily, it aimed to examine the association between EMG indices of muscle fatigue and blood lactate in these patients. METHODS Thirty-four participants took part in the study: 19 individuals with T2DM (age, 53.5 ± 6.85 years) and 15 age-matched healthy controls (age, 50.2 ± 3.55 years). Participants performed a dynamic fatigue protocol consisting of 5 sets of 10 repetitions each at an intensity of the 10-repetition maximum. Surface EMG of the vastus medialis and vastus lateralis muscles was recorded during the dynamic fatigue protocol, and EMG indices such as median frequency (MF), slope of MF (MFslope), Dimitrov muscle fatigue spectral index, and root-mean-square were evaluated for each contraction across all the 5 sets. Blood lactate concentrations were also assessed 3 times during the fatigue protocol. RESULTS Findings revealed that EMG muscle fatigue indices such as MF, MFslope, and Dimitrov muscle fatigue spectral index were significantly altered in individuals with T2DM vs healthy individuals across the sets and repetitions for both the vastus medialis (P < .001) and vastus lateralis muscles (P < .001). There was a significantly greater rise in blood lactate in individuals with T2DM than in healthy individuals (P < .001), which was not found to be associated with changes in EMG indices of muscle fatigue. CONCLUSION Findings suggest the existence of significantly greater fatigue in the knee extensor muscles of individuals with T2DM than healthy individuals.
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Affiliation(s)
- Pooja Bhati
- Assistant Professor, Faculty of Physiotherapy, Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana-122505, India
| | - Deepika Singla
- Assistant Professor, Faculty of Physiotherapy, Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana-122505, India
| | - Sarfaraz Masood
- Professor and Dean, Faculty of Physiotherapy & Allied Health Sciences, Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana-122505, India
| | - M Ejaz Hussain
- Assistant Professor, Faculty of Physiotherapy, Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana-122505, India.
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10
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Eetvelde BLV, Lapauw B, Proot P, Wyngaert KV, Helleputte S, Stautemas J, Cambier DC, Calders P. The impact of diabetic neuropathy on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 diabetes mellitus: a cross-sectional study. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2021; 21:464-474. [PMID: 34854385 PMCID: PMC8672402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to determine the impact of diabetic neuropathy (dNP) on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 Diabetes Mellitus (T2DM). METHODS 19 healthy male controls without neuropathy (HC) and 35 male T2DM patients, without dNP (n=8), with sensory dNP (n=13) or with sensorimotor dNP (dNPsm; n=14), were enrolled in this study. Maximal isometric (IM) and isokinetic (IK) muscle strength and IK muscle endurance of the dominant knee, ankle and elbow, and maximal IM handgrip strength were measured by means of dynamometry. RESULTS Ankle muscle endurance was lower compared to the knee, independently of dNP (p<0.001). Maximal IK ankle muscle strength was also lower compared to the knee, albeit only in dNPsm (p=0.003). No differences were found between maximal IM handgrip and elbow strength. CONCLUSIONS Our results suggest an impact of T2DM -with or without dNP- on lower limb muscle strength more distally than proximally, while this was not observed in the upper limb. The gradient of dNP seemed to be a determining factor for the maximal muscle strength, and not for muscle endurance, in the lower limb.
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Affiliation(s)
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Belgium
| | - Pascal Proot
- Department of Neurology, Ghent University Hospital, Belgium
| | | | - Simon Helleputte
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Jan Stautemas
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Dirk C. Cambier
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Belgium,Corresponding author: Prof. dr. Patrick Calders, Department of Rehabilitation Sciences, Campus UZ Gent, Corneel Heymanslaan 10, B3, Entrance 46, 9000 Ghent, Belgium E-mail:
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White S, McCullough MBA, Akangah PM. The Structural Effects of Diabetes on Soft Tissues: A Systematic Review. Crit Rev Biomed Eng 2021; 49:11-27. [PMID: 35993948 DOI: 10.1615/critrevbiomedeng.2022043200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hyperglycemia, which is associated with diabetes, increases the production of advanced glycation end products. Advanced glycation end products lead to the structural degradation of soft tissues. The structural degradation of diabetic soft tissues has been investigated in humans, rodents, and canines. Therefore, the objective of this review is to unify the various contributions to diabetes research through the mechanical properties and geometric characteristics of soft tissues. A systematic review was performed and identified the effects of diabetes on mechanical and geometric properties of soft tissues via experimental testing or in vivo - driven finite element analysis. The literature concludes that diabetes contributes to major structural changes in soft tissues but does not cause the same structural changes in all soft tissues (e.g., diabetic tendons are weaker and diabetic plantar tissues are tougher). Diabetes stiffens and toughens soft tissues, thus altering viscoelastic behavior (e.g., poor strain and stress response). However, diabetes management routines can prevent or minimize the effects of diabetes on the mechanical and geometric properties of soft tissues. Unification of the structural effects of diabetes on soft tissues will contribute to the pathophysiology of diabetes.
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Affiliation(s)
- Shunafrica White
- Department of Mechanical Engineering, North Carolina Agricultural and Technical State University
| | - Matthew B A McCullough
- Department of Chemical, Biological, and Bioengineering at North Carolina Agricultural and Technical State University
| | - Paul M Akangah
- Department of Mechanical Engineering, North Carolina Agricultural and Technical State University
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12
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Effect of a 6-week strength-training program on neuromuscular efficiency in type 2 diabetes mellitus patients. Diabetol Int 2020; 11:376-382. [PMID: 33088645 DOI: 10.1007/s13340-020-00432-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
Background The neuromuscular system generates human movement. The functional capacity of the neuromuscular system in patients with type 2 diabetes mellitus (T2DM) is decreased and this affects the generation of muscle force. Exercise is recommended as an effective treatment in such cases. Short-duration strength training causes neural adaptations in healthy participants, but the effects of strength training on T2DM are unclear. The present study aimed to evaluate the effect of strength training on neuromuscular efficiency of lower limb muscles in T2DM. Methods Surface electromyograms (SEMG) of the knee flexors and extensors were recorded during isometric contractions. The ratio of peak torque to SEMG amplitude was calculated as neuromuscular efficiency. Measurements were taken before the intervention after 6 weeks of non-training, and after 6 weeks of strength training. Results SEMG amplitudes did not differ among the subsequent measurement sessions. Flexor and extensor peak torque increased after the strength-training program. The neuromuscular efficiency of all muscles increased after the 6 weeks of strength training. Conclusion A 6-week strength-training program increased the neuromuscular efficiency and peak torque in patients with T2DM; however, the electrical properties of the muscles did not change. These results may be related to increased neural adaptations and motor learning in the early stages of strength training.
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Van Eetvelde BLM, Lapauw B, Proot P, Vanden Wyngaert K, Celie B, Cambier D, Calders P. The impact of sensory and/or sensorimotor neuropathy on lower limb muscle endurance, explosive and maximal muscle strength in patients with type 2 diabetes mellitus. J Diabetes Complications 2020; 34:107562. [PMID: 32122790 DOI: 10.1016/j.jdiacomp.2020.107562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 12/29/2022]
Abstract
AIMS The purpose of this study was to investigate the impact of diabetic neuropathy (dNP) on lower limb endurance, explosive and maximal muscle strength in patients with Type 2 Diabetes Mellitus (T2DM). METHODS Fifty-four participants, aged between 55 and 85, were enrolled in this observational comparative study. The patients with T2DM had an average HbA1c of 7.4% (±1.03) and diabetes duration of 13 years. Participants were classified by means of electroneuromyography as T2DM without dNP (dNP-; n = 8), T2DM with sensory dNP (dNPs; n = 13), T2DM with sensorimotor dNP (dNPsm; n = 14), and healthy controls without neuropathy (C; n = 19). Maximal muscle strength and muscle endurance of the dominant knee and ankle were measured by dynamometry, while explosive muscle strength was evaluated by mechanography. RESULTS Muscle endurance "total work" in knee extension and ankle plantar flexion was higher in the healthy controls compared to dNP-, dNPs and dNPsm, in knee flexion compared to dNPs and dNPsm, and in ankle dorsiflexion compared to dNPsm only (p<0.05). Furthermore, relative explosive muscle strength "total power/body weight" and relative maximal muscle strength "peak torque/lean body mass of the dominant leg" considering knee flexion, ankle plantar flexion and dorsiflexion, were higher in healthy controls compared to the dNPsm group, and for maximal muscle strength ankle dorsiflexion even between dNP- and dNPsm (p < 0.05). CONCLUSIONS Muscle endurance is impaired in patients with T2DM, independent of the presence of dNP. Explosive and maximal muscle strength are more likely affected by the presence and severity of dNP.
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Affiliation(s)
- Birgit L M Van Eetvelde
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Pascal Proot
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Karsten Vanden Wyngaert
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Bert Celie
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Dirk Cambier
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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14
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Bavaresco SS, Oliveira LZD, Albarello JCDS, Tognon AP, Bona CC, Bettinelli LA, Leguisamo CP. Comparação entre pico de torque e flexibilidade dos membros inferiores de indivíduos com e sem diabetes mellitus tipo 2. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17024826022019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RESUMO O objetivo deste trabalho foi comparar o pico de torque e flexibilidade dos membros inferiores de indivíduos com e sem diabetes mellitus tipo 2 (DM2). O método foi o estudo com grupos expostos e não expostos ao DM2. Foram incluídos indivíduos com diagnóstico médico de DM2, encaminhados para eletroneuromiografia, e não expostos ao DM2. Foram excluídos da pesquisa indivíduos com idade superior a 70 anos ou que, por algum motivo, não conseguiram realizar um ou dois dos testes. A amostra foi não probabilística, composta por 64 indivíduos: 34 (53,1%) expostos ao DM2 e 30 não expostos; 50 (78,1%) eram do sexo feminino, a idade média era de 60,7±7,1 anos, e o membro inferior dominante era o direito em 57 (89,1%) dos indivíduos. Comparando indivíduos com e sem diagnóstico de DM2, observou-se redução do torque de flexão à esquerda, em velocidade angular de 120° (25,94±2,26 vs. 33,79±2,4nm, p=0,027, respectivamente). Relatou-se menor valor do torque de dorsiflexão à direita, em velocidade angular de 60°, dos diabéticos em relação aos não diabéticos (10,95±0,89 vs. 13,95±0,96nm, p=0,033, respectivamente). Ao comparar indivíduos com DM2, com e sem diagnóstico de neuropatia diabética periférica (NDP), notou-se maior déficit de flexão entre os indivíduos neuropatas em comparação com não neuropatas (46,57±9,47 vs. 11,63±13,85nm, p=0,049, respectivamente). Não foram encontradas diferenças estatisticamente significativas ao comparar os grupos de expostos e não expostos ao DM2 e diabéticos neuropatas e não neuropatas.
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15
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Ghanjal A, Motaqi M, Arab Z, Hatef B. Force Variability in the Short- and Long-Term Type 2 Diabetes Mellitus. JOURNAL OF MEDICAL SIGNALS & SENSORS 2019; 9:50-58. [PMID: 30967990 PMCID: PMC6419562 DOI: 10.4103/jmss.jmss_24_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Force variability is related to many kinesiological and neuromuscular properties of the body. This study was conducted to evaluate the effect of type 2 diabetes mellitus (T2DM) and sex on the several fractal and entropy indices of force changing during the repetitive isokinetic exercise of knee flexion-extension. Methods: Fifty individuals were allowed to participate in the study, and they consist of 18 patients with short-term T2DM, 12 patients with long-term T2DM, and 20 gender/body mass index/ankle imposed to brachial pressure index and physical activity index-matched healthy control (HC) individuals. Torque of knee flexion-extension was recorded for each cycle of 40 isokinetic repetitions at a velocity of 150°/s. The slope across the peak of torques and nonlinear fractal and entropy features in the time series was calculated. Two-way univariate analysis of variance was used to analyze the effect of the groups and gender on the variables. Results: The slope of flexor peak torques was significantly less in the long-term T2DM than the other groups. However, the fractal features such as SD1 and 2 of Poincare plot and fractal dimension katz were significantly decreased in the T2DM groups than the HC and in the women than men. Alpha detrended fluctuation analysis and empirical hurts exponent increased in women of short-term T2DM than men. Conclusion: The force variability decreased in the T2DM as compared to HC and in women as compared to men. However, the randomness of force was significantly increased in women of short-term T2DM.
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Affiliation(s)
- Ali Ghanjal
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Monireh Motaqi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Arab
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Boshra Hatef
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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16
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Eshima H, Tamura Y, Kakehi S, Nakamura K, Kurebayashi N, Murayama T, Kakigi R, Sakurai T, Kawamori R, Watada H. Dysfunction of muscle contraction with impaired intracellular Ca 2+ handling in skeletal muscle and the effect of exercise training in male db/db mice. J Appl Physiol (1985) 2018; 126:170-182. [PMID: 30433865 DOI: 10.1152/japplphysiol.00048.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Type 2 diabetes is characterized by reduced contractile force production and increased fatigability of skeletal muscle. While the maintenance of Ca2+ homeostasis during muscle contraction is a requisite for optimal contractile function, the mechanisms underlying muscle contractile dysfunction in type 2 diabetes are unclear. Here, we investigated skeletal muscle contractile force and Ca2+ flux during contraction and pharmacological stimulation in type 2 diabetic model mice ( db/db mice). Furthermore, we investigated the effect of treadmill exercise training on muscle contractile function. In male db/db mice, muscle contractile force and peak Ca2+ levels were both lower during tetanic stimulation of the fast-twitch muscles, while Ca2+ accumulation was higher after stimulation compared with control mice. While 6 wk of exercise training did not improve glucose tolerance, exercise did improve muscle contractile dysfunction, peak Ca2+ levels, and Ca2+ accumulation following stimulation in male db/db mice. These data suggest that dysfunctional Ca2+ flux may contribute to skeletal muscle contractile dysfunction in type 2 diabetes and that exercise training may be a promising therapeutic approach for dysfunctional skeletal muscle contraction. NEW & NOTEWORTHY The purpose of this study was to examine muscle contractile function and Ca2+ regulation as well as the effect of exercise training in skeletal muscle in obese diabetic mice ( db/db). We observed impairment of muscle contractile force and Ca2+ regulation in a male type 2 diabetic animal model. These dysfunctions in muscle were improved by 6 wk of exercise training.
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Affiliation(s)
- Hiroaki Eshima
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine , Tokyo , Japan.,Sportology Center, Juntendo University Graduate School of Medicine , Tokyo , Japan.,The Japan Society for the Promotion of Science , Tokyo , Japan
| | - Yoshifumi Tamura
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine , Tokyo , Japan.,Sportology Center, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Saori Kakehi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine , Tokyo , Japan.,Sportology Center, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Kyoko Nakamura
- Department of Physiology, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Nagomi Kurebayashi
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Takashi Murayama
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Ryo Kakigi
- Department of Physiology, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Takashi Sakurai
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Ryuzo Kawamori
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine , Tokyo , Japan.,Sportology Center, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine , Tokyo , Japan.,Sportology Center, Juntendo University Graduate School of Medicine , Tokyo , Japan.,Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine , Tokyo , Japan.,Center for Molecular Diabetology, Juntendo University Graduate School of Medicine , Tokyo , Japan
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17
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Ferreira JP, Leal AMO, Vasilceac FA, Sartor CD, Sacco ICN, Soares AS, Salvini TF. Decreased muscle strength is associated with proinflammatory cytokines but not testosterone levels in men with diabetes. ACTA ACUST UNITED AC 2018; 51:e7394. [PMID: 30043856 PMCID: PMC6065880 DOI: 10.1590/1414-431x20187394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/11/2018] [Indexed: 01/06/2023]
Abstract
The aim of this study was to compare muscle strength in male subjects with type 2 diabetes mellitus (DM2) with and without low plasma testosterone levels and assess the relationship between muscle strength, testosterone levels, and proinflammatory cytokines. Males (75) aged between 18 and 65 years were divided into 3 groups: control group that did not have diabetes and had a normal testosterone plasma level (>250 ng/dL), DnormalTT group that had DM2 with normal testosterone levels, and the DlowTT group that had DM2 and low plasma testosterone levels (<250 ng/dL). The age (means±SD) of the groups was 48.4±10, 52.6±7, and 54.6±7 years, respectively. Isokinetic concentric and isometric torque of knee flexors and extensors were analyzed by an isokinetic dynamometer. Plasma testosterone and proinflammatory cytokine levels were determined by chemiluminescence and ELISA, respectively. Glycemic control was analyzed by glycated hemoglobin (HbA1C). In general, concentric and isometric torques were lower and tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β plasma levels were higher in the groups with diabetes than in controls. There was no correlation between testosterone level and knee torques or proinflammatory cytokines. Concentric and isometric knee flexion and extension torque were negatively correlated with TNF-α, IL-6, and HbA1C. IL-6 and TNF-α were positively correlated with HbA1C. The results of this study demonstrated that muscle strength was not associated with testosterone levels in men with DM2. Low muscle strength was associated with inflammatory markers and poor glycemic control.
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Affiliation(s)
- J P Ferreira
- Laboratório de Plasticidade Muscular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - A M O Leal
- Departamento de Medicina, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - F A Vasilceac
- Departamento de Gerontologia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - C D Sartor
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Fisioterapia, Universidade Ibirapuera, São Paulo, SP, Brasil
| | - I C N Sacco
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A S Soares
- Laboratório de Plasticidade Muscular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - T F Salvini
- Laboratório de Plasticidade Muscular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
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18
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Howrey BT, Al Snih S, Markides KS, Ottenbacher KJ. Frailty and diabetes among Mexican American older adults. Ann Epidemiol 2018; 28:421-426.e1. [PMID: 29778652 DOI: 10.1016/j.annepidem.2018.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/15/2018] [Accepted: 04/19/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Progressive physical frailty in older adults is associated with increased risk of falls, disability, institutionalization, and mortality. Although associations between diabetes and frailty have been observed, the impact of diabetes on frailty in older Hispanics is largely unexplored. We examine the association of diabetes on the odds of frailty among older Mexican Americans. METHODS Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly from 1995 until 2012, frailty was assessed by slow gait, weak hand grip strength, exhaustion, and unexplained weight loss (n = 1327). RESULTS Logistic regression showed a large magnitude of effect of diabetes on the odds of frailty (odds ratio 1.47, 95% confidence interval 1.14-1.90). Other contributors to frailty included arthritis, heart attack, and hip fracture. Positive and negative effects had significant and opposing associations. Ordinal logit models assessed the odds of frail compared to nonfrail and prefrail. In these models, diabetes was associated with a 32% increase in the odds of a higher level of frailty. CONCLUSIONS Diabetes is a significant contributor to increased frailty in older Mexican Americans. Interventions to reduce frailty rates should focus on mitigating the effects of diabetes and shifting away from negative and toward positive effect.
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Affiliation(s)
- Bret T Howrey
- Department of Family Medicine, University of Texas Medical Branch, Galveston.
| | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | - Kyriakos S Markides
- Department of Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston
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19
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Abadi L, Salahzadeh Z, Rezaei M, Oskouei AE, Azghani MR. Hip joint torques in type II diabetes with and without neuropathy. Hong Kong Physiother J 2017; 37:27-33. [PMID: 30931043 PMCID: PMC6385154 DOI: 10.1016/j.hkpj.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Patients with diabetes and peripheral neuropathy demonstrate significantly reduced peak torques at the peripheral joints. Objectives The aim of this study was to assess isometric and concentric peak torques of the hip joint in people with type II diabetes with and without peripheral neuropathy in comparison with healthy participants. Methods 27 patients with type II diabetes including 15 patients without peripheral neuropathy, 12 patients with diabetes and peripheral neuropathy and 15 healthy people participated. Isometric and concentric peak torques of hip flexion, extension, adduction and abduction of the non-dominant leg were measured by motorized dynamometer. Results Peak and average peak concentric torques of the hip extension and abduction in patients with diabetes and peripheral neuropathy were lower than those patients with diabetes and control group. Angle of extension peak torque was significantly greater in patients with diabetes and peripheral neuropathy compared with other groups. Angle of flexion peak torque was lower in the patients with diabetes and peripheral neuropathy. Conclusions Torque related parameters in patients with type II diabetes with or without peripheral neuropathy, are different from healthy subjects. As a result, patients with diabetes especially with peripheral neuropathy are more susceptible of injury and disability in lower limbs.
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Affiliation(s)
- Laleh Abadi
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Salahzadeh
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mandana Rezaei
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali E Oskouei
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmood Reza Azghani
- Biomechanics Department, Faculty of Biomechanics Engineering, Sahand University of Technology, Tabriz, Iran
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20
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Ferreira JP, Sartor CD, Leal ÂMO, Sacco ICN, Sato TO, Ribeiro IL, Soares AS, Cunha JE, Salvini TF. The effect of peripheral neuropathy on lower limb muscle strength in diabetic individuals. Clin Biomech (Bristol, Avon) 2017; 43:67-73. [PMID: 28213167 DOI: 10.1016/j.clinbiomech.2017.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/29/2017] [Accepted: 02/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Skeletal muscle strength is poorly described and understood in diabetic participants with diabetic peripheral neuropathy. This study aimed to investigate the extensor and flexor torque of the knee and ankle during concentric, eccentric, and isometric contractions in men with diabetes mellitus type 2 with and without diabetic peripheral neuropathy. METHODS Three groups of adult men (n=92), similar in age, body mass index, and testosterone levels, were analyzed: 33 non-diabetic controls, 31 with type 2 diabetes mellitus, and 28 with diabetic peripheral neuropathy. The peak torques in the concentric, eccentric, and isometric contractions were evaluated using an isokinetic dynamometer during knee and ankle flexion and extension. FINDINGS Individuals with diabetes and diabetic peripheral neuropathy presented similar low concentric and isometric knee and ankle torques that were also lower than the controls. However, the eccentric torque was similar among the groups, the contractions, and the joints. INTERPRETATION Regardless of the presence of peripheral neuropathy, differences in skeletal muscle function were found. The muscle involvement does not follow the same pattern of sensorial losses, since there are no distal-to-proximal impairments. Both knee and ankle were affected, but the effect sizes of the concentric and isometric torques were found to be greater in the participants' knees than in their ankles. The eccentric function did not reveal differences between the healthy control group and the two diabetic groups, raising questions about the involvement of the passive muscle components.
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Affiliation(s)
- Jean P Ferreira
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Cristina D Sartor
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ângela M O Leal
- Department of Medicine, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Tatiana O Sato
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Ivana L Ribeiro
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Alice S Soares
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Jonathan E Cunha
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Tania F Salvini
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil.
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21
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Orlando G, Balducci S, Bazzucchi I, Pugliese G, Sacchetti M. Muscle fatigability in type 2 diabetes. Diabetes Metab Res Rev 2017; 33. [PMID: 27155086 DOI: 10.1002/dmrr.2821] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/31/2016] [Accepted: 04/17/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with type 2 diabetes (T2D) may be subject to premature muscle fatigue. However, the effect of diabetes on muscle fatigability has not yet been thoroughly examined. The purpose of this study was to investigate the effect of T2D on muscle fatigability at the upper and lower body. METHODS Thirty-three T2D patients (18 men and 15 women; mean age, 59.3 ± 5.3 years) and 34 matched healthy control participants (17 men and 17 women; mean age, 60.1 ± 6.1 years) were recruited. Clinical characteristics of diabetic patients were assessed by considering a wide range of vascular and neurological parameters in order to exclude the presence of micro- and macro-vascular complications. Gender-specific muscle function was evaluated measuring the maximal voluntary isometric contraction (MVIC), and the endurance time at 50% of the MVIC at the shoulder and at the knee extensor muscles. RESULTS Muscle strength in the upper body was similar among groups, whereas in the lower body, it was significantly reduced in T2D men (-16%) and women (-22%) compared with the controls. Additionally, the endurance time in both upper and lower body was significantly lower in T2D men (-18% and -29%) and women (-19% and -25%, respectively) than controls. CONCLUSIONS Besides the reduction in strength, muscle dysfunction in T2D is characterized by a higher fatigability that affects both upper and lower body muscles. This effect is independent to the presence of diabetic complications and may represent a more sensitive marker of muscular dysfunction than muscle strength. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Giorgio Orlando
- Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Rome, Italy
| | - Stefano Balducci
- Department of Clinical and Molecular Medicine, 'La Sapienza' University, and Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Ilenia Bazzucchi
- Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, 'La Sapienza' University, and Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Rome, Italy
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22
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Askary-Ashtiani A, Ghanjal A, Motaqi M, Meftahi GH, Hatef B, Niknam H. The Isokinetic and Electromyographic Assessment of Knee Muscles Strength in the Short- and Long-Term Type 2 Diabetes. Asian J Sports Med 2016; 7:e37008. [PMID: 28144413 PMCID: PMC5259685 DOI: 10.5812/asjsm.37008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/09/2016] [Accepted: 05/17/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2DM) patients are subject to muscle weakness. OBJECTIVES The aim of the study was an assessment of electromyographic (EMG) activity of knee muscles during isometric maximal voluntary contraction in the different disease durations of T2DM. METHODS Eighteen patients with less than 10 years and twelve patients with more than 10 years of T2DM were compared with nineteen matched healthy control subjects. EMG of flexor and extensor muscles of knee concurrently with isometric maximal peak torque of knee flexion and extension at 75 degrees of knee flexion were recorded in three groups. RESULTS Isometric maximal peak torque of extension and root mean squared (RMS) of vastus lateralis and medial hamstring in the healthy control was significantly higher than both patient groups. Whenever the maximal isometric peak flexion torque was not significantly different between groups, the mean power frequency (MPF) of flexor muscles especially medial hamstrings were higher in the short-term T2DM than healthy control groups. The two factors, gender and age, had significant effect on maximal peak torque and RMS of knee muscles. CONCLUSIONS EMG could show the effect of T2DM, gender and age on knee muscles activity. It seems that the medial hamstring was the most sensitive muscle of knee compartment to show the effect of T2DM and difference of short and long-term T2DM in EMG study.
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Affiliation(s)
| | - Ali Ghanjal
- Health Management Research Centre, Department of Physical Medicine and Rehabilitation, Baqiyatallah University, Tehran, Iran
| | - Monireh Motaqi
- Departement of Basic Science, Rehabilitation Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Boshra Hatef
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hoda Niknam
- Department of Physical Therapy, Tarbiat Modares University, Tehran, Iran
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23
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Hatef B, Ghanjal A, Meftahi GH, Askary-Ashtiani A. Isokinetic and Electromyographic Properties of Muscular Endurance in Short and Long-Term Type 2 Diabetes. Glob J Health Sci 2016; 8:54366. [PMID: 27045412 PMCID: PMC5016357 DOI: 10.5539/gjhs.v8n8p210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/16/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) are subject to progressive reduction of muscle mass and strength. The aim of this study was to assess muscle forces and electromyography (EMG) indices in short and long-term diabetes during an isokinetic exercise. METHODS The peak torque, work, mean power frequency (MPF) and root mean square (RMS) of knee flexors and extensors during 40 isokinetic knee extension-flexion repetitions with a velocity of 150 degree/s were recorded. 18 patients with less than 10 years with T2DM and 12 patients with equal and more than 10 years of disease were compared with 20 gender, body mass index, physical activity and peripheral circulation matched healthy controls. RESULTS The fatigue index and slope of line across the peak torque values of the knee flexor indicate that patients with long-term T2DM were significantly more resistant to fatigue in comparison with the two other groups (p<0.009). Whereas the MPF decrease during isokinetic protocol interact with grouping in the medial hamstring (p<0.042), but it was independent to groups in other muscles (p<0.0001). The increase of RMS after fatigue protocol interacted with sex for the medial hamstring and vastus lateralis (p<0.039) and interacted with group for the extensor muscles (p<0.045). DISCUSSION & CONCLUSION It seems that long-term T2DM cause some neuromuscular adaptations to maintain knee flexor muscle performance during functional activity especially postural control.
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Affiliation(s)
- Boshra Hatef
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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24
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Orlando G, Balducci S, Bazzucchi I, Pugliese G, Sacchetti M. Neuromuscular dysfunction in type 2 diabetes: underlying mechanisms and effect of resistance training. Diabetes Metab Res Rev 2016; 32:40-50. [PMID: 25950170 DOI: 10.1002/dmrr.2658] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/30/2015] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Giorgio Orlando
- Department of Movement, Human and Health Sciences, 'Foro Italico' University, Rome, Italy
| | - Stefano Balducci
- Department of Clinical and Molecular Medicine, 'La Sapienza' University and Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Ilenia Bazzucchi
- Department of Movement, Human and Health Sciences, 'Foro Italico' University, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, 'La Sapienza' University and Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, 'Foro Italico' University, Rome, Italy
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Błażkiewicz M, Sundar L, Healy A, Ramachandran A, Chockalingam N, Naemi R. Assessment of lower leg muscle force distribution during isometric ankle dorsi and plantar flexion in patients with diabetes: a preliminary study. J Diabetes Complications 2015; 29:282-7. [PMID: 25454742 DOI: 10.1016/j.jdiacomp.2014.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/06/2014] [Accepted: 10/15/2014] [Indexed: 12/25/2022]
Abstract
AIM The aim of this study was to evaluate the differences in ankle muscle strength using hand-held dynamometry and to assess difference in the isometric muscle force distribution between the people with diabetes and control participants. METHODS The maximal muscle strength of ankle plantarflexion, dorsiflexion, eversion, inversion, lesser toes flexors and extensors, hallux flexors, and extensors was assessed in 20 people with diabetes and 20 healthy participants using hand-held dynamometry. The maximal isometric ankle plantarflexion and dorsiflexion were imported to OpenSim software to calculate 12 individual muscle (8 plantarflexors and 4 dorsiflexors) forces acting on ankle joint. RESULTS A significant reduction in ankle strength for all measured actions and a significant decrease in muscle force for each of the 12 muscles during dorsi and plantar flexion were observed. Furthermore, the ratios of agonist to antagonist muscle force for 6 of the muscles were significantly different between the control group and the group with diabetes. CONCLUSIONS It is likely that the muscles for which the agonist/antagonist muscle force ratio was significantly different for the healthy people and the people with diabetes could be more affected by diabetes.
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Affiliation(s)
- Michalina Błażkiewicz
- Department of Physiotherapy, Józef Piłsudski University of Physical Education, Warsaw, Poland; CSHER, Faculty of Health Sciences, Staffordshire University, Stoke on Trent, ST4 2DF, UK.
| | - Lakshmi Sundar
- CSHER, Faculty of Health Sciences, Staffordshire University, Stoke on Trent, ST4 2DF, UK; AR Hospitals, India Diabetic Research Foundation, Egmore, Chennai, India
| | - Aoife Healy
- CSHER, Faculty of Health Sciences, Staffordshire University, Stoke on Trent, ST4 2DF, UK
| | | | | | - Roozbeh Naemi
- CSHER, Faculty of Health Sciences, Staffordshire University, Stoke on Trent, ST4 2DF, UK
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