1
|
Wang Z, Zhao S, Zhang A, Quan B, Duan C, Liang M, Yang J. Trends of type 2 diabetes with pulmonary tuberculosis patients,2013-2022, and changes after the coronavirus disease 2019 (COVID-19) pandemic. Tuberculosis (Edinb) 2024; 146:102499. [PMID: 38442538 DOI: 10.1016/j.tube.2024.102499] [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: 09/03/2023] [Revised: 02/13/2024] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND To describe the trends of Type 2 Diabetes with Pulmonary Tuberculosis (T2DM-TB) patients from 2013 to 2022 and to investigate the impact of COVID-19 lockdown on glycemic control and associated factors in T2DM-TB. METHODS In this population-based study of the First Affiliated Yijishan Hospital of Wannan Medical College in China, we described the 10-year trends of patients diagnosed with T2DM-TB. We included patients diagnosed with TB, T2DM-TB and T2DM-TB patients for comparative analysis, aged 15 years or older. Data were missing, and both multidrug-resistant (MDR) TB patients and non-T2DM patients were excluded from our study. RESULTS We pooled Type 2 Diabetes (T2DM) and Tuberculosis (TB) data from The First Affiliated Yijishan Hospital of Wannan Medical College in China, gathered between January 1, 2013, and December 31, 2022. The data included 14,227 T2DM patients, 6130 TB patients, and 982 T2DM-TB patients. During the past 10 years, the number of inpatients with TB decreased, while the number of patients with T2DM and T2DM-TB increased year by year. To rule out any influence factors, we analyzed the ratio of the three groups. The ratio of TB/T2DM decreased year by year (p < 0.05), while the ratio of TB-T2DM/TB increasing year by year (p = 0.008). During the COVID-19 epidemic period, there was no significant change in the ratio of TB-T2DM/T2DM (p = 0.156). There was no significant change in the proportion of male patients with TB and TB-T2DM (p = 0.325; p = 0.190), but the proportion of male patients with T2DM showed an increasing trend (p < 0.001). The average age of TB patients over the past 10 years was 54.5 ± 18.4 years and showed an increasing trend year by year (p < 0.001). However, there was no significant change in the age of T2DM or TB-T2DM patients (p = 0.064; p = 0.241). Patients data for the first (2013-2017) and the last (2018-2022) five years were compared. We found that the number of T2DM and TB-T2DM in the last five years was significantly higher than in the first five years, but the number of TB was significantly lower than in the first five years. There is a significant statistical difference in the proportion of TB/T2DM and TB-T2DM/TB, which is similar to the previous results. The average age (56.0 ± 17.6 years) of TB patients in the last five years is significantly higher than in the first five years (53.1 ± 18.9) (p < 0.001). The number of male patients with T2DM in the last five years is higher than that in the first five years, with significant difference (p < 0.001). CONCLUSION The trends of T2DM-TB among hospitalized TB patients have increased significantly over the past 10 years, which may be related to the increase in the number of T2DM cases. The COVID-19 pandemic has been effective in controlling the transmission of TB, but it has been detrimental to the control of T2DM. Male patients with T2DM and elderly TB patients are the key populations for future prevention and control efforts.
Collapse
Affiliation(s)
- Zijian Wang
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Sheng Zhao
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Aiping Zhang
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Bin Quan
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Chun Duan
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Manman Liang
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Janghua Yang
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China.
| |
Collapse
|
2
|
Yeung AM, Huang J, Nguyen KT, Xu NY, Hughes LT, Agrawal BK, Ejskjaer N, Klonoff DC. Painful Diabetic Neuropathy: The Need for New Approaches. J Diabetes Sci Technol 2024; 18:159-167. [PMID: 36305521 PMCID: PMC10899841 DOI: 10.1177/19322968221132252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Painful diabetic neuropathy is a common vexing problem for people with diabetes and a costly problem for society. The pathophysiology is not well understood, and no safe and effective mechanistically-based treatment has been identified. Poor glycemic control is a risk factor for painful diabetic neuropathy. Excessive intraneuronal glucose in people with diabetes can be shunted away from physiological glycolysis into multiple pathological pathways associated with neuropathy and pain. The first three treatments that are traditionally offered consist of risk factor reduction, lifestyle modifications, and pharmacological therapy, which includes only three drugs that are approved for this indication by the United States Food and Drug Administration. All of these traditional treatments are often inadequate for relieving neuropathic pain, and thus, new approaches are needed. Modern devices based on neuromodulation technology, which act directly on the nervous system, have been recently cleared by the United States Food and Drug Administration for painful diabetic neuropathy and offer promise as next-in-line therapy when traditional therapies fail.
Collapse
Affiliation(s)
| | | | | | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA, USA
| | - Lorenzo T. Hughes
- Balance Health, San Francisco, CA, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | | | - Niels Ejskjaer
- Steno Diabetes Center North Denmark and Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - David C. Klonoff
- Diabetes Technology Society, Burlingame, CA, USA
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| |
Collapse
|
3
|
Turčinović K, Cigrovski V, Bilić-Ćurćić I, Mrzljak A, Kuna L, Klobučar S, Cigrovski Berković M. THE IMPACT OF TOTAL PHYSICAL ACTIVITY ON MICROVASCULAR COMPLICATIONS IN TYPE 1 DIABETES MELLITUS PATIENTS. Acta Clin Croat 2023; 62:330-338. [PMID: 38549602 PMCID: PMC10969643 DOI: 10.20471/acc.2023.62.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/19/2021] [Indexed: 04/02/2024] Open
Abstract
The incidence of diabetes is increasing worldwide, emphasizing an emerging need for blood glucose control optimization to prevent the development of chronic complications and improve the quality of life. This retrospective cohort study aimed to investigate the effects of total physical activity on microvascular diabetic complication development in patients with type 1 diabetes mellitus (T1DM). The study included 71 T1DM patients, average age 41 years and HbA1c 7.78%. Most patients (82.1%) reported having hypoglycemia, while the minority of patients developed microvascular complications, mostly nonproliferative retinopathy (17.7%). All subjects included in the study were moderately or vigorously physically active. No association was observed between total physical activity and regulation of glycemia, hypoglycemic incidents, or development of microvascular complications. Until sufficient data from prospective studies become available, our data support the findings of no negative effect of higher intensity physical activity on the development of microvascular complications in T1DM patients.
Collapse
Affiliation(s)
| | | | - Ines Bilić-Ćurćić
- Department of Pharmacology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Endocrinology and Metabolism Disorders, Osijek University Hospital Center, Osijek, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, Zagreb University Hospital Center, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Lucija Kuna
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health in Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Sanja Klobučar
- Department of Endocrinology, Diabetes and Metabolism, Rijeka University Hospital Center, Rijeka, Croatia
| | | |
Collapse
|
4
|
Kristianto H. Analysis of risk factors responsible for neuropathy in patients with type 2 diabetes mellitus with diabetic foot during the COVID-19 pandemic. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:85-91. [DOI: 10.4103/ijnmr.ijnmr_180_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/10/2022] [Accepted: 10/19/2022] [Indexed: 01/26/2023]
|
5
|
Hulleck AA, Menoth Mohan D, Abdallah N, El Rich M, Khalaf K. Present and future of gait assessment in clinical practice: Towards the application of novel trends and technologies. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:901331. [PMID: 36590154 PMCID: PMC9800936 DOI: 10.3389/fmedt.2022.901331] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Despite being available for more than three decades, quantitative gait analysis remains largely associated with research institutions and not well leveraged in clinical settings. This is mostly due to the high cost/cumbersome equipment and complex protocols and data management/analysis associated with traditional gait labs, as well as the diverse training/experience and preference of clinical teams. Observational gait and qualitative scales continue to be predominantly used in clinics despite evidence of less efficacy of quantifying gait. Research objective This study provides a scoping review of the status of clinical gait assessment, including shedding light on common gait pathologies, clinical parameters, indices, and scales. We also highlight novel state-of-the-art gait characterization and analysis approaches and the integration of commercially available wearable tools and technology and AI-driven computational platforms. Methods A comprehensive literature search was conducted within PubMed, Web of Science, Medline, and ScienceDirect for all articles published until December 2021 using a set of keywords, including normal and pathological gait, gait parameters, gait assessment, gait analysis, wearable systems, inertial measurement units, accelerometer, gyroscope, magnetometer, insole sensors, electromyography sensors. Original articles that met the selection criteria were included. Results and significance Clinical gait analysis remains highly observational and is hence subjective and largely influenced by the observer's background and experience. Quantitative Instrumented gait analysis (IGA) has the capability of providing clinicians with accurate and reliable gait data for diagnosis and monitoring but is limited in clinical applicability mainly due to logistics. Rapidly emerging smart wearable technology, multi-modality, and sensor fusion approaches, as well as AI-driven computational platforms are increasingly commanding greater attention in gait assessment. These tools promise a paradigm shift in the quantification of gait in the clinic and beyond. On the other hand, standardization of clinical protocols and ensuring their feasibility to map the complex features of human gait and represent them meaningfully remain critical challenges.
Collapse
Affiliation(s)
- Abdul Aziz Hulleck
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Dhanya Menoth Mohan
- School of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, Australia
| | - Nada Abdallah
- Weill Cornell Medicine, New York City, NY, United States
| | - Marwan El Rich
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Biomedical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates,Health Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates,Correspondence: Kinda Khalaf
| |
Collapse
|
6
|
Luo J, Zhu HQ, Gou B, Zheng YL. Mechanisms of exercise for diabetic neuropathic pain. Front Aging Neurosci 2022; 14:975453. [PMID: 36313015 PMCID: PMC9605799 DOI: 10.3389/fnagi.2022.975453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022] Open
Abstract
Diabetic neuropathic pain (DNP) is a common disease that affects the daily lives of diabetic patients, and its incidence rate is very high worldwide. At present, drug and exercise therapies are common treatments for DNP. Drug therapy has various side effects. In recent years, exercise therapy has received frequent research and increasing attention by many researchers. Currently, the treatment of DNP is generally symptomatic. We can better select the appropriate exercise prescription for DNP only by clarifying the exercise mechanism for its therapy. The unique pathological mechanism of DNP is still unclear and may be related to the pathological mechanism of diabetic neuropathy. In this study, the mechanisms of exercise therapy for DNP were reviewed to understand better the role of exercise therapy in treating DNP.
Collapse
Affiliation(s)
- Jing Luo
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Hui-Qi Zhu
- College of Kinesiology, Shenyang Sport University, Shenyang, China
| | - Bo Gou
- Department of Sport Rehabilitation, Xian Physical Education University, Xian, China
- *Correspondence: Bo Gou,
| | - Yi-Li Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- *Correspondence: Bo Gou,
| |
Collapse
|
7
|
Lekhanya PK, Mokgalaboni K. Exploring the effectiveness of vitamin B 12 complex and alpha-lipoic acid as a treatment for diabetes mellitus/neuropathy: a protocol for systematic review and meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e065630. [PMID: 36008079 PMCID: PMC9422795 DOI: 10.1136/bmjopen-2022-065630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Diabetic neuropathy (DN) is common in patients diagnosed with diabetes mellitus. This often causes peripheral nerve damage. For many years vitamin B12 and alpha-lipoic acid (ALA) have been regarded as components that can be used in reducing markers of inflammation and oxidative stress. In this study, we will explore the effectiveness of vitamin B12 and ALA as a possible treatment for diabetic mellitus/neuropathy, emphasising markers of inflammation, lipid profile, and glucose metabolism. METHODS AND ANALYSIS We will conduct a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P). The search strategies and information sources for the literature will be PubMed, Google Scholar, Web of Science and Science direct. The literature search will include studies published from inception until 30 June 2022. All included studies will be evaluated for quality and risk of bias according to the Cochrane guidelines. To investigate the stability of the results, we will conduct a sensitivity analysis of the outcomes. All data analysis will be performed using Review Manager V.5. 4. ETHICAL AND DISSEMINATION This systematic review and meta-analysis will not require ethical approval from an institution committee as it does not have direct participants. We will obtain all our data from previous studies. The findings will be disseminated through publications in peer-reviewed journals and presented at local and international seminars and conferences.
Collapse
Affiliation(s)
- Portia Keabetswe Lekhanya
- Life and Consumer Sciences, University of South Africa, College of Agriculture and Environmental Sciences, Florida, Gauteng, South Africa
| | - Kabelo Mokgalaboni
- Life and Consumer Sciences, University of South Africa, College of Agriculture and Environmental Sciences, Florida, Gauteng, South Africa
| |
Collapse
|
8
|
Whittier TT, Weller ZD, Fling BW. I Can Step Clearly Now, the TENS Is On: Transcutaneous Electric Nerve Stimulation Decreases Sensorimotor Uncertainty during Stepping Movements. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22145442. [PMID: 35891122 PMCID: PMC9317326 DOI: 10.3390/s22145442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 06/01/2023]
Abstract
Transcutaneous electric nerve stimulation (TENS) is a method of electrical stimulation that elicits activity in sensory nerves and leads to improvements in the clinical metrics of mobility. However, the underlying perceptual mechanisms leading to this improvement are unknown. The aim of this study was to apply a Bayesian inference model to understand how TENS impacts sensorimotor uncertainty during full body stepping movements. Thirty healthy adults visited the lab on two occasions and completed a motor learning protocol in virtual reality (VR) on both visits. Participants were randomly assigned to one of three groups: TENS on first visit only (TN), TENS on second visit only (NT), or a control group where TENS was not applied on either visit (NN). Using methods of Bayesian inference, we calculated the amount of uncertainty in the participants' center of mass (CoM) position estimates on each visit. We found that groups TN and NT decreased the amount of uncertainty in the CoM position estimates in their second visit while group NN showed no difference. The least amount of uncertainty was seen in the TN group. These results suggest that TENS reduces the amount of uncertainty in sensory information, which may be a cause for the observed benefits with TENS.
Collapse
Affiliation(s)
- Tyler T. Whittier
- Sensorimotor Neuroimaging Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA;
| | - Zachary D. Weller
- Department of Statistics, Colorado State University, Fort Collins, CO 80523, USA;
| | - Brett W. Fling
- Sensorimotor Neuroimaging Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA;
- Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, CO 80523, USA
| |
Collapse
|
9
|
Foot-ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: a randomized controlled trial. Sci Rep 2022; 12:7561. [PMID: 35534614 PMCID: PMC9082985 DOI: 10.1038/s41598-022-11745-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/29/2022] [Indexed: 11/08/2022] Open
Abstract
This study sought to determine whether a foot–ankle therapeutic exercise program can improve daily physical activity (i.e. number of steps) and fast and self-selected gait speed in people with diabetic peripheral neuropathy (DPN). In this single-blind randomized controlled trial and intention-to-treat analysis, 78 volunteers with DPN were allocated into a control group, which received usual care, and an intervention group (IG), which received usual care plus a 12-week foot–ankle exercise program. The adherence at 12 weeks rate in the IG was 92.3% (36 participants) and the dropout was 5.1% in the control group (2 participants). The number of steps and self-selected gait speed did not change significantly in either group (p > 0.05), although a 1,365-step difference between groups were observed at 1-year followup. The 12-week foot–ankle therapeutic exercises improved significantly fast-gait speed (primary outcome) (p = 0.020), ankle range of motion (p = 0.048), and vibration perception (secondary outcomes) (p = 0.030), compared with usual-care at 12 weeks. At 24 weeks, the IG showed better quality of life than controls (p = 0.048). At 1-year, fast-gait speed and vibration perception remained higher in the IG versus controls. Overall, the program may be a complementary treatment strategy for improving musculoskeletal and functional deficits related to DPN. Trial registration ClinicalTrials.gov NCT02790931 (06/06/2016).
Collapse
|
10
|
Lewis EJH, Lovblom LE, Lanctot S, Scarr D, Cardinez N, Boulet G, Weisman A, Lovshin JA, Lytvyn Y, Keenan HA, Brent MH, Paul N, Cherney DZI, Bril V, Perkins BA. The association between physical activity time and neuropathy in longstanding type 1 diabetes: A cross-sectional analysis of the Canadian study of longevity in type 1 diabetes. J Diabetes Complications 2022; 36:108134. [PMID: 35123866 DOI: 10.1016/j.jdiacomp.2022.108134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/18/2021] [Accepted: 09/25/2021] [Indexed: 11/24/2022]
Abstract
AIM Physical activity (PA) is recommended to improve glycemic control in T1D; however, the effect of PA on distal symmetric polyneuropathy (DSPN) and cardiac autonomic function in longstanding T1D is unknown. METHODS Data from 75 participants were collected as part of the Canadian Study of Longevity in T1D. Participants completed a physical exam, medical history, extensive complications phenotyping and reported their daily PA from the preceding 12-months. Pearson and Spearman correlations were used to assess PA time and complications variables. Linear regression was used to test associations between PA time, neurological and electrophysiological measures. Univariable regression was used to indicate the change in the given independent variables associated with a 30-min increase in PA per week. RESULTS Participants were 66 ± 8 years old with diabetes duration of 54 [52,58] years, HbA1c was 7.3 ± 0.8, 65(89%) had DSPN. Weekly PA time was 156 ± 132 min, and 35(47%) reported ≧150 min/week. Participants with DSPN reported lower PA time compared to individuals without DSPN (141 ± 124 min/week vs. 258 ± 129 min/week; p = 0.015). PA time was associated with better cooling detection threshold (r = 0.24; p = 0.043), peroneal and sural amplitude (r = 0.36; p = 0.0017, rs = 0.26; p = 0.024) and conduction velocity (rs = 0.28; p = 0.015, r = 0.23; p = 0.050). Linear regression adjusting for age and HbA1c, showed that for each 30-min of PA there was a 0.09mv higher peroneal amplitude (p = 0.032) and 0.048 ms lower peroneal F-wave latency (p = 0.022). CONCLUSION In longstanding T1D, PA time is associated with superior large nerve fibre function in the lower limbs and some better measures of small nerve fibre function.
Collapse
Affiliation(s)
- Evan J H Lewis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Leif E Lovblom
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sebastien Lanctot
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daniel Scarr
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nancy Cardinez
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Genevieve Boulet
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto. Toronto, Ontario, Canada
| | - Alanna Weisman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto. Toronto, Ontario, Canada
| | - Julie A Lovshin
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto. Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, University of Toronto. Toronto, Ontario, Canada
| | - Yuliya Lytvyn
- Division of Nephrology, Department of Medicine, University of Toronto. Toronto, Ontario, Canada
| | | | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, Department of Medicine, University of Toronto. Toronto, Ontario, Canada
| | - Narinder Paul
- Joint Department of Medical Imaging, Division of Cardiothoracic Radiology, University Health Network, Toronto, Ontario, Canada
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University of Toronto. Toronto, Ontario, Canada
| | - Vera Bril
- The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto. Toronto, Ontario, Canada
| |
Collapse
|
11
|
Abdelaal AA, El-Shamy SM. Effect of lower body positive pressure aerobic training on fall risk in patients with diabetic polyneuropathy: randomized controlled trial. Eur J Phys Rehabil Med 2022; 58:33-42. [PMID: 34636527 PMCID: PMC9980519 DOI: 10.23736/s1973-9087.21.06847-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Retarded task-oriented gait, balance performance and increased fall risk are among the most debilitating problems in patients with diabetic polyneuropathy (DPN). The lower body positive pressure (LBPP) training was recently introduced in the field of rehabilitation, but evaluating the effects of the LBPP on gait, balance and fall risk in patients with DPN has not been thoroughly investigated. AIM The aim of this study was to evaluate the effect of LBPP treadmill training program on task-oriented gait, balance performance and fall risk in patients with DPN. DESIGN Single-blinded, randomized-controlled trial. SETTING Rehabilitative outpatient unit. POPULATION Sixty-two patients with DPN were randomly assigned into 5-groups; group-A (100% weight-bearing; N.=12), group-B (75% weight-bearing; N.=13), group-C (50% weight-bearing; N.=13), group-D (25% weight-bearing; N.=12) and group-E (control group; N.=12). METHODS The intervention groups (A, B, C, D) received moderate intensity aerobic exercise training (AET) program (30-45 minutes, 50-70% heart rate reserve) on the AlterG (AlterG, Inc., Fremont, CA, USA) treadmill for 12-weeks. Task-oriented gait, balance performance and the fall risk were evaluated at baseline (evaluation-1), after 12-weeks (evaluation-2) and 12-weeks poststudy cessation (evaluation-3; follow-up) for all groups using the Tinetti balance assessment tool. RESULTS At evaluation-2, there were significant "within-groups" increases in the balance, gait and fall risk scores. There were significant "between-groups" differences in the same evaluated variables, with the highest increases were in group-B (P<0.05). At evaluation-3, there was a decline in the mean values of the evaluated variables, but still significant increases in the mean values of balance, gait and fall risk compared to the baseline mean values. There were significant "between-groups" differences in all variables, with the highest increases were in group-B (P<0.05). CONCLUSIONS Moderate intensity LBPP treadmill training program can effectively improve task-oriented gait, balance performance, and fall risk scores in patients with DPN. The 25% off-loading weight percentage during the LBPP treadmill training program yielded the most favorable short and long-term improvements compared to the other weight off-loading percentages in patients with DPN. CLINICAL REHABILITATION IMPACT The LBPP aerobic training program is an effective rehabilitation procedure in patients with DPN especially when utilizing the 25% off-loading weight percentage during the LBPP treadmill training program.
Collapse
Affiliation(s)
- Ashraf A Abdelaal
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia -
| | - Shamekh M El-Shamy
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| |
Collapse
|
12
|
Abdelaal A, El-Shamy S. Effect of Antigravity Treadmill Training on Gait and Balance in Patients with Diabetic Polyneuropathy: A Randomized Controlled Trial. F1000Res 2022; 11:52. [PMID: 36606118 PMCID: PMC9763767 DOI: 10.12688/f1000research.75806.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Diabetic polyneuropathy (DPN) is the most prevalent consequence of diabetes mellitus, and it has a significant impact on the patient's health. This study aims to evaluate effects of antigravity treadmill training on gait and balance in patients with DPN. Methods: The study included 45 males with type 2 diabetes who were randomly assigned to one of two groups: the experimental group (n=23) or the control group (n=22). For a period of 12 weeks, the experimental group received antigravity treadmill training (75% weight bearing, 30 min per session, three times per week) combined with traditional physical therapy. During the same time period, the control group received only traditional physical therapy. The Biodex Balance System was used to assess postural stability indices, while the GAITRite Walkway System was used to assess spatiotemporal gait parameters. All measurements were obtained before and at the end of the study after 12 weeks of treatment. Results: The mean values of all measured variables improved significantly in both groups (P<0.05), with the experimental group showing significantly greater improvements than the control group. The post-treatment gait parameters ( i.e., step length, step time, double support time, velocity, and cadence) were 61.3 cm, 0.49 sec, 0.25 sec, 83.09 cm/sec, and 99.78 steps/min as well as 56.14 cm, 0.55 sec, 0.29 sec, 75.73 cm/sec, and 88.14 steps/min for the experimental and control group, respectively. The post-treatment overall stability index was 0.32 and 0.70 for the experimental and control group, respectively. Conclusions: Antigravity treadmill training in combination with traditional physical therapy appears to be superior to traditional physical therapy alone in terms of gait and balance training. As a result, the antigravity treadmill has been found to be an effective device for the rehabilitation of DPN patients.
Collapse
Affiliation(s)
- Ashraf Abdelaal
- Physical Therapy, Umm-Al-Qura University, Makkah, 715, Saudi Arabia
| | - Shamekh El-Shamy
- Physical Therapy, Umm-Al-Qura University, Makkah, 715, Saudi Arabia
| |
Collapse
|
13
|
Abdelaal A, El-Shamy S. Effects of Antigravity Treadmill Training on Gait and Balance in Patients with Diabetic Polyneuropathy: A Randomized Controlled Trial. F1000Res 2022; 11:52. [PMID: 36606118 PMCID: PMC9763767 DOI: 10.12688/f1000research.75806.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/02/2023] Open
Abstract
Background: Diabetic polyneuropathy (DPN) is the most prevalent consequence of diabetes mellitus, and it has a significant impact on the patient's health. This study aims to evaluate effects of antigravity treadmill training on gait and balance in patients with DPN. Methods: The study included 45 males with type 2 diabetes who were randomly assigned to one of two groups: the experimental group (n=23) or the control group (n=22). For a period of 12 weeks, the experimental group received antigravity treadmill training (75% weight bearing, 30 min per session, three times per week) combined with traditional physical therapy. During the same time period, the control group received only traditional physical therapy. The Biodex Balance System was used to assess postural stability indices, while the GAITRite Walkway System was used to assess spatiotemporal gait parameters. All measurements were obtained before and at the end of the study after 12 weeks of treatment. Results: The mean values of all measured variables improved significantly in both groups (P<0.05), with the experimental group showing significantly greater improvements than the control group. The post-treatment gait parameters ( i.e., step length, step time, double support time, velocity, and cadence) were 61.3 cm, 0.49 sec, 0.25 sec, 83.09 cm/sec, and 99.78 steps/min as well as 56.14 cm, 0.55 sec, 0.29 sec, 75.73 cm/sec, and 88.14 steps/min for the experimental and control group, respectively. The post-treatment overall stability index was 0.32 and 0.70 for the experimental and control group, respectively. Conclusions: Antigravity treadmill training in combination with traditional physical therapy appears to be superior to traditional physical therapy alone in terms of gait and balance training. As a result, the antigravity treadmill has been found to be an effective device for the rehabilitation of DPN patients.
Collapse
Affiliation(s)
- Ashraf Abdelaal
- Physical Therapy, Umm-Al-Qura University, Makkah, 715, Saudi Arabia
| | - Shamekh El-Shamy
- Physical Therapy, Umm-Al-Qura University, Makkah, 715, Saudi Arabia
| |
Collapse
|
14
|
Abdelaal A, El-Shamy S. Effect of Antigravity Treadmill Training on Gait and Balance in Patients with Diabetic Polyneuropathy: A Randomized Controlled Trial. F1000Res 2022; 11:52. [PMID: 36606118 PMCID: PMC9763767 DOI: 10.12688/f1000research.75806.2] [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] [Accepted: 03/23/2022] [Indexed: 11/02/2023] Open
Abstract
Background: Diabetic polyneuropathy (DPN) is the most prevalent consequence of diabetes mellitus, and it has a significant impact on the patient's health. This study aims to evaluate effects of antigravity treadmill training on gait and balance in patients with DPN. Methods: The study included 45 males with type 2 diabetes who were randomly assigned to one of two groups: the experimental group (n=23) or the control group (n=22). For a period of 12 weeks, the experimental group received antigravity treadmill training (75% weight bearing, 30 min per session, three times per week) combined with traditional physical therapy. During the same time period, the control group received only traditional physical therapy. The Biodex Balance System was used to assess postural stability indices, while the GAITRite Walkway System was used to assess spatiotemporal gait parameters. All measurements were obtained before and at the end of the study after 12 weeks of treatment. Results: The mean values of all measured variables improved significantly in both groups (P<0.05), with the experimental group showing significantly greater improvements than the control group. The post-treatment gait parameters ( i.e., step length, step time, double support time, velocity, and cadence) were 61.3 cm, 0.49 sec, 0.25 sec, 83.09 cm/sec, and 99.78 steps/min as well as 56.14 cm, 0.55 sec, 0.29 sec, 75.73 cm/sec, and 88.14 steps/min for the experimental and control group, respectively. The post-treatment overall stability index was 0.32 and 0.70 for the experimental and control group, respectively. Conclusions: Antigravity treadmill training in combination with traditional physical therapy appears to be superior to traditional physical therapy alone in terms of gait and balance training. As a result, the antigravity treadmill has been found to be an effective device for the rehabilitation of DPN patients.
Collapse
Affiliation(s)
- Ashraf Abdelaal
- Physical Therapy, Umm-Al-Qura University, Makkah, 715, Saudi Arabia
| | - Shamekh El-Shamy
- Physical Therapy, Umm-Al-Qura University, Makkah, 715, Saudi Arabia
| |
Collapse
|
15
|
Singleton JR, Foster-Palmer S, Marcus RL. Exercise as Treatment for Neuropathy in the Setting of Diabetes and Prediabetic Metabolic Syndrome: A Review of Animal Models and Human Trials. Curr Diabetes Rev 2022; 18:e230921196752. [PMID: 34561989 DOI: 10.2174/1573399817666210923125832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/21/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peripheral neuropathy is among the most common complications of diabetes, but a phenotypically identical distal sensory predominant, painful axonopathy afflicts patients with prediabetic metabolic syndrome, exemplifying a spectrum of risk and continuity of pathogenesis. No pharmacological treatment convincingly improves neuropathy in the setting of metabolic syndrome, but evolving data suggest that exercise may be a promising alternative. OBJECTIVE The aim of the study was to review in depth the current literature regarding exercise treatment of metabolic syndrome neuropathy in humans and animal models, highlight the diverse mechanisms by which exercise exerts beneficial effects, and examine adherence limitations, safety aspects, modes and dose of exercise. RESULTS Rodent models that recapitulate the organismal milieu of prediabetic metabolic syndrome and the phenotype of its neuropathy provide a strong platform to dissect exercise effects on neuropathy pathogenesis. In these models, exercise reverses hyperglycemia and consequent oxidative and nitrosative stress, improves microvascular vasoreactivity, enhances axonal transport, ameliorates the lipotoxicity and inflammatory effects of hyperlipidemia and obesity, supports neuronal survival and regeneration following injury, and enhances mitochondrial bioenergetics at the distal axon. Prospective human studies are limited in scale but suggest exercise to improve cutaneous nerve regenerative capacity, neuropathic pain, and task-specific functional performance measures of gait and balance. Like other heath behavioral interventions, the benefits of exercise are limited by patient adherence. CONCLUSION Exercise is an integrative therapy that potently reduces cellular inflammatory state and improves distal axonal oxidative metabolism to ameliorate features of neuropathy in metabolic syndrome. The intensity of exercise need not improve cardinal features of metabolic syndrome, including weight, glucose control, to exert beneficial effects.
Collapse
Affiliation(s)
| | | | - Robin L Marcus
- Department Physical Therapy and Athletic Training, University of Utah, UT, United States
| |
Collapse
|
16
|
Gialanella B, Prometti P, Comini L, Monguzzi V, Santoro R. Predictive factors of functional abilities in older patients with peripheral neuropathy. Aging Clin Exp Res 2022; 34:193-199. [PMID: 34258734 DOI: 10.1007/s40520-021-01910-2] [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: 02/13/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Little is known about the outcome predictors in peripheral neuropathy (PN). This prospective observational study aimed to identify possible factors predicting the functional abilities in older patients with PN undergoing motor rehabilitation. METHODS Data were collected in 80 PN patients, aged over 65 years, performing a standard inpatient motor rehabilitation program. The total Functional Independence Measure (FIM) score after rehabilitation, as well as efficiency and effectiveness in total-FIM, were the outcome measures. Backward multiple regression analyses identified the predictors of functional status. RESULTS At the end of rehabilitation, total-FIM score was 102.66 ± 10.75, efficiency in total-FIM 0.64 ± 0.29 and effectiveness in total-FIM 48.81 ± 15.35%. Katz index at admission was a predictor of the final total-FIM score (beta 0.46, p < 0.001) and efficiency in total-FIM (beta - 0.38, p = 0.001). Conversely, age was a predictor of the final total-FIM score (beta - 0.31, p = 0.002) and effectiveness in total-FIM (beta - 0.49, p < 0.001). The R2 values of the models were, respectively, 0.39, 0.15, and 0.24. DISCUSSION In PN patients, functional impairment at admission and age are important predictors of functional abilities at the end of rehabilitation. CONCLUSIONS These findings suggest the need for more intensive rehabilitation in older, more disabled PN patients because they risk achieving lower functional levels with standard rehabilitation programs.
Collapse
Affiliation(s)
- Bernardo Gialanella
- Istituti Clinici Scientifici Maugeri IRCCS, Operative Unit for Recovery and Functional Rehabilitation of the Institute of Lumezzane, Via G. Mazzini 129, Lumezzane, Brescia, Italy.
| | - Paola Prometti
- Istituti Clinici Scientifici Maugeri IRCCS, Operative Unit for Recovery and Functional Rehabilitation of the Institute of Lumezzane, Via G. Mazzini 129, Lumezzane, Brescia, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Vittoria Monguzzi
- Istituti Clinici Scientifici Maugeri IRCCS, Operative Unit for Recovery and Functional Rehabilitation of the Institute of Lissone, Monza-Brianza, Italy
| | - Raffaele Santoro
- Istituti Clinici Scientifici Maugeri IRCCS, Operative Unit for Recovery and Functional Rehabilitation of the Institute of Lumezzane, Via G. Mazzini 129, Lumezzane, Brescia, Italy
| |
Collapse
|
17
|
The Application of Exercise Training for Diabetic Peripheral Neuropathy. J Clin Med 2021; 10:jcm10215042. [PMID: 34768562 PMCID: PMC8584831 DOI: 10.3390/jcm10215042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes. It is associated with pain, paresthesia, sensory loss, muscle atrophy with fat infiltration, and muscular dysfunction typically starting distally in the feet and progressing proximally. Muscle deterioration within the leg and foot can lead to muscle dysfunction, reduced mobility, and increases the risk of disability, ulceration, and amputation. Exercise training is an established method for increasing the different components of physical fitness, including enhancing body composition and improving neuromuscular strength. A number of experimental studies have utilized exercise training to treat various impairments associated with DPN, such as nerve conduction velocity, pain tolerance, and balance. However, the broad spectrum of exercise training modalities implemented and differences in target outcome measurements have made it difficult to understand the efficacy of exercise training interventions or provide appropriate exercise prescription recommendations. Therefore, the aims of this review were to (1) briefly describe the pathophysiology of DPN and (2) discuss the effects of exercise training interventions on sensorimotor, metabolic, and physical functions in people with DPN.
Collapse
|
18
|
Jafarnezhadgero A, Mamashli E, Granacher U. An Endurance-Dominated Exercise Program Improves Maximum Oxygen Consumption, Ground Reaction Forces, and Muscle Activities in Patients With Moderate Diabetic Neuropathy. Front Physiol 2021; 12:654755. [PMID: 33868023 PMCID: PMC8044992 DOI: 10.3389/fphys.2021.654755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background The prevalence of diabetes worldwide is predicted to increase from 2.8% in 2000 to 4.4% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility. Objective We aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN. Methods Sixty male and female individuals aged 45–65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40–55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s. Results No statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p < 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p < 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001–0.037; d = 0.56–1.53). For IG, post-hoc analyses showed decreases in peak lateral (p < 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p < 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001–0.044; d = 0.54–0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p < 0.001; d = 1.28). Conclusions This study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.
Collapse
Affiliation(s)
- AmirAli Jafarnezhadgero
- Department of Sport Management and Biomechanics, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Elahe Mamashli
- Department of Sport Management and Biomechanics, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
| |
Collapse
|
19
|
Zouita S, Zouhal H, Ferchichi H, Paillard T, Dziri C, Hackney AC, Laher I, Granacher U, Ben Moussa Zouita A. Effects of Combined Balance and Strength Training on Measures of Balance and Muscle Strength in Older Women With a History of Falls. Front Physiol 2020; 11:619016. [PMID: 33424642 PMCID: PMC7786296 DOI: 10.3389/fphys.2020.619016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/07/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We investigated the effects of combined balance and strength training on measures of balance and muscle strength in older women with a history of falls. METHODS Twenty-seven older women aged 70.4 ± 4.1 years (age range: 65 to 75 years) were randomly allocated to either an intervention (IG, n = 12) or an active control (CG, n = 15) group. The IG completed 8 weeks combined balance and strength training program with three sessions per week including visual biofeedback using force plates. The CG received physical therapy and gait training at a rehabilitation center. Training volumes were similar between the groups. Pre and post training, tests were applied for the assessment of muscle strength (weight-bearing squat [WBS] by measuring the percentage of body mass borne by each leg at different knee flexions [0°, 30°, 60°, and 90°], sit-to-stand test [STS]), and balance. Balance tests used the modified clinical test of sensory interaction (mCTSIB) with eyes closed (EC) and opened (EO), on stable (firm) and unstable (foam) surfaces as well as spatial parameters of gait such as step width and length (cm) and walking speed (cm/s). RESULTS Significant group × time interactions were found for different degrees of knee flexion during WBS (0.0001 < p < 0.013, 0.441 < d < 0.762). Post hoc tests revealed significant pre-to-post improvements for both legs and for all degrees of flexion (0.0001 < p < 0.002, 0.697 < d < 1.875) for IG compared to CG. Significant group × time interactions were found for firm EO, foam EO, firm EC, and foam EC (0.006 < p < 0.029; 0.302 < d < 0.518). Post hoc tests showed significant pre-to-post improvements for both legs and for all degrees of oscillations (0.0001 < p < 0.004, 0.753 < d < 2.097) for IG compared to CG. This study indicates that combined balance and strength training improved percentage distribution of body weight between legs at different conditions of knee flexion (0°, 30°, 60°, and 90°) and also decreased the sway oscillation on a firm surface with eyes closed, and on foam surface (with eyes opened or closed) in the IG. CONCLUSION The higher positive effects of training seen in standing balance tests, compared with dynamic tests, suggests that balance training exercises including lateral, forward, and backward exercises improved static balance to a greater extent in older women.
Collapse
Affiliation(s)
- Sghaier Zouita
- Higher Institute of Sport and Physical Education, Ksar-said, University of Manouba, Manouba, Tunisia
| | - Hassane Zouhal
- M2S (Laboratoire Mouvement, Sport, Santé), University of Rennes, Rennes, France
| | - Habiba Ferchichi
- Department of Medicine Physical and Functional Rehabilitation of the National Institute of Orthopedics “M.T. Kassab”, Tunis, Tunisia
| | - Thierry Paillard
- Movement, Balance, Performance and Health Laboratory, Tarbes, E2S/University of Pau and Pays de l’Adour, Pau, France
| | - Catherine Dziri
- Department of Medicine Physical and Functional Rehabilitation of the National Institute of Orthopedics “M.T. Kassab”, Tunis, Tunisia
| | - Anthony C. Hackney
- Department of Exercise and Sport Science, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Urs Granacher
- Division of Training and Movement Science, University of Potsdam, Potsdam, Germany
| | - Amira Ben Moussa Zouita
- Higher Institute of Sport and Physical Education, Ksar-said, University of Manouba, Manouba, Tunisia
| |
Collapse
|
20
|
Rippetoe J, Wang H, James SA, Dionne C, Block B, Beckner M. Improvement of Gait after 4 Weeks of Wearable Focal Muscle Vibration Therapy for Individuals with Diabetic Peripheral Neuropathy. J Clin Med 2020; 9:E3767. [PMID: 33266464 PMCID: PMC7700661 DOI: 10.3390/jcm9113767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
People with diabetic peripheral neuropathy (DPN) experience lower quality of life caused by associated balance, posture, and gait impairments. While focal muscle vibration (FMV) has been associated with improvements in gait performance in individuals with neurological disorders, little is known about its effectiveness in patients with DPN. The purpose of this study was to investigate the effect of FMV on gait outcomes in patients with DPN. The authors randomized 23 participants into three FMV intervention groups depending upon the delivery of vibration. Participants applied wearable FMV to the bilateral quadriceps, gastrocnemius, and tibialis anterior, 10 min per muscle, three times per week over a four-week period. Spatiotemporal, kinematic, and kinetic gait parameters at baseline and post-intervention were calculated and analyzed. Gait speed, cadence, stride time, left and right stance time, duration of double limb support, and left and right knee flexor moments significantly improved after four weeks of FMV. Trends toward significant improvements were noted in maximum left and right knee flexion. Results indicate that FMV therapy was associated with improvements in gait parameters in individuals with DPN, warranting expanded study of FMV therapy for long-term gait performance improvement in these individuals.
Collapse
Affiliation(s)
- Josiah Rippetoe
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| | - Hongwu Wang
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
- Peggy and Charles Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Shirley A. James
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| | - Carol Dionne
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| | - Bethany Block
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| | - Matthew Beckner
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| |
Collapse
|