Sensorimotor and gait training improves proprioception, nerve function, and muscular activation in patients with diabetic peripheral neuropathy: a randomized control trial.

OBJECTIVES: To examine the effect of sensorimotor and gait training on proprioception, nerve function, and muscle activation in diabetic peripheral neuropathy (DPN) patients. METHODS: Thirty-eight (25 male and 13 female) participants with DPN were selected and randomly allocated to intervention and control group. Participants in the intervention group were provided sensorimotor and gait training for eight weeks (3 days/week) along with diabetes and foot care education; participants in the control group received diabetes and foot care education only. Outcome measures involved proprioception, nerve conduction studies of peroneal and tibial nerve, and activation of lower limb muscles and multifidus while standing with eyes open and eyes closed, and treadmill walking. RESULTS: Mixed ANOVA revealed significant time effect and time×group interaction of proprioception in all four directions (p<0.05). The conduction velocity of peroneal nerve revealed significant time effect (p=0.007) and time×group interaction (p=0.022). Interaction effect was found to be significant for medial gastrocnemius and multifidus while standing with eyes open as well as with eyes closed (p≤0.004). Only multifidus showed significant group (p=0.002) and interaction effect (p=0.003) during walking. CONCLUSIONS: Sensorimotor and gait training is an effective tool for improvement of proprioception and nerve function. It benefits muscle activation around ankle and multifidus during postural control and walking in DPN patients. Clinical Trials Registry - India, National Institute of Medical Statistics (Indian Council of Medical Research): Registration Number - CTRI/2017/08/009328.

Resistance Training Leads to Clinically Meaningful Improvements in Control of Glycemia and Muscular Strength in Untrained Middle-aged Patients with type 2 Diabetes Mellitus.

BACKGROUND: Previous studies in diverse ethnic groups have reported that progressive resistance training is effective for glycemic control. However, it is unknown whether this form of exercise therapy leads to clinically meaningful changes in metabolic, cardiovascular and anthropometric parameters in Asian Indians. AIM: The study was designed to investigate the efficacy of progressive resistance training on glycemic, musculoskeletal, anthropometric and cardiovascular variables in untrained middle-aged type 2 diabetic patients living in North India. MATERIALS AND METHODS: Forty-eight untrained patients, 35 men and 13 women (mean ± SD age, 44.7 ± 4.2 years), with a diagnosis of type 2 diabetes were randomly divided into 2 groups: A group receiving progressive resistance training and a control group who provided participative involvement. The primary outcomes were glycemic control and muscle strength. Additionally, anthropometric and cardiovascular risk parameters were evaluated at baseline and after intervention or control program at 8 weeks. RESULTS: Mixed ANOVA revealed a significant group-by-time interaction for the main outcomes of the study. Change in glycosylated hemoglobin was mean ± SD, 0.6 ± 0.5 in progressive resistance training group compared to no change in control group (P < .001). Progressive resistance training group showed a greater improvement in upper and lower body muscle strength (P < .001), waist circumference (P = .008), and high density lipoprotein cholesterol (P = .004). However, no significant group-by-time interaction was detected on body weight, total cholesterol, triglycerides, low density lipoprotein cholesterol, and systolic and diastolic blood pressure. CONCLUSIONS: A short-term progressive resistance training program leads to clinically meaningful improvements in glycemic control and muscle strength in untrained middle-aged type 2 diabetic patients of Asian Indian ethnicity.

Reliability of 1-repetition maximum estimation for upper and lower body muscular strength measurement in untrained middle aged type 2 diabetic patients.

PURPOSE: The 1-repetition maximum (1-RM) test is the gold standard test for evaluating maximal dynamic strength of groups of muscles. However, safety of actual 1-RM testing is questionable in clinical situations such as type 2 diabetes (T2D), where an estimated 1-RM test is preferred. It is unclear if acceptable test retest reliability exists for the estimated 1-RM test in middle aged T2D patients. This study examined the reliability of the estimated 1-RM strength test in untrained middle aged T2D subjects. METHODS: Twenty five untrained diabetic males (n=19) and females (n=6) aged 40.7+0.4 years participated in the study. Participants undertook the first estimated 1-RM test for five exercises namely supine bench press, leg press, lateral pull, leg extension and seated biceps curls. A familiarisation session was provided three to five days before the first test. 1-RM was estimated for all participants by Brzycki 1-RM prediction equation. Another identical 1-RM estimation procedure occurred one week after first test. Intraclass correlation coefficients (ICC), paired t-test, standard error of measurement (SEM), Bland-Altman plots, and estimation of 95% CI were used to assess reliability. RESULTS: Test-retest reliability was excellent (ICC(2,1)=0.98-0.99) for all measurements with the highest for leg extension (ICC(2,1)=0.99). The SEM was lowest for lateral pull and leg extension exercises. Paired t-tests showed non-significant differences between the means of 2 sessions across three of five exercises. CONCLUSIONS: The study findings suggest that estimation of 1-RM is reliable for upper and lower body muscular strength measurement in untrained middle aged T2D patients.