In the Journals

Multicomponent training improves balance, strength in type 2 diabetes, peripheral neuropathy

A targeted multicomponent program that includes functional strengthening exercises, walking, aerobics or tai chi can improve balance and strength for adults with type 2 diabetes and peripheral neuropathy, but long-term data are insufficient to determine whether any improvements reduce the risk for falls, according to researchers.

In a meta-analysis of 10 studies investigating the effects of exercise training on fall risk in patients with type 2 diabetes and peripheral neuropathy, researchers noted that, among the studies conducting strength exercises, only two measured fall risk as an outcome measure, with one study reporting insignificant results.

“The complex nature of [diabetic peripheral neuropathy] and a lack of guidelines in falls prevention for people with [diabetic peripheral neuropathy] means that it is not clear if falls prevention exercises are effective in improving balance and reducing falls risk in this population,” wrote Yu Gu, BAppSci, of the faculty of health sciences, and Sarah M. Dennis, MSc, PhD, senior lecturer in physiotherapy, both at the University of Sydney. “The aim of this systematic review was to determine whether falls prevention exercises improve the muscle strength and balance of people with [type 2 diabetes] and [diabetic peripheral neuropathy].”

Gu and Dennis analyzed data from six randomized controlled trials, one quasi-experimental trial, one case study and two nonrandomized controlled trials that included patients with type 2 diabetes and peripheral neuropathy. Patients were assigned lower-limb strengthening exercises (weight-bearing or non-weight-bearing), balance exercises, walking programs and tai chi. Studies were conducted between 2000 and 2014.

Eight of the 10 studies included lower-limb strengthening and balance exercises as components of the interventions; one used a strength training machine and nine included functional strengthening exercises, such as sit-to-stand, squats and step-ups. Balance interventions included machine-based or functional balance training and tai chi. Researchers found that evidence from three of the randomized controlled trials showed no difference in muscle strength with lower-limb exercises when comparing the intervention group with an active-control group; two other trials that compared the lower-limb intervention with non-exercise programs (such as education) showed mixed results. One study showed improvements in hip strength that persisted at 6-month follow-up; another showed improvement in ankle power with lower-limb training.

In two studies using tai chi intervention, researchers observed improvements in both single-leg stance vs. controls and improvements vs. controls in health-related quality of life in the domains of physical role limitation and social functioning.

Among interventions that included a walking program (either with treadmill or ground walking), researchers observed that participants demonstrated improvements in reaction time, balance, gait velocity and gait variability.

The researchers noted that the included studies demonstrated that patients with diabetic neuropathy could substantially improve muscle strength or peak power in the short term after a targeted training program, and that the programs were well tolerated despite decreased nerve innervation to peripheral muscles.

“However, limited evidence indicates that there was loss of benefit with longer follow-up durations,” the researchers wrote. – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.

A targeted multicomponent program that includes functional strengthening exercises, walking, aerobics or tai chi can improve balance and strength for adults with type 2 diabetes and peripheral neuropathy, but long-term data are insufficient to determine whether any improvements reduce the risk for falls, according to researchers.

In a meta-analysis of 10 studies investigating the effects of exercise training on fall risk in patients with type 2 diabetes and peripheral neuropathy, researchers noted that, among the studies conducting strength exercises, only two measured fall risk as an outcome measure, with one study reporting insignificant results.

“The complex nature of [diabetic peripheral neuropathy] and a lack of guidelines in falls prevention for people with [diabetic peripheral neuropathy] means that it is not clear if falls prevention exercises are effective in improving balance and reducing falls risk in this population,” wrote Yu Gu, BAppSci, of the faculty of health sciences, and Sarah M. Dennis, MSc, PhD, senior lecturer in physiotherapy, both at the University of Sydney. “The aim of this systematic review was to determine whether falls prevention exercises improve the muscle strength and balance of people with [type 2 diabetes] and [diabetic peripheral neuropathy].”

Gu and Dennis analyzed data from six randomized controlled trials, one quasi-experimental trial, one case study and two nonrandomized controlled trials that included patients with type 2 diabetes and peripheral neuropathy. Patients were assigned lower-limb strengthening exercises (weight-bearing or non-weight-bearing), balance exercises, walking programs and tai chi. Studies were conducted between 2000 and 2014.

Eight of the 10 studies included lower-limb strengthening and balance exercises as components of the interventions; one used a strength training machine and nine included functional strengthening exercises, such as sit-to-stand, squats and step-ups. Balance interventions included machine-based or functional balance training and tai chi. Researchers found that evidence from three of the randomized controlled trials showed no difference in muscle strength with lower-limb exercises when comparing the intervention group with an active-control group; two other trials that compared the lower-limb intervention with non-exercise programs (such as education) showed mixed results. One study showed improvements in hip strength that persisted at 6-month follow-up; another showed improvement in ankle power with lower-limb training.

In two studies using tai chi intervention, researchers observed improvements in both single-leg stance vs. controls and improvements vs. controls in health-related quality of life in the domains of physical role limitation and social functioning.

Among interventions that included a walking program (either with treadmill or ground walking), researchers observed that participants demonstrated improvements in reaction time, balance, gait velocity and gait variability.

The researchers noted that the included studies demonstrated that patients with diabetic neuropathy could substantially improve muscle strength or peak power in the short term after a targeted training program, and that the programs were well tolerated despite decreased nerve innervation to peripheral muscles.

“However, limited evidence indicates that there was loss of benefit with longer follow-up durations,” the researchers wrote. – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.