Supervised structured exercise training for people with diabetic peripheral neuropathy: A randomised control trial
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Publication: Journal of Science and Medicine in Sport
Start Page: e95
Introduction: Diabetic Peripheral Neuropathy (DPN) is a serious complication that affects approximately one half of people with diabetes mellitus. DPN is an established risk factor for ulceration and lower limb amputation. Recent quasi-experimental studies provide low-level evidence to support the beneficial effects of exercise on neuropathic symptoms in patients with DPN. The aim of this randomised control trial was to compare the effectiveness of supervised exercise training with an education program on markers of neuropathy for people with DPN.
Methods: Twenty-four participants with DPN (54% male; age: 71Â±2 y; duration of diabetes: 12Â±2 y) were randomly allocated to either exercise training (exercise) or an education program (education). The exercise group received 3 supervised sessions of low- to moderate-intensity combined aerobic and resistance exercise per week for 8 weeks. The education group received weekly diabetes education sessions for 8 weeks. The primary outcome measure was the Michigan Neuropathy Screening Instrument (clinical signs, score out of 8 and self-reported symptoms, score out of 13). Secondary outcome measures included vibratory perception threshold (VPT) and cardiorespiratory fitness, estimated using a sub-maximal cycle assessment. Baseline and post-intervention values were analysed using mixed-model repeated measures ANOVAs (between: group; within: time).
Results: Ten participants in the exercise group and 12 participants in the education group completed the experimental requirements and were included in the analysis. No adverse responses were reported during either intervention. Although the baseline to post-intervention mean differences were greater in exercise when compared to education for all outcome measures, the pattern of response in the primary or secondary outcomes did not differ between interventions (groupÃ—time interaction effect: pâ‰¥0.26). Significant improvements were observed in baseline to post-intervention values (main effect of time) for all outcome measures. MNSI clinical signs decreased from 4.5 to 3.5 (MD: 1.0, 95%CI: 0.4-1.7; p < 0.01; h2 = 0.36) and MNSI symptoms reduced from 4.8 to 3.6 (MD: 1.1, 95%CI: 0.3-1.9; p < 0.01; h2 = 0.31). VPT improved from 36.8 to 32.5V (MD: 4.2, 95%CI: 0.4-8.0; p = 0.03; h2 = 0.21) and estimated peak oxygen uptake increased from 19.3 to 21.5 ml/kg/min (MD: 2.2, 95%CI: 0.2-4.2; p = 0.03; h2 = 0.24).
Discussion: The results demonstrate that eight weeks of exercise training or lifestyle education can improve neuropathic signs and symptoms in patients with DPN. These findings provide additional support for lifestyle interventions in patients with DPN.