Skip to main content

Advertisement

SpringerLink
Log in

Effect of an Exercise Program on the Balance, Gait, Vibration Sense, and Cardiometabolic Parameters Among Patients with Diabetic Peripheral Neuropathy: a Randomized Controlled Trial

  • Original Paper
  • Published:
SN Comprehensive Clinical Medicine Aims and scope Submit manuscript

Abstract

This study was conducted to assess the effect of an exercise program on balance measurements, vibration sense, and walking speed as well as cardiometabolic parameters in patients with diabetic peripheral neuropathy (DPN). The pre- and post-testing designs were used in this randomized clinical trial with 44 patients with DPN who were randomly assigned to equal control and exercise groups (n = 22). The intervention was an 8-week program comprising balance exercise and proprioceptive exercise in 3 sessions per week. The hemoglobin A1C (HbA1c), fasting plasma glucose (FPG), triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), balance, vibration sense, and walking speed were assessed. The time up and go (TUG) test and the Berg balance scale were used to measure dynamic and static balance. We applied analysis of covariance (ANCOVA) to test the comparison of all parameters between the two groups at the end of the study after adjusting for their baseline. We observed significantly improved vibration sense and walking speed in the exercise group compared to the control group. We also observed a significant decrease in TUG, body weight, FPG, LDL-C, TC, and triglycerides and a significant increase in HDL-C levels after 8 weeks of exercise in the intervention group compared to the control one. The results showed the exercise program improved balance and vibration sense, walking speed, lipid profile, and body weight as well as FPG in patients with DPN. It seems that this exercise program is appropriate and can be an influential factor in the management of these patients, along with medication. IRCT2017022231875N3. First registration date was 03/04/2017.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

All data used during the current study are available from the corresponding author on reasonable request.

Code Availability

Not applicable.

Abbreviations

DM :

diabetes mellitus;

DPN :

diabetic peripheral neuropathy

CNS :

central nervous system

MNSI :

Michigan neuropathy screening instrument

TUG :

timed up and go

BBS :

Berg balance scale

VBS :

vibration sense

FPG :

fasting plasma glucose

TC :

total cholesterol

HbA1c :

hemoglobin A1c

SD :

standard deviation

ANCOVA :

one-way analysis of covariance

References

  1. Vizvari E, Farzanegi P. Abbas Zade Sourati H: Effect of vigorous aerobic exercise on serum levels of SIRT1, FGF21 and fetuin A in women with type II diabetes. Med Lab J. 2018;12:1–6.

    Article  Google Scholar 

  2. Ramezankhani A, Habibi-Moeini AS, Zadeh SS, Azizi F, Hadaegh F. Effect of family history of diabetes and obesity status on lifetime risk of type 2 diabetes in the Iranian population. J Glob Health. 2022;12.

  3. Sun J, Wang Y, Zhang X, Zhu S, He H. Prevalence of peripheral neuropathy in patients with diabetes: a systematic review and meta-analysis. Prim Care Diabetes. 2020;14(5):435–44.

    Article  PubMed  Google Scholar 

  4. Albers JW, Pop-Busui R. Diabetic neuropathy: mechanisms, emerging treatments, and subtypes. Curr Neurol Neurosci Rep. 2014;14:473.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nascimento OJ, Pupe CC, Cavalcanti EB. Diabetic Neuropathy Revista Dor. 2016;17:46–51.

    Google Scholar 

  6. Khan KS, Andersen H. The impact of diabetic neuropathy on activities of daily living, postural balance and risk of falls-a systematic review. J Diabetes Sci Technol. 2022;16:289–94.

    Article  PubMed  Google Scholar 

  7. Riandini T, Khoo EY, Tai BC, Tavintharan S, Phua MS, Chandran K, Hwang SW, Venkataraman K. Fall risk and balance confidence in patients with diabetic peripheral neuropathy: an observational study. Front Endocrinol. 2020;23(11):573804.

    Article  Google Scholar 

  8. Mustapa A, Justine M, Mohd Mustafah N, Jamil N, Manaf H. Postural control and gait performance in the diabetic peripheral neuropathy: a systematic review. Biomed Res Int. 2016;2016.

  9. Khdour MR. Treatment of diabetic peripheral neuropathy: a review. J Pharm Pharmacol. 2020;72(7):863–72.

    Article  CAS  PubMed  Google Scholar 

  10. Dixit S, Asiri F. Pharmacological and nonpharmacological therapies in the management of diabetic peripheral neuropathy in type 2 diabetes: A comprehensive review. J Cardiovasc Dis Res. 2014;5(4):37.

    Article  Google Scholar 

  11. Pattyn N, Cornelissen VA, Eshghi SR, Vanhees L. The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome: a meta-analysis of controlled trials. Sports Med. 2013;43:121–33. https://doi.org/10.1007/s40279-012-0003-z.

    Article  PubMed  Google Scholar 

  12. Akbari M, Jafari H, Moshashaee A. Forugh BJJoRR, Development: do diabetic neuropathy patients benefit from balance training? J Rehabil Res Dev. 2012;49:333–8.

    Article  PubMed  Google Scholar 

  13. Streckmann F, Zopf EM, Lehmann HC, et al. Exercise intervention studies in patients with peripheral neuropathy: a systematic review. Sports Med. 2014;44:1289–304. https://doi.org/10.1007/s40279-014-0207-5.

    Article  PubMed  Google Scholar 

  14. Saremi A, Bahrami A, Jamilian M, Moazami GP. Effects of 8 weeks pilates training on anti-Mullerian hormone level and cardiometabolic parameters in polycystic ovary syndrome women. Arak Med Univ J (AMUJ). 2014;17(9):59–69.

    Google Scholar 

  15. Dominguez-Muñoz FJ, Hernández-Mocholi MA, Manso LJ, et al. Test-retest reliability of kinematic parameters of timed up and go in people with type 2 diabetes. Appl Sci. 2019;9:4709.

    Article  Google Scholar 

  16. Kashani VO, Salmanzade M, Bahrami L. Determination of validity and reliability of the Persian version of the 9-item Berg balance scale in elderly people. Koomesh. 2018;20:25–33.

    Google Scholar 

  17. Madureira MM, Takayama L, Gallinaro A, Caparbo V, Costa R, Pereira RM. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos Int. 2007;18:419–25.

    Article  CAS  PubMed  Google Scholar 

  18. Steadman J, Donaldson N, Kalra L. A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients. J Am Geriatr Soc. 2003;51:847–52.

    Article  PubMed  Google Scholar 

  19. Song CH, Petrofsky JS, Lee SW, Lee KJ, Yim JE. Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies. Diabetes Technol Ther. 2011;13:803–11.

    Article  PubMed  Google Scholar 

  20. Espejo-Antúnez L, Pérez-Mármol JM, de los Ángeles Cardero-Durán M, Toledo-Marhuenda JV, Albornoz-Cabello M. The impact of proprioceptive exercises on balance and physical function in institutionalized older adults: a randomized controlled trial. Arch Phys Med Rehabil. 2020;101(10):1780–8.

    Article  PubMed  Google Scholar 

  21. El-Wishy A, Elsayed E. Effect of proprioceptive training program on balance in patients with diabetic neuropathy: a controlled randomized study. Bulletin of Faculty of. Phys Ther. 2012;17

  22. Ebersbach G, Edler D, Kaufhold O, Wissel J. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson’s disease. Arch Phys Med Rehabil. 2008;89:399–403.

    Article  PubMed  Google Scholar 

  23. Balducci S, Iacobellis G, Parisi L, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complicat. 2006;20:216–23.

    Article  Google Scholar 

  24. Yoo M, Sharma N, Pasnoor M, Kluding PM. Painful diabetic peripheral neuropathy: presentations, mechanisms, and exercise therapy. J Diabetes Metab. 2013;Suppl 10:005. https://doi.org/10.4172/2155-6156.S10-005.

  25. Hosseini A, Abdollahi M. Diabetic neuropathy and oxidative stress: therapeutic perspectives. Oxidative Med Cell Longev. 2013;2013.

  26. Byl N, Roderick J, Mohamed O, et al. Effectiveness of sensory and motor rehabilitation of the upper limb following the principles of neuroplasticity: patients stable poststroke. Neurorehabil Neural Repair. 2003;17:176–91. https://doi.org/10.1177/0888439003257137.

    Article  PubMed  Google Scholar 

  27. Granacher U, Gollhofer A, Strass D. Training induced adaptations in characteristics of postural reflexes in elderly men. Gait Posture. 2006;24:459–66. https://doi.org/10.1016/j.gaitpost.2005.12.007.

    Article  CAS  PubMed  Google Scholar 

  28. Nesreen G, Yasmin M, Hakem M, Sally A. Effect of pilates exercise on cardio metabolic risk factors in women with type 2 diabetes. Med J Cairo Univ. 2019;87:851–1.

    Article  Google Scholar 

  29. Cugusi L, Cadeddu C, Nocco S, et al. Effects of an aquatic-based exercise program to improve cardiometabolic profile, quality of life, and physical activity levels in men with type 2 diabetes mellitus. PM R. 2015;7:141–8.

    Article  PubMed  Google Scholar 

  30. Laddu DR, Ozemek C, Hauer TL, et al. Cardiometabolic responses to cardiac rehabilitation in people with and without diabetes. Int J Cardiol. 2020;301:156–62.

    Article  PubMed  Google Scholar 

  31. Mashrouteh M, Khanjani N. Evaluation of oral medication adherence and its related factors in type II diabetic patients in Iran: a systematic review. Int J Diabetes Res. 2017;6:24–33.

    Google Scholar 

  32. Buchner DM, Cress ME, De Lateur BJ, et al. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol Ser A Biol Med Sci. 1997;52:M218–24.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We express our appreciation to the participants of the study for their enthusiastic support and to the staff of the clinic for their valuable help. We also would like to thank Soheila Samadzadeh, a computer engineer, for her support.

Funding

This work was funded by the Golestan University of Medical Sciences, Gorgan, Iran. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.

Author information

Author notes

  1. Reyhane Hizomi Arani and Farima Fakhri contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Reyhane Hizomi Arani

  2. Department of Neurocritical Care, University of Chicago Medical Center, Chicago, IL, USA

    Farima Fakhri

  3. Faculty of Physical Education and Sport Sciences, Sanate University of Shahrood, Semnan, Iran

    Atena Shams

  4. Department of Internal Medicine, Endocrinology and Metabolic Disorders, Clinical Research Development Unit (CRDU), Sayyad Shirazi Hospital, Golestan University of Medical Sciences, Sayyad Shirazi Boulevard, Gorgan, Iran

    Maryam Zahedi

Authors
  1. Reyhane Hizomi Arani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Farima Fakhri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atena Shams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maryam Zahedi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RHA: wrote the manuscript. F.F and A.S: reviewed and edited the manuscript. M.Z designed the study and analyses the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Maryam Zahedi.

Ethics declarations

Ethics Approval

This study was approved by the Ethics Committee of the Golestan University of Medical Sciences.

Consent to Participate

Written informed consent was obtained from the patients for publication of this study. A copy of the written consent is available for review by the Series Editor of this journal.

Consent for Publication

Written informed consent was obtained from the participants for publication of this study. A copy of the written consent is available for review by the Series Editor of this journal.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Medicine

Supplementary Information

ESM 1

(DOCX 24 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hizomi Arani, R., Fakhri, F., Shams, A. et al. Effect of an Exercise Program on the Balance, Gait, Vibration Sense, and Cardiometabolic Parameters Among Patients with Diabetic Peripheral Neuropathy: a Randomized Controlled Trial. SN Compr. Clin. Med. 5, 129 (2023). https://doi.org/10.1007/s42399-023-01470-8

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s42399-023-01470-8

Keywords

Search

Navigation