Acta Diabetologica

, Volume 51, Issue 4, pp 647–654 | Cite as

Effect of supervised exercise training on musculoskeletal symptoms and function in patients with type 2 diabetes: the Italian Diabetes Exercise Study (IDES)

  • Stefano Balducci
  • Maria Chiara Vulpiani
  • Luca Pugliese
  • Valeria D’Errico
  • Stefano Menini
  • Gerardo Salerno
  • Luca Gargiulo
  • Andrea Ferretti
  • Giuseppe Pugliese
Original Article


Musculoskeletal disorders are common in subjects with type 2 diabetes mellitus (T2DM) and may represent a barrier to physical activity (PA). In the Italian Diabetes and Exercise Study, we assessed whether a strategy aimed at minimizing the risk of injury and worsening of musculoskeletal symptoms favors participation in exercise training and results in improvements in joint-specific functional scores, along with amelioration of metabolic profile. Sedentary patients with T2DM (n = 606) from 22 outpatient diabetes clinics were randomized to twice-a-week supervised aerobic and resistance training plus exercise counseling (EXE) versus counseling alone (CON) for 12 months. Musculoskeletal symptoms were evaluated at baseline in the entire cohort by the use of a self-reported questionnaire in order to design tailored exercise programs with exclusion of painful segments, and validated joint-specific scores were calculated at the end of study in a subgroup of CON (n = 65) and EXE subjects (n = 62). Musculoskeletal symptoms were present in more than ¾ of EXE and CON subjects. Yet, volumes of non-supervised PA were high, whereas dropout rates and adverse events were low in both groups. Moreover, in the EXE group, no difference was observed between patients with and without symptoms in session attendance and PA/exercise volume. Scores for symptoms and functional status of limbs and spine were significantly better in EXE than in CON subjects and correlated with PA/exercise volume and improvements in fitness parameters. Preliminary evaluation of musculoskeletal symptoms is useful in favoring compliance with supervised training programs and obtaining significant benefits to the functional status of the involved joints.


Musculoskeletal symptoms Physical activity Supervised exercise Type 2 diabetes 



Physical activity


Type 2 diabetes mellitus


Limited joint mobility


Randomized controlled trial


Italian Diabetes and Exercise Study


Exercise group


Control group


Maximal oxygen consumption


1 Repetition maximum


Blood pressure


Cardiovascular disease


Homeostasis model assessment-insulin resistance


Body mass index


High-sensitivity-C-reactive protein


Metabolic equivalents



The authors thank the IDES Investigators for participating in this study (see the complete list as on-line Appendix). This work was supported by Lifescan SrL, Novo Nordisk Ltd, Bristol Myers Squibb Italy, Technogym SpA and Cosmed SrL. The sponsors had no role in design and conduct of the study; collection, management, and interpretation of the data; or preparation, review, and approval of the manuscript.

Conflict of interest

Stefano Balducci, Maria Chiara Vulpiani, Luca Pugliese, Valeria D’Errico, Stefano Menini, Gerardo Salerno, Luca Gargiulo, Andrea Ferretti, and Giuseppe Pugliese declare they have no conflict of interest.

Human and Animal Rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee of human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised on 2008 (5).

Informed consent disclosure

Informed consent was obtained from all patients for being included in the study.

Supplementary material

592_2014_571_MOESM1_ESM.doc (130 kb)
Supplementary material 1 (DOC 130 kb)


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Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Stefano Balducci
    • 1
    • 2
    • 3
  • Maria Chiara Vulpiani
    • 4
    • 5
  • Luca Pugliese
    • 6
  • Valeria D’Errico
    • 2
    • 3
  • Stefano Menini
    • 1
  • Gerardo Salerno
    • 1
  • Luca Gargiulo
    • 4
    • 5
  • Andrea Ferretti
    • 4
    • 7
  • Giuseppe Pugliese
    • 1
    • 2
  1. 1.Department of Clinical and Molecular Medicine“La Sapienza” UniversityRomeItaly
  2. 2.Diabetes UnitSant’Andrea HospitalRomeItaly
  3. 3.Metabolic Fitness AssociationMonterotondoItaly
  4. 4.Department of Medical and Surgical Sciences and Translational Medicine“La Sapienza” UniversityRomeItaly
  5. 5.Physical Medicine and Rehabilitation UnitSant’Andrea HospitalRomeItaly
  6. 6.Radiology UnitSant’Andrea HospitalRomeItaly
  7. 7.Orthopedic Unit and Kirk Kilgour Sports Injury CenterSant’Andrea HospitalRomeItaly

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