Effect of supervised exercise training on musculoskeletal symptoms and function in patients with type 2 diabetes: the Italian Diabetes Exercise Study (IDES)
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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.
KeywordsMusculoskeletal symptoms Physical activity Supervised exercise Type 2 diabetes
Type 2 diabetes mellitus
Limited joint mobility
Randomized controlled trial
Italian Diabetes and Exercise Study
Maximal oxygen consumption
1 Repetition maximum
Homeostasis model assessment-insulin resistance
Body mass index
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.
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