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Results: Thirty participants were recruited (mean age 57 SD 27.8; BMI 27.8 SD 4.2); 17 were females. Four patients had non-usable data. Main analysis used paired t tests comparing within subject patellar position with and without brace.For bisect offset index, patellar tilt and patellar height ratio there were no significant differences between the brace and no brace conditions. However, the brace increased lateral facet contact area (p =.04) and decreased lateral patellofemoral separation (p = .03). For bisect offset index, patellar tilt and patellar height ratio there were no significant 22 differences between the brace and no brace conditions. However, the brace increased 23 lateral facet contact area (p =.04) and decreased lateral patellofemoral separation (p = 24 .03).

including titles -250 words, Total -2'948 words Funding Statement Funded by a Clinical Research Grant from the European Foundation for the Study of Diabetes (EFSD) Conflicts of InterestThe authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript. Novelty StatementHere we examined for the first time, the effects of a resistance exercise based intervention on speed of knee and ankle strength generation in people with diabetic peripheral neuropathy, during stair ascent and descent. We observed that after a 16 week intervention, people with diabetic peripheral neuropathy, and people with diabetes without neuropathy, increased the speed at which strength was developed at the ankle and knee during stair ascent and descent. This is expected to decrease the risk of falling during these movements. Therefore, such exercises could be incorporated into a multi-faceted exercise programme to improve safety in people with diabetes and diabetic peripheral neuropathy.Aims: People with diabetic peripheral neuropathy (DPN) are slower at generating strength at the ankle and knee, leading to unsteadiness during stair negotiation tasks.This study examines the effects of a 16-week resistance exercise training intervention on the speed of ankle and knee strength generation during stair ascent and descent, in people with neuropathy.Methods: Forty three participants: 9 patients with DPN; 13 patients with diabetes but no neuropathy (D) and 21 healthy controls (H-CON) ascended and descended a custombuilt staircase. The speed at which ankle and knee strength were generated, and muscle activation patterns of the ankle and knee extensor muscles were analyzed before and after a 16-week intervention period.Results: Ankle and knee strength generation during both stair ascent and descent were significantly higher post-intervention compared to pre-intervention in the participants with diabetes who undertook the resistance exercise intervention (p<0.05). Although muscle activations were altered by the intervention, there were no observable patterns that underpinned the observed changes. Conclusions:The increased speed of ankle and knee strength generation observed after the intervention, are expected to improve stability during the crucial weight acceptance phase of stair ascent and descent, and ultimately contribute towards reducing the risk of falling. Improvements in muscle strength as a result of the resistance exercise training intervention are expected to be the most influential factor for increasing the speed of strength generation It is advocated that these exercises could be incorporated into a multi-faceted exercise programme to improve safety in people with diabetes and neuropathy.

People with diabetes walk slower and display biomechanical gait alterations compared with controls, but it remains unknown whether the metabolic cost of walking (CoW) is elevated. The aim of this study was to investigate the CoW and the lower limb concentric joint work as a major determinant of the CoW, in patients with diabetes and diabetic peripheral neuropathy (DPN). Thirty-one nondiabetic controls (Ctrl), 22 diabetic patients without peripheral neuropathy (DM), and 14 patients with moderate/severe DPN underwent gait analysis using a motion analysis system and force plates and treadmill walking using a gas analyzer to measure oxygen uptake. The CoW was significantly higher particularly in the DPN group compared with controls and also in the DM group (at selected speeds only) compared with controls, across a range of matched walking speeds. Despite the higher CoW in patients with diabetes, concentric lower limb joint work was significantly lower in DM and DPN groups compared with controls. The higher CoW is likely due to energetic inefficiencies associated with diabetes and DPN reflecting physiological and biomechanical characteristics. The lower concentric joint work in patients with diabetes might be a consequence of kinematic gait alterations and may represent a natural strategy aimed at minimizing the CoW.

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