The increase in the proportion of elderly people in the population is one of the most remarkable sociodemographic phenomena of the twenty-first century. The number of patients with diabetes is also increasing worldwide with this demographic change. Given these facts, consideration of the problems the general elderly population is facing in the management of diabetes is essential. In this review article, we focus on sarcopenia, which is the decrease in lower extremity muscle mass and muscle strength accompanying aging, describe the relationship between sarcopenia and diabetes, and highlight the specific factors through which diabetes contributes to loss of muscle strength. The quantitative methods for evaluating lower extremity muscle strength will also be described. These methods hold the key to assessing the effectiveness of exercise therapy and optimizing the assessment of the degree of autonomy in the activities of daily living. Exercise is one of the basic treatments for type 2 diabetes and may also prevent and improve sarcopenia. This review discusses the aspects common to the two health conditions and elucidates the effectiveness and necessity of exercise as a preventive measure against diabetes among the elderly.

Aims/IntroductionThe present study elucidated the effect of diabetic polyneuropathy (DPN) on lower extremity strength in a wide age range of type 2 diabetes patients.Materials and MethodsParticipants (n = 1,442) were divided into three age groups (30–49 years, 50–69 years and 70–87 years), and comparisons were made separately for each sex. Lower extremity strength was measured in terms of knee extension force (KEF) with a hand‐held dynamometer. KEF was compared according to the presence or absence of DPN. Furthermore, the effect of DPN on KEF with other diabetic complications (diabetic retinopathy and diabetic nephropathy), diabetes status (diabetes duration and glycated hemoglobin) and habitual behavior (regular exercise, smoking and drinking behaviors) as explanatory variables was analyzed using multiple regression analysis in several models.ResultsThe frequency of DPN differed among age groups, ranging from 14.3 to 49.6%, and increasing with age. There was no significant difference in KEF between patients aged 30–49 years with and without DPN. However, among both men and women aged 50–69 years and 70–87 years, patients with DPN showed significantly diminished KEF (11.0–12.9% and 11.9–16.6%, respectively) compared with those without DPN (P < 0.01–0.001). In women aged 50–69 years and 70–87 years, and in men aged 50–69 years, DPN was a significant explanatory variable for KEF in all multiple regression analysis models.Conclusion DPN might reinforce a KEF decline in middle‐aged and elderly type 2 diabetes patients.

Abstract. To examine the effect of muscle strength on insulin resistance, we investigated the association between quantitative lower-extremity muscle strength and insulin resistance index as evaluated by homeostasis model assessment (HOMA-IR) in patients with type 2 diabetes (20 men and 20 women, mean age ± SD: 53.3 ± 12.7 years). By simple linear regression analyses, the knee extension force normalized for body weight (%KEF) was found to be significantly correlated with HOMA-IR in both male (r = -0.510, P<0.05) and female patients (r = -0.462, P<0.05). Stepwise regression analysis also showed that %KEF was an independent determinant of HOMA-IR (β = -0.331, F = 5.400, P<0.005), as was BMI (β = 0.409, F = 8.260, P<0.05). Our data suggest that lower-extremity muscle strength is independently associated with insulin resistance, which seems to be consistent with previous reports that resistance training improves glycemic control in type 2 diabetic patients. Further studies based on a larger study population will be required to confirm this possibility.

BackgroundHigh prevalence of low back pain (LBP) in nurses has been reported globally. Ergonomic factors and work-related psychosocial factors have been focused on as risk factors. However, evidence on the role of fear-avoidance beliefs (FABs) concerning LBP in nurses is lacking. This study examined LBP prevalence and the association between FABs and chronic disabling LBP that interfered with work and lasted ≥ 3 months.MethodsFemale nurses (N = 3066; mean age = 35.8 ± 10.6 years) from 12 hospitals in Japan participated. A self-reported questionnaire was used to collect information on sociodemographics, LBP, work-related factors, and psychological distress. FABs about physical activity were assessed using a subscale from the FAB Questionnaire (score range = 0–24). The participants were asked to choose one of four statements regarding their LBP in the past 4 weeks: 1) I did not have LBP, 2) I had LBP without work difficulty, 3) I had LBP with work difficulty but without requiring absence from work, and 4) I had LBP requiring absence from work. If the participant had LBP in the past 4 weeks, it was also inquired if the LBP had lasted for ≥ 3 months. Chronic disabling LBP was defined as experiencing LBP with work difficulty in the past 4 weeks which had lasted for ≥ 3 months. In the nurses who had experienced any LBP in the past 4 weeks, we examined the association between FABs and experiencing chronic disabling LBP using multiple logistic regression models adjusting for pain intensity, age, body mass index, smoking status, psychological distress, hospital department, weekly work hours, night shift work, and the12 hospitals where the participants worked.ResultsFour-week and one-year LBP prevalence were 58.7 and 75.9%, respectively. High FABs (≥ 15) were associated with chronic disabling LBP (adjusted odds ratio = 1.76, 95% confidence interval [1.21–2.57], p = 0.003).ConclusionsLBP is common among nurses in Japan. FABs about physical activity might be a potential target for LBP management in nurses.Trial registrationUMIN-CTR UMIN000018087. Registered: June 25, 2015.

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