An Endurance-Dominated Exercise Program Improves Maximum Oxygen Consumption, Ground Reaction Forces, and Muscle Activities in Patients With Moderate Diabetic Neuropathy

Abstract

BackgroundThe prevalence of diabetes worldwide is predicted to increase from 2.8% in 2000 to 4.4% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility.ObjectiveWe aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN.MethodsSixty male and female individuals aged 45–65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40–55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s.ResultsNo statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p < 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p < 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001–0.037; d = 0.56–1.53). For IG, post-hoc analyses showed decreases in peak lateral (p < 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p < 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001–0.044; d = 0.54–0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p < 0.001; d = 1.28).ConclusionsThis study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.

Effect of Brisk Walking on Health-Related Physical Fitness Balance and Life Satisfaction Among the Elderly: A Systematic Review

“…A higher CRF is associated with improved survival and decreased incidence of CVD and other comorbidities, including hypertension, diabetes, heart failure, and atrial fibrillation ( 54 ). A previous study has shown that brisk walking can assist to improve cardiopulmonary fitness by increasing blood circulation, oxygen intake, and heart rate ( 55 ). Identically, this literature review revealed that moderate-intensity brisk walking had a positive and significant effect on cardiorespiratory fitness for elderly women and a mixture of males and females, but limited evidence presented on males ( 21 , 22 , 24 , 26 , 27 , 46 ).…”

Change of Fibroblast Growth Factor 21 Level Correlates with the Severity of Diabetic Sensory Polyneuropathy after Six-Week Physical Activity

“…Therefore, increased serum FGF21 levels may predict the clinical response to aerobic exercise. Previous studies have demonstrated a significant improvement in neurological function, affecting both sensorimotor and autonomic components of the peripheral nervous system, in patients with DN during physical exercise programmes [ 2 , 36 ]. The mechanism of improvement of neuropathic symptoms and nerve function is thought to be related to improvement in endothelial dysfunction and reduction of inflammation in DN.…”

“…Previous research indicates that physical activity may improve the neurological function and impaired nerve conduction in DN [ 2 ]. Physical activity and regular exercise are effective interventions to reduce the development and progression of diabetic neuropathy.…”

Attenuation of Apoptosis and Oxidative Stress by Endurance Training in the Cerebellum of Diabetic Rats

“…Diabetic neuropathy (DN) with damage to glial neurons, their axons, and endothelial cells leads to impaired brain function (1). Insulin signaling in the brain regulates neuronal survival, synaptic plasticity, and cognitive and locomotor functions (2).…”