Resistance exercise training increases lower limb speed of strength generation during stair ascent and descent in people with diabetic peripheral neuropathy

Abstract

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.

Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy

“…97 Participation in a 16 week moderate intensity resistance training intervention (1 hour per week, exercises included leg press, leg extension and ankle press) was accompanied by faster torque development during stair negotiation. 99 Taken together, these studies indicate that moderate intensity aerobic and resistance training have significant potential to improve symptoms and mitigate strength deficits in individuals with DPN.…”

“…Recently, functional rates of force development were improved following resistance training in DPN. 99 The effect of resistance exercise and increased muscle mass is essential to improve glycemic control as skeletal muscle is typically responsible for the majority of whole body glucose uptake. Therefore, substantial increases in skeletal muscle mass alone would be expected to lower blood glucose.…”

Frequency and circumstances of falls for people with Charcot–Marie–Tooth disease: A cross sectional survey

“…This survey suggests that failure to recover from a trip is a common perceived cause of falls and may indicate a delayed reactive strategy. This could be due to slowed rate of force production in weakened muscles or sensory dysfunction, as seen in other peripheral neuropathies and older people (Handsaker et al, ; Kim & Robinson, ). A study by Nardone et al () explored reactive strategies in people with peripheral neuropathy, relating them to postural control but not to falls.…”

The 2017 Banting Memorial Lecture The diabetic lower limb – a forty year journey: from clinical observation to clinical science

“…It appeared that resistance exercise training might be a useful clinical intervention for improving these abnormalities and therefore reducing fall risk. Thus, in the next study, we examined 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 diabetic peripheral neuropathy [45]. In a similar design incorporating people with and without diabetic peripheral neuropathy together with people without diabetes, we assessed ankle and knee strength generation during climbing and descending stairs, and showed that after the resistance exercise intervention, these measures were significantly higher.…”