Exercise training is associated with reduced pains from the musculoskeletal system in patients with type 2 diabetes

Exercise Training During Working Hours at a Hospital Department: A Pilot Study

OBJECTIVES

This pilot study tested the use of an exercise offer to hospital employees during working hours and changes in work and health parameters.

METHODS

Employees (n = 214) from a medical department on a Danish hospital were invited to 30 minutes' exercise training twice weekly for 12 weeks. Outcomes included health- and work-related parameters.

RESULTS

Eighty employees (mean age, 44.4 [SD, 10.7] years; 81.3% women) completed the study. Intervention adherence was 36.3% (SD, 25.1%). Aerobic capacity increased from 34.6 (95% confidence interval [CI], 32.3 to 36.9) to 36.7 (95% CI, 34.1 to 39.4) mL O 2 /min per kilogram, P = 0.004. Blood pressure decreased from 120 (95% CI, 117 to 123)/79 (95% CI, 76 to 81) to 116 (95% CI, 112 to 120)/76 (95% CI, 74 to 79) mm Hg, P = 0.003. Waist circumference and musculoskeletal pain decreased. Well-being, social capital, and quality of life increased.

CONCLUSIONS

Despite low training adherence, completers improved outcomes related to metabolic and self-rated health.

Mechanisms of exercise for diabetic neuropathic pain

Diabetic neuropathic pain (DNP) is a common disease that affects the daily lives of diabetic patients, and its incidence rate is very high worldwide. At present, drug and exercise therapies are common treatments for DNP. Drug therapy has various side effects. In recent years, exercise therapy has received frequent research and increasing attention by many researchers. Currently, the treatment of DNP is generally symptomatic. We can better select the appropriate exercise prescription for DNP only by clarifying the exercise mechanism for its therapy. The unique pathological mechanism of DNP is still unclear and may be related to the pathological mechanism of diabetic neuropathy. In this study, the mechanisms of exercise therapy for DNP were reviewed to understand better the role of exercise therapy in treating DNP.

Motives and Barriers to Exercise Training during Hospitalization in Patients with Type 2 Diabetes: A Cross-Sectional Study

Background: Exercise training during hospitalization may prevent loss of physical function and hyperglycemia in patients with type 2 diabetes. The aim of this study was to assess motives and barriers to exercise training in hospitalized patients with type 2 diabetes. Methods: Data were collected using a questionnaire about motives and barriers to exercise training during hospitalization. Additional data for clinical characteristics of the participants were collected from patient records. Results: 79 patients participated (mean ± SD age 72 ± 12 years; 42% women), of whom 25% had a low level of education and 46% lived alone. The median (IQR) length of the stay was 6 (4–10) days. A total of 67% of the participants wished to be more physically active. Walking as exercise was preferred by 51%. The most frequently reported barriers to exercise training were bodily pain (48%) and dizziness (42%). Low vs. high level of education, and living alone vs. being married/living with a partner were associated with reduced odds of a wish to be more physically active, odds ratio (OR) 0.15 [95% CI 0.03; 0.76], p = 0.022, and 0.21 [0.05; 0.82], p = 0.025, respectively. Conclusion: Two out of three hospitalized patients with type 2 diabetes wished to be more physically active during admission. Bodily pain was a barrier to exercise training and needs attention in training programs. As a low level of education was associated with reduced odds of a wish to be more active, a strategy to include all patients in training programs which considers social inequality is needed.

Changes of Physical Function and Quality of Life in Patients with Type 2 Diabetes after Exercise Training in a Municipality or a Hospital Setting

INTRODUCTION

The aim was to compare changes in physical function and quality of life (QOL) after an exercise training programme to patients with type 2 diabetes mellitus (T2DM) in a municipality and a hospital setting and to compare the patients' physical function and QOL with an age- and sex-matched general population.

METHODS

Patients with T2DM were stratified to exercise training in a municipality (n = 26) or a hospital (n = 46), respectively. The training was one hour twice weekly for 12 weeks. The outcomes were physical function (30 sec chair stand test (CST)) and QOL (using the SF-36). The data for the general population were collected from previous reference studies.

RESULTS

Fifty-one (71%) participants completed the intervention. The CST results improved in both groups with no difference between the municipality and hospital groups (1.6 [0.1; 3.1] vs. 3.5 [2.3; 4.8] no., respectively, p = 0.062). The QOL scales physical function and general health increased more in the municipality group than in the hospital group (10.5 [2.8; 18.2] vs. -1.2 [-7.9; 5.5], respectively, p = 0.031, and 8.3 [2.3; 14.4] vs. -0.2 [-5.6; 5.1], respectively, p = 0.042). Dropout (n = 21) during the intervention was associated with reduced QOL at baseline. The patients' CST results at baseline were reduced compared to the general population (11.8 ± 3.5vs.18.9 ± 3.3, respectively, p < 0.001). All QOL scales apart from social function were reduced in the patients compared to the general population.

CONCLUSION

Patients in a 12-week exercise training programme in a hospital or a municipality setting had significantly lower QOL compared to an age- and sex-matched population sample. Similar improvements in physical function were observed in patients after completion of the exercise programme irrespective of exercise setting, whereas patient exercising in a municipality setting had higher positive changes in QOL than patients undergoing the same exercise programme in a hospital setting.

Is There an Association between Diabetes and Neck and Back Pain? Results of a Case-Control Study

We aimed to assess if subjects with diabetes exhibit higher prevalence of chronic back pain than age-sex-province of residence-matched non-diabetic controls. We also aimed to identify predictors for chronic neck pain (CNP) or chronic low back pain (CLBP) among subjects with diabetes. A case control study was conducted using data obtained from the Spanish National Health Survey 2017. Multivariable conditional and unconditional logistic regression models were constructed. A total of 2095 diabetes sufferers and 2095 non-diabetic matched controls were analyzed. The prevalence of CNP and CLBP was 27.3% and 34.8%, respectively, in diabetes sufferers and 22.1% and 29.0% in non-diabetes controls (both, p < 0.001). After multivariable analysis, the ORs showed significantly higher adjusted risk of CNP (OR 1.34; 95% CI 1.19–1.51) and CLBP (OR 1.19, 95% CI 1.09–1.31) in diabetes cases. Diabetes sufferers with CNP or CLBP showed higher use of pain medication and higher prevalence of migraine/frequent headache than controls. Female sex, worse self-rated health and use of pain medication were predictors for CNP and CLBP in subjects with diabetes. CNP and CLBP are significantly more prevalent in diabetes sufferers than in controls. Current results can help to design better preventive and educational strategies for these highly prevalent and burdensome pains among diabetic patients.

Relationships within and between lower and upper extremity dysfunction in people with diabetes

INTRODUCTION

Diabetes mellitus (DM) is associated with systemic musculoskeletal system impairments suggesting concurrent development of lower and upper extremity musculoskeletal problems. This study aims to examine relationships between lower and upper extremity function in people with DM.

METHODS

Sixty people with type 2 DM and peripheral neuropathy [mean (standard deviation); 67(6) years old, DM duration 14(10) yrs] completed the following measures: 1) Self-reports of function: Foot and Ankle Ability Measure (FAAM; higher = better function) and Shoulder Pain and Disability Index (SPADI; lower = better function), 2) Range of motion (goniometry): ankle dorsiflexion and shoulder flexion, and 3) Strength: unilateral heel rise power (UHR, 3D kinetics) and hand grip dynamometry. Pearson correlations examined associations between lower and upper extremity measures, p < .05.

RESULTS

Forty of 60 (67%) reported pain/disability in both the foot/ankle and shoulder and 95% of study participants had some limitation in foot or shoulder function. Significant between extremity correlations: FAAM and SPADI (r = -0.39), ankle dorsiflexion and shoulder flexion range of motion (r = 0.35), and UHR and hand grip strength (r = 0.40). Significant within extremity correlations: FAAM and UHR (r = .47) and SPADI with shoulder flexion (r = -0.44).

CONCLUSION

Upper and lower extremity inter- and intra-relationships indicate systemic musculoskeletal impairments in people with DM. Healthcare practitioners should consider the potential for concurrent and disabling musculoskeletal problems in people with DM.

Effect of different exercise training intensities on musculoskeletal and neuropathic pain in inactive individuals with type 2 diabetes - Preliminary randomised controlled trial

AIMS

People with type 2 diabetes (T2D) have a greater prevalence of musculoskeletal and neuropathic pain. This exploratory analysis investigated whether exercise of different intensities leads to changes in self-reported musculoskeletal pain or symptoms of diabetic neuropathy in inactive individuals with type 2 diabetes.

METHODS

Thirty-two inactive adults with T2D (59% male, mean age 58.7 ± 9.1yrs, median HbA_1c 7.8%) were randomised to usual care (CON), supervised combined aerobic and resistance moderate-intensity continuous training (C-MICT), or supervised combined high-intensity interval training (C-HIIT). At baseline and 8-weeks, musculoskeletal and neuropathic pain were evaluated using a modified Nordic Musculoskeletal Questionnaire and the Neuropathy Total Symptom Score-6 respectively. Quantitative sensory testing was used to determine thermal, mechanical and vibration detection thresholds, as well as pain pressure thresholds. Adverse events were recorded throughout the intervention.

RESULTS

Compared to CON, reduction in musculoskeletal pain intensity was significantly greater for C-HIIT (MD -5.4, 95% CI [-10.6 to -0.2], p = 0.04) and non-significantly greater for C-MICT (MD -5.9 [-12.4 to 0.7], p = 0.08). Changes in neuropathy symptoms were not different between C-HIIT and CON (MD 1.0 [-0.9 to 2.8], p = 0.31), or C-MICT and CON (MD 0.2 [-3.1 to 3.6], p = 0.89). No differences in sensory function were observed between groups. Similar rates of adverse events were seen in both exercise interventions (19 C-HIIT; 17 C-MICT), all but one of which were mild.

CONCLUSIONS

Preliminary data suggests 8-weeks of high-intensity combined aerobic and resistance exercise may be safely prescribed for inactive individuals with T2D and may reduce musculoskeletal pain but not neuropathic symptoms.

TRIAL REGISTRATION

ACTRN12615000475549.