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Published in: BMC Endocrine Disorders 1/2021

Open Access 01-12-2021 | Diabetes | Research article

Balance and motion coordination parameters can be improved in patients with type 2 diabetes with physical balance training: non-randomized controlled trial

Authors: Artur Stolarczyk, Igor Jarzemski, Bartosz M. Maciąg, Kuba Radzimowski, Maciej Świercz, Magda Stolarczyk

Published in: BMC Endocrine Disorders | Issue 1/2021

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Abstract

Background

Type 2 diabetes (T2D) is a cause of multiple complications, including retinopathy and peripheral neuropathy. These complications are well understood and believed to contribute to gait instability. Poor balance control and increased falling risk have also been reported in people with diabetic peripheral neuropathy (DPN).
Patients with DPN have increased risk of falling due to decreased proprioceptive feedback. Effective balance training should improve postural control in patients with DPN. For this purpose further evaluation was conducted and balance training was designed.

Methods

The goal of our study was to determine values of proprioception, balance, muscle coordination and strength in patients with T2D and analyze whether biofeedback balance training with use of the Biodex Balance System could improve these parameters. To assess the fall risk the general stability index (GSI), the index of frontal-posterior (FPI) and medial–lateral (MLI) stability were evaluated. 37 patients with diagnosed type 2 diabetes mellitus were recruited to this study. Their results were compared with control group consisting of 41 healthy participants who were homogenic to the study group in terms of age and body mass index (BMI).

Results

There were statistically significant differences between patients with diabetes compared to healthy subjects in GSI (2.79 vs 1.1), FPI (1.66 vs 0.7), MLI (0.88 vs 0.52) and risk of falling (5.18 vs 2.72) p < 0.05. There were also statistically significant changes before and after training in all stability indices (GSI: 2.79 vs 1.26, FPI: 1.66 vs 0.77, MLI: 0.88 vs 0.54 accordingly) p < 0.05 and risk of falling (5.18 vs 3.87) p < 0.05 in the study group who had undergone training with biofeedback.

Conclusions

This study found that there is a decreased balance and motor coordination and an increased risk of falling in patients with type 2 diabetes. These parameters improved in patients who have undergone training programme with biofeedback. Furthermore, an age-dependent deprivation of static balance was observed along with an increased risk of falling as a result of increasing BMI.
Literature
4.
go back to reference Gutierrez EM, Helber MD, Dealva D, Ashton-Miller JA, Richardson JK. Mild diabetic neuropathy affect ankle motor function. Clin Biomech. 2001;16:522–8.CrossRef Gutierrez EM, Helber MD, Dealva D, Ashton-Miller JA, Richardson JK. Mild diabetic neuropathy affect ankle motor function. Clin Biomech. 2001;16:522–8.CrossRef
6.
go back to reference Wallace C, Reiber GE, LeMaster J, Smith DG, Sullivan K, Hayes S, et al. Incidence of falls, risk factors for falls and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care. 2002;25:1983–6.CrossRef Wallace C, Reiber GE, LeMaster J, Smith DG, Sullivan K, Hayes S, et al. Incidence of falls, risk factors for falls and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care. 2002;25:1983–6.CrossRef
10.
go back to reference Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, et al. Older women with diabetes have higher risk of falls. A prospective study. Diabetes Care. 2002;25:1749–54.CrossRef Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, et al. Older women with diabetes have higher risk of falls. A prospective study. Diabetes Care. 2002;25:1749–54.CrossRef
11.
go back to reference Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti AT, Azevedo MJ, Gross JL, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305:1790–9.CrossRef Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti AT, Azevedo MJ, Gross JL, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305:1790–9.CrossRef
12.
go back to reference Figueira FR, Umpierre D, Cureau FV, et al. Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: a systematic review and meta-analysis. Sports Med. 2014;44:1557–72.CrossRef Figueira FR, Umpierre D, Cureau FV, et al. Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: a systematic review and meta-analysis. Sports Med. 2014;44:1557–72.CrossRef
13.
go back to reference Cadore EL, Moneo ABB, Mensat MM, et al. Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint. Age. 2014;35:801–11.CrossRef Cadore EL, Moneo ABB, Mensat MM, et al. Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint. Age. 2014;35:801–11.CrossRef
14.
go back to reference Arnold BL, Schmitz RJ. Examination of balance measures produced by the biodex stability system. J Athl Train. 1998;33:323–7.PubMedPubMedCentral Arnold BL, Schmitz RJ. Examination of balance measures produced by the biodex stability system. J Athl Train. 1998;33:323–7.PubMedPubMedCentral
20.
go back to reference Yamamoto R, Kinoshita T, Momoki T, Arai T, Okamura A, Hirao K, et al. Postural sway and diabetic peripheral neuropathy. Diabetes Res Clin Pract. 2001;52:213–21.CrossRef Yamamoto R, Kinoshita T, Momoki T, Arai T, Okamura A, Hirao K, et al. Postural sway and diabetic peripheral neuropathy. Diabetes Res Clin Pract. 2001;52:213–21.CrossRef
21.
go back to reference Horak FB, Dickstein R, Peterka RJ. Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance. Somatosens Mot Res. 2002;19:316–26.CrossRef Horak FB, Dickstein R, Peterka RJ. Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance. Somatosens Mot Res. 2002;19:316–26.CrossRef
22.
go back to reference Boucher P, Teasdle N, Courtemanche R, et al. Postural stability in diabetic polyneuropathy. Diabetes Care. 1995;18:638–45.CrossRef Boucher P, Teasdle N, Courtemanche R, et al. Postural stability in diabetic polyneuropathy. Diabetes Care. 1995;18:638–45.CrossRef
23.
go back to reference Simoneau GG, Ulbrecht JS, Derr JA, et al. Postural instability in patients with diabetic sensory neuropathy. Diabetes Care. 1994;17:1411–21.CrossRef Simoneau GG, Ulbrecht JS, Derr JA, et al. Postural instability in patients with diabetic sensory neuropathy. Diabetes Care. 1994;17:1411–21.CrossRef
24.
go back to reference Roman de Mettelinge T, Cambier D, Calders P, et al. Understanding the relationship between type 2 diabetes mellitus and falls in older adults: a prospective cohort study. PLoS ONE. 2013;8:e67055.CrossRef Roman de Mettelinge T, Cambier D, Calders P, et al. Understanding the relationship between type 2 diabetes mellitus and falls in older adults: a prospective cohort study. PLoS ONE. 2013;8:e67055.CrossRef
25.
go back to reference Ivers RQ, Cumming RG, Mitchell P, et al. Diabetes and risk of fracture: the Blue Mountains Eye Study. Diabetes Care. 2001;24:1198–203.CrossRef Ivers RQ, Cumming RG, Mitchell P, et al. Diabetes and risk of fracture: the Blue Mountains Eye Study. Diabetes Care. 2001;24:1198–203.CrossRef
26.
go back to reference Yau RK, Strotmeyer ES, Resnick HE, et al. Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care. 2013;36:3985–91.CrossRef Yau RK, Strotmeyer ES, Resnick HE, et al. Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care. 2013;36:3985–91.CrossRef
27.
go back to reference Napoli N, Strotmeyer ES, Ensrud KE, et al. Fracture risk in diabetic elderly men: the MrOS study. Diabetologia. 2014;57:2057–65.CrossRef Napoli N, Strotmeyer ES, Ensrud KE, et al. Fracture risk in diabetic elderly men: the MrOS study. Diabetologia. 2014;57:2057–65.CrossRef
28.
go back to reference Yamaguchi T, Sugimoto T. Bone metabolism and fracture risk in type 2 diabetes mellitus. J Endocrinol. 2011;58:613–24. Yamaguchi T, Sugimoto T. Bone metabolism and fracture risk in type 2 diabetes mellitus. J Endocrinol. 2011;58:613–24.
29.
go back to reference Strotmeyer ES, Cauley JA, Schwartz AV, et al. Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging and body composition study. Arch Intern Med. 2005;165:1612–7.CrossRef Strotmeyer ES, Cauley JA, Schwartz AV, et al. Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging and body composition study. Arch Intern Med. 2005;165:1612–7.CrossRef
30.
go back to reference Pijpers E, Ferreira I, de Jongh RT, et al. Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors, the Longitudinal Ageing Study Amsterdam. Ageing. 2012;41:358–65. Pijpers E, Ferreira I, de Jongh RT, et al. Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors, the Longitudinal Ageing Study Amsterdam. Ageing. 2012;41:358–65.
31.
go back to reference Morrison S, Colberg SR, Parson HK, et al. Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy. J Diabetes Complicat. 2014;28:715–22.CrossRef Morrison S, Colberg SR, Parson HK, et al. Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy. J Diabetes Complicat. 2014;28:715–22.CrossRef
32.
go back to reference Reid RD, Tulloch HE, Sigal RJ, et al. Effects of aerobic exercise, resistance exercise or both on patient-reported health status and well-being in type 2 diabetes mellitus: a randomised trial. Diabetologia. 2010;53:632–40.CrossRef Reid RD, Tulloch HE, Sigal RJ, et al. Effects of aerobic exercise, resistance exercise or both on patient-reported health status and well-being in type 2 diabetes mellitus: a randomised trial. Diabetologia. 2010;53:632–40.CrossRef
33.
go back to reference Kruse RL, Lemaster JW, Madsen RW. Fall and balance outcome after an intervention to promote leg strength, balance and walking in people with diabetic peripheral neuropathy: “feet first” randomized controlled trial. Phys Theraphy. 2010;90:1568–79.CrossRef Kruse RL, Lemaster JW, Madsen RW. Fall and balance outcome after an intervention to promote leg strength, balance and walking in people with diabetic peripheral neuropathy: “feet first” randomized controlled trial. Phys Theraphy. 2010;90:1568–79.CrossRef
34.
go back to reference Allet L, Armand S, de Bia RA, et al. The gait and balance of patients with diabetes can be improved: a randomised controlled trial. Diabetologia. 2010;53:458–66.CrossRef Allet L, Armand S, de Bia RA, et al. The gait and balance of patients with diabetes can be improved: a randomised controlled trial. Diabetologia. 2010;53:458–66.CrossRef
Metadata
Title
Balance and motion coordination parameters can be improved in patients with type 2 diabetes with physical balance training: non-randomized controlled trial
Authors
Artur Stolarczyk
Igor Jarzemski
Bartosz M. Maciąg
Kuba Radzimowski
Maciej Świercz
Magda Stolarczyk
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2021
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/s12902-021-00804-8

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