September 2021

Strength & Balance Exercises Improve Function in DPN

Diabetic peripheral neuropathy (DPN) contributes to reduced functional status, and lower balance confidence and health-related quality of life (HRQoL) in individuals with diabetes. In turn, functional status and balance confidence partially mediate the association between HRQoL and DPN. So, researchers from National University of Singapore posed the question: Can a structured strength and balance training intervention in individuals with DPN improve HRQoL, functional status, and balance confidence?

They devised a single-blind parallel-group randomized controlled trial and recruited community dwelling patients with diagnosed type 2 diabetes and neuropathy. In all, 70 participants were assigned to the intervention and 73 to standard medical therapy; ages ranged from 40 to 79 years.

The intervention consisted of 2 months of once-weekly home-based strength and balance training where participants met 1:1 with a physiotherapist; measures were taken at baseline, 2 months, and 6 months. The evidence-based intervention was designed to address the following conditions known to affect individuals with DPN: 1) diminished muscle strength at the ankle and below; 2) reduced ankle mobility and range of motion, and 3) postural instability or reduced balance during standing and while walking, and included the following components:

  • 5-minute warm-up to start
  • Range of motion exercises: passive movements to the extent possible of the knee (flexion–extension), ankle (dorsi–plantar flexion), forefoot (inversion–eversion) and toe (flexion–extension, adduction–abduction) joints
  • Muscle strengthening exercises: active movements against resistance (using a theraband) at the knee (flexion–extension), ankle (dorsi–plantar flexion), forefoot (inversion–eversion) and toe (flexion–extension, adduction–abduction) joints
  • Exercises for improving static balance: single leg stance, tandem leg stance, toe and heel stance
  • Exercises for improving dynamic balance: tandem walk, sideways walk, backward walk
  • Endurance exercises: eg, sitting-to-standing minihops, brisk walking
  • 5-minute cool down to end
  • While there were no significant differences in the HRQoL scores (primary outcome measure), there were significant improvements in:
  • Timed-up-and-go (TUG) performance (mean difference [MD] −14 [95% CI −2.18, −0.1] s; P=0.032)
  • Five times sit-to-stand (FTSTS) performance (MD −31 [95% CI −2.12, −0.51] s; P=0.001)
  • Ankle muscle strength (MD 4.18 [95% CI 0.4, 7.92] N; P=0.031),
  • Knee range of motion (MD 6.82 [95% CI 2.87, 10.78]°; P=0.001)
  • Balance confidence score (MD 6.17 [95% CI 1.89, 10.44]; P=0.005).

These findings demonstrate that short-term structured strength and balance training did not influence HRQoL in patients with DPN but did produce sustained improvements in functional status and balance confidence at 6 months. More intensive interventions may be needed to influence HRQoL in these individuals. However, this intervention may be a useful clinical treatment option for individuals with DPN to reduce the risk of falls and injuries.

Source: Venkataraman K, Tai BC, Khoo EYH, et al. Short-term strength and balance training does not improve quality of life but improves functional status in individuals with diabetic peripheral neuropathy: a randomised controlled trial. Diabetologia. 2019;62:2200–2210.

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