Progressive Relaxation Exercise on Sleep Quality in Patients With Type 2 Diabetes
Condition: Diabetes Mellitus, Type 2
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the effect of progressive relief exercise on sleep
      quality in patients with type 2 diabetes. Diabetes is among the diseases known as
      non-communicable or chronic diseases that occur as a result of the pancreas not producing
      enough insulin or the body's inability to use the insulin it produces and increasing the
      costs of care all over the world. Counseling and health education are among the key
      components of diabetes management. Diabetes management consists of drug therapy,
      self-management, medical nutrition therapy, exercise and education parameters, and sleep
      disorders are ignored in diabetes management. The slightest disruption to sleep patterns has
      definite and direct effects on daily life and general health. Therefore; stay healthy; Sleep
      is necessary renew and repair systems such as to renew and muscle systems. Inadequate sleep
      quality can lead to impaired cognition, and sleep quality is an important aspect of life.
      Sleep disturbance or poor sleep quality is higher in individuals with chronic disease. Sleep
      disturbance in diabetes is associated with higher HbA1c levels and diseases such as diabetes
      reduce sleep quality and regularity; It is known to cause sleep disorders. Especially in Type
      2 Diabetes cases, sleep problems are common. Having a chronic illness like Type 2 Diabetes
      can have an impact on sleep quality and rate alone. Complementary and integrated applications
      such as progressive relaxation exercise, which is one of the cognitive behavioral techniques,
      have been frequently used in researches in the field of nursing, due to its effects such as
      relatively relieving tension and anxiety in skeletal muscles, facilitating the transition to
      sleep and helping to reduce sleep problems. Despite the differences in progressive muscle
      relaxation methods, studies have shown that progressive muscle relaxation has important
      results in improving sleep quality in individuals with chronic diseases. In this respect, it
      is predicted that progressive relaxation exercise may give positive results on sleep quality
      in individuals with diabetes.
    

Detailed description: 
      Diabetes is among the diseases known as non-communicable or chronic diseases that occur as a
      result of the pancreas not producing enough insulin or the body's inability to use the
      insulin it produces and increasing the costs of care all over the world. Worldwide, 537
      million adults live with diabetes, and Type 2 Diabetes is the most common type of diabetes
      worldwide, accounting for approximately 90% of all diabetes cases. According to the Diabetes
      Epidemiological Study in Turkey data (TURDEP-I and II), the prevalence of diabetes increased
      from 7.2% to 13.7%. While there is a globally agreed target to halt the increase in diabetes
      by 2025, both the number of cases and the prevalence of diabetes continue to rise steadily
      over the past few decades. It is estimated that the total number of individuals with diabetes
      will increase to 643 million by 2030 and to 784 million by 2045. Counseling and health
      education are among the key components of diabetes management. Diabetes management consists
      of drug therapy, self-management, medical nutrition therapy, exercise and education
      parameters, and sleep disorders are ignored in diabetes management. diabetes association
      recently included sleep as a behavior to watch among adults living with diabetes in its 2019
      and 2020 standards of care. Sleep; It is a periodic process in which physical activities are
      at the lowest level and the level of consciousness shows reversible changes. Sleep quality,
      which is one of the most important aspects of sleep; It is a complex phenomenon that is
      difficult to define and measure objectively. Sleep quality; It includes quantitative aspects
      of sleep such as sleep latency, duration of sleep, and the number of awakenings per night,
      and more subjective aspects such as sleep depth and restfulness. Sleep; It includes a
      multidimensional regeneration process, including physiological, psychological and social. For
      this reason, it is affected by positive/negative changes in the dimensions it covers. The
      slightest disruption to sleep patterns has definite and direct effects on daily life and
      general health. Therefore; stay healthy; Sleep is necessary to renew and repair systems such
      as neurological and muscle systems. Inadequate sleep quality can lead to impaired cognition,
      and sleep quality is an important aspect of life. Sleep disturbance or poor sleep quality is
      higher in individuals with chronic disease. Sleep disturbance in diabetes is associated with
      higher HbA1c levels and chronic diseases such as diabetes reduce sleep quality and
      regularity; It is known to cause sleep disorders. Individuals with uncontrolled diabetes
      often wake up sweating at night or due to nocturia. Controlling blood sugar with dietary
      changes, exercise, and medications can reduce sleep problems. Night movements or pain caused
      by the presence of neuropathy in the patient may also negatively affect sleep
      quality.Especially in Type 2 Diabetes cases, sleep problems are common. Having a chronic
      illness like Type 2 Diabetes can have an impact on sleep quality and rate alone. Sleep
      deprivation is a risk factor for impaired glucose tolerance, patients with diabetes have low
      sleep quality, there is a significant relationship between diabetes and sleep quality, and
      people with Type 2 Diabetes have poor sleep quality. Studies have determined that the
      probability of developing impaired fasting blood glucose in individuals is 6 times higher
      than in individuals who sleep an average of 6-8 hours at night and have good sleep quality.
      According to the report of the "American Academy of Sleep Medicine" center, the development
      or worsening of diabetes with sleep deprivation and sleep disorder there is a link between
      them. There are metabolic syndrome components such as hyperinsulinemia, central obesity,
      glucose intolerance in "Obstructive Sleep Apnea" which is a kind of sleep disorder. It is
      stated in the publications that "Obstructive Sleep Apnea" causes the development of diabetes
      by disrupting the glucose metabolism. Obstructive sleep apnea, short sleep duration, shift
      work, and insomnia are all associated with a higher risk of type 2 diabetes and may have
      worse outcomes for those with existing diabetes. Complementary and integrated applications
      such as progressive relaxation exercise, which is one of the cognitive behavioral techniques,
      have been frequently used in research in the field of nursing, due to its effects such as
      relatively relieving tension and anxiety in skeletal muscles, facilitating the transition to
      sleep and helping to reduce sleep problems.

      Progressive relaxation is a method that provides relaxation throughout the body by regular
      voluntary and successive contraction and relaxation of large muscle groups in the human body.
      Purpose of progressive relaxation exercises; It is based on feeling the difference between
      tension and looseness in the body and learning to relax in our daily life. This method, which
      is applied in the form of stretching and relaxing the muscles, allows the patients to learn
      where their muscles are, what they are in the moment of tension, and the difference when the
      tension disappears. Benefits of progressive muscle relaxation in diabetes; It improves
      metabolic control, lowers blood sugar, lowers catecholamines and autonomic nerve activity.
      After relaxation, the patient will feel relaxed and relaxed, progressive relaxation body;
      will be able to make the mind calm and relaxed. Relaxation improves blood circulation,
      increases the secretion of endorphins and decreases the secretion of adrenal hormones,
      reduces stress and anxiety after the emergence of a positive attitude due to increased brain
      function, and facilitates sleep. Progressive relaxation exercises are a skill that can be
      taught by nurses and learned in both inpatient and outpatient settings that include the
      nurse's role as educator, caregiver, role model and patient advocate, and is included in the
      Classification of Nursing Interventions (NIC). Nurses' use of high-level nursing practices,
      such as training patients with relaxation exercises, improves the patient's self-management
      skills and provides symptom control. Despite the differences in progressive muscle relaxation
      methods, studies have shown that progressive muscle relaxation has important results in
      improving sleep quality in individuals with chronic diseases. In this respect, it is
      predicted that progressive relaxation exercise may give positive results on sleep quality in
      individuals with diabetes.
    

Intervention name(s): progressive relaxation exercise sessions; Sham
Intervention type(s): Other; Other
Intervention description(s): Intervention Group: A total of 6 weeks of planning will be made with the working group.
week: Patients included in the study group and meeting the research criteria will be informed about the research. Pre-test data forms for each patient who accepted to participate in the study, Patient Identification Form, Pittsburgh Sleep Quality Index (PUKI) within 30 minutes will be collected.
,3.,4.,5. week: Patients will practice a total of 12 progressive relaxation exercise sessions for 30 minutes, 3 times a week (Monday, Wednesday, Friday) for 4 weeks, accompanied by the training booklet and music player.
6. week: In the last week of the application, individuals will be called to the hospital and in the Diabetes Polyclinic training room. A final test will be made by the researcher. The Pittsburgh Sleep Quality Index (PUKI) will be reapplied.; 1. week: After informing Sham group patients about the research at the first interview, Patient Information Form, Pittsburgh Sleep Quality Index (PUKI) will be applied.
6. week: In the 6th week of the study, individuals will be called to the hospital and the post-test Pittsburgh Sleep Quality Index (PUKI) will be re-administered by the researcher in the diabetes outpatient training room. Since the study was terminated after the 6th week, a booklet and music player will be given to the patients. In addition, progressive relaxation exercise training will be given to the patients and the importance of using it in their lives will be explained.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The research is carried out in two groups as control and intervention groups.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: sleep quality; exercise