Effect of Alter-G Training on Glycemic Control and Quality of Life in Diabetic Neuropathy
Condition: Diabetic Polyneuropathy
MeSH terms: Diabetic Neuropathies; Polyneuropathies
Study type: Interventional

Summary: 
      Aging is a natural process that is frequently accompanied by chronic physical or mental
      health problems. Aging as well as a sedentary lifestyle behavior may produce identical
      pathological and morphological changes. Saudi population, especially elderly people assume
      sedentary lifestyle, with little physical activity is a strong predisposition for developing
      a disability that adversely affects many aspects of physical and mental functions; mainly
      mobility and the ability to perform the basic daily living activities (ADL); resulting
      finally in increased risk of independence, loss of functionality, and falls. Type 2 diabetes
      mellitus (T2DM) is a widespread chronic metabolic disorder, accounts for 90-95% of all
      patients with diabetes. It is one of the most life-threatening public health challenges in
      the world, characterized by long term complications that almost involves all systems of the
      body. Polyneuropathy is the most common symptomatic complication in patients with type 2
      diabetes mellitus, found in 50 to 60 % of patients over the age of sixty, with the impaired
      glycemic control and deteriorated quality of life are among the most debilitating problems in
      patients with diabetic polyneuropathy.
    

Detailed description: 
      Regular physical activity is an important component in healthy aging. Regular activity is
      very beneficial to our health as we age. Physical therapy can play an important role in the
      evaluation and treatment of older people with gait and balance disorders. Physical Therapy
      can help in the determination of the impairments produced by balance and gait abnormality and
      develop individualized plans aiming for identification of functional limitations.

      Lower extremity aerobic exercise training (e.g., walking, treadmill and bicycle ergometer) is
      a good procedure to control and disrupt the progression of hyperglycemia in elderly with DPN.
      Furthermore; it improves lower limb muscle oxygen uptake, enhances the nerve conduction and
      proprioceptors sensitivity during activities. Lowe extremity aerobic exercise training can
      enhance balance, thereby reducing the falling risk. Aerobic exercise is also helpful in
      preventing age related lifestyle disease and improving quality of life (QOL) of the elderly.
      A conflict was clearly evoked between prescribing weight bearing and non- weight bearing
      exercise for elderly with diabetic polyneuropathy.

      Weight bearing theoretical basis assumes that weight bearing activities such as walking are
      superior to other non- weight- bearing activities because of its ability to promote and
      restore muscular strength, joint proprioception and range of motion necessary to effectively
      perform typical daily activities. Although weight bearing training can significantly improve
      walking and balance abilities in patients with diabetic polyneuropathy compared with non-
      weight bearing training, but there were still not enough evidences to prove the ideal
      percentage level of weight reduction or unloading during practicing lower extremity training
      exercise in elderly with diabetic polyneuropathy. Quite recently, a new antigravity treadmill
      based on The National Aeronautics and Space Administration (NASA) technology was introduced.
      It permits low- load walking using an emerging technology called lower body positive pressure
      (LBPP) to modify body weight during ambulation. Few trials handled the utilization of LBPP
      technology and further trials are still warranted to to develop a more effective conservative
      and intervention treatment protocol for enhancing physical activities, quality of life and
      functional performance in elderly patients with diabetic polyneuropathy.
    

Intervention name(s): weight off-loading aerobic exercise training.
Intervention type(s): Other
Intervention description(s): Mild to moderate intensity weight off-loading aerobic exercise training on the anti-gravity Alter-G treadmill. (speed 8-12 mph, 50%-70% heart rate reserve "HRR", 12-16 score on the Borg's scale)
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: This interventional study aims to explore the effectiveness of the lower body positive pressure aerobic exercise training program on the glycemic control and the health-related quality of life in patients with diabetic polyneuropathy. Eighty eligible participants were randomly allocated to either group-A (0-percentage weight off-loading; 16-participants), group-B (25-percentage weight off-loading; 15-participants), group-C (50-percentage weight off-loading; 16-participants), group-D (75-percentage weight off-loading; 15-participants), and group-E (control group; 18-participants).
Participants in the study groups received twelve-weeks mild to moderate intensity aerobic training program on the Alter-G anti-gravity treadmill.
The Glycemic control (Fasting blood glucose in mg/dl, glycated hemoglobin, and health-related quality of life were evaluated at three time points: at the beginning of the study, after three months aerobic exercise training and three months post-training cessation.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Diabetic neuropathy,Quality of Life,Blood Glucose,Hemoglobin