Effects of Whole Body Vibration in Diabetic Peripheral Neuropathy .
Condition: Diabetic Neuropathies
MeSH terms: Peripheral Nervous System Diseases; Diabetic Neuropathies
Study type: Interventional

Summary: 
      The aim of this study is to conduct a randomized controlled trail to compare and analyze the
      effects of both whole body vibrator (WBV) and Tai Chi program on static and dynamic postural
      balance variables of the diabetic population. The purpose of the study is to determine that
      whether whole body vibrator is more evident for promoting functional independency and
      improving balance in diabetic neuropathy. Hence distinguishing choices to prevent fall and
      advancing functional independency by using the appropriate intervention without using extreme
      loads.
    

Detailed description: 
      Diabetes Mellitus (DM) is defined as a state of hyperglycemia, in either fasting or
      postprandial states. DM is a group of metabolic diseases characterized by hyperglycemia
      resulting from defects in insulin secretion, insulin action, or both . Type 2 diabetes
      mellitus (T2DM) is one of these diseases and it is characterized by insulin resistance . The
      International Diabetes Federation (IDF) estimates that the global prevalence of diabetes
      mellitus is 366 million in 2011 and expects an increase to 552 million in 2030. In this
      sense, the increase in the DM prevalence, especially in T2D, has become one of the major
      problems in modern society [5]. In this regard, this chronic disease is connected with the
      increase of obesity prevalence [6] and the high levels of physical inactivity [5] in people
      with T2DM.

      Peripheral neuropathy is one of the most common complications and consequences of chronic
      hyperglycemia . This is characterized by a progressive degeneration that primarily affects
      the small-diameter cutaneous nociceptive fibers. Diabetic patients encounter impaired
      balance, proprioception loss and decreased ROM. Physical exercise has become a therapy for
      people with T2DM , improving physical fitness , quality of life, and autonomic modulation ;
      as well as enhancing metabolic control and insulin sensitivity; and reducing inflammatory
      markers and neuropathy symptoms . Interestingly, physical activity could also increase the
      regenerative capacity of cutaneous axons, slowing or preventing neuropathy progression .

      Exercises based on whole-body vibration (WBV) training have shown to enhance balance,
      mobility muscle strength, pain, cardiorespiratory fitness, and bone density, in both healthy
      and clinical populations. In this regard, a recent systematic review and meta-analysis (with
      a total of seven studies, involving 279 older adults with T2DM) focused on the effects of WBV
      determined that this training improved the mobility, balance and aerobic capacity without any
      known adverse effects. Moreover, WBV could have positive effects on glycemic indices or body
      composition. Regarding glycemic indices, a previous study showed that acute WBV decreases the
      glucose level in elderly women with T2DM. However, the effects of WBV intervention on
      glycosylated hemoglobin (HbA1c) is uncertain. Tai Chi exercise program which is actually a
      form of proprioceptive and balance training helps in reduction of fall and balance issues and
      also beneficial for the pain reduction in osteoarthritic patients.

      Basic TC exercise is a mind-body exercise composed of a series of refined motions linked
      together as a rhythmical sequence in which the body is continuously shifting with low center
      of gravity from one foot to the other. These exercises can help in training of dual task
      performance as the practitioner's eye focuses on the leading arm and the mind focuses on the
      breath and movement sequences. It also improves cardiovascular endurance, aerobic capacity
      and quality of life and reduces stress
    

Intervention name(s): Whole body vibration group; Tai Chi group
Intervention type(s): Other; Other
Intervention description(s): Experimental Group will receive WBV training and balance exercises under the supervision of a physical therapist by using a vibration platform. Balance exercises include:
Double leg stance with eyes open and eyes closed 10 Reps * 3 minutes Tandem walk for 3 minutes Sideways walk for 3 minutes Single leg stance for 1 minute with 5 Reps, with 30 sec rest interval
WHOLE BODY VIBRATION:
The patient stood on the platform with his/her feet barefoot shoulder width and stared at the front, delivered on a side alternating vibration platform in an intermittent way: five repetitions of 1 min vibration followed by a 1 min rest. The vibration frequency and amplitude were 20 Hz and 3.0 mm respectively.
These outcomes will be evaluated at baseline, and after 4 week and at 8th week; Control group will receive Balance exercises include:
Double leg stance with eyes open and eyes closed 10 Reps * 3 minutes Tandem walk for 3 minutes Sideways walk for 3 minutes Single leg stance for 1 minute with 5 Reps ,with 30 sec rest interval Yang style Tai chi exercise which consist of 10 positions. 1. Hold the ball ward off 2: Grasping the sparrows tail left; 3.Grasping the sparrows tail Right;; 5.Repulse Monkey; 6. Part wild horse's Mane; 7.Brush knee Twist step; 8.Lift kick left; 9.Lift kick Right; 10.Cross hands with double leg stance
1st and 2nd week will last for 5reps, 3rd and 4th week will last for 10reps,5th and 6th week will last for 15reps,7th and 8th week will last for 20reps, starting with 10 minutes warming- up and ending with 10 minutes cool-down. These outcomes will be evaluated at baseline, and after 4 week and at 8th week
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other