the incidence of diabetes mellitus is increasing worldwide ; this trend is particularly 
 strong for type 2 diabetes mellitus ( t2dm)1 . t2 dm is a chronic disease characterized by decreased insulin 
 sensitivity and overall poor glucose control . the systematic review by boule et al . indicates structured exercise programs have a 
 statistically and clinically significant beneficial effect on glycemic control in patients 
 with t2dm3 . in addition , patients with 
 t2 dm who use insulin , low - intensity exercise significantly reduces the prevalence of 
 hyperglycemia4 . despite the benefits of physical activity , many people with t2 dm for some individuals , secondary diabetes - related complications such as lower - limb 
 amputations , neuropathies , hypertension , nephropathies , and retinopathies can either 
 contraindicate exercise or make it more difficult . in addition , many elderly people with 
 t2 dm do not have sufficient physical ability to perform aerobic exercise and thus have 
 problems maintaining euglycemia5 . passive static stretching occurs when sustained tension develops within a person s muscles 
 through external forces . accordingly , blood glucose levels could decrease following a program of 
 successive sustained muscle stretching . in addition , because passive stretching requires 
 minimum effort by the person performing the stretch , people with t2 dm who are reluctant or 
 unable to exercise may be willing to follow a stretching protocol6 . therefore , this study determined the effect of passive 
 static stretching on blood glucose levels in people with t2 dm . fifteen in - patients with t2 dm at a hospital in busan , korea participated in this study . patients were eligible if they were sedentary ( i.e. , not participating in regular aerobic or 
 strengthening exercises 6 months before the study ) and willing to commit to an 8-week 
 supervised exercise program7 . all patients 
 were diagnosed with t2 dm confirmed by a glycated hemoglobin ( hba1c ) level 6.5% or higher as 
 a criterion for the diagnosis of diabetes8 . all patients meeting the inclusion criteria were given verbal and 
 written information about this study . patients were randomized to the control group ( n = 7 ) or passive static 
 stretching group ( pss , n = 8) . the control group was instructed to maintain 
 their diet and medications for diabetes and not to perform any exercise during the 
 experiment . meanwhile , patients in the pss group followed the same instructions as the 
 control group but received a 40-minute intervention consisting of 6 lower - body and 4 
 upper - body static passive stretches . for each stretch , the muscle was held in the stretched 
 position for 30 seconds and was repeated 4 times . each repetition was separated by a 
 15-second relaxation period , and different stretches were separated by a minimum of 1 
 minute . a description of stretch is provided in table 
 1table 1.descriptions of the stretches used in the interventionstretchdescriptionseated knee flexor ( bilateral)the patient sat on the floor with their legs extended 
 and arms above their head . from this position , they lowered their head toward 
 their knees while the experimenter pushed down on their back.seated knee flexor hip adductor ( bilateral)the patient sat on the floor in the cross - legged 
 position . from this position , the patient lowered their head toward the floor 
 while the experimenter pushed down on their back.seated shoulder lateral flexor ( bilateral)the patient sat in a chair with fingers interlaced 
 behind their head . keeping their arms in this position , the experimenter stood 
 behind the patient and pulled the elbows back toward the body s midline.supine hip flexor knee extensor ( unilateral)the patient lay on their back with their leg hanging 
 over the edge of the table with the knee flexed at approximately 90. the hip was 
 then hyperextended by the experimenter while pushing down on the thigh.seated hip external rotators , extensors 
 ( unilateral)the patient sat on the floor with one leg extended . the opposite leg was flexed at the knee , and the foot was placed flat against the 
 extended leg s inner thigh . the patient then lowered their head toward the 
 extended knee while the experimenter pushed down on their back.seated shoulder extensors , adductors , retractors 
 ( unilateral)while seated in a chair , the patient extended one arm 
 and placed it horizontally across the front of the chest . the experimenter stood 
 behind the patient , grabbed their wrist , and pulled their arm against the chest as 
 much as possible while keeping the arm parallel to the floor.supine knee flexor plantar flexor ( unilateral)the patient lay on their back with the legs extended . the experimenter then raised one leg and simultaneously flexed the hip and 
 dorsiflexed the ankle.prone hip flexor ( unilateral)the patient lay on their stomach and flexed one knee 
 at approximately 60. keeping the knee in the flexed position , the experimenter 
 lifted the thigh to hyperextend the hip.seated shoulder flexors , depressors ( bilateral)the patient sat on the floor with the legs extended . the experimenter then grabbed their wrists and hyperextended the shoulder by 
 raising the arms behind the back and up toward the head while keeping the back and 
 elbows straight.seated shoulder and elbow flexors ( unilateral)the patient sat on the floor with the legs extended , 
 with one elbow flexed and brought up near the ear . from this position , the 
 shoulder was hyperflexed by the experimenter by pushing the upper arm down toward 
 the floor.6 . the pss group performed 
 the stretches 3 times per week for 8 weeks . for outcome measurements , a 10-ml blood sample was collected from each patient to determine 
 blood glucose levels using an hba1c analyzer ( variant  turbo , bio - rad laboratories , inc . a paired t - test was used to 
 determine whether there were significant changes in blood glucose levels before and after 
 the intervention . meanwhile , an independent t - test was used to analyze differences between 
 the 2 groups . the level of significance was set at p < 0.05 . the baseline characteristics of the patients are shown in table 2table 2.baseline characteristics of the patientscon ( n = 7)pss ( n = 8)page ( years)58.4  1.849.6  5.20.2duration of diabetes ( years ) 5.2  2.9 5.4 con : control group ; pss : passive static stretching group ; bmi : 
 body mass index . there were no significant differences in the baseline characteristics between 
 groups ( p > 0.05 ) . the results of outcome measures are summarized in table 3table 3.outcome measurescontrol group(n = 7)passive static stretching group(n = 
 8)pre - intervention post - interventionpre - interventionpost - interventionhba1c ( % ) 7.4  1.37.4  1.47.4  1.56.8 1.5*values are means  sd . * p < 0.05 vs. post - intervention . hba1c : glycated hemoglobin a1c .. there was no significant difference in hba1c level after the intervention in 
 the control group ( p > 0.05 ) . however , hba1c levels decreased significantly in the pss 
 group after the intervention ( p < 0.05 ) and were significantly different between groups 
 ( p < 0.05 ) . con : control group ; pss : passive static stretching group ; bmi : 
 body mass index values are means  sd . * p < 0.05 vs. post - intervention . as mentioned above , this study determined the effect of passive static stretching on blood 
 glucose levels in patients with t2 dm . the results showed hba1c levels decreased 
 significantly after an 8-week passive static stretching intervention . there are several 
 possible mechanisms that could explain how passive stretching of skeletal muscles decreased 
 blood glucose levels . according to a review by dohm9 , glucose transport into the skeletal muscles is primarily mediated 
 by a glucose transport protein , glut-4 ; accordingly , exercise can increase glut-4 levels in 
 the skeletal muscles . furthermore , increased metabolic activity accompanying passive muscle 
 stretching is related to the glut-4 activation pathway9 , 10 . therefore , passive 
 muscle stretching could induce the incorporation of glut-4 into the stretched skeletal 
 muscles . other studies also support the possibility of stretching - induced incorporation of glut-4 
 into the skeletal muscles . first , the activity of protein kinase b controls glut-4 
 incorporation ; accordingly , protein kinase b is activated by passive stretching of isolated 
 muscles11 . report 
 that ischemia induces the translocation of glut-4 to the plasma membrane of cardiac 
 myocytes12 ; accordingly , passive 
 stretching of the skeletal muscles can cause ischemia13 . third , in an experimental study by roberts et al . , 
 exercise - induced increases in nitric oxide levels resulted in increased glucose 
 transport14 ; accordingly , passive 
 stretching can increase nitric oxide release from excised soleus muscles by 20%15 . finally , mitogen - activated protein kinase 
 activity stimulates glucose uptake in muscle cells16 ; martineau et al . report that the activity of mitogen - activated 
 protein kinase directly reflects the magnitude of mechanical stress ( e.g. , actively or 
 passively generated tension ) applied to the muscle17 . the sample size is 
 insufficient to generalize the results to all patients with t2 dm . in addition , as hba1c 
 reflects the average plasma glucose level over the preceding 23 months , the 8-week study 
 period might have been too short to determine changes in blood glucose levels as a result of 
 stretching18 . therefore , further 
 studies are required to ascertain the long - term ( i.e. , more than 3 months ) effects of 
 passive static stretching on blood glucose levels in a larger population of patients with 
 t2 dm .
[ purpose ] this study determined the effects of passive static stretching on blood glucose 
 levels in patients with type 2 diabetes . [ subjects ] fifteen patients ( 8 males and 7 
 females ) with type 2 diabetes were recruited and randomly assigned to the control group or 
 passive static stretching group . 
 [ methods ] glycated hemoglobin was measured before and 
 after the 8-week training period . 
 [ results ] glycated hemoglobin levels decreased 
 significantly in the passive static stretching group , and there were significant 
 differences in blood glucose levels between the 2 groups . 
 [ conclusion ] passive static 
 stretching of the skeletal muscles may be an alternative to exercise to help regulate 
 blood glucose levels in diabetes patients .