The gait and balance of patients with diabetes can be improved: a randomised controlled trial

Aims/hypothesisGait characteristics and balance are altered in diabetic patients. Little is known about possible treatment strategies. This study evaluates the effect of a specific training programme on gait and balance of diabetic patients.MethodsThis was a randomised controlled trial (n = 71) with an intervention (n = 35) and control group (n = 36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening (twice weekly over 12 weeks). Controls received no treatment. Individuals were allocated to the groups in a central office. Gait, balance, fear of falls, muscle strength and joint mobility were measured at baseline, after intervention and at 6-month follow-up.ResultsThe trial is closed to recruitment and follow-up. After training, the intervention group increased habitual walking speed by 0.149 m/s (p < 0.001) compared with the control group. Patients in the intervention group also significantly improved their balance (time to walk over a beam, balance index recorded on Biodex balance system), their performance-oriented mobility, their degree of concern about falling, their hip and ankle plantar flexor strength, and their hip flexion mobility compared with the control group. After 6 months, all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength. Two patients developed pain in their Achilles tendon: the progression for two related exercises was slowed down.Conclusions/interpretationSpecific training can improve gait speed, balance, muscle strength and joint mobility in diabetic patients. Further studies are needed to explore the influence of these improvements on the number of reported falls, patients’ physical activity levels and quality of life.Trial registration:ClinicalTrials.gov NCT00637546Funding:This work was supported by the Swiss National Foundation (SNF): PBSKP-123446/1/

[1]  K Turcot,et al.  Investigation of standing balance in diabetic patients with and without peripheral neuropathy using accelerometers. , 2009, Clinical biomechanics.

[2]  Hélène Corriveau,et al.  Postural control mechanisms during quiet standing in patients with diabetic sensory neuropathy. , 2004, Diabetes care.

[3]  Marjan J Faber,et al.  Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. , 2006, Archives of physical medicine and rehabilitation.

[4]  P. Estabrooks,et al.  Sustaining Exercise Participation through Group Cohesion , 2000, Exercise and sport sciences reviews.

[5]  M. Kolber,et al.  Strength testing using hand-held dynamometry , 2005 .

[6]  Kamiar Aminian,et al.  Gait alterations of diabetic patients while walking on different surfaces. , 2009, Gait & posture.

[7]  F. A. Gries,et al.  The Epidemiology of Diabetic Neuropathy , 1993 .

[8]  Maria A. Fiatarone Singh,et al.  Health benefits of Tai Chi for older patients with type 2 diabetes: The “Move It for Diabetes Study” – A randomized controlled trial , 2007, Clinical interventions in aging.

[9]  M. Turvey,et al.  Diabetes and Postural Stability: Review and Hypotheses , 2009, Journal of motor behavior.

[10]  David Moher,et al.  Methods and processes of the CONSORT Group: example of an extension for trials assessing nonpharmacologic treatments. , 2008, Annals of internal medicine.

[11]  J. Judge,et al.  The Relationship Between Physical Performance Measures and Independence in Instrumental Activities of Daily Living , 1996 .

[12]  A. Campbell,et al.  Preventing Injuries in Older People by Preventing Falls: A Meta‐Analysis of Individual‐Level Data , 2002, Journal of the American Geriatrics Society.

[13]  K Aminian,et al.  Reliability of diabetic patients' gait parameters in a challenging environment. , 2008, Gait & posture.

[14]  Stephen R Lord,et al.  Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. , 2003, Age and ageing.

[15]  Eling D de Bruin,et al.  Effect of additional functional exercises on balance in elderly people , 2007, Clinical rehabilitation.

[16]  Jeffrey M. Hausdorff,et al.  Increased gait unsteadiness in community-dwelling elderly fallers. , 1997, Archives of physical medicine and rehabilitation.

[17]  Scott W. Lee,et al.  Gait characteristics in patients with type 2 diabetes; improvement after administration of rosiglitazone. , 2005, Medical science monitor : international medical journal of experimental and clinical research.

[18]  Sibylle Thies,et al.  An exploration of step time variability on smooth and irregular surfaces in older persons with neuropathy. , 2008, Clinical biomechanics.

[19]  Jeffrey M. Hausdorff,et al.  Gait variability and fall risk in community-living older adults: a 1-year prospective study. , 2001, Archives of physical medicine and rehabilitation.

[20]  Maria A. Fiatarone Singh,et al.  Mobility Impairment in Type 2 Diabetes , 2006, Diabetes Care.

[21]  J. Judge,et al.  The relationship between physical performance measures and independence in instrumental activities of daily living. The FICSIT Group. Frailty and Injury: Cooperative Studies of Intervention Trials. , 1996, Journal of the American Geriatrics Society.

[22]  Michael J. Mueller,et al.  Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls. , 1994, Physical therapy.

[23]  Lalit Kalra,et al.  A Randomized Controlled Trial of an Enhanced Balance Training Program to Improve Mobility and Reduce Falls in Elderly Patients , 2003, Journal of the American Geriatrics Society.

[24]  M. Spüler,et al.  The epidemiology of diabetic neuropathy. Diabetic Cardiovascular Autonomic Neuropathy Multicenter Study Group. , 1992, Journal of diabetes and its complications.

[25]  S. Sauseng,et al.  The value of the Rydel‐Seiffer tuning fork as a predictor of diabetic polyneuropathy compared with a neurothesiometer , 2004, Diabetic medicine : a journal of the British Diabetic Association.

[26]  R. Cumming,et al.  Interventions for preventing falls in the elderly. , 2000 .

[27]  Z. Pataky,et al.  Diabetic foot disease in the elderly. , 2007, Diabetes & metabolism.

[28]  Michael J. Mueller,et al.  Comparison of muscle activity during walking in subjects with and without diabetic neuropathy. , 2003, Gait & posture.

[29]  R. Craik,et al.  Effect of therapeutic exercise on gait speed in community-dwelling elderly people: a meta-analysis. , 2006, Physical therapy.

[30]  D. Sandman,et al.  A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. , 2001, Archives of physical medicine and rehabilitation.

[31]  Marjan J Faber,et al.  Clinimetric properties of the performance-oriented mobility assessment. , 2006, Physical therapy.

[32]  L. Yardley,et al.  Development and initial validation of the Falls Efficacy Scale-International (FES-I). , 2005, Age and ageing.

[33]  R. Cumming,et al.  WITHDRAWN: Interventions for preventing falls in elderly people. , 2009, The Cochrane database of systematic reviews.

[34]  Marco Schieppati,et al.  Balance control in peripheral neuropathy: are patients equally unstable under static and dynamic conditions? , 2006, Gait & posture.

[35]  Sibylle B Thies,et al.  Interventions Improve Gait Regularity in Patients with Peripheral Neuropathy While Walking on an Irregular Surface Under Low Light , 2004, Journal of the American Geriatrics Society.

[36]  S. Nissen,et al.  Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. , 2007, The New England journal of medicine.

[37]  Karen Soeken,et al.  A Meta-Analysis of Fall Prevention Programs for the Elderly: How Effective Are They? , 2002, Nursing research.

[38]  M. Tinetti.  Performance‐Oriented Assessment of Mobility Problems in Elderly Patients , 1986, Journal of the American Geriatrics Society.

[39]  J. Derr,et al.  Postural Instability in Patients with Diabetic Sensory Neuropathy , 1994, Diabetes Care.

[40]  E. D. de Bruin,et al.  Gait characteristics of diabetic patients: a systematic review , 2008, Diabetes/metabolism research and reviews.

[41]  N. Alexander,et al.  Standing balance and trunk position sense in impaired glucose tolerance (IGT)-related peripheral neuropathy , 2008, Journal of the Neurological Sciences.

[42]  Claudine J Barrett,et al.  A comparison of community-based resistance exercise and flexibility exercise for seniors. , 2002, The Australian journal of physiotherapy.

[43]  K. Aminian,et al.  Clinical factors associated with gait alterations in diabetic patients , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[44]  B. Arnold,et al.  Examination of balance measures produced by the biodex stability system. , 1998, Journal of athletic training.

[45]  W. J. Litchy,et al.  The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population‐based cohort , 1993, Neurology.

[46]  L. Rubenstein,et al.  Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[47]  H. Rubash,et al.  Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. , 2004, The Journal of bone and joint surgery. American volume.

[48]  M. Maurer,et al.  Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility. , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.