Novaković-Bursać S, Talić G, Tomić N, Škrbić R, Soldatovic I. Effect of three-week exercise program on muscle strength and joint mobility in patients with diabetic polyneuropathy: Randomized controlled trial. World J Diabetes 2024; 15(12): 2311-2321 [DOI: 10.4239/wjd.v15.i12.2311]
Corresponding Author of This Article
Snježana Novaković-Bursać, MD, MSc, Doctor, Medical Director, Management, Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotović” Banja Luka, Slatinska 11, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina. snjezana.nb@ms.zotovicbl.org
Research Domain of This Article
Rehabilitation
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Dec 15, 2024; 15(12): 2311-2321 Published online Dec 15, 2024. doi: 10.4239/wjd.v15.i12.2311
Effect of three-week exercise program on muscle strength and joint mobility in patients with diabetic polyneuropathy: Randomized controlled trial
Snježana Novaković-Bursać, Goran Talić, Nataša Tomić, Ranko Škrbić, Ivan Soldatovic
Snježana Novaković-Bursać, Goran Talić, Nataša Tomić, Management, Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotović” Banja Luka, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina
Ranko Škrbić, Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina
Ivan Soldatovic, Institute of Medical Statistics and Informatic, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
Co-corresponding authors: Snježana Novaković-Bursać and Ivan Soldatovic.
Author contributions: Novaković-Bursać S was responsible for designing and performing the study; Soldatovic I and Škrbic R were responsible for data analysis; Novaković-Bursać S, Talić G, Tomić N, Škrbić R and Soldatovic I were responsible for discussing and interpreting the results and writing the final version to be published; All authors read and approved the final manuscript.
Institutional review board statement: The clinical trial was approved by the Ethics Committees of the Institute, protocol number: No. 116-31-3090-1/20.
Clinical trial registration statement: The trial is registered in ANZCRT with registration number: No. ACTRN12624000844549.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: All the data and materials that are required to reproduce these findings can be shared by contacting the corresponding author.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Snježana Novaković-Bursać, MD, MSc, Doctor, Medical Director, Management, Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotović” Banja Luka, Slatinska 11, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina. snjezana.nb@ms.zotovicbl.org
Received: May 30, 2024 Revised: August 28, 2024 Accepted: October 9, 2024 Published online: December 15, 2024 Processing time: 171 Days and 17 Hours
Abstract
BACKGROUND
Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints. Evidence shows that a foot-related exercise program, combined with a health-promoting program, can improve the signs and symptoms of diabetic polyneuropathy, enhance gait, restore mobility in the foot and ankle joints, redistribute pressure while walking, and increase foot strength and function. As a result, these exercise programs can help mitigate the risk factors for diabetic foot ulceration.
AIM
To determine the effect of supervised stretching, strengthening, functional and walking exercises on joint mobility and muscle strength in patients with diabetic polyneuropathy.
METHODS
This was a randomized controlled trial conducted in a tertiary hospital. The study included 82 participants allocated into the intervention group (alpha-lipoic acid and exercise on 15 consecutive therapeutic days, n = 42) and control group (alpha lipoic acid only, n = 40). Muscle strength included dorsal and plantar flexors dynamometry and strength score, while range of motion included ankle, subtalar and first metatarsophalangeal joint goniometry.
RESULTS
Change of motion range was significantly higher in the intervention group compared to the control group regarding ankle joint on day 15 (9.9 ± 7.2 vs 0.1 ± 3.3; P = 0.006) and month 6 (2.8 ± 7.3 vs -0.9 ± 4.1; P < 0.001), subtalar joint on day 15 (7.5 ± 5.1 vs -0.25 ± 2.25; P < 0.001) and month 6 (3.9 ± 6.4 vs -0.13 ± 3.49; P < 0.001). Change in dorsal flexors was significantly higher in the intervention group compared to the control group on day 15 (2.62 ± 1.69 vs 0.10 ± 1.35; P < 0.001) and month 6 (0.66 ± 2.38 vs -0.75 ± 1.94; P = 0.004) as well as plantar flexors on day 15 (3.3 ± 1.6 vs 0.3 ± 1.5; P < 0.001) and month 6 (1.8 ± 2.2 vs -0.9 ± 2.1; P < 0.001). Muscle strength score change was significantly lower in the intervention group compared to the control group on day 15 (-1.45 ± 1.42 vs -0.03 ± 0.16; P < 0.001) and month 6 (-1.17 ± 1.53 vs 0.20 ± 0.56; P < 0.001).
CONCLUSION
Exercise in combination with alpha-lipoic acid can improve joint mobility, as well as strength of the foot and lower leg muscles in patients with diabetic polyneuropathy.
Core Tip: Improvement in biomechanical parameters, while enhancing mobility and overall patient condition, has the potential to reduce the risk of developing diabetic ulcers in patients with diabetic neuropathy. A combined and supervised exercise program lasting 15 therapy days, consisting of stretching, strength, functional and walking exercises, can improve the mobility in the ankle, subtalar and first metatarsophalangeal joint, as well as the strength of the foot and lower leg muscles in patients with diabetic peripheral neuropathy. The effects achieved by this treatment can last up to 6 months after the intervention.
