BackgroundThe prevalence of diabetes worldwide is predicted to increase from 2.8% in 2000 to 4.4% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility.ObjectiveWe aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN.MethodsSixty male and female individuals aged 45–65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40–55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s.ResultsNo statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p < 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p < 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001–0.037; d = 0.56–1.53). For IG, post-hoc analyses showed decreases in peak lateral (p < 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p < 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001–0.044; d = 0.54–0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p < 0.001; d = 1.28).ConclusionsThis study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.

Background and Aims: The diabetes is associated with dysfunction, and failure of various organs, especially the nerves, heart, and blood vessels.The aim of this study was to evaluate the effect of aerobic training on ankle joint co-contraction in patients with Diabetic neuropathy during walking. Methods: The statistical sample of the present study included 20 patients (age: 54.9± 7.3, Body mass index: 28.4±5.1) with diabetic neuropathy in experimentat goup and 20 patients (age: 54.1± 7.1, Body mass index: 28.5±5.1) with diabetic neuropathy in control goup who were selected by convenience sampling. The electrical activity of selected lower limb muscles was recorded using electromyography system during walking. The experimental group did aerobic training for eight weeks (three sessions per week). Two ways ANOVA with repeated measure was used for statistical analysis. Results: The results demonstrated lower general ankle co-contraction in the loading phase during post-test compared with the pre-test in the eperimental group (P-value=0.001). Other components of directed co-contraction in the all phases and general co-contraction in other phases did not demonstrate any significant differences after training protocol (P-value >0.05). Conclusion: Damage to peripheral nerve due to diabetic neuropathy in patients with moderate neuropathy causes abnormal co-contraction contentment of lower limb muscles during walking. Therfore, lowering the general ankle co-contraction results on proper control of the lower limbs, which could possibly decrease the likelihood of injury and falls in patients.

Background: Training of elastic walking is a new method for elasticity in gait and correction of the distribution pattern of plantar pressure in patients with low back pain during gait. This study aimed to investigate the distribution pattern of plantar pressure during gait in women with low back pain following 8 weeks-training of elastic walking. Methods: The present study was quasi-experimental. In this research, 20 women with low back pain were divided into control (n=11) and experimental (n=9) groups. Subjects from the experimental group performed elastic gait training for 3 sessions per week for 8 weeks while the control group didn’t have any exercise program. The plantar pressure variables included the peak of vertical ground reaction forces, the time to peak of ground reaction forces, loading rate, the peak of plantar pressure on the ten foot regions, the peak of ground reaction forces on the ten foot regions, and displacement of the pressure center in two internal-external (copx) and anterior-posterior (copy) lines. The distribution pattern of plantar pressure during gait was recorded by a foot scan system (Sampling rate 300 Hz) in pre-training and post-training. Two-way ANOVA was used to analyze the data. The significance level was set at P < 0.05. Results: In the experimental group, the results of this study demonstrated lower peak vertical reaction force (FzMS component) during post-test compared with pre-test (P = 0.002). Moreover, findings showed that the main effect of group on peak pressure in the mid-foot region was significant (P = 0.011). The results showed no significant difference concerning the main effect of group, the main effect of time and effect, interaction time and group on peak vertical reaction force, displacement of pressure center, vertical loading rate, and walking stance time (P > 0.05). Conclusion: The findings of this study showed that training of elastic walking does not have a significant effect on stance time. Also, training of elastic walking in the experimental group reduced the peak vertical ground reaction force (FzMS component) during the post-test compared with the pre-test that can correct the walking pattern and improve the chronic low back pain.