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

Abstract

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/Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-009-1592-4) contains supplementary material, which is available to authorised users.

Dynamic stability training improves standing balance control in neuropathic patients with type 2 diabetes

“…While some well-performed studies have described the effects of balance training on patients with DN [13,[22][23][24], few investigations have attempted to mitigate the context-specific postural instability problem in this population [24][25]. Some studies, however, have reported on the correlation between balance training and visual external feedback.…”

The Effect of Biofeedback-based Balance Training while Performing Cognitive Tasks on Temporal and Spatial Parameters and Gait Stability of the Elderly

“…Previous studies have shown velocity increases in senior citizens as a result of balance training. Allet et al 32) reported that task-oriented balance exercises for 12 weeks resulted in an 11.6% improvement in velocity, and Hill et al 33) reported that 6 months of multi-factorial interventions with tasks increased velocity by 11.5% in elderly people. Although the present study included people of different ages, and has limitations on directly comparing gait changes, balance training with cognitive tasks is considered to enhance mobility.…”

Peripheral Nervous System Involvement in Diabetes and Role of Rehabilitation

“…Gait could be affected in three possible levels, peripheral secondary myopathy, DPN and DAN, spinal cord to brainstem resulting from small vessel strokes causing loss of sensory information and coordination, and cortical/subcortical lesions from DM related strokes, neurodegenerative diseases and small vessel disease causing higher level gait apraxia [62]. Specific advice on lifestyle choices as well as training has been shown to improve reaction time, postural balance and gait speed [63]. Directed physical therapy to the ankle to help reduce rollovers and improve stability [64].…”