Jafarnezhadgero AmirAli, Mamashli Elahe, Granacher Urs
Department of Sport Management and Biomechanics, University of Mohaghegh Ardabili, Ardabil, Iran.
Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany.
Front Physiol. 2021 Mar 18;12:654755. doi: 10.3389/fphys.2021.654755. eCollection 2021.
The 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.
We aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VOmax), ground reaction forces, and muscle activities during walking in patients with moderate DN.
Sixty male and female individuals aged 45-65 years with DN were randomly assigned to an intervention (IG, = 30) or a waiting control (CON, = 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, VOmax 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.
No statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VOmax ( < 0.001; = 1.22). The test revealed a significant increase in IG ( < 0.001; = 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 ( = 0.001-0.037; = 0.56-1.53). For IG, analyses showed decreases in peak lateral ( < 0.001; = 1.33) and vertical ( = 0.004; = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off ( < 0.001; = 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 ( = 0.001-0.044; = 0.54-0.81). tests indicated significant intervention-related increases in vastus lateralis ( = 0.001; = 1.08) and gluteus medius ( = 0.008; = 0.67) during the loading phase and vastus medialis activity during mid-stance ( = 0.001; = 0.86). In addition, tests showed decreases in gastrocnemius medialis during the push-off phase in IG only ( < 0.001; = 1.28).
This study demonstrated that an endurance-dominated exercise program has the potential to improve VOmax 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.
预计全球糖尿病患病率将从2000年的2.8%升至2030年的4.4%。糖尿病性神经病变（DN）与神经胶质细胞、其轴突及内皮细胞受损相关，进而导致功能及活动能力受损。
我们旨在研究以耐力为主的运动计划对中度DN患者步行时最大摄氧量（VO₂max）、地面反作用力及肌肉活动的影响。
60名年龄在45 - 65岁的DN男性和女性被随机分为干预组（IG，n = 30）或等待对照组（CON，n = 30）。本研究的研究方案已在当地临床试验组织注册（IRCT20200201046326N1）。IG组进行了以耐力为主的运动计划，包括自行车测力计运动和步态治疗。渐进性干预计划持续12周，每周3次，每次40 - 55分钟。CON组在测试后接受与IG组相同的治疗。训练前和训练后，使用肺功能仪在分级运动测试中测量VO₂max。此外，在以约1 m/s的恒定速度行走时记录地面反作用力和下肢肌肉活动。
所有分析变量在组间差异上均未观察到具有统计学意义的基线差异。VO₂max存在显著的组×时间交互作用（P < 0.001；η² = 1.22）。t检验显示IG组有显著增加（P < 0.001；η² = 1.88），而CON组没有。在足跟接触时的峰值侧向和垂直地面反作用力以及蹬离时的峰值垂直地面反作用力方面观察到显著的组×时间交互作用（P = 0.001 - 0.037；η² = 0.56 - 1.53）。对于IG组，事后检验显示足跟接触时峰值侧向（P < 0.001；η² = 1.33）和垂直（P = 0.004；η² = 0.55）地面反作用力降低，蹬离时峰值垂直地面反作用力增加（P < 0.001；η² = 0.92）。在肌肉活动方面，在负重阶段外侧股四头肌和臀中肌、支撑中期的股内侧肌以及蹬离阶段的腓肠内侧肌存在显著的组×时间交互作用（P = 0.001 - 0.044；η² = 0.54 - 0.81）。事后检验表明，负重阶段外侧股四头肌（P = 0.001；η² = 1.08）和臀中肌（P = 0.008；η² = 0.67）以及支撑中期股内侧肌活动（P = 0.001；η² = 0.86）有与干预相关的显著增加。此外，事后检验仅显示IG组蹬离阶段腓肠内侧肌活动降低（P < 0.001；η² = 1.28）。
本研究表明，以耐力为主的运动计划有可能改善DN患者的VO₂max和糖尿病相关的异常步态。步行足跟接触时观察到的峰值垂直地面反作用力降低可能是由于负重阶段外侧股四头肌和臀中肌活动增加所致。因此，我们建议在2型糖尿病患者中实施以耐力为主的运动计划，因为它通过改善有氧能力和步态特征是可行、安全且有效的。
