Novaković-Bursać Snježana, Talić Goran, Tomić Nataša, Škrbić Ranko, Soldatovic Ivan
Management, Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery "Dr Miroslav Zotović" Banja Luka, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina.
Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina.
World J Diabetes. 2024 Dec 15;15(12):2311-2321. doi: 10.4239/wjd.v15.i12.2311.
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.
To determine the effect of supervised stretching, strengthening, functional and walking exercises on joint mobility and muscle strength in patients with diabetic polyneuropathy.
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, = 42) and control group (alpha lipoic acid only, = 40). Muscle strength included dorsal and plantar flexors dynamometry and strength score, while range of motion included ankle, subtalar and first metatarsophalangeal joint goniometry.
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 0.1 ± 3.3; = 0.006) and month 6 (2.8 ± 7.3 -0.9 ± 4.1; < 0.001), subtalar joint on day 15 (7.5 ± 5.1 -0.25 ± 2.25; < 0.001) and month 6 (3.9 ± 6.4 -0.13 ± 3.49; < 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 0.10 ± 1.35; < 0.001) and month 6 (0.66 ± 2.38 -0.75 ± 1.94; = 0.004) as well as plantar flexors on day 15 (3.3 ± 1.6 0.3 ± 1.5; < 0.001) and month 6 (1.8 ± 2.2 -0.9 ± 2.1; < 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 -0.03 ± 0.16; < 0.001) and month 6 (-1.17 ± 1.53 0.20 ± 0.56; < 0.001).
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.
当距下关节和第一跖趾关节出现活动受限情况时，其是已证实的糖尿病足溃疡的危险因素。有证据表明，一项与足部相关的运动计划，结合促进健康的计划，可以改善糖尿病多发性神经病变的体征和症状，增强步态，恢复足踝关节的活动能力，在行走时重新分配压力，并增加足部力量和功能。因此，这些运动计划有助于减轻糖尿病足溃疡的危险因素。
确定有监督的伸展、强化、功能性和步行运动对糖尿病多发性神经病变患者关节活动度和肌肉力量的影响。
这是在一家三级医院进行的一项随机对照试验。该研究纳入了82名参与者，分为干预组（连续15个治疗日进行α-硫辛酸和运动，n = 42）和对照组（仅使用α-硫辛酸，n = 40）。肌肉力量包括背屈肌和跖屈肌的肌力测定和力量评分，而活动范围包括踝关节、距下关节和第一跖趾关节的角度测量。
在第15天，干预组踝关节的活动范围变化显著高于对照组（9.9±7.2对0.1±3.3；P = 0.006），在第6个月时也是如此（2.8±7.3对 -0.9±4.1；P < 0.001）；距下关节在第15天（7.5±5.1对 -0.25±2.25；P < 0.001）和第6个月时（3.9±6.4对 -0.13±3.49；P < 0.001）；干预组背屈肌在第15天的变化显著高于对照组（2.62±1.69对0.10±1.35；P < 0.001），在第6个月时也是如此（0.66±2.38对 -0.75±1.94；P = 0.004），跖屈肌在第15天（3.3±1.6对0.3±1.5；P < 0.001）和第6个月时（1.8±2.2对 -0.9±2.1；P < 0.001）。在第15天，干预组的肌肉力量评分变化显著低于对照组（-1.45±1.42对 -0.03±0.16；P < 0.001），在第6个月时也是如此（-1.17±1.53对0.20±0.56；P < 0.001）。
运动与α-硫辛酸联合使用可改善糖尿病多发性神经病变患者的关节活动度以及足部和小腿肌肉的力量。
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