3.2.3. Exercises can improve gait and balance of patients with diabetes mellitus

Safety should be a major consideration for both health-care professionals and patients before

Therefore physiotherapists should encourage patients who are at high risk of developing

2. Start a regular physical activity program: 3–4 days per week for 10–15 minutes per

3. Start with a preliminary resistance exercise: It can be done for 1–2 days per week, and for

4. Practicing an aerobic exercise for a minimum of 30 minutes per session of 5 days per week. 5. Doing a regular resistance exercise for a minimum of 30 minutes per session of up to 2 or

3.2. Physiotherapy management of physical impairments and associated complications

Clinical trials have provided strong evidence that a combination of both aerobic and resistance exercise has a significant effect in glycemic control than either aerobic exercise only or resistance exercise only [27, 37]. These two studies added that both aerobic exercise and resistance training have better outcomes in glycemic control than advice through phone call and maintaining present life style. Progressive resistance training was also found to be helpful in

A RCT comparing aerobic exercise and resistance training found that both exercises have similar effects in reducing HbA1c. However, there is a chance of potential increase in lateonset hypoglycemia risk after aerobic exercise [40]. It is also been found that physical activities using Physio ball among type 2 diabetes has also its own result in improving glycemic control

An evidence done on the comparison of muscle strength and short-term endurance in the different periods of type 2 diabetes suggested that patients suffering from diabetes mellitus

Generally, the major benefits of resistance training in individuals with diabetes are:

initiating a new program of physical activity.

diabetes mellitus type 2 to do the following.

15–30 minutes per session.

improving glycemic control [38, 39].

1. improved blood cholesterol profiles,

4. improved insulin sensitivity and blood glucose control,

3.2.2. Both aerobic and resistance training helps to improve muscular strength

more days per week.

with diabetes mellitus

and blood pressure [41].

2. increased heart function, 3. decreased blood pressure,

session.

172 Diabetes Food Plan

1. Increase their physical activities and reduce their sedentary time

3.2.1. Both aerobic and resistance exercises help to improve metabolic control

Individuals with diabetic peripheral neuropathy (DPN) are 15 times more likely to experience fall compared to the healthy subjects. Falls are marked as a dangerous health issue in DPN especially in the geriatric population. Therefore, knowledge of the factors that influence falls such as postural control deficit and gait instability in DPN patients is essential. Tailored preventive programs including specific gait and balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes.

A growing number of studies have shown that exercises have some effect on gait and balance. Multisensory exercise and specific gait and balance training programs combined with functional orientated strengthening activities can improve gait speed and balance, and increase both muscle strength and joint mobility of diabetic patients [43, 44].

Task-oriented motor gait training for DPN patients can be used to enhance performance during walking, balance and foot mechanics during walking. Changes in the provided sensorimotor information and enhanced muscle abilities can be regarded as reliable contributions for gait responses in DPN patients [44].

As evidenced by a review on the effectiveness of balance training in the intervention of fall risk in elderly with DPN, Proprioception training, vestibular training, lower limb strength training and mixed sports training enhance balance and reduce its risk of falling in elderly with DPN [45]. When the therapist applies the balance training to elderly patients with DPN, they should focus on the features of different kinds of balance training.

Proprioceptive training can be applied to moderate to severe neuropathy in elderly patients due to the safety and its effectiveness. Vestibular training is more suitable for younger DPN patients. When we apply it to elderly patients, we should pay attention to their safety and should choose low-intensity training. Weight training could significantly improve the lower limbs of patients with DPN walking ability, and relatively more effective than non-weight training [44].

#### 3.3. Physical therapy for diabetic peripheral neuropathy

Peripheral neuropathy is the most common complication of diabetes mellitus (DM) both in developed and developing countries. It is found in about 10% of diabetic patients at diagnosis and in the majority of patients 25 years later on. In diabetic peripheral neuropathy peripheral nerves are unable to function optimally as a result of high blood sugar levels. This condition affects almost half of patients with type 1 and type 2 DM. It involves the presence of symptoms or signs of peripheral nerve dysfunction in people with diabetes after other possible causes have been excluded. Thus, decreasing blood glucose levels can help inhibit and possibly reverse some of the consequences of diabetic peripheral neuropathy.

In type 1 diabetes mellitus, distal lower extremity peripheral neuropathy typically becomes symptomatic after many years of chronic extended hyperglycemia. However, it will be usually obvious after only a few years of well-known poor glycemic control in patients with type 2 DM. Sometimes it may even be recognized at diagnosis. Clinical features of peripheral neuropathy can be categorized in three: sensory, motor and autonomic symptoms.

Here are some useful aerobic exercises:

• Swimming helps to stretch and relax muscles

is another useful form aerobics exercise

of the benefits of working out a strengthening exercise are:

developed. Some of the exercises may involve the following:

• It helps them to respond better to insulin • It Improves the way it uses blood sugar

• It helps to lower the risk for heart disease

• It helps to lose weight

of functional mobility [35].

physical activity.

3.3.3. Strengthening exercises

• Walking for 30–60 minutes, three times per week is a great and easy way to increase

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http://dx.doi.org/10.5772/intechopen.71392

• Though it is not easily accessible for all diabetics individuals, stationary bicycling indoors

There are different forms of strengthening exercises that can be done by diabetic patients. Resistance exercises are commonly applied in physical rehabilitation programs to improve muscular strength, power and endurance of diabetic's patients. Many newly recognized type 2 diabetics may not have exercised in years. Therefore, there should be an awareness rising program together with health promotion and disease prevention campaigns about the clinical advantages of exercises with weights or other forms of mechanical resistance [46]. Then it will be imperative if they check in with their doctor first. After asking if there are any contraindicated moves they should avoid, they can start learning the right way to do each strengthening exercise. However, strengthening exercises have different requirements depending upon the treatment goals or function [28, 47]. The strengthening exercise programs need to be personalized to each patient's chief complaint, functional problems and goals. The workout variables such as speed, the intensity, the frequency and the type of muscle contraction used or the amount of muscles recruited in each contraction all effect the outcome of the program. Physiotherapists are experts who can guide and supervise patients with DPN. In addition to muscle strength, which can involve power, endurance and speed of contraction, the timing and balance of muscle contractions is very important. There are many different benefits of strengthening exercises for people with diabetes. Some

In addition, the American College of Sports Medicine recommends that people with type 2 diabetes should start practicing a strength training program to reduce the risk of further injury, to improve muscle strength, to improve the quality and range of movement and overall quality

Strengthening exercise programs will include a variety of exercises designed to target specific groups or individual muscles. These exercises will begin easier and progress as strength is

• Participating in a low-impact aerobics class is also very important


Physical therapy can improve the overall quality of life of DM patients with peripheral neuropathy and alleviate them from the symptoms of diabetic neuropathy. It is also improve muscle strength, joint mobility, balance, coordination and physical function.
