Optimization of Efficacy of Core Strengthening Exercise Protocols on Patients Suffering from Diabetes Mellitus

Open access


Background and Aims: Lack of physical activity, obesity, eating habits contributes to an increase in metabolic disorders. Patients with diabetes have balance, gait, and proprioceptive impairments which hinder the activity of daily living. Therefore, the main objective of present research was to optimize and to find efficacy of the exercise protocols on gait, balance, proprioception and glycated haemoglobin (HbA1c) levels in patients suffering from Type 2 Diabetes mellitus (T2DM).

Material and Methods: Forty individuals with T2DM age between 35 to 60 were recruited and randomly allocated to four groups with 10 subjects per group. Core strengthening exercises were given with duration of twenty or thirty minutes per session and frequency of twice or thrice weekly for six weeks.

Results: Design Expert Software version 10.0.6 was used to analyse data Design Expert software. Further duration and frequency of exercises were compares using ful factorial design. Paired sample t test was used at significance level p<0.05 to find efficacy of core strengthening exercises. The results showed the roe of duration and frequency along with significant effect of exercises on balance, gait, proprioception and HbA1c.

Conclusion: Pilates based core strengthening exercises (PBCS) significantly improved all the parameter selected if exercise protocol was given for 30 minutes and thrice weekly for six weeks. Study has also shown impact of duration and frequency of exercises separately on these parameters.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. International Diabetes federation. DMAtlas. 7 2015. Accessed at: http://www.idf.org/sites/default/files/Atlas7e-poster.pdf.

  • 2. Kaur J Singh SK Vij JS. Physiotherapy and Rehabilitation in the management of DM: A Review. Indian J Sci Res 6(2): 171-181 2015.

  • 3. Fulk GD Robinson CJ Mondal S Storey CM Hollister AM. The effects of diabetes and/or peripheral neuropathy in detecting short Postural perturbations in mature adults. J Neuroeng Rehabil 7: 1-10 2010.

  • 4. Schwartz AV Hillier RA Sellmeyer DE et al. Older women with diabetes have higher risk of falls: a prospective study. Diabetes Care 25(10): 1749-1754 2002.

  • 5. Najafi B Horn D Marclay S Crews RT Wu S Wrobel JS. Assessing Postural Control and postural control strategy in diabetes patients using innovative and wearable technology. J Diabetes Sci Technol 4(4): 780-791 2010.

  • 6. Lim KB Kim DJ Noh JH Yoo J Moon JW. Comparison of balance ability between patients with type 2 diabetes and with and without peripheral neuropathy. PM R 6(3): 209-14 2014

  • 7. Brach JS Talkowski JB Strotmeyer ES Newman AB. diabetes and gait Dysfunction. A Possible Explanatory Factors. Phys Ther 88(11): 1365-1374 2008.

  • 8. Allet L Armand S de Bie RA et al. Tha gait and balance of patients with diabetes can be improved. A randomized controlled trial. Diabetologia 53(3): 458-466 2010.

  • 9. Yavuzer G Yetkin I Toruner FB Koca N Bolukbasi N. Gait deviations of patients with diabetes. Looking beyond peripheral neuropathy. Eura Medicophys 42(2): 127-133 2006.

  • 10. Vaz MM Costa GC Reis JG Junior WM Albuquerque de Paula FJ Abreu DC. Postural control and functional strength in patients with type 2 DM with and without PN. Arch Phys Med Rehabil. 94(12): 2465-70 2013.

  • 11. VanSwearingen JM Paschal KA Bonino P Yang JF. The modified Gait Abnormality Rating Scale for recognizing the risk of recurrent falls in community-dwelling elderly adults. Phys Ther. 76(9): 994-1002 1996.

  • 12. Schwartz MH Rozumalski A. The gait deviation index: A new comprehensive index of gait pathology. Gait Posture 28(3): 351–357 2008.

  • 13. Whitney SL Hudak MT Marchetti GF. The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction. J Vestib Res 10(2): 99-105 2000.

  • 14. Hillman SJ Hazlewood ME Schwartz MH van der Linden ML Robb JE. Correlation of the Edinburgh Gait Score With the Gillette Gait Index the Gillette Functional Assessment Questionnaire and Dimensionless Speed. J Pediatr Orthop 27(1): 7-11 2007.

  • 15. Sullivan SO Schmitz TJ. Physical Rehabilitation Assessment and Rehabilitation 5 th Edition. F.A.Davis Company Philadelphia pp 320-321 2001.

  • 16. Klein PJ Fiedler RC Rose DJ. Rasch Analysis of the Fullerton Advanced Balance (FAB) Scale. Physiother Can 63(1): 115-125 2011.

  • 17. Van Deursen RW Simoneau GG. Foot and ankle sensory neuropathy proprioception and posturl stability. J Orthop Sports Phys Ther 29: 718-726 1999.

  • 18. Boyd BS Wanek L Gray AT Topp KS. Mechanosenstivity during lower extremity neurodynamics testing is diminished in individuals with type 2 DM and PN. a cross sectional study. BMC Neurl 10:75:3-14 2010.

  • 19. Dardano A Penno G Del Prato S Miccoli R. Optimal therapy of type 2 diabetes: a controversial challenge. Aging (Albany NY) 6(3):187-206 2014.

  • 20. Klein PJ Fiedler RC Rose DJ. Rasch Analysis of the Fullerton Advanced Balance (FAB) Scale. Physiother Can 63(1): 115-125 2011.

  • 21. Vij JS Multani NKL. Efficacy of Neuro - Developmental Therapy Based Gait Training in Correction of Gait Pattern of Post Stroke Hemiparetic Patients. Journal of Exercise Science and Physiotherapy 8(1): 30-38 2012.

  • 22. Bajpayi S Tanner CJ Slentz CA et al. Effect of exercise intensity and volume on persistence of insulin sensitivity during training cessation. J Appl Physiol (1985) 106(4): 1079-1085 2009.

  • 23. Hawley JA. Exercise as a therapeutic intervention for the prevention and treatment of insulin resistance. Diabetes Metab Res Rev 20: 383-393 2001.

  • 24. Sung JY Park SB Liu YT et al. Progressive axonal dysfunction precedes development of neuropathy in type 2 diabetes. Diabetes 61: 1592-1598 2012.

  • 25. Wolkodoff NE Andrick R Lazarus E Braunstein B Patch T. The Physiological and Health Effects of a Pilates Program combined With Nutritional Intervention on Subjects with Metabolic Syndrome. Journal of Fitness Research 2: 17-29 2013.

  • 26. Newell D Shead V Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised Pilates programme. J Bodyw Mov Ther 16: 549-554 2012.

  • 27. Hyun J Hwangbo K Lee CW. The Effects of Pilates mat exercise on the balance ability of elderly females. J Phys Ther Sci 26(2): 291-293 2014.

  • 28. Granacher U1 Lacroix A Muehlbauer T Roettger K Gollhofer A. Effects of core instability strength training on trunk muscle strength spinal mobility dynamic balance and functional mobility in older adults. Gerontology 59: 105-113 2013.

  • 29. Bird ML Hill KD Fell JW. A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates. Arch Phys Med Rehabil 93(1): 43-49 2013.

  • 30. Kahle N Tevald MA. Core muscle strengthening's improvement of balance performance in community-dwelling older adults: a pilot study. J Aging Phys Act 22(1): 65-73 2014.

  • 31. Irez GB Ozdemir RA Evin R Irez SG Korkusuz F. Integrating pilates exercise into an exercise program for 65+ year-old women to reduce falls. J Sports Sci Med 10: 105-111 2011.

  • 32. Allet L Armand S Aminian K et al. Clinical factors associated with gait alterations in diabetic patients. Diabet Med 26: 1003-1009 2016.

  • 33. Allet L Armand S Aminian K et al. An exercise intervention to improve diabetic patients' gait in a real-life environment. Gait Posture 32(2): 185-190 2010.

  • 34. Hastings MK Mueller M Sinacore DR Salsich GB Engsberg JR Johnson JE. Effects of a Tendo-Achilles Lengthening Procedure on Muscle function-and gait Characteristics in a Patient with DM. J Orthop Sports Phys Ther 30(2): 85-90 2000.

  • 35. Orr R Tsang T Lam P Comino E Singh MF. Mobility impairment in type 2 diabetes: association with muscle power and effect of Tai Chi intervention. Diabetes Care 29: 2120-2122 2006.

  • 36. Kalron A Rosenblum U Frid L Achiron A. Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: a randomized controlled trial. Clin Rehabil 31(3): 319-328 2016.

  • 37. Da Fonseca JL Magini M de Freitas TH. Laboratory Gait Analysis in Patients with Low Back Pain before and after a Pilates Intervention. J Sport Rehabil 18: 269-282 2009.

  • 38. Levine B1 Kaplanek B Jaffe WL. Pilates training for use in rehabilitation after total hip and knee arthroplasty: a preliminary report. Clin Orthop Relat Res 467: 1468-1475 2009.

  • 39. Freeman J1 Fox E Gear M Hough A. Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial. BMC Neurol 5: 12-19 2012.

  • 40. Moslemi-Haghighi F Ghafarinejad F Hemmati L et al. Evaluation of ankle joint proprioception and balance in patients with type 2 diabetes and healthy subjects. JRSR 2: 17-19 2015.

  • 41. Sadaqat H Amin S Malik AN. Kinesthetic and proprioception impairments in diabetic patients. Journal of Riphah College of Rehabilitation Sciences 2: 12-16 2014.

  • 42. Yoosefinejad AK Farzaneh MH. Evaluation of knee proprioception and kinesthesia in patients with type 2 DM. Nigerian Journal of Medical Rehabilitation 17: 1-12 2014.

Journal information
Impact Factor

CiteScore 2018: 0.19

SCImago Journal Rank (SJR) 2018: 0.128
Source Normalized Impact per Paper (SNIP) 2018: 0.229

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 420 132 11
PDF Downloads 272 82 4