Article

Weight-bearing exercise has been discouraged for people with diabetes
mellitus and peripheral neuropathy (DM+PN).
However, people with diabetes
mellitus and insensate feet have an increased risk of falling. Lower-extremity
exercise and balance training reduce fall risk in some older adults. It is
unknown whether those with neuropathy experience similar benefits. OBJECTIVE: As
part of a study of the effects of weight-bearing exercise on foot ulceration in
people with DM+PN, the effects of a lower-extremity exercise and walking
intervention on balance, lower-extremity strength (force-generating capacity),
and fall incidence were determined. Design The study was an observer-masked,
12-month randomized controlled trial. SETTING: Part 1 of the intervention took
place in physical therapy offices, and part 2 took place in the community.
PATIENTS: The participants were 79 people who were mostly sedentary, who had
DM+PN, and who were randomly assigned to either a control group (n=38) or an
intervention group (n=41). Intervention Part 1 included leg strengthening and
balance exercises and a graduated, self-monitored walking program; part 2
included motivational telephone calls. Both groups received regular foot care,
foot care education, and 8 sessions with a physical therapist. MEASUREMENTS: The
measurements collected were strength, balance, and participant-reported falls for
the year after enrollment. RESULTS: There were no statistically significant
differences between the groups for falls during follow-up. At 12 months, there
was a small increase in the amount of time that participants in the intervention
group could stand on 1 leg with their eyes closed. No other strength or balance
measurements differed between the groups. LIMITATIONS: The study was designed to
detect differences in physical activity, not falls.
The intensity of the
intervention was insufficient to improve strength and balance in this population.
CONCLUSIONS: The training program had a minimal effect on participants' balance
and lower-extremity strength. Increasing weight-bearing activity did not alter
the rate of falling for participants in the intervention group relative to that
for participants in the control group. People who are sedentary and who have
DM+PN appear to be able to increase activity without increasing their rate of
falling.

Langue : ANGLAIS