The effects of two different exercise protocols in patients with good controlled type 2 diabetes mellitus: proprioceptive exercise vs resistive exercise

Exercise has benefits on glycemic control, increasing exercise capacity, and muscle strength in patients with type 2 diabetes mellitus (T2DM). In the progression of T2DM, proprioceptive deficits may develop, which can cause inadequate muscle strength and neuropathy. Preventive strategies are needed for T2DM patients without neuropathy even in the early stage of disease. Proprioceptive exercises has a potential to improve dynamic balance through an increase in peripheral sensitivity, and prevent from neuropathy and reduction in falls associated with sensory deficits.

To compare the effects of proprioceptive exercise training or resistive exercise training on glycemic control, functional capacity, dynamic balance, sensation and muscle strength in patients with good-controlled T2DM.

Thirty patients with good-controlled T2DM were randomized into Proprioceptive Training Group (PG) (n=15, mean %glycated hemoglobin (HbA1c)=6.85±0.58, mean age=51.6±8.09/years, 12 F, 3 M) and Resistive Training Group (RG) (n=15, mean %HbA1c= 6.8±1.1, mean age= 50.86±7.51/years, 12 F, 3 M). Fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were analyzed. Functional capacity assessed with six-minute walking test (6MWT) and dynamic balance was evaluated using a dynamic balance system (Prokin PK200 platform). Proprioception sense measured with angle reproduction test in direction of dorsiflexion and plantar flexion and deviation. Cortical sensation was evaluated with two-point discrimination test. Quadriceps and Ankle muscle strength were assessed with a digital hand-held dynamometer (JTech PowerTrack II Commander). All subjects were performed moderate intensity of aerobic exercise 3 times/week for 6 weeks. In addition, patients in PG continued the proprioceptive training for the lower extremities while RG performed moderate intensity lower extremity resistive training 2 times/week.

Significant but not clinically important decrease in HbA1c and FBG were obtained in the groups. Functional capacity, and lower extremity proprioception, cortical sensation and muscle strength showed in-group improvements in both groups. PG also showed significant intragroup improvements in dynamic balance. The groups were similar in terms of obtained changes in all parameters after training (Table 1 and Table 2).

The proprioceptive training leads similar benefits with resistance training on functional capacity and lower extremity sensation, and muscle strength in patients with good-controlled T2DM. Besides, proprioceptive training can be considered to improve dynamic balance.