EFFECTS OF WEIGHT BEARING EXERCISE ON PEOPLE WITH DIABETES AND NEUROPATHIC FEET

描述(申请人提供)：患有糖尿病和周围神经病变(DMPN)的人有严重的下肢损伤、功能限制和残疾。除了肌肉无力和平衡不良外，他们患足部溃疡的风险也很高，特别是如果他们有溃烂史的话。运动是帮助控制糖尿病并发症的重要治疗组成部分。美国糖尿病协会和美国运动医学院建议，患有糖尿病的成年人每天至少参加30分钟中等强度的体育活动，这与快步走是一致的。然而，由于运动导致足部损伤的风险，这些团体不鼓励患有DM PN的人进行负重运动。关于运动对DM PN患者的影响的数据很少，也没有数据支持限制DM PN患者的负重运动。这项建议的主要目标是进行一项试点随机前瞻性对照临床试验，以确定患有DM PN的人是否可以从渐进的负重锻炼计划中受益(与非负重锻炼计划和非锻炼对照组相比)，而不增加皮肤破裂或足部皮损。结果包括病理生理学、损伤、功能限制和残疾的测量。这项研究的结果将有助于确定神经性皮肤和肌肉是否能够在不损伤的情况下适应日益增加的身体应激水平，并可能对DMPN患者的负重和运动指南具有重要意义。公共卫生相关性：患有糖尿病和周围神经病变的人在腿部虚弱、僵硬和不敏感方面存在严重问题，导致皮肤破裂、平衡、功能活动(步行和爬楼梯)和参与社区活动。运动已被证明有助于糖尿病患者的这些行动能力问题，但尚未在同时患有周围神经病变的人身上进行测试。这项建议的主要目标是进行一项试点随机前瞻性对照临床试验，以确定糖尿病和周围神经病变患者是否可以从渐进的负重锻炼计划中受益，而不会增加皮肤破裂或足部损伤。负重锻炼计划的好处将与非负重锻炼计划和非锻炼对照组的好处进行比较。这项研究的结果将对糖尿病和周围神经病变患者的负重和运动指南具有重要意义。

DESCRIPTION (provided by applicant): People with diabetes and peripheral neuropathy (DM+PN) have substantial lower extremity impairments, functional limitations and disability. In addition to muscle weakness and poor balance, they also are at high risk for foot ulcerations, especially if they have a history of ulceration. Exercise is an important treatment component to help control the complications of diabetes. The American Diabetes Association and the American College of Sports Medicine recommend that adults with DM participate in at least 30 minutes a day of moderate-intensity physical activity that is consistent with a brisk walk. However, these groups discourage weight-bearing exercise for people with DM+PN due to risk of exercise-induced foot injury. Little data exists on the effect of exercise on people with DM+PN and no data support the restriction to limit weight bearing exercise in those with DM+PN. The Primary Goal of this proposal is to conduct a pilot randomized prospective controlled clinical trial to determine if people with DM+PN can benefit from a progressive weight-bearing exercise program (compared to a non weight bearing exercise program and a non exercising control group) without an increase in skin breakdown or foot lesions. Outcomes are included from measures of pathophysiology, impairments, functional limitations, and disability. The results of this study will help to determine if neuropathic skin and muscle can adapt to increasing physical stress levels without injury, and could have important implications for weight- bearing and exercise guidelines for people with DM+PN. PUBLIC HEALTH RELEVANCE: People with diabetes and peripheral neuropathy have substantial problems with weakness, stiffness, and insensitivity in their legs that result in problems with skin breakdown, balance, functional mobility (walking and stair climbing) and participation in community activities. Exercise has been shown to help these mobility problems in people with diabetes, but has not been tested in people who also have peripheral neuropathy. The Primary Goal of this proposal is to conduct a pilot randomized prospective controlled clinical trial to determine if people with diabetes and peripheral neuropathy can benefit from a progressive weight-bearing exercise program without an increase in skin breakdown or foot lesions. The benefits of a weight bearing exercise program will be compared to the benefits of a non weight bearing exercise program and a non exercising control group. The results of this study would have important implications for weight-bearing and exercise guidelines for people with diabetes and peripheral neuropathy.