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

描述（由申请人提供）：糖尿病和周围神经病变（DM+PN）患者有严重的下肢损伤，功能限制和残疾。除了肌肉无力和平衡能力差，他们也有患足部溃疡的高风险，特别是如果他们有溃疡史。运动是控制糖尿病并发症的重要治疗手段。美国糖尿病协会和美国运动医学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，与快走相一致。然而，由于运动引起足部损伤的风险，这些团体不鼓励DM+PN患者进行负重运动。关于运动对DM+PN患者影响的数据很少，DM+PN患者限制负重运动的研究也没有数据支持。本提案的主要目标是进行一项随机前瞻性对照临床试验，以确定DM+PN患者是否可以从渐进式负重锻炼计划中获益（与非负重锻炼计划和非锻炼对照组相比），而不会增加皮肤破裂或足部病变。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受伤的情况下适应不断增加的身体压力水平，并可能对DM+PN患者的负重和运动指导具有重要意义。公共卫生相关性：糖尿病和周围神经病变患者存在腿部无力、僵硬和不敏感等严重问题，导致皮肤破裂、平衡、功能活动（行走和爬楼梯）和参与社区活动等问题。运动已被证明可以帮助糖尿病患者解决行动不便的问题，但还没有在患有周围神经病变的人群中进行测试。本提案的主要目标是进行一项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式负重锻炼计划中获益，而不会增加皮肤破裂或足部病变。将负重锻炼计划的益处与非负重锻炼计划和非锻炼对照组的益处进行比较。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导具有重要意义。

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.