Abstract
Introduction: Diabetes mellitus (DM) is a metabolic disorder characterized by an abnormal increase in blood glucose levels resulting from insulin secretion and/or dysfunctional activity that can lead to several serious complications in addition to decreased postural balance.
Objective: This study aimed to identify and analyze the main interventions used to improve static balance in patients with DM.
Methods: For the selection of articles, a bibliographic search was performed using PubMed, Scopus, Web of Science, Embase, and Cochrane databases. Only clinical trials that investigated the effect of training on static balance in adults with type 2 DM were selected, and 34 studies were included.
Results: The search resulted in the identification of 2681 articles, and of these, 31 were eligible for the study. The identified interventions were proprioceptive, aerobic, resistance training on platforms, in virtual reality, and Tai Chi. The main results obtained were an increase in time in the one-leg stance, Romberg test, and tandem position, a significant increase in the Berg Balance Scale score and balance index, and a reduction in the variables of postural sway.
Conclusion: There are a variety of effective training methods for improving static balance, and the choice of intervention to be applied goes beyond proven effectiveness, depending on reproducibility and/or financial cost.
[1]
Cole JB, Florez JC. Genetics of diabetes mellitus and diabetes complications. Nat Rev Nephrol 2020; 16(7): 377-90.
[http://dx.doi.org/10.1038/s41581-020-0278-5] [PMID: 32398868]
[http://dx.doi.org/10.1038/s41581-020-0278-5] [PMID: 32398868]
[2]
International Diabetes Federation. IDF diabetes atlas 2017. Available from: https://diabetesatlas.org/
[3]
García-Chapa EG, Leal-Ugarte E, Peralta-Leal V, Durán-González J, Meza-Espinoza JP. Genetic epidemiology of type 2 diabetes in mexican mestizos. BioMed Res Int 2017; 2017: 1-10.
[http://dx.doi.org/10.1155/2017/3937893] [PMID: 28607931]
[http://dx.doi.org/10.1155/2017/3937893] [PMID: 28607931]
[4]
Albalawi RA, Alshehri HD, Alnejaimi SS, et al. Diabetes mellitus: Screening and diagnosis. Going Am JP Sci 2018; 05: 14027-32.
[5]
Cameron NE, Eaton SEM, Cotter MA, Tesfaye S. Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. Diabetologia 2001; 44(11): 1973-88.
[http://dx.doi.org/10.1007/s001250100001] [PMID: 11719828]
[http://dx.doi.org/10.1007/s001250100001] [PMID: 11719828]
[6]
Jack M, Wright D. Role of advanced glycation endproducts and glyoxalase I in diabetic peripheral sensory neuropathy. Transl Res 2012; 159(5): 355-65.
[http://dx.doi.org/10.1016/j.trsl.2011.12.004] [PMID: 22500508]
[http://dx.doi.org/10.1016/j.trsl.2011.12.004] [PMID: 22500508]
[7]
Crews RT, Yalla SV, Fleischer AE, Wu SC. A growing troubling triad: Diabetes, aging, and falls. J Aging Res 2013; 2013: 1-6.
[http://dx.doi.org/10.1155/2013/342650] [PMID: 23476773]
[http://dx.doi.org/10.1155/2013/342650] [PMID: 23476773]
[8]
Hewston P, Deshpande N. Falls and balance impairments in older adults with type 2 diabetes: Thinking beyond diabetic peripheral neuropathy. Can J Diabetes 2016; 40(1): 6-9.
[http://dx.doi.org/10.1016/j.jcjd.2015.08.005] [PMID: 26778679]
[http://dx.doi.org/10.1016/j.jcjd.2015.08.005] [PMID: 26778679]
[9]
Swink LA, Schmid AA, Atler KE, et al. Fall risk factors for individuals under the age of 65 years with type 2 diabetes mellitus. Br J Occup Ther 2020; 83(3): 191-6.
[http://dx.doi.org/10.1177/0308022619876552]
[http://dx.doi.org/10.1177/0308022619876552]
[10]
Qin J, Zhao K, Chen Y, et al. The effects of exercise interventions on balance capacity in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. INQUIRY. Inquiry 2021; 58.
[http://dx.doi.org/10.1177/00469580211018284] [PMID: 34032161]
[http://dx.doi.org/10.1177/00469580211018284] [PMID: 34032161]
[11]
Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; 2012(9): CD007146.
[PMID: 22972103]
[PMID: 22972103]
[12]
Salsabili H, Bahrpeyma F, Esteki A, Karimzadeh M, Ghomashchi H. Spectral characteristics of postural sway in diabetic neuropathy patients participating in balance training. J Diabetes Metab Disord 2013; 12(1): 29.
[http://dx.doi.org/10.1186/2251-6581-12-29] [PMID: 23782873]
[http://dx.doi.org/10.1186/2251-6581-12-29] [PMID: 23782873]
[13]
Rojhani-Shirazi Z, Barzintaj F, Salimifard MR. Comparison the effects of two types of therapeutic exercises Frenkele vs. Swiss ball on the clinical balance measures in patients with type II diabetic neuropathy. Diabetes Metab Syndr 2017; 11 (Suppl. 1): S29-32.
[http://dx.doi.org/10.1016/j.dsx.2016.08.020] [PMID: 27720359]
[http://dx.doi.org/10.1016/j.dsx.2016.08.020] [PMID: 27720359]
[14]
Ahmad I, Noohu MM, Verma S, Singla D, Hussain ME. Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy. Gait Posture 2019; 74: 114-20.
[http://dx.doi.org/10.1016/j.gaitpost.2019.08.018] [PMID: 31499405]
[http://dx.doi.org/10.1016/j.gaitpost.2019.08.018] [PMID: 31499405]
[15]
Silva P, Figueredo Borges Botelho PF, de Oliveira Guirro EC, Vaz MMOLL, de Abreu DCC. Long-term benefits of somatosensory training to improve balance of elderly with diabetes mellitus. J Bodyw Mov Ther 2015; 19(3): 453-7.
[http://dx.doi.org/10.1016/j.jbmt.2014.11.002] [PMID: 26118517]
[http://dx.doi.org/10.1016/j.jbmt.2014.11.002] [PMID: 26118517]
[16]
Grewal GS, Schwenk M, Lee-Eng J, et al. Sensor-based interactive balance training with visual joint movement feedback for improving postural stability in diabetics with peripheral neuropathy: The randomized controlled trial. Gerontology 2015; 61(6): 567-74.
[http://dx.doi.org/10.1159/000371846] [PMID: 25721132]
[http://dx.doi.org/10.1159/000371846] [PMID: 25721132]
[17]
Ng TKW, Kwan RLC, Lo SK, Cheing GLY. A tailor-made exercise program for improving balance and mobility in older adults with type 2 diabetes. J Gerontol Nurs 2018; 44(2): 41-8.
[http://dx.doi.org/10.3928/00989134-20171002-04] [PMID: 28990633]
[http://dx.doi.org/10.3928/00989134-20171002-04] [PMID: 28990633]
[18]
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372(71): n71.
[http://dx.doi.org/10.1136/bmj.n71] [PMID: 33782057]
[http://dx.doi.org/10.1136/bmj.n71] [PMID: 33782057]
[19]
de Oliveira Lima RA, Piemonte GA, Nogueira CR, Dos Santos Nunes-Nogueira V. Efficacy of exercise on balance, fear of falling, and risk of falls in patients with diabetic peripheral neuropathy: A systematic review and meta-analysis. Arch Endocrinol Metab 2021; 65(2): 198-211.
[PMID: 33905633]
[PMID: 33905633]
[20]
Morrison S, Colberg SR, Parson HK, Vinik AI. Relation between risk of falling and postural sway complexity in diabetes. Gait Posture 2012; 35(4): 662-8.
[http://dx.doi.org/10.1016/j.gaitpost.2011.12.021] [PMID: 22269128]
[http://dx.doi.org/10.1016/j.gaitpost.2011.12.021] [PMID: 22269128]
[21]
De Carvalho AP, Silva V, Grande AJ. Risk of bias assessment of randomized clinical trials using the Cochrane collaboration tool. Diagnosis & Treatment 2013; 18: 38-44.
[22]
Johnson CE, Takemoto JK. A review of beneficial low-intensity exercises in diabetic peripheral neuropathy patients. J Pharm Pharm Sci 2019; 22(1): 22-7.
[http://dx.doi.org/10.18433/jpps30151] [PMID: 30599819]
[http://dx.doi.org/10.18433/jpps30151] [PMID: 30599819]
[23]
Simoneau GG, Ulbrecht JS, Derr JA, Becker MB, Cavanagh PR. Postural instability in patients with diabetic sensory neuropathy. Diabetes Care 1994; 17(12): 1411-21.
[http://dx.doi.org/10.2337/diacare.17.12.1411] [PMID: 7882810]
[http://dx.doi.org/10.2337/diacare.17.12.1411] [PMID: 7882810]
[24]
Simoneau GG, Derr JA, Ulbrecht JS, Becker MB, Cavanagh PR. Diabetic sensory neuropathy effect on ankle joint movement perception. Arch Phys Med Rehabil 1996; 77(5): 453-60.
[http://dx.doi.org/10.1016/S0003-9993(96)90033-7] [PMID: 8629921]
[http://dx.doi.org/10.1016/S0003-9993(96)90033-7] [PMID: 8629921]
[25]
Martinelli AR, Mantovani AM, Nozabieli AJL, et al. Muscle strength and ankle mobility for the gait parameters in diabetic neuropathies. Foot 2013; 23(1): 17-21.
[http://dx.doi.org/10.1016/j.foot.2012.11.001] [PMID: 23274122]
[http://dx.doi.org/10.1016/j.foot.2012.11.001] [PMID: 23274122]
[26]
Mueller MJ, Minor SD, Sahrmann SA, Schaaf JA, Strube MJ. Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls. Phys Ther 1994; 74(4): 299-308.
[http://dx.doi.org/10.1093/ptj/74.4.299] [PMID: 8140143]
[http://dx.doi.org/10.1093/ptj/74.4.299] [PMID: 8140143]
[27]
Balducci S, Iacobellis G, Parisi L, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications 2006; 20(4): 216-23.
[http://dx.doi.org/10.1016/j.jdiacomp.2005.07.005] [PMID: 16798472]
[http://dx.doi.org/10.1016/j.jdiacomp.2005.07.005] [PMID: 16798472]
[28]
Chan CL, Ngai EK, Leung PK, Wong S. Effect of the adapted Virtual Reality cognitive training program among Chinese older adults with chronic schizophrenia: A pilot study. Int J Geriatr Psychiatry 2010; 25(6): 643-9.
[PMID: 19806599]
[PMID: 19806599]
[29]
Yavuzer G, Senel A, Atay MB, Stam HJ. “Playstation eyetoy games” improve upper extremity-related motor functioning in subacute stroke: A randomized controlled clinical trial. Eur J Phys Rehabil Med 2008; 44(3): 237-44.
[PMID: 18469735]
[PMID: 18469735]
[30]
Lamoth CJ, Alingh R, Caljouw SR. Exergaming for elderly: Effects of different types of game feedback on performance of a balance task. Stud Health Technol Inform 2012; 181: 103-7.
[PMID: 22954837]
[PMID: 22954837]
[31]
Nardone A, Godi M, Artuso A, Schieppati M. Balance rehabilitation by moving platform and exercises in patients with neuropathy or vestibular deficit. Arch Phys Med Rehabil 2010; 91(12): 1869-77.
[http://dx.doi.org/10.1016/j.apmr.2010.09.011] [PMID: 21112428]
[http://dx.doi.org/10.1016/j.apmr.2010.09.011] [PMID: 21112428]
[32]
Kiani N, Marryam M, Malik AN, Amjad I. The effect of aerobic exercise on balance in patients with diabetic neuropathy. Journal of Medical Sciences 2018; 26: 141-5.
[33]
Dixit S, Maiya A, Shastry BA, Guddattu V. Analysis of postural control during quiet standing in a population with diabetic peripheral neuropathy undergoing moderate intensity aerobic exercise training: A single blind, randomized controlled trial. Am J Phys Med Rehabil 2016; 95(7): 516-24.
[http://dx.doi.org/10.1097/PHM.0000000000000426] [PMID: 26745226]
[http://dx.doi.org/10.1097/PHM.0000000000000426] [PMID: 26745226]
[34]
Abdelaal A, El-Shamy S. Effect of antigravity treadmill training on gait and balance in patients with diabetic polyneuropathy: A randomized controlled trial. F1000 Res 2022; 11: 52.
[http://dx.doi.org/10.12688/f1000research.75806.3] [PMID: 36606118]
[http://dx.doi.org/10.12688/f1000research.75806.3] [PMID: 36606118]
[35]
Yilmaz Menek M, Budak M. The effect of combination of aerobic and strengthening exercise on muscle strength, balance, and sleep quality in individuals with type 2 diabetes. Düzce Tıp Fakültesi Dergisi 2022; 24(3): 235-40.
[http://dx.doi.org/10.18678/dtfd.1109209]
[http://dx.doi.org/10.18678/dtfd.1109209]
[36]
Du Plessis R, Dembskey N, Bassett SH. Effects of an isometric exercise training program on muscular strength, ankle mobility, and balance in patients with diabetic peripheral neuropathy in the lower legs in South Africa. Int J Diabetes Dev Ctries 2022; 1-6.
[PMID: 35400974]
[PMID: 35400974]
[37]
Khan KS, Overgaard K, Tankisi H, et al. Effects of progressive resistance training in individuals with type 2 diabetic polyneuropathy: A randomised assessor-blinded controlled trial. Diabetologia 2022; 65(4): 620-31.
[http://dx.doi.org/10.1007/s00125-021-05646-6] [PMID: 35048156]
[http://dx.doi.org/10.1007/s00125-021-05646-6] [PMID: 35048156]
[38]
Demır F, Şahın M, Ergezen G. Effectiveness of proprioceptive exercise on balance and sensory function in nursing home geriatric individuals with diabetes: Randomized controlled trial. turkiye klinikleri. Journal of Medical Science 2022; 42(1): 27-34.
[39]
Stolarczyk A, Jarzemski I, Maciąg BM, Radzimowski K, Świercz M, Stolarczyk M. Balance and motion coordination parameters can be improved in patients with type 2 diabetes with physical balance training: non-randomized controlled trial. BMC Endocr Disord 2021; 21(1): 143.
[http://dx.doi.org/10.1186/s12902-021-00804-8] [PMID: 34217288]
[http://dx.doi.org/10.1186/s12902-021-00804-8] [PMID: 34217288]
[40]
Daud SAH, Rahman MU, Arsh A, Junaid M. Effect of balance training with Biodex Balance System to improve balance in patients with diabetic neuropathy: A quasi experimental study. Pak J Med Sci 2021; 37(2): 389-92.
[http://dx.doi.org/10.12669/pjms.37.2.2336] [PMID: 33679919]
[http://dx.doi.org/10.12669/pjms.37.2.2336] [PMID: 33679919]
[41]
Mullerpatan RP, Kanjirathingal JP, Nehete G, Raghuram N. Effect of yogasana intervention on standing balance performance among people with diabetic peripheral neuropathy: A pilot study. Int J Yoga 2021; 14(1): 60-70.
[http://dx.doi.org/10.4103/ijoy.IJOY_75_20] [PMID: 33840978]
[http://dx.doi.org/10.4103/ijoy.IJOY_75_20] [PMID: 33840978]
[42]
Venkataraman K, Tai BC, Khoo EYH, et al. Short-term strength and balance training does not improve quality of life but improves functional status in individuals with diabetic peripheral neuropathy: a randomised controlled trial. Diabetologia 2019; 62(12): 2200-10.
[http://dx.doi.org/10.1007/s00125-019-04979-7] [PMID: 31468106]
[http://dx.doi.org/10.1007/s00125-019-04979-7] [PMID: 31468106]
[43]
Hung ESW, Chen SC, Chang FC, Shiao Y, Peng CW, Lai CH. Effects of interactive video game-based exercise on balance in diabetic patients with peripheral neuropathy: An open-level, crossover pilot study. Evid Based Complement Alternat Med 2019; 2019: 1-9.
[http://dx.doi.org/10.1155/2019/4540709] [PMID: 30956680]
[http://dx.doi.org/10.1155/2019/4540709] [PMID: 30956680]
[44]
Battesha HHM, Ahmed GM, Amer HA, El Gohary AM, Ragab WM. Effect of core stability exercises and desensitisation therapy on limit of stability in diabetic peripheral neuropathy patients. Int J Ther Rehabil 2018; 25(3): 128-34.
[http://dx.doi.org/10.12968/ijtr.2018.25.3.128]
[http://dx.doi.org/10.12968/ijtr.2018.25.3.128]
[45]
Morrison S, Simmons R, Colberg SR, Parson HK, Vinik AI. Supervised balance training and wii fit-based exercises lower falls risk in older adults with type 2 diabetes. J Am Med Dir Assoc 2018; 19(2): 185.e7-185.e13.
[http://dx.doi.org/10.1016/j.jamda.2017.11.004] [PMID: 29289541]
[http://dx.doi.org/10.1016/j.jamda.2017.11.004] [PMID: 29289541]
[46]
Eftekhar-Sadat B, Azizi R, Aliasgharzadeh A, Toopchizadeh V, Ghojazadeh M. Effect of balance training with biodex stability system on balance in diabetic neuropathy. Ther Adv Endocrinol Metab 2015; 6(5): 233-40.
[http://dx.doi.org/10.1177/2042018815595566] [PMID: 26445646]
[http://dx.doi.org/10.1177/2042018815595566] [PMID: 26445646]
[47]
Grewal GS, Sayeed R, Schwenk M, et al. Balance rehabilitation. J Am Podiatr Med Assoc 2013; 103(6): 498-507.
[http://dx.doi.org/10.7547/1030498] [PMID: 24297986]
[http://dx.doi.org/10.7547/1030498] [PMID: 24297986]
[48]
Morrison S, Colberg SR, Parson HK, Vinik AI. Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy. J Diabetes Complications 2014; 28(5): 715-22.
[http://dx.doi.org/10.1016/j.jdiacomp.2014.04.007] [PMID: 24929798]
[http://dx.doi.org/10.1016/j.jdiacomp.2014.04.007] [PMID: 24929798]
[49]
Taveggia G, Villafañe JH, Vavassori F, Lecchi C, Borboni A, Negrini S. Multimodal treatment of distal sensorimotor polyneuropathy in diabetic patients: A randomized clinical trial. J Manipulative Physiol Ther 2014; 37(4): 242-52.
[http://dx.doi.org/10.1016/j.jmpt.2013.09.007] [PMID: 24656867]
[http://dx.doi.org/10.1016/j.jmpt.2013.09.007] [PMID: 24656867]
[50]
Quigley PA, Bulat T, Schulz B, et al. Exercise interventions, gait, and balance in older subjects with distal symmetric polyneuropathy: A three-group randomized clinical trial. Am J Phys Med Rehabil 2014; 93(1): 1-16.
[http://dx.doi.org/10.1097/PHM.0000000000000052] [PMID: 24355993]
[http://dx.doi.org/10.1097/PHM.0000000000000052] [PMID: 24355993]
[51]
Lee S, Shin S. Effectiveness of virtual reality using video gaming technology in elderly adults with diabetes mellitus. Diabetes Technol Ther 2013; 15(6): 489-96.
[http://dx.doi.org/10.1089/dia.2013.0050] [PMID: 23560480]
[http://dx.doi.org/10.1089/dia.2013.0050] [PMID: 23560480]
[52]
Lee K, Lee S, Song C. Whole-body vibration training improves balance, muscle strength and glycosylated hemoglobin in elderly patients with diabetic neuropathy. Tohoku J Exp Med 2013; 231(4): 305-14.
[http://dx.doi.org/10.1620/tjem.231.305] [PMID: 24334483]
[http://dx.doi.org/10.1620/tjem.231.305] [PMID: 24334483]
[53]
El-wishy A, Elsayed E. Effect of proprioceptive training program on balance in patients with diabetic neuropathy: A controlled randomized study Bulletin of Faculty of Physical Therapy - Cairo University. 2012. Available from: http://erepository.cu.edu.eg/index.php/BFPTH/article/view/502
[54]
Kadabi NB, Kumar S. Effects of customized proprioceptive training and balance exercises among diabetic patients. Ind J Physio & Occupa Therapy-An Inter J 2012; 6: 77-80.
[55]
Lee SW, Song CH. Virtual reality exercise improves balance of elderly persons with type 2 diabetes: A randomized controlled trial. J Phys Ther Sci 2012; 24(3): 261-5.
[http://dx.doi.org/10.1589/jpts.24.261]
[http://dx.doi.org/10.1589/jpts.24.261]
[56]
Akbari M, Jafari H, Moshashaee A, Forugh B. Do diabetic neuropathy patients benefit from balance training? J Rehabil Res Dev 2012; 49(2): 333-8.
[http://dx.doi.org/10.1682/JRRD.2010.10.0197] [PMID: 22773533]
[http://dx.doi.org/10.1682/JRRD.2010.10.0197] [PMID: 22773533]
[57]
Ajimsha MS, Paul JK, Chitra S. Efficacy of stability trainer in improving balance in type II diabetic patients with distal sensory neuropathy. Journal of Diabetology 2011; 2: 7.
[58]
Song CH, Petrofsky JS, Lee SW, Lee KJ, Yim JE. Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies. Diabetes Technol Ther 2011; 13(8): 803-11.
[http://dx.doi.org/10.1089/dia.2011.0036] [PMID: 21561371]
[http://dx.doi.org/10.1089/dia.2011.0036] [PMID: 21561371]
[59]
Salsabili H, Bahrpeyma F, Forogh B, Rajabali S. Dynamic stability training improves standing balance control in neuropathic patients with type 2 diabetes. J Rehabil Res Dev 2011; 48(7): 775-86.
[http://dx.doi.org/10.1682/JRRD.2010.08.0160] [PMID: 21938664]
[http://dx.doi.org/10.1682/JRRD.2010.08.0160] [PMID: 21938664]
[60]
Allet L, Armand S, de Bie RA, et al. The gait and balance of patients with diabetes can be improved: A randomised controlled trial. Diabetologia 2010; 53(3): 458-66.
[http://dx.doi.org/10.1007/s00125-009-1592-4] [PMID: 19921145]
[http://dx.doi.org/10.1007/s00125-009-1592-4] [PMID: 19921145]
[61]
Santos AA, Bertato FT, Montebelo MI, Guirro EC. Effect of proprioceptive training among diabetic women. Braz J Phys Ther 2008; 12: 183-7.
[62]
Tsang T, Orr R, Lam P, Comino EJ, Singh MF. Health benefits of Tai Chi for older patients with type 2 diabetes: the “Move It For Diabetes study”--a randomized controlled trial. Clin Interv Aging 2007; 2(3): 429-39.
[PMID: 18044193]
[PMID: 18044193]
[63]
Richardson JK, Sandman D, Vela S. A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Arch Phys Med Rehabil 2001; 82(2): 205-9.
[http://dx.doi.org/10.1053/apmr.2001.19742] [PMID: 11239311]
[http://dx.doi.org/10.1053/apmr.2001.19742] [PMID: 11239311]
