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Exercise improves balance, lower limb strength and gait in older adults with diabetes

Chapman A, Meyer C, Renehan E, et al. Exercise interventions for the improvement of falls-related outcomes among older adults with diabetes mellitus: A systematic review and meta-analyses Journal of Diabetes and Its Complications. 2016; doi: 10.1016/j.jdiacomp.2016.09.015

Review question

Does exercise decrease falls and improve balance, strength and gait in older adults with diabetes?

Background

The risk of diabetes, falling and injuries due to a fall all increase with age. People with diabetes have an increased risk of falling due, in part, to peripheral neuropathy (loss of feeling/movement in the foot and ankle). After a fall, a person may develop a fear of falling and reduce the amount they exercise. However, previous research shows that exercise may help to reduce the risk of falls in older adults.

How the review was done

This is a review of 16 studies including 889 participants. Of these, 10 randomized controlled trials were combined in a meta-analysis. All studies were published between 2003 and 2015.

• The average age of participants was 68 years old. All participants had a diagnosis of diabetes.  
• The amount of exercise in the included studies ranged from 90-180 minutes (1 ½ to 3 hours) per week with exercise sessions two to three times per week and 45-60 minutes per session. The shortest exercise period was four weeks; the longest was 2 years.
• Exercise programs varied and included aerobic exercise, balance training, resistance exercise and/or strength training and tai chi programs. Most studies included balance and lower limb strength training.
• All programs were centre-based, supervised by physiotherapists and/or members of the research team. Only one study also included a home-based program.
• Researchers measured the risk of falling, number of falls, balance, gait and muscle strength among people in exercise programs.
• Results were compared to people in control groups who had the usual care (no exercise training other than their usual amount of exercise) and/or received health education about diabetes management.

What the researchers found

People with diabetes who participated in supervised exercise programs showed significant improvements in balance, lower limb (knee and ankle) strength and gait compared to people in control groups. Exercise may also reduce the risk of falling among healthy older adults with type 2 diabetes.

Conclusion

Supervised exercise programs – such as strength and resistance training – improves balance, lower limb (knee and ankle) strength and gait in older adults with diabetes.