Search

Background, People with diabetes are at high risk for shoulder pain, limited joint mobility, and adhesive capsulitis. Objective. The objective of this study was to evaluate the effects of a shoulder movement intervention (ShoMo) compared to a wellness intervention on the primary outcomes of active shoulder flexion and reported Shoulder Pain and Disability Index (SPADI) measured after intervention and 9 months later. Design. The design was a prospective, randomized, controlled clinical trial. Setting. The setting was a research center at an academic medical center. Participants. Fifty-two participants with type 2 diabetes and shoulder pain or limited motion were randomized to a group receiving ShoMo (N = 27; mean age = 59-3; SD = 7.0) or a group receiving wellness activities (N = 25; mean age = 57.9; SD = 7.7). Intervention. The ShoMo group received instruction in a progressive, active shoulder movement program. The wellness group received instruction in diabetes management. Measurements. Measurements were made at baseline, after 3 months of intervention, and at 6, 9, and 12 months after baseline. Results. After intervention, the ShoMo group had a 7.2-degree increase in active shoulder flexion compared with the wellness group (95% CI = 0.9-13.5[degrees]), but there was no difference at subsequent follow-ups. The ShoMo group showed a 12.7-point improvement in the SPADI score compared to the wellness group after intervention (95% CI = 1.1-24.3), which remained better than the wellness group 9 months later. Limitations. The number of participants and duration of follow-up were inadequate to determine if intervention can help to prevent future severe shoulder problems. Conclusions. A progressive shoulder movement program can have meaningful effects on active motion and symptoms in people with type 2 diabetes and mild-to-moderate shoulder symptoms, with symptom improvement lasting at least 9 months., Musculoskeletal shoulder problems leading to pain and disability are substantial, under-recognized, and tend to worsen over time in people with type 2 diabetes. (1-4) Unlike shoulder problems in people without [...]

Objective. Osteolysis and low bone mineral density (BMD) are underappreciated consequences of several chronic diseases that may elevate the risk for fracture. The purpose of this study was to assess [...]

Background and Purpose. Patients with diabetes mellitus and peripheral neuropathy are at high risk for plantar skin breakdown due to unnoticed plantar stresses during walking. The purpose of this study was to determine differences in stress variables (peak plantar pressure, peak pressure gradient, peak maximal subsurface shear stress, and depth of peak maximal subsurface shear stress) between the forefoot (where most ulcers occur) and the rear foot in subjects with and without diabetes mellitus, peripheral neuropathy, and a plantar ulcer measured during barefoot walking. Subjects. Twenty-four subjects participated: 12 with diabetes mellitus, peripheral neuropathy, and a plantar ulcer (DM + PN group) and 12 with no history of diabetes mellitus or peripheral neuropathy (control group). The subjects (11 men, 13 women) had a mean age (± SD) of 54 ± 8 years. Methods. Plantar pressures were measured during barefoot walking using a pressure platform. Stress variables were estimated at the forefoot and the rear foot for all subjects. Results. All stress variables were higher (127%-871%) in the forefoot than in the rear foot, and the peak pressure gradient showed the greatest difference (538%871%). All stress variables were higher in the forefoot in the DM+PN group compared with the control group (34%-85%), and the peak pressure gradient showed the greatest difference (85%). The depth ([bar.X] ± SD) of peak maximum subsurface shear stress in the forefoot in the DM+PN group was half that in the control group (3.8 ± 2.0 versus 8.0 ± 4.3 mm, respectively). Discussion and Conclusions. These results indicate that stresses are relatively higher and located closer to the skin surface in locations where skin breakdown is most likely to occur. These stress variables may have additional value in predicting skin injury over the traditionally measured peak plantar pressure, but prospective studies using these variables to predict ulcer risk are needed to test this hypothesis., Plantar Stresses on the Neuropathic Foot A number of important physiological and physical factors combine to contribute to skin breakdown on the feet of people with diabetes mellitus and peripheral [...]

Background and Purpose. The primary purpose of this study was to report differences in calf intermuscular adipose tissue (IMAT), muscle strength (peak torque), power, and physical function in individuals with obesity, diabetes mellitus (DM), and peripheral neuropathy (PN) compared with those without these impairments. A secondary purpose was to assess the relationship between IMAT and muscle strength, power, and physical function. Subjects and Methods. six participants with obesity, DM, and PN (2 women, 4 men; mean age = 58 years, SD = 10; mean body mass index = 36.3, SD = 5; mean modified Physical Performance Test [PPT] score = 22, SD = 3) and 6 age- and sex-matched control subjects without these impairments were assessed and compared in muscle strength, muscle power, physical functioning, and muscle and fat volume, including IMAT in the calf muscles. Muscle, adipose tissue, and IMAT volumes of each calf were quantified by noninvasive magnetic resonance imaging. Muscle strength and power of the plantar-flexor and dorsiflexor muscles were quantified using isokinetic dynamometry. The modified PPT was used to assess physical function. Results. Leg muscle and fat volumes were similar between groups, although IMAT volumes were 2.2-fold higher in the subjects with obesity, DM, and PN ([bar.X] = 120 [cm.sup.3], SD = 47) than in the control subjects ([bar.X] = 54 [cm.sup.3], SD = 41). Muscle strength, muscle power, ratio of leg muscle power to leg muscle volume, and modified PPT scores were lower in subjects with obesity, DM, and PN compared with the control subjects. Discussion and Conclusion. The data indicate that excess fat infiltration in leg skeletal muscles is associated with low calf muscle strength, low calf muscle power, and impaired physical function in individuals who are obese with DM and PN., The incidence and prevalence of obesity, diabetes mellitus (DM), and their attendant complications are rising to epidemic levels. (1-3) Obesity is a condition characterized by excessive fat accumulation, resulting in [...]

Background and Purpose At 3 months after hip fracture, most people are discharged from physical therapy despite residual muscle weakness and overall decreased functional capabilities. The purposes of this study were: (1) to determine, in frail elderly adults after hip fracture and repair, whether a supervised 6-month exercise program would result in strength gains in the fractured limb equivalent to the level of strength in the nonfractured limb; (2) to determine whether the principle of specificity of training would apply to this population of adults; and (3) to determine the relationship between progressive resistance exercise training (PRT) intensity and changes in measures of strength and physical function. Subjects The study participants were 31 older adults (9 men and 22 women; age [[bar.X] ± SD], 79 ± 6 years) who had surgical repair of a hip fracture that was completed less than 16 weeks before study enrollment and who completed at least 30 sessions of a supervised exercise intervention. Methods Participants completed 3 months of light resistance and flexibility exercises followed by 3 months of PRT. Tests of strength and function were completed at baseline, before PRT, and after PRT. Results After PRT, the subjects increased knee extension and leg press 1-repetition maximum by 72% ± 56% and 37% ± 30%, respectively. After 3 and 6 months of training, lower-extremity peak torques all increased. Specificity of training appeared to apply only to the nonfractured limb after PRT. Strong correlations were observed between training intensity and lower-extremity strength gains as well as improvements in measures of physical function. Discussion and Conclusion Frail elderly adults after hip fracture can benefit by extending their rehabilitation in a supervised exercise setting, working at high intensities in order to optimize gains in strength and physical function., With aging, there is a decline in muscle mass and function. (1-5) Older adults with muscle weakness and physical frailty are at increased risk for hip fracture, a leading cause [...]