Cardiopulmonary and Quality of Life Responses of Individuals with Type 2 Diabetes to Therapeutic Excercises
A Thesis Submitted to the School of Postgraduate Studies, University of Lagos
BACKGROUND: Cardiopulmonary complications of diabetes mellitus contribute greatly to the morbidity, mortality, and reduced quality of life in people with type 2 diabetes (T2DM). These complications require multifactorial treatment which includes targeting hyperglycaemia, obesity, hypertension and reduced lung functions among other factors which had been shown to pose challenge to people with T2DM. The inclusion of an appropriate exercise program is thus critical for optimal health in individuals with diabetes. OBJECTIVE: This study was designed to investigate the cardiopulmonary, biochemical, anthropometric and QoL of individuals with T2DM in response to therapeutic exercises. It was also aimed at determining the time frame when therapeutic effects of exercise interventions occur. METHODOLOGY: Sixty individuals with T2DM, both male and female within the age range of 20-75years participated in this study. They were consecutively recruited and randomly allocated into two exercise groups and a control group. Therapeutic exercise interventions for groups I and II were existing exercise protocols which were aerobic exercises on treadmill and bicycle ergometer respectively at progressive moderate intensity of 60%, 70% and 80% of heart rate reserve combined with resistance exercises at moderate intensity of 50%, 60% and 70% of one repetition maximum. The outcome measures were obtained at baseline, 4th week, 8th week and 12th week of the intervention period. These included cardiovascular parameters [resting arterial systolic (RASBP) and diastolic blood pressure (RADBP) and resting rate pressure product (RRPP)], pulmonary parameters [oxygen uptake (VO2max), forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1)], anthropometric parameters (body mass index (BMI), waist hip ratio (WHR), and waist circumference (WC)) and QoL variables. The QoL was assessed using Diabetes Quality of Life Clinical Trial Questionnaire-Revised. The biochemical parameter [glycosylated haemoglobin (HbA1C)] of the subjects was assessed at baseline and at the end of the 12th week. Descriptive and inferential statistics were utilized for data analysis. Level of significance was set at p<0.05. RESULTS: Groups I and II recorded significant reduction in cardiovascular, biochemical and some anthropometric variables while pulmonary and QoL variables were significantly increased post intervention (<0.05). RASBP, RADBP, RRPP, HbA1c were significantly reduced while VO2max, FEV1, and QoL were significantly improved in the two exercise groups when compared with the control group (P<0.05). However, FVC and WC were only significant in group I (p=0.00 and 0.03). Furthermore, Group I recorded better improvement in pulmonary function (FEV1 and FVC) when compared to group II. Therapeutic effect of moderate intensity combined aerobic and resistance exercise on some cardiopulmonary variables occurred as early as four week post exercise intervention (RRPP, VO2max and FEV1), the trend of this effect continue to the eighth and twelfth week post intervention. CONCLUSION: Weight bearing and non-weight bearing aerobic exercises when combined with resistance exercise both gave significant therapeutic benefits on the cardiopulmonary and QoL of people with T2DM. However, the choice of either should ultimately depend on the superior judgment of the clinicians; it should also depend on the outcome measures which the clinicians are aiming at improving on. In the absence of significant reduction of pulmonary variables, non-weight bearing exercises combined with resistance exercises will be suggested especially if there are contradicting foot pathologies which may be aggravated by weight bearing aerobic exercises combined with resistance exercises (WBARE). Otherwise, WBARE will be more beneficial in the absence of foot pathologies. In addition, assessment of RRPP, VO2max and FEV1 in people with T2DM should commence after four weeks post intervention.