The effect of eight weeks aerobic exercise with high and moderate intensities on quality of life, life expectancy and anthropometrical indices of patients with diabetic neuropathy
Journal of Clinical Physiotherapy Research,
Vol. 10 No. 1 (2025),
15 November 2025
Abstract
Background : Diabetic neuropathy (DN) is a common chronic complication of diabetes mellitus and having active lifestyle is a way of control for diabetic neuropathies. The aim of this study was to investigate the effect of eight weeks aerobic exercise with high and moderate intensities on quality of life, life expectancy and anthropometric indices of patients with diabetic neuropathy. Materials and Methods: This study is a quasi-experimental study with pretest-posttest design by control group. The statistical population included all women with diabetic neuropathy from endocrine clinic of Emam Khomeini Hospital of Ardabil University of Medical Sciences in 2020; then 90 samples were selected by convenience sampling method. Subjects were randomly assigned to Exercise with high intensity (Exercise with 80% of maximum heart rate, n=30), Exercise with moderate intensity (Exercise with 70% of maximum heart rate and routine care, n=30), and control (routine care, n=30) groups. The subjects of exercise groups has trained aerobic exercise for 8 weeks; 3d/w under supervision of researcher in Health Center of University of Mohaghegh Ardabili. A demographic and disease characteristic questionnaire, short-form of health (SF-36) to assessing quality of life and 48-item Miller questionnaire to assessing life expectancy were completed by all patients at the beginning and after eight week. Waist-to-height and waist-to-hip ratios were measured by a tape measure. Multivariate covariance test (MANCOVA) was used to analysis of data. The significant level was considered as 0.05. Results: The physical heath and its subtitle (general health) of exercise group with 70-80% were significantly higher than exercise group with 60-70% (p=0.001, p=0.001) and control group (p<0.001, p<0.001). The psychological health and its subtitle (social function) of this group were higher than control group (p=0.012, p=0.005). Life expectancy index of exercise groups were higher than control. Also, waist to height ratio in exercise groups was lower than control group (p=0.005, p=0.016). However, there is no difference between aerobic with high and moderate intensities in life expectancy index and waist to height ratio (p= 0.107, p=0.760). Conclusion: Aerobic exercise with high intensity effect on quality of life of Diabetic neuropathy patients more than moderate intensity. Also, both intensities can increase the life expectancy of these patients and improve some of the anthropometric indices. Therefore, it is suggested that aerobic exercise especially with higher intensity will insert into treatment plan of diabetic neuropathy patients.
- Aerobic exercise with variable intensity
- Quality of life
- life expectancy
- anthropometrics
- diabetic neuropathy
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References
1. Bansal V, Kalita, J, Misra UK. Diabetic neuropathy. Postgrad Med J 2006;82:95–100.
2. Yang H, Sloan G, Ye Y, Wang S, Duan B, Tesfaye S and Gao L. New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine. Front. Endocrinol 2020;10:929.
3. Kaneto H, Kajimoto Y, Miyagawa J-i, Matsuoka T-a, Fujitani Y, Umayahara Y, et al. Beneficial effects of antioxidants in diabetes: possible protection of pancreatic beta-cells against glucose toxicity, 1999, 48.12: 2398-2406.
4. Rodica Pop-Busui, Andrew J.M. Boulton, Eva L. Feldman, Vera Bril, Roy Freeman, Rayaz A. Malik, Jay M. Sosenko, and Dan Ziegler. Diabetic Neuropathy: A Position Statement by the American Diabetes Association Diabetes Care 2017;40:136–154
5. Girach A, Julian TH, Varrassi G, Paladini A, Vadalouka A, Zis P. Quality of Life in Painful Peripheral Neuropathies: A Systematic Review. Pain research & management 2019; 2019: 2091960.
6. Dermanovic Dobrota V, Hrabac P, Skegro D, et al. The impact of neuropathic pain and other comorbidities on the quality of life in patients with diabetes. Health Qual Life Outcomes 2014;12: 171.
7. Won JC, Im Y-J, Lee J-H, et al. Clinical phenotype of diabetic peripheral neuropathy and relation to symptom patterns: cluster and factor Analysis in patients with type 2 diabetes in Korea. Journal of Diabetes Research 2017; 2017:9.
8. DaCosta DiBonaventura M, Cappelleri JC, Joshi AV. A longitudinal assessment of painful diabetic peripheral neuropathy on health status, productivity, and health care utilization and cost. Pain Medicine 2011;12(1):118–126.
9. Poliakov I, Toth C. Impact of pain in patients with polyneuropathy. European Journal of Pain 2011; 15(10): 1015–1022
10. Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Research and Clinical Practice. 2000;47(2):123–128.
11. Geelen CC, Brouwer BA, Hoeijmakers JGJ, Faber CG, Merkies ISJ, Verbunt JA. Painful diabetic neuropathy anxiety rasch-transformed questionnaire (PART-Q30) Journal of the Peripheral Nervous System 2016; 21(2):96–104.
12. Geelen CC, Kindermans HP, van den Bergh JP, Verbunt JA. Perceived physical activity decline as a mediator in the relationship between pain catastrophizing, disability, and quality of life in patients with painful diabetic neuropathy. Pain Practice 2017; 17(3):320–328.
13. Singh-Franco D, Jacobs RJ. Patient perspectives on peripheral neuropathic pain experience within the community. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2017; 11(1):S243–S246.
14. Rokicka D, Wróbel M, Szymborska-Kajanek A, et al. Porównanie dożylnego i podskórnego podawania insulin na intensywność bólu neuropatycznego u chorych na cukrzycę Endokrynologia Polska 2015; 66(3):237–243.
15. Strojek P, Huffman C, Toth C, et al. Pregabalin in patients with inadequately treated painful diabetic peripheral neuropathy: a randomized withdrawal trial. Clinical Journal of Pain 2014; 30(5):379–390.
16. Shaibani A, Biton V, Rauck R, Koch B, Simpson J. Long-term oral lacosamide in painful diabetic neuropathy: a two-year open-label extension trial. European Journal of Pain 2009; 13(5):458–463.
17. Backonja MM. Gabapentin monotherapy for the symptomatic treatment of painful neuropathy: a multicenter, double-blind, placebo-controlled trial in patients with diabetes mellitus. Epilepsia. United States 1999; 40(6):S57–S59.
18.Yasuda H, Hotta, N, Kasuga M, et al. Efficacy and safety of 40 mg or 60 mg duloxetine in Japanese adults with diabetic neuropathic pain: results from a randomized, 52-week, openlabel study. Journal of Diabetes Investigation 2016; 7(1):100–108.
19. Freeman R, Raskin P, Hewitt DJ, et al. Randomized study of tramadol/acetaminophen versus placebo in painful diabetic peripheral neuropathy. Current Medical Research and Opinion 2007; 23(1): 147–161.
20. Vinik AI, Perrot S, Vinik EJ, et al. Capsaicin 8% patch repeat treatment plus standard of care [SOC] versus SOC alone in painful diabetic peripheral neuropathy: a randomised, 52-week, open-label, safety study. BMC Neurol England 2016; 16(1):251.
21. Rajanandh MG, Kosey S, Prathiksha G. Assessment of antioxidant supplementation on the neuropathic pain score and quality of life in diabetic neuropathy patients - a randomized controlled study. Pharmacological Reports 2014; 66(1): 44–48.
22. Alam, U, Fawwad,A, Shaheen, F, Tahir, B, Basit, A, and Malik,RA. Improvement in neuropathy specific quality of life in patients with diabetes after Vitamin D supplementation. Journal of Diabetes Research 2017; 2017: 7.
23.Yang W, Guo Z, Yu Y, Xu J, Zhang L. Pain relief and health-related quality-of-life improvement after microsurgical decompression of entrapped peripheral nerves in patients with painful diabetic peripheral neuropathy. Journal of Foot and Ankle Surgery 2016; 55(6): 1185–1189.
24. Kluding PM, Pasnoor M, Singh R, et al. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications 2012; 26:424–429.
25. Smith AG, Russell J, Feldman EL, et al. Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care 2006; 29:1294–1299.
26. Balducci S, Iacobellis G, Parisi L, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications 2006; 20: 216–223.
27. Singleton JR, Marcus RL, Jackson JE, K Lessard M, Graham TE, Smith AG. Exercise increases cutaneous nerve density in diabetic patients without neuropathy. Ann Clin Transl Neurol 2014; 1:844–849.
28. Rathmann W, Ziegler D, Jahnke M, et a.l Mortality in diabetic patients with cardiovascular autonomic neuropathy. Diabet Med 1993;10: 820–824.
29. Aghajani S, Samadifard S. The relationship between cognitive fusion and cognitive distortion with death anxiety in patients with diabetes mellitus. Chronic Dis J 2018; 6(1): 18-22.
30. Kamari S, Fathabadi J. The role of religious orientation and life expectancy in life satisfaction. J Mod Psychol Res. 2013; 7(28):159-78 [In Persian].
31. Mohammad Shahi M, Shirani F, Elahi S, Ghasemi, SH, Alaei Shahni M, Heidari F. Investigating the relationship between dietary patterns and quality of life in patients with type 2 diabetes. Daneshvar Medicine: Basic and Clinical Research Journal, 2014; 22 (5):1-12. [In Persian]
32. Di Raimondo D, Musiari G, Rizzo G, Tuttolomondo A, Pinto A. Effects of physical inactivity in cardiovascular biomarkers. Journal of Laboratory and Precision Medicine 2020; 5: 21.
33. Kim YS, Nam JS, Yeo DW, Kim KR, Suh SH, Ahn CWJCe. The effects of aerobic exercise training on serum osteocalcin, adipocytokines and insulin resistance on obese young males. 2015; 82(5):686-94.
34. Callaghan B, Feldman E. The metabolic syndrome and neuropathy: therapeutic challenges and opportunities. Ann Neurol 2013; 74: 397–403.
35. Smith AG, Singleton JR. Obesity and hyperlipidemia are risk factors for early diabetic neuropathy. J Diabetes Complications 2013; 27: 436–442.
36. Myers, J., Kokkinos, P., & Nyelin, E. Physical Activity, cardiorespiratory fitness, and the metabolic Syndrome. Nutrients 2019; 11(7): 1652.
37. Yoo EG .Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk. Korean J Pediatr 2016; 59:425–31.
38. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 2012; 13: 275–86.
39. Tee JYH, Gan WY, Lim PY. Comparisons of body mass index, waist circumference, waist-to-height ratio and a body shape index (ABSI) in predicting high blood pressure among Malaysian adolescents: a cross-sectional study BMJ Open 2020;10:e032874.
40. Association WM. Ethical principles for medical research involving human subjects. Declaration of Helsinki. 2004.
41. Nejati Safa A, Larijani B, Shariati B, Amini H, Rezagholizadeh A. Depression, quality of life and glycemic control in patients with diabetes. ijdld. 2007; 7 (2):195-204 (In Persian)
42. Fichna J, Janecka A, Costentin J, Do Rego JC. The endomorphin system and its evolving neurophysiological role. Pharmacol Rev 2007; 59(1):88–123.
43.Dinas PC, Y Koutedakis Y, Flouris AD. Effects of exercise and physical activity on depression. Irish Journal of Medical Science 2011;180(2):319-25.
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