An exercise intervention to improve diabetic patients’ gait in a real-life environment

Allet, L.; Armand, S.; Aminian, K.; Pataky, Z.; Golay, A.; de Bie, R.A.; de Bruin, E.D.

doi:10.1016/j.gaitpost.2010.04.013

« Previous Next »Gait & Posture
Volume 32, Issue 2 , Pages 185-190, June 2010

An exercise intervention to improve diabetic patients’ gait in a real-life environment

L. Allet
- Care Services Directorate, Unit of Physiotherapy Research and Quality Assurance, Geneva University Hospital and University of Geneva, Geneva, Switzerland
- University of Applied Sciences of Western Switzerland, HES-SO, Geneva, Switzerland
- Corresponding author at: Care Service Directorate, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland. Tel.: +41 22 372 36 46; fax: +41 22 372 82 15.
S. Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospital and University of Geneva, Geneva, Switzerland
K. Aminian
- Service of Therapeutic Education for Chronic Diseases and the Service of Endocrinology, Geneva University Hospital and University of Geneva, Geneva, Switzerland
Z. Pataky
- Laboratory of Movement Analysis and Measurement, EPFL, Lausanne, Switzerland
A. Golay
- Laboratory of Movement Analysis and Measurement, EPFL, Lausanne, Switzerland
R.A. de Bie
- Institute of Human Movement Sciences and Sport, ETH, Zürich, Switzerland
E.D. de Bruin
- Department of Epidemiology, Maastricht University and Caphri research school, Maastricht, Netherlands

Received 19 November 2009; received in revised form 19 March 2010; accepted 15 April 2010. published online 14 May 2010.

Abstract

Aims

Gait characteristics and balance are altered in diabetic individuals. Little is known about possible treatment strategies. This study evaluated the effect of a specific training program on diabetic patients’ gait.

Methods

A randomized controlled trial (N=71) with an intervention (IG) (N=35), and control group (CG) (N=36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-oriented strengthening. Controls received no treatment.

Results

After intervention the IG increased their habitual walking speed by 0.149ms⁻¹ (0.54kmh⁻¹) on tarred terrain and by 0.169ms⁻¹ (0.61kmh⁻¹) on the cobblestones. This significant treatment effect (p<0.001) decreased slightly at the six-month follow-up, but remained significant (p<0.001). In a similar manner, significant improvement was observed for cadence, gait cycle time and stance time on both terrains. All outcomes except stance time on the tarred terrain remained significant at the six-month follow-up. No significant effect was observed for stride length and the coefficient of variation of gait cycle time (on either surface) at the corrected significance level of p<0.004. CG patients’ parameters all remained unchanged or progressively deteriorated compared to baseline values.

Discussion

Cadence contributed 80%, whereas stride length only contributed 20% to the change of gait velocity. This may be due to the treatment or to diabetic patients’ potential to regulate their cadence and stride length.

Conclusion

A specific training program can improve diabetic patients’ gait in a real life environment. A challenging environment highlights treatment effects on patients’ gait better than an evenly tarred surface.

Abbreviations: GCT, gait cycle time (stride time), CVGCT, coefficient of variation of gait cycle time, PN, peripheral neuropathy, IG, intervention group, CG, control group