International Journal of Physiotherapy and Research

Welcome to International Journal of Physiotherapy and Research



Type of Article : Original Research

Year: 2015 | Volume 3 | Issue 2 | Page No. 928-937

Date of Publication: 28-02-2015

DOI: 10.16965/ijpr.2015.108


Renu B. Pattanshetty *1, Santosh P. Dobhal 2.  

*1 Assistant Professor, KLEU Institute Of Physiotherapy, Belgaum, Karnataka, India.
2 Post graduate student (M.P.T.), KLEU Institute Of Physiotherapy, Belgaum, Karnataka, India.

Corresponding author: Dr.Renu B. Pattanshetty MPT; Ph.D, Assistant Professor, KLEU Institute Of Physiotherapy, Belgaum-590010, Karnataka, India. Contact no.:+919448482564 E-Mail:


Background and Objectives: Type 2 diabetes mellitus is a heterogeneous group of disorders characterized by variable degree of insulin resistance, impaired insulin secretion, and increased glucose production.  Physical activity is central to the management type 2 diabetes. There is less evidence to suggest the efficacy of combined effect of physiotherapist- designed supervised exercise protocol on muscle strength and autonomic parameters in such subjects. Hence, the present study was designed to evaluate effect of physiotherapist designed supervised exercise protocol of muscle strength and autonomic parameters in this subject population.
Material and Methods: This clinical trial was conducted in thirty (30) adult subjects with type 2 diabetes mellitus including both males and females in the age group of 18 to 65 years. All subjects received physiotherapist designed supervised exercise training protocol consisting of aerobic, resistance & flexibility training. Pre-exercise and post-exercise outcome measurements were taken at baseline, 7th & 14th day in the form of 1-RM for muscle strength and autonomic parameters.
Results: Statistical analysis of outcomes at baseline, 7th day and 14th day showed statistically significant difference in strength (p=0.0001), and reduction in autonomic parameters (p=0.0001)
Conclusion: The therapist designed exercise protocol has shown to improve muscle strength , mean systolic blood pressure, diastolic blood pressure, pulse rate, pulse pressure, mean arterial pressure, rate pressure product. The protocol has also proved to be safe since no adverse event was noted post exercise.
KEYWORDS: Type 2 diabetes mellitus, Muscle strength, Blood pressure, Rate pressure poroduct, Aerobic exercise, Resistance training, Stretching.


  1. Gupta A, Gupta R, Sarna M, Rastogi S, Gupta VP, Kothari K. Prevalence of diabetes, impaired fasting glucose and insulin resistance syndrome in an urban Indian population. Diabetes Res ClinPract. 2003; 61: 69–76.
  2. Ramachandran A, Snehalatha C, Kapur A. Diabetes Epidemiology Study Group in India (DESI): High prevalence of diabetes and impaired glucose tolerancein India. National urban diabetes survey. Diabetologia.2001; 44: 1094–101.
  3. Menon VU, Kumar KV, Gilchrist A. Prevalence of known and undetected diabetes and associated risk factors in central Kerala: ADEPS. Diabetes Res ClinPract.2006; 74: 289–94.
  4. Rao CR,  Kamath VG, Shetty A,  Asha Kamath. A study on the prevalence of type 2    diabetes in coastal Karnataka Int J Diabetes DevCtries. 2010 Apr-Jun; 30(2): 80–85.
  5. Power AC. Diabetes Mellitus. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL,Longo DL, Jameson JL, et al. editors. Harrison’s Principles of Internal Medicine. 17th Ed. New York: McGraw Hills Medical; 2008, pp 2475-2304.
  6. Rius RF, Salinas VI, Lucas MA, Romero GR, Sanmarti SA. A prospective study of cardiovascular disease in patients with Type 2 diabetes 6.3 years of follow-up.J Diabetes Complications. 2003; Sep-Oct; 17(5):235–242.
  7. Adler AI, Stevens RJ, Neil A. Hyperglycemia and other potentially modifiable risk factors for peripheral vascular disease in type 2 diabetes. Diabetes Care.2002; 25:894–899.
  8. Guillausseau PJ, Massin P, Charles MA.Glycaemic control and development of retinopathy in type 2 diabetes mellitus: a longitudinal study. Diabet Med. 1998 Feb; 15(2): 151–155.
  9. Bruce DG, Davis WA, Davis TM. Longitudinal predictors of reduced mobility and physical disability in patients with type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2005 Oct; 28(10):2441–2447.
  10. Park SW, Goodpaster BH, Strotmeyer ES, Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care. 2007 Jun; 30(6):1507–1512.
  11. Sayer AA, Dennison EM, Syddall HE, Glibody HJ, Philips DI, Copper C. Type 2 diabetes, muscle strength, and impaired physical function: the tip of the iceberg? Diabetes Care. 2005 Oct; 28(10): 2541–2542.
  12. Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetes Autonomic Neuropathy, Diabetes care 2003 May; 26(5):1553-1579.
  13. American Diabetes Association. Standards of medical care in diabetes 2010. Diabetes Care 2010 Jan; 33 (Suppl1):S11–S61.
  14. Sheri RC, Ronald JS, Fernhall BO, Judith GR, Bryan JB, Richard RR et al. Exercise and type 2 diabetes the American college of sports medicine and the American diabetes Association: joint position statement diabetes care. Diabetes Care 2010; 33:e147–e167.
  15. Walter RT, Neil FG, Linda SP. American College of sports medicine.ACSM’S Guidelines for Exercise Testing & Prescription. Philadelphia 8th edition: Lippincott Williams & Wilkins; 2009.    
  16. Houglum PA. Therapeutic Exercise for Athletic Injuries. Champaign: Human Kinetics, 2001.
  17. Taylor JD, Fletcher JP, Tiarks J.  Impact of Physical Therapist–Directed Exercise Counseling Combined With Fitness Center–Based Exercise Training on Muscular Strength and Exercise Capacity in People With Type 2 Diabetes Physical Therapy 2009 sept ;89( 9) 884-892.
  18. Sadikot SM, Nigam A, Das S, Bajaj S, Zargar AH, Prasannakumar KM. Diabetes India. The burden of diabetes and impaired fasting glucose in India using the ADA1997 criteria: prevalence of diabetes in India study (PODIS). Diabetes Res ClinPract 2004; 66: 293-300.
  19. Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries, 2012 3(6), 110–117.
  20. Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, Hu FB. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA 2009; 301: 2129-2140.
  21. Snehalatha C, Viswanathan V, Ramachandran A. Cutoff values for normal anthropometric variables in asian Indian adults. Diabetes Care 2003; 26: 1380-1384.
  22. Grossman, E., &Messerli, H. Hypertension and Diabetes, 45, 82–89.In: Fisman EZ, Tenenbaum A (eds): Cardiovascular Diabetology: Clinical, Metabolic and Inflammatory Facets. AdvCardiol. Basel, Karger, 2008, vol 45, pp 82–106
  23. Bays HE, Chapman RH, Grandy S. The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia : comparison of data from two national surveys Int J ClinPract, May 2007; 61(5):737–747.
  24. Willi C, Bodenmann P, Ghali WA, Faris PD, CornuzJ.Active  smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2007; 298: 2654-2664.
  25. Barrett-Connor E, Khaw KT. Cigarette smoking and in¬creased central adiposity. Ann Intern Med 1989; 111: 783-787.
  26. Tonstad.SType of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes, Diabetes Care 32:791–796, 2009.
  27. Colberg SR. Use of Heart Rate Reserve and Rating of Perceived Exertion to Prescribe Exercise Intensity in Diabetic Autonomic Neuropathy Diabetes Care.2003 26:986–990.
  28. Sander GE, Giles TD. Diabetes  mellitus and heart failure. The American Heart Hospital Journal. 2003;1(4): 273–280.
  29. Ryder JW, Gilbert M, Zierath JR. Skeletal muscle and insulin sensitivity: pathophysiological alterations. Front Biosci.2001; 6: D154–163.
  30. Abdul-Ghani MA, DeFronzo RA. Pathogenesis of insulin resistance in skeletal muscle.Journal of Biomedicine and Biotechnology. 2010;19: doi:10.1155/2010/476279.
  31. Park SW, Goodpaster BH, Strotmeyer ES. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes 2006;(55):6 1813–1818.
  32. Park SW, Goodpaster BS, Lee JS. Health, aging, and body composition study: excessive loss of skeletal muscle mass in older adults with type 2 diabetes. Diabetes Care 2009 ;32(11):1993–1997.
  33. Rhea MR, Ball SD, Phillips WT. A comparison of linear and daily undulating periodized programs with equated volume and intensity for strength. J Strength Cond Res 2002; 16:250-5.
  34. Braith RW, Graves JE, Leggett SH. Effect of training on the relationship between maximal and submaximal strength.Med Sci Sports Exerc 1993; 25:132-8.
  35. Lesuer DA, Mccomick JH, Mayhew JL. The accuracy of prediction equations for estimating 1-RM performance in the bench press, squat, and deadlift.J Strength Cond Res 1997; 11:211-3.
  36. Gordon BA, Benson AC. Bird SR, Fraser SF. Resistance training improves metabolic health in type 2 diabetes. Diabetes Research in clinical Practice 2009;83:157-175.
  37. Maiorana, A., &O’Driscoll, G. Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Research and Clinical Practice 56; (2002):115–
  38. Reaven GM. Metabolic effects of diuretic and beta-blocker treatment of hypertension in patients with non-insulin-dependent diabetes mellitus. Am J Hypertens 1990;3:387-90.
  39. Franklin SS, Kahn SS, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk forcoronary heart disease? The Framingham Heart Study.Circulation 1999; 100:354-60.
  40. Seamus P. Effect of aerobic exercise on blood pressure a meta- analysis of randomized controlled trails. Ann Intern med. 2002;136:493-503.
  41. McCartney N. Acute responses to resistance training and safety. Med Sci Sports Exerc 1999; 31: 31-37.
  42. Almeida MB, Araujo CGS. Effects of aerobic training on heart rate. Rev. Bras. Med. Esporte 2003; 9:113-118.
  43. Cockcroft JR, Wilkinson IB, Evans M, McEwan P, Peters JR, Davies S. Pulse pressure predicts cardiovascular risk in patients with type 2 diabetes mellitus. Am J Hypertens. 2005 Nov; 18(11):1463-1467.
  44. Segan, R, Gupta V, Walia L, Mittal N. Rate Pressure Product Predicts Cardiovascular Risk in Type 2 Diabetics with Cardiac Autonomic Neuropathy. National Journal of Physiology, Pharmacy & Pharmacology 2013; 3(1): 43 – 47.






Volume 1 (2013)

Volume 2 (2014)

Volume 3 (2015)

Submit Manuscript