|
Exercise and feet
Many people around the world live with diabetes,
and the number is on the rise. One complication related to
diabetes, diabetic peripheral neuropathy, can cause individuals
to develop foot ulcers and, in extreme cases, amputation might
be necessary. Previously, doctors and scientists have
recommended that individuals with this complication stay off
their feet. Now, a University of Missouri researcher has
concluded that individuals with diabetic peripheral neuropathy
be able to engage in a graduated walking program under close
supervision of a medical professional and thus prevent other
life threatening illnesses.
Diabetic peripheral neuropathy is a nerve disorder that mostly
affects the legs and feet by causing ulcerations, pain, tingling
or even total loss of feeling. Ulcers might occur due to loss of
muscle, which would expose the bones to greater pressure under
the foot, or to loss of feeling in the foot.
"Physical activity is recommended for people with diabetes
because it is proven to reduce the risk of mortality and
development of cardiovascular disease," said Joseph LeMaster, an
associate professor of family and community medicine at the
University of Missouri. "Individuals with type 2 diabetes can
increase their risk of cardiovascular disease by 34 percent and
their risk of mortality by 39 percent if they do not participate
regularly in some type of moderately intense exercise. People
who have diabetes are already less active than most of the
population and those with diabetic peripheral neuropathy tend to
be even less active."
In the MU study, LeMaster examined the effects of
lower-extremity exercise and walking intervention programs on
foot ulcer occurrence in people with diabetic peripheral
neuropathy. Participants with diabetic neuropathy were assigned
to one of two groups: an intervention group, which was
frequently monitored and assisted through leg strengthening
exercises, a graduated walking program and motivational
telephone calls every two weeks, and a control group. Both
groups received diabetic and regular foot care education and
eight sessions with a physical therapist.
During the first six months, LeMaster noted an increase in the
total number of minor foot lesions and ulcers. However, at the
end of the year, the number of lesions and ulcers in the
intervention group had started to decrease compared to the
control group, indicating a reduced risk.
"Because weight-bearing activity did not lead to a significant
increase in foot ulcers, our study suggests that weight-bearing
exercise might be appropriate for people with neuropathy if the
patient currently has no foot ulcers, wears proper footwear, and
is in a walking program that is well-supervised and safely
monitored by a medical professional," LeMaster said.
Bariatric surgery improves co-morbidities
Patients who undergo bariatric surgery (weight loss surgery)
lose more than just weight. Recent research finds they also see
their diabetes, hyperlipidemia, hypertension, and obstructive
sleep apnea either go away, or improve significantly. It appears
that the surgery alters the body's chemistry, resulting in
improvements in these metabolic conditions, and other
obesity-related consequences. In the case of diabetes, for
example, the rearrangement of the intestinal tract has an
immediate positive impact on the disease even before the patient
begins to shed large amounts of weight. This may be due to
alterations in intestinal hormones after the operation.
The findings come from an elaborate systematic review and
meta-analysis of the bariatric surgery literature. A total of
2738 English-language citations published between 1900 and 2003
were screened. All told, these represented 22,094 patients
undergoing some sort of bariatric surgery. At least two-thirds
were women.
Overall, the mean percentage of excess weight loss was 61.2%
for all procedures. Mortality was lowest for restrictive
procedures (0.1%) such as gastric banding. Gastric bypass
produced a 61.6% of excess weight loss, and a mortality rate of
only 0.5%. (JAMA, 2004:292:1724-37)
|
