The effect of an exercise program on balance in people with diabetic neuropathy

INTERVENTION: Control Group: Balance‐resisted exercise: 1. single leg standing 2. standing on toes and heels 3. tandem standing 4. Quadriceps strengthening 5. Lunge exercise Intervention 1: Intervention Group: WEBB Exercise: 1.High stepping on the spot 2. Standing with a decreased base 3. Graded reaching in standing 4. Stepping in different directions 5. Walking practice 6. Sit‐to‐stand 7. Heel raises 8. Lateral step‐up 9. Forward step‐up 10. Half‐ squats sliding down a wall 11. Bike, treadmill walk, overground walk or sit‐to‐stand. Intervention 2: Control Group: Balance‐resisted exercise: 1. single leg standing 2. standing on toes and heels 3. tandem standing 4. Quadriceps strengthening 5. Lunge exercise. Intervention Group: WEBB Exercise: 1.High stepping on the spot 2. Standing with a decreased base 3. Graded reaching in standing 4. Stepping in different directions 5. Walking practice 6. Sit‐to‐stand 7. Heel raises 8. Lateral step‐up 9. Forward step‐up 10. Half‐ squats sliding down a wall 11. Bike, treadmill walk, overground walk or sit‐to‐stand Rehabilitation CONDITION: Diabetic polyneuropathy Diabetic Polyneuropathy. ; Diabetic polyneuropathy G63.2* PRIMARY OUTCOME: Functional balance score. Timepoint: 8 weeks. Method of measurement: Berg balance scale. Mean velocity of center of pressure. Timepoint: 8 weeks. Method of measurement: force plate & instrumental wobble board. Standard deviation of center of pressure velocity (Anteroposterior). Timepoint: 8 weeks. Method of measurement: force plate & instrumental wobble board. Standard deviation of center of pressure velocity (Mediolateral). Timepoint: 8 weeks. Method of measurement: force plate & instrumental wobble board. Sway Area. Timepoint: 8 weeks. Method of measurement: force plate & instrumental wobble board. SECONDARY OUTCOME: Depression. Timepoint: 8 weeks. Method of measurement: GDS15 questionnaire. Functional mobility. Timepoint: 8 weeks. Method of measurement: Timed up and go test. INCLUSION CRITERIA: INCLUSION CRITERIA: Diabetes mellitus diagnosed by physician; DPN diagnosis via clinical and laboratory assessments; Ability to participate in tests and exercises; Ability to perform aerobic activities for at least 30 mins without assistance Exclusion: Foot ulcer; Orthopedic or surgical impairments interfering with walking; Neurological consequences except diabetic polyneuropathy interfering with walking; Peripheral vascular disease; CNS involvement signs (dementia, Parkinson Disease, or Multiple Sclerosis); Musculoskeletal deformities at Lower Limb; Uncontrolled cardiopulmonary disease; History of dizziness, unstable angina, uncontrolled BP, tachycardia or resting arrhythmia; People who participated in balance training exercise, three months before starting study; Corrected visual acuity less than 20/70; MMSE score less than 24