Effects of Aerobic Exercise on Shoulder Pain, Disability, and Ultrasonographic Outcomes in Patients With Type 2 Diabetes Mellitus With Supraspinatus Tendinopathy

Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by persistentlyelevated blood glucose levels. If left untreated, it can lead to serious long‐termvascular and neurological complications. T2DM is also an important cause of morbidity dueto microvascular complications, including retinopathy, nephropathy, and neuropathy;macrovascular complications, including ischemic heart disease, stroke, and peripheralvascular disease; and reduced quality of life.In addition to its metabolic effects, T2DM has significant effects on the musculoskeletalsystem. Musculoskeletal disorders such as tendinopathy, entrapment neuropathies, andosteoarthritis have been reported to occur more frequently and with greater severity inpatients with T2DM. Although musculoskeletal disorders in patients with diabetes havereceived relatively limited attention in the literature, they can contribute to bothphysical and psychological morbidity and substantially impair patients' quality of life.Current evidence suggests two main pathophysiological mechanisms underlying thedevelopment of diabetic shoulder disorders. The first involves connective tissuedegeneration in the rotator cuff and joint capsule, while the second is associated withperipheral or autonomic neuropathy. Recent studies have shown that advanced glycation endproducts (AGEs), which develop as a result of chronic hyperglycemia, accumulate intissues and increase cross‐linking between collagen fibers. This process disruptscollagen architecture and compromises the structural integrity and biomechanicalproperties of connective tissue .Aerobic exercise has been shown to be one of the most effective approaches for improvingglycemic control, reducing cardiovascular risk factors, promoting weight loss, andenhancing overall well‐being . Therefore, aerobic exercise may serve as an importantadjunctive treatment in musculoskeletal rehabilitation programs for patients withdiabetes. However, very few studies have investigated the effectiveness of aerobicexercise in patients with diabetes who have specific musculoskeletal disorders .Furthermore, most clinical studies focusing on shoulder rehabilitation have beenconducted either in individuals without diabetes or in patients with diabetes who have aspecific shoulder condition, such as adhesive capsulitis, with limited attention given toother shoulder disorders .The limited research in this area may be partly due to the clinical prioritization ofmore life‐threatening complications of diabetes, such as cardiovascular diseases.However, musculoskeletal disorders can reduce physical mobility, increase morbidity, andimpose a substantial burden on quality of life in this patient population . Therefore,further research is needed to better understand whether adding aerobic exercise tostandard shoulder rehabilitation programs can help reduce musculoskeletal complicationsin individuals with diabetes.Previous studies have investigated conventional and shoulder‐specific treatmentapproaches for various shoulder disorders in patients with type 2 diabetes mellitus(T2DM) . However, evidence regarding the effectiveness of aerobic exercise in thispatient population remains limited. To date, only one study has evaluated the effects ofaerobic exercise on pain and range of motion in patients with T2DM and adhesivecapsulitis.The present study aims to investigate whether the addition of aerobic exerciseresults in significant improvements in shoulder pain, functional disability, and thestructural characteristics of the supraspinatus tendon, as assessed by ultrasonographyand elastography, in patients with T2DM and supraspinatus tendinopathy. The findings ofthis study are expected to provide scientific evidence for the development of moreeffective and comprehensive rehabilitation strategies for patients with diabetes andshoulder pain.