Abstract
M.Phil. (Biokinetics)
Exercise treatment modalities as treatment for type II diabetes has been a popular research area and there is a large debate about which treatment is most effective. One such treatment is active living (AL), which is formulated as a functional approach to fitness and is an alternative treatment strategy that has been advocated for older adults as a way to improve physical ability and mobility. The active living approach has been proven to be effective in providing cardiovascular and health rewards previously sought through aerobic fitness programmes. However, conclusive data is limited with regard to the elderly, diabetic population and on the question whether it is as effective as structured, supervised exercise training (SET). In order to evaluate the effects of both SET and AL on glycaemic, lipid, physical fitness, cardiovascular and psychological profiles, a group of 29 sedentary, elderly males (mean age 71.59 ± 5.4) with type II diabetes were assigned by convenience sampling into a non-activity control (NC) (n = 10), an AL experimental (n = 11), and a SET experimental (n = 8) group. The SET experimental group performed supervised exercise training for a period of eight weeks. The SET experimental training programme consisted of eight exercises performed under supervision at a Biokinetic facility. These exercises were performed three times weekly on non-consecutive days, at 50-60% heart rate reserve (HRR). The AL group performed habitual activities of daily living in their home-based environment and were encouraged to increase their daily activity levels to a minimum of 30 minutes daily. Both groups recorded their daily activities and eating habits in a diary. Serum was analysed for HbA1c, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Resting blood pressure was recorded to determine the risk of cardiovascular disease (CVD). The Senior Fitness Test (SFT) was also administered to determine functional capacity and mobility. In addition, the Activities-specific Balance Confidence (ABC) Scale was calculated to determine perceived risk of falling and confidence levels.
The Kruskal-Wallis one-way analysis of variance by ranks, a non-parametric method for testing whether samples originate from the same distribution, was used to determine homogeneity or heterogeneity between the groups. All the groups were homogenous at the pre-test assessment in all the parameters tested, except for the 8-foot up-and-go test for agility and dynamic balance. With regards to the post-test, the groups were homogeneous in all the parameters except the 2-minute step test for aerobic endurance, the 8-foot up-and-go test and the quality of life assessment, indicating a significant increase or decrease in these parameters in one or more of the groups included in the investigation after the eight-week period. The non-parametric Wilcoxon signed-ranks test was utilised to determine the significance (at a 95% confidence level, p ≤ 0.05) of the above profile changes from pre- to post-test. This test revealed statistically significant improvements in systolic blood pressure, aerobic endurance, upper body flexibility, upper body strength, and agility and dynamic balance in the SET group; and TG, aerobic endurance, and upper body flexibility in the AL group. There were no statistically significant changes noted in the other parameters relating to glycaemic and lipid control. Neither of the intervention groups resulted in statistically significant changes in body mass, body mass index (BMI) or waist-to-hip ratio (WHR).
The overall success of the SET as opposed to the AL group exemplified the fact that an optimal training regime for the management of diabetes in the elderly may require both an aerobic exercise and resistance training component in conjunction with increased daily habitual activities. SET should form the cornerstone in the treatment of diabetes to minimise and prevent cardiovascular, musculoskeletal and metabolic complications and thus improve health-related quality of life.