Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy.

PURPOSE: Fatigue, decreased functionality, and impaired quality of life are some of the most common adverse outcomes of chemo-radiotherapy (CRT). Head and neck cancers (HNC) affect more than half a million individuals globally and its treatment takes a heavy toll on the patient, often affecting their speech, swallowing, and respiratory functions, and as a result they often develop fatigue, depression, and physical inactivity. The purpose of this study was to evaluate the effectiveness of exercise-based rehabilitation on functional capacity, quality of life, fatigue, hemoglobin, and platelet counts in patients with HNC on CRT. PATIENTS AND METHODS: A randomized controlled trial was conducted on 148 patients with head and neck cancer undergoing CRT to evaluate the effectiveness of exercise on functional capacity measured by the 6-min walk test, quality of life measured by the Medical Outcomes Survey Short Form 36 v2 questionnaire, fatigue by the NCCN (0-10) scale, hemoglobin, and platelets. The control group received standard physical activity recommendations while the exercise group received a structured exercise program of aerobic and active resistance exercises for a period of 11 weeks. RESULTS: There was a significant improvement in the functional capacity (p < 0.001), quality of life (p < 0.001), and prevention of worsening of fatigue (p < 0.001) in the exercise group. The blood parameters did not show a significant difference between the control group and the exercise group. CONCLUSION: Our results elucidate that an 11-week structured exercise program for HNC patients receiving CRT helps in improving their functional capacity and quality of life. It also prevents deterioration of fatigue levels in the exercise group.

Photobiomodulation therapy in neuroischaemic diabetic foot ulcers: a novel method of limb salvage.

OBJECTIVE: Low-level laser therapy (also known as photobiomodulation therapy, PBMT) promotes accelerated healing of diabetic foot ulcers (DFUs), thereby preventing the risk of future complications and amputation. The aim of this study was to determine the effect of PBMT, with structured, graded mobilisation and foot care, on DFU healing dynamics. METHOD: Patients diagnosed with type 2 diabetes, diabetic peripheral neuropathy and presenting with a chronic neuroischaemic DFU, were treated with PBMT using scanning and non-contact probe methods. The DFU was clinically observed and the area measured every seven days until complete healing. Neuropathic parameters were also measured. The PBMT was administered until complete closure of the DFU and patients also undertook a programme of graded mobilisation. RESULTS: A total of 17 participants were recruited, with a mean age of 69±8 years, and a mean duration of diabetes of 13±5 years. Mean complete closure time was 26±11days. In addition, a mean reduction of the semi-quantitative vibration pressure threshold from 49±2 volts to 20±4 volts was observed in all participants. CONCLUSION: PBMT can be effectively used as a treatment mode for neuroischaemic DFUs in patients with type 2 diabetes. Graded mobilisation with focused foot care could improve the function of people living with type 2 diabetes with a chronic DFU.

Effects of the Pulmonary Hypertension Manual (PulHMan) on Awareness of Exercise in Patients with Pulmonary Hypertension.

BACKGROUND: Patient education is an important part of holistic care for patients with chronic diseases. With the success of the Heart Manual, it was felt there is a strong need to develop such a manual for those with pulmonary hypertension (PH) - the Pulmonary Hypertension Manual (PulHMan). This was developed through a qualitative methodology in order to ensure the needs of the patients were being met. The impact of the PulHMan on awareness about exercise-related benefits and PH are not known. Therefore the aim of this study was to assess the effects of the PulHMan on improving awareness among individuals with PH. METHODS: A repeat cross sectional study was carried out on 30 patients with PH to assess the effects of using the PulHMan on awareness of exercise-related benefits in PH. Awareness was assessed from a self-developed and validated questionnaire that included components of PH and exercise related components. RESULTS: Thirty patients with PH (mean right ventricular systolic pressure and six minute walk distance of 89.2±4.1mm Hg and 322.8±102m respectively) were included in the study. At baseline, it was seen that there was a low awareness regarding the benefits of exercise for PH. However, they were aware of the general health benefits of walking. After three months, it was seen that the PulHMan improved awareness on the benefits of exercising. Despite a low number willing to exercise (2/30) and participate in a home-based program (2/30), after using the PulHMan for three months, there was an improvement in those willing to exercise and participate in a home-based program (22/30 and 25/30 respectively). CONCLUSIONS: The PulHMan was seen to improve awareness regarding the exercise-related benefits among patients with PH. More studies are needed to determine if this change in awareness translates into a behavioural change for those with PH.

Effects of Exercise Training on Exercise Capacity in Pulmonary Arterial Hypertension: A Systematic Review of Clinical Trials.

BACKGROUND: Pulmonary arterial hypertension (PAH) causes profound functional limitations and poor quality of life. Yet, there is only a limited literature available on the role of exercise training. This paper systematically reviews the effects of exercise training on exercise capacity in PAH. METHODS: A systematic search of databases (PubMed, CINAHL, CENTRAL, Web of Science and PEDRo) was undertaken for English language articles published between 1(st) January 1980 and 31(st) March 2015. Quality rating for all articles was done using the Downs and Black scoring system. RESULTS: Fifteen articles of good (n=4), moderate (n=6) and poor (n=5) quality were included in the review. Exercise interventions included aerobic, resistance, inspiratory muscle training or a combination, for 6-18 weeks. Improvements were seen in exercise capacity (six minute walk distance (6MWD) and peak VO2) by 17-96m and 1.1-2.1ml/Kg/min, functional class by one class and quality of life, with minimal adverse events. CONCLUSIONS: There is evidence to recommend the use of exercise training as an adjunct to medical treatment in PAH. More clinical trials and research are required to assess the effects of different types of exercise programs in patients with PAH, while focussing on strong exercise endpoints to quantify the improvements seen with exercise training.

Test-retest reliability of a portable gas analysis system under free living conditions.

INTRODUCTION: K4b2 (COSMED Srl Italy) is a portable device that is considered valid and reliable for measuring oxygen uptake (VO2) and carbon dioxide production (VCO2) under laboratory conditions. OBJECTIVES: Evaluate the test-retest reliability of K4b2 during walking, stair climbing and descending stairs under free living conditions. METHODS: Twelve participants completed two self-selected comfortable paced walking tests and 20 participants completed two self-selected comfortable paced stair climbing and descending tests. VO2 and VCO2 were measured during the tests using K4b2. RESULTS: ICCs for VO2 (ICC & 95% Cl: 0.91, 0.72-0.97) and VCO2 (0.91, 0.72-0.97) of walking demonstrated high reliability whereas reliability was moderate for stair climbing (VO2: 0.82, 0.6-0.93; VCO2: 0.73, 0.44 - 0.88) and low for descending stairs (VO2: 0.67, 0.33-0.85; VCO2: 0.51, 0.1-0.77). CONCLUSION: K4b2 is a highly reliable device for VO2 and VCO2 measurement during self-paced walking in free living environment.

Awareness of chronic disease related health benefits of physical activity among residents of a rural South Indian region: a cross-sectional study.

BACKGROUND: Physical activity trends for a lower-middle income country like India suggest a gradual decline in work related physical activity and no concomitant increase in leisure time physical activity. Perceived health benefits of physical activity and intention to increase physical activity have been established as independent correlates of physical activity status. In India, not much is known about peoples' perceptions of health benefits of physical activity and their intention to increase physical activity levels. This study was performed to understand peoples' perceptions and awareness about health benefits of physical activity in a rural South Indian region. METHODS: This cross-sectional study was conducted using a multistage cluster sampling design. A content validated, field tested questionnaire was administered in person by a trained interviewer in the participants' native language. The questionnaire assessed the participants' perceptions about their lifestyle (active or sedentary), health benefits of physical activity and need for increasing their physical activity. In addition, the participant's physical activity was assessed using version 2 of global physical activity questionnaire. Frequencies and percentages were used to summarise perceived health benefits of physical activity and other categorical variables. Age and body mass index were summarised using mean ± SD, whereas physical activity (MET.min.wk -1) was summarised using median and interquartile range. RESULTS: Four hundred fifty members from 125 randomly selected households were included in the study, of which 409 members participated. 89% (364) of participants felt they lead an active lifestyle and 83.1% (340) of participants did not feel a need to increase their physical activity level. 86.1%, (352) of the participants were physically active. Though 92.4% (378) of participants felt there were health benefits of physical activity, majority of them (75.1%) did not report any benefit related to chronic diseases. None mentioned health benefits related to heart disease or stroke. CONCLUSION: There is low awareness of chronic disease related benefits of physical activity and participants do not see a need to increase their physical activity level. Public health awareness programs on importance and health benefits of physical activity would be useful to counter the anticipated decline in physical activity.

Effect of Structured Exercise-Based Intervention on Upper Quadrant Dysfunction among Fish Processing Workers with Work-Related Musculoskeletal Disorders.

Background: Musculoskeletal disorders (MSDs) are one of the major causes of morbidity, which affect particularly the upper quadrant in industrial settings and so upset the quality of life (QoL). The influence of the protocol of exercise-based programs at the workplace on the well-being of the worker is contradictory. The objective of the study was to find the effect of the structured exercise-based intervention on upper quadrant dysfunction among fish processing workers with work-related MSDs. Methods: The intervention group (n = 91) participated in an individually tailored structured exercise-based intervention (SEBI) program for three months, which consisted of stretching, strengthening, and active exercises. The control group (n = 93) was instructed to continue routine daily activities. The outcome measures of the cluster-randomized controlled trial were Neck Disability Index (NDI), Disabilities of Arm, Shoulder, and Hand (DASH), Visual Analog Scale (VAS), and Short Form-36, used to evaluate at baseline, eighth, and twelfth week. The data were analyzed by repeated analysis of variance and Student's t-tests. Results: The results for the overall perception of upper quadrant dysfunction showed statistically significant differences (P < 0.0001) for NDI, DASH, and VAS. Further, we obtained a significant difference in QoL between the intervention and control groups for physical and psychological health sub-domains. Conclusion: SEBI effectively enhanced the general health of fish processing workers by showing improvements in the measures of NDI, DASH, VAS, and QoL. Hence, SEBI can be recommended in the fish processing industries to achieve potential impact on upper quadrant dysfunction and improve the QoL.

Profiling of swallowing function in head and neck cancer patients prior to radiation therapy-Findings from a tertiary hospital in South India.

Purpose: Head and neck cancer (HNC) patients often face difficulties with swallowing, which can be due to the cancer itself or the treatment modalities like radiation therapy. The presentation of HNC can vary between developing and developed countries due to socioeconomic factors. The current study aimed to profile the swallowing function of HNC patients before starting radiation therapy in a tertiary hospital in India. Method: This cross-sectional observational study examined patients with HNC who were scheduled for radiation therapy. The Functional Oral Intake Scale (FOIS) and Karnofsky Performance Status Scale were used to assess the patients' swallowing status and functional abilities, respectively. The study also evaluated the relationship between swallowing function and clinical-demographic factors. Results: Our assessment of 162 HNC patients found that the cancer site significantly affects swallowing. Although 92% of patients had an oral diet, 64% made dietary modifications. Patients with non-oral intake had either oral or pharyngeal cancer, and over 80% of oral cancer patients and 60% of those with pharyngeal cancer had already made changes to their diet. Patients with laryngeal cancer had a better oral intake, with 58% reporting no swallowing issues. Conclusion: Patients with HNC scheduled for radiation therapy may experience varying degrees of swallowing difficulty. Early intervention and teaching of safe swallowing strategies are crucial to prepare for the potential worsening of swallowing difficulties resulting from the treatment. Advanced tumor stages and oral/pharyngeal cancers increase the risk of significant swallowing issues.

Barriers and Enablers for Physical Activity Engagement Among Individuals From India With Type 2 Diabetes Mellitus: A Mixed-Method Study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a complex, chronic condition that can cause multiple complications due to poor glycemic control. Self-management plays a crucial role in the management of T2DM. Lifestyle modifications, including physical activity (PA), are fundamental for self-management. This study explored the knowledge, perception, practice, enablers, and barriers of PA among individuals with T2DM. METHODS: A mixed-method study was conducted among individuals with T2DM in Udupi taluk, India. A cross-sectional survey (n = 467) followed by an in-depth interview (n = 35) was performed. The data were analyzed using descriptive statistics and thematic analysis, respectively. RESULTS: About half (48.8%) of the participants engaged in PA of which 28.3% had an adequate score in the practice of PA. Walking was the most preferred mode. Self-realization, Comprehension, perception, and source of information, PA training, Current PA practices, enablers and barriers for PA were 6 themes derived under knowledge, perception, and practice of PA. CONCLUSION: Despite knowing the importance of PA, compliance with PA was poor. The personal/internal, societal, and external factors constituted the trinity of barriers and enablers in compliance with PA. Behavioral changes, societal changes, policy initiatives, and PA training in health care settings may enhance PA practice among individuals with T2DM.

Effect of low-level laser therapy on patient reported measures of oral mucositis and quality of life in head and neck cancer patients receiving chemoradiotherapy--a randomized controlled trial.

PURPOSE: Chemoradiotherapy (CRT)-induced oral mucositis (OM) adversely affects a patient's oral functions and quality of life (QOL). Low-level laser therapy (LLLT) showed some preventive and curative effects against clinically reported objective measures of OM in few trials including our recently published study. There is dearth of evidence regarding the effects of LLLT on patient's subjective experience of OM and QOL. Hence, we did this study to evaluate the effects of LLLT on a patient's reported measures of OM and QOL in head and neck cancer (HNC) patients receiving CRT. METHODS: This triple blinded study randomized 220 HNC patients scheduled for CRT (three weekly Cisplatin + RT = 66 Gray (2 Gy/session), five fractions/week for 6.5 weeks, total 33 fractions) into laser (110) and placebo (110) groups. The laser group received LLLT (Technomed Electronics Advanced Laser Therapy 1000, He-Ne, λ = 632.8 nm, power density = 24 mW/cm(2), dosage = 3.0 J at each point, total dose/session = 36-40 J, spot size 1 cm(2), irradiation time/point 125 s) before each radiation session, while the placebo group did not receive laser therapy. Methodology was similar to our recently published study (Gautam et al. Radiother Oncol 104:349-354, 2012). In this part of our study, a blinded assessor collected subjective outcomes of the patient's reported measures of OM using Oral Mucositis Weekly Questionnaire-Head and Neck (OMWQ-HN) and QOL using Functional Assessment of Cancer Treatment-Head and Neck (FACT-HN) Questionnaire. Data were analyzed using repeated measure ANOVA through general linear model. Statistical significance was kept at p < 0.05. RESULTS: Results analysis revealed that OMWQ-HN (F = 12.199, df = 6,1314, p < 0.001) and FACT-HN (p < 0.05) scores were significantly lower in LLLT than placebo group patients. Also, a significant reduction (p < 0.001) in incidence of severe OM, need for opioid analgesics, and total parenteral nutrition was observed. CONCLUSIONS: LLLT was effective in improving the patient's subjective experience of OM and QOL in HNC patients receiving CRT.

A review of ongoing trials in exercise based rehabilitation for pulmonary arterial hypertension.

Exercise based rehabilitation for patients with pulmonary arterial hypertension (PAH) is a new treatment option for these patients to improve their functional capacity and quality of life. Despite the benefits seen in cardiopulmonary rehabilitation in various other conditions, it has been underutilized for the patients with PAH. A review of currently registered ongoing trials on exercise training for patients with PAH from the World Health Organization International Clinical Trial Registry Platform was done using the key words "rehabilitation", "exercise training", "pulmonary artery hypertension" and "pulmonary hypertension" for a period of 10 years (2002-2012). The search revealed 57 registered trials in various trial registries from which seven met the inclusion criteria. The current studies are being carried out in Germany (n=4), Brazil (n=1), Australia (n=1) and India (n=1). This indicates a shift in focus from the only medical management to the rehabilitation and long term care for patients with PAH.

Association of physical activity and heart rate variability in people with overweight and obesity: A systematic review.

Background: Obesity is a major public health issue globally which is intrinsically linked to reduced heart rate variability (HRV). Physical inactivity and reduced resting HRV are linked to an increased risk of coronary heart disease, while athletes have a greater HRV. However, the exact correlation between physical activity and HRV remains uncertain. This systematic review aims to collect, report, and critically assess the current scientific literature about the association between physical activity and HRV in individuals with higher weight and obesity. Methods: A systematic search was carried out in electronic databases (Medline/PubMed, SCOPUS and CINAHL Plus) to retrieve studies that evaluated the relationship between physical activity and HRV in individuals with higher weight and obesity. Case-control, longitudinal/cohort, cross-sectional and observational studies were included. Using a critical narrative approach, information about the HRV, and physical activity was extracted and synthesized. The study was registered in PROSPERO: CRD42020208018 on October 9 2020. Results: After removing duplicates, 980 title/abstract records were checked for eligibility, and 12 papers were finally included in the narrative synthesis. The included studies contained physical activity as well as HRV in adults with higher weight or obesity with or without comorbidities. A negative relationship between moderate to vigorous physical activity and HRV indices had been found in two studies. There was also a negative relationship between sedentary time and HF (p = 0.049) and LF/HF (p = 0.036), as well as a positive relationship between sedentary time and LF (p = 0.014). Also dose-response association was found between vigorous exercise and higher SDNN, LF power, and HF power in one of the studies. Conclusions: This systematic review revealed a wide range of responses to physical activity and HRV; however, the current evidence uses a variety of approaches to objectively assess physical activity and measure HRV with different equipment.

Effect of exercise on renal function in diabetic nephropathy-a systematic review and meta-analysis.

Diabetic nephropathy causes cardiovascular complications among individuals with diabetes which results in decreased kidney function and overall physical decline. The objective of this systematic review was to determine effects of exercise on various renal function parameters amond individuals with type 2 diabetes and nephropathy. It was registered with PROSPERO (CRD42020198754). Total 6 databases (PubMed/Medline, Scopus, Web of Science, CINAHL, ProQuest, and Cochrane) were searched. Among 1734 records, only four randomized controlled trials were included. The review included a total of 203 participants (103 in the intervention group and 100 in the control/standard group) with type 2 diabetic nephropathy or stage 2,3, or 4 of chronic kidney disease. The meta-analysis showed no effects of exercise on serum creatinine, serum cystatin c and varied eGFR equations. However, exercise decreased urinary albumin to creatinine ratio, urinary protein to creatinine ratio, serum urea nitrogen, creatinine clearance, and urinary protein excretion while increasing urea clearance. Limited evidence on the reno-protective role of exercise demands future research in this direction.

The DFUC 2020 Dataset: Analysis Towards Diabetic Foot Ulcer Detection.

Every 20 seconds a limb is amputated somewhere in the world due to diabetes. This is a global health problem that requires a global solution. The International Conference on Medical Image Computing and Computer Assisted Intervention challenge, which concerns the automated detection of diabetic foot ulcers (DFUs) using machine learning techniques, will accelerate the development of innovative healthcare technology to address this unmet medical need. In an effort to improve patient care and reduce the strain on healthcare systems, recent research has focused on the creation of cloud-based detection algorithms. These can be consumed as a service by a mobile app that patients (or a carer, partner or family member) could use themselves at home to monitor their condition and to detect the appearance of a DFU. Collaborative work between Manchester Metropolitan University, Lancashire Teaching Hospitals and the Manchester University NHS Foundation Trust has created a repository of 4,000 DFU images for the purpose of supporting research toward more advanced methods of DFU detection. This paper presents a dataset description and analysis, assessment methods, benchmark algorithms and initial evaluation results. It facilitates the challenge by providing useful insights into state-of-the-art and ongoing research.

Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review.

BACKGROUND: Coronary revascularization procedures often cause lowered exercise capacity and declining physical activity levels. These outcomes are paramount in predicting morbidity and mortality after these procedures. Cardiac rehabilitation (CR) focuses on incrementing cardiovascular endurance, exercise capacity, muscle strength, levels of physical activity, and quality of life through health education and lifestyle modification in post-coronary revascularization patients. OBJECTIVE: To review the impact of cardiac rehabilitation on functional capacity, levels of physical activity, and health related quality of life in patients following coronary revascularization. METHODS: A structured literature search in PubMed, Scopus, CINAHL, and ProQuest for studies focused on CR and its effects on functional capacity, physical activity, and quality of life after coronary revascularization. RESULTS: A total of 2,010 studies were retrieved. Deduplication and eligibility screening included 190 studies after the application of filters. A sum of 21 studies were considered for this review. Most studies reported that exercise and physical activity programs were centre-based and home-based and via telerehabilitation. Treadmill and cycle ergometry training with callisthenics and flexibility exercises in phase 2 CR exhibited significant improvement in functional capacity and physical activity levels in patients after coronary revascularization procedures. CONCLUSION: Although centre-based supervised CR programs do improve functional capacity after coronary revascularization, home-based or telerehabilitation-based CR programs are feasible, improve patient compliance in improving physical activity, and thereby increase functional capacity. Patient education improves levels of physical activity, health related quality of life, and adherence to home- and centre-based CR programs.

Relationship Between Glycated Hemoglobin and Vibration Perception Threshold in Diabetic Peripheral Neuropathy.

Foot ulcers, infections, and deformity are some of the major sources of mortality and morbidity among the diabetic population. The relationship between glycated hemoglobin (HbA1c) and diabetic peripheral neuropathy (DPN) has been well established. There is a dearth of literature on the relationship between vibration perception threshold (VPT) and HbA1c values. So, the objective of the study was to determine the strength of linear relationship between HbA1c levels and vibration perception threshold in DPN. This cross-sectional study was conducted at Kasturba Hospital, Manipal, and diabetic foot screening camps held at various parts of Udupi district. Ethical approval was obtained from the Institutional Ethics Committee, Kasturba Hospital, Manipal (IEC:281/2017). A total of 534 participants ranging from 30 to 70 years of age and were diagnosed with type 2 diabetes mellitus on medications were included in the study. Neuropathy assessment consisting of monofilament and vibration perception threshold was done using Neurotouch beta version (Yostra Labs, Bengaluru, India). HbA1c measurement was done using turbidimetric inhibition immunoassay technique (Roche Diagnostics, Mannheim, Germany). Pearson correlation coefficient showed a moderate to good correlation between HbA1c and VPT (r = .0.753, P < .001). Linear regression result has shown a significant relationship of VPT with HbA1c (4.033 [95% confidence interval = 3.67-4.39]). The present study has concluded that there is strong relationship between HbA1c values and VPT and could be a predictor for complications in the foot following DPN.

Effect of photobiomodulation on serum neuron specific enolase (NSE) among patients with diabetic peripheral neuropathy - A pilot study.

BACKGROUND AND AIM: Photobiomodulation is an emerging therapy for Diabetic peripheral neuropathy (DPN) of which the management is still a dilemma for clinicians. Elevated Neuron Specific Enolase (NSE) is associated with neuropathy. We aimed this study to assess the effect of Low Level Laser Therapy (LLLT) on Serum Neuron Specific Enolase in Type II Diabetes Mellitus patients with DPN. METHODOLOGY: Pre post interventional study was done on 50 patients with DPN. DPN was confirmed using 10g Monofilament test, Vibration perception threshold (VPT) and Michigan Neuropathy Screening Instrument. All patients were provided with LLLT for 9 min on dorsal and plantar of foot with a dosage of 3.1 J/cm 2 for 10 days. A blood sample was collected at baseline and 4 weeks after LLLT for NSE estimation. RESULT: A significant reduction in serum NSE levels (0.006) after 4 weeks of laser therapy was observed in 42 patients when compared with baseline. A significant reduction in the vibration perception threshold (p = 0.003) and Numeric pain rating scale (p = 0.004) were observed. CONCLUSION: In this pilot study, we have assessed the effect of LLLT on serum NSE levels among patients with DPN and showed improved quality of life and decrease in serum NSE levels. These findings should be investigated in larger trials.

Effects of graded exercise training on functional capacity, muscle strength, and fatigue after renal transplantation: a randomized controlled trial.

Successful renal transplantation (RT) recipients suffer residual muscle weakness, fatigue, and low functional capacity. A safe, feasible, structured, early graded exercise training to improve functional capacity, muscle strength, and fatigue is the need of the hour. The aim of the study is to assess the effectiveness of graded exercise training on the functional capacity, muscle strength, and fatigue after RT. It is a randomized controlled trial conducted at a tertiary care hospital from January 2012 to December 2016. This trial included 104 consented, stable renal transplant recipients without cardiopulmonary/neuromuscular impairment. They received either routine care (51) or graded exercise training (53) for 12 weeks after randomization. The functional capacity, isometric quadriceps muscle strength, and fatigue score were measured at baseline, six, and 12 weeks later to induction. The outcomes of the study and control groups were analyzed using the /-test, Wilcoxon signed-rank test, ANOVA, and Pearson's correlation. For all analyses, P <0.05 was fixed acceptable. The functional capacity improved by 147 and 255 m, the muscle strength by 6.35 and 9.27 kg, and fatigue score by 0.784 and 1.781 in the control and the study group (SG), respectively, significantly more in the SG. Functional capacity had a positive and negative correlation with muscle strength and fatigue, respectively (P <0.05). The graded exercise training significantly improved the functional capacity, fatigue levels, and muscle strength after RT.

Effect of Supervised Exercise Program on Individuals in Peripheral Arterial Disease with Type 2 Diabetes Mellitus - A Systematic Review.

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) is usually accompanied by various micro and macro vascular complications. Peripheral Arterial Disease (PAD) is one of the major complications of diabetes which is accountable for morbidity and mortality throughout the world. The first line of treatment in these individuals is life style modification and exercise. There is a dearth of literature on effect of supervised exercise program in PAD with T2DM on quality of life, walking impairment, change in Ankle Brachial Index (ABI) values. So, we conducted a systematic review to explore the available literature on supervised exercise program in PAD with T2DM. METHODS: We conducted a systematic review (PubMed, Web of Science, CINAHL and Cochrane) to summarise the evidence on a supervised exercise program in PAD with T2DM. Randomised and nonrandomised studies were included in the review. RESULTS: Three studies met the inclusion criteria. The outcomes taken into accounts by the studies were the quality of life, walking impairment questionnaire, Ankle brachial index. Neither of the studies matched in their supervised exercise program nor in their outcome. CONCLUSION: In conclusion, the data evaluating the supervised exercise program in PAD with T2DM is inadequate to determine its effect on this population. Future large-scale studies can be conducted on both subjective and objective outcomes of PAD with T2DM to have a better understanding of the condition and for a universally acceptable exercise program for these individuals which the healthcare practitioners can use in their practice. Prospero registration number: CRD42018112465.