Effectiveness Of Neuro Mobilisation On Pain, Range Of Motion, Muscle Endurance And Disability In Cervical Radiculopathy: A Systematic Review.

Objective: To assess the effects of the neural mobilisation technique on mobility, pain and disability in cervical radiculopathy patients, and to assess the functional activity level. METHODS: The systematic review was conducted from January 5 to July 5, 2022, and comprised search on Medline, PEDro, Cochrane Library and Embase databases for randomised controlled trials involving patients diagnosed with cervical radiculopathy that were published in the preceding 10 years in the English language. The search terms were divided into four classes by using the guideline for systematic reviews of trials of interventions in the Cochrane neck and back groups and related spinal disorders. Data wasretrieved afterthe studies were subjected to quality assessment and risk of biasness. RESULTS: Of the 1563 studies initially found, 8 (0.51%)were reviewed.Nomatter the approach ordosage used,manual therapy was successful in treating cervical radiculopathy symptomsin all investigations. Conclusion: A multimodal strategy incorporating neural mobilisation appears to be the most successful short-term technique.

The combined effects of virtual reality with motor imagery techniques in patients with Parkinson's disease.

A 60-year-old man and a 63-year-old woman, diagnosed with Parkinson's disease received virtual reality (VR) and motor imagery (MI) with routine physical therapy (PT) treatment to improve balance, motor function and activities of daily living for a total of 60 minutes each session, three visits per week for 12 weeks and follow-up on week 16. This case report revealed 15 and 18 points improvement in motor function on Unified Parkinson's Disease Rating Scale part III (UPDRS) in male and female patients and in Activities of daily living on UPDRS-part II for 9 and 8 points for male and female patients respectively. The Berg Balance Score (BBS) score also improved with a clinically significant change of 9 and 11 points in male and female patients, respectively. The male and female patients reported a significant improvement in their balance, confidence on the Activities-specific balance confidence scale (ABC) scale as 14% and 16% were observed, respectively. VR in combination with MI in addition to routine Physical Therapy showed improvement in outcomes for the 2 patients presented in this case report.

Effect of median nerve neuromobilization on functional status in patients with carpal tunnel syndrome: A double blinded randomized control trial.

Objectives: To measure additional benefits of neuromobilisation along with conventional treatment in improving the functional status in patients having carpal tunnel syndrome. METHODS: The prospective, double-blind randomised controlled trial was conducted from August 2018 to June 2019 at the Physiotherapy outdoor clinic of Mayo Hospital, Lahore, Pakistan, and comprised patients of either gender aged 20-45 years with <3-month history of carpal tunnel syndrome. The patients were randomised into control group 1 and experimental group 2. Group 1 received conservative treatment including ultrasound therapy, wrist splinting, and tendon-gliding exercises, while Group 2 additionally received neuromobilisation. Functional limitation was measured using the Functional Status Scale and the Symptom Severity Scale of the Boston Carpal Tunnel Syndrome Questionnaire. Patients had 2 sessions per week for 6 weeks. Clinical data was noted at baseline, after 3 weeks of treatment and finally at the end of the 6-week intervention. Data was analysed using SPSS 21. RESULTS: Of the 66 patients, there were 33(50%) in Group 1; 3(9.1%) males, 30(90.9%) females, overall mean age 37.79 ±5.91 years. The remaining 33(50%) were in Group 2; 2(6.1%) males, 31(93.9%) females, overall mean age 35.58 ±7.15 years. Both the groups showed significant improvement (p <0.05), but the addition of neuromobilisation in Group 2 showed better results compared to Group 1(p<0.05). CONCLUSIONS: The addition of neuromobilisation to routine physical therapy was found to have significantly decreased the symptoms of carpal tunnel syndrome and improved the functional status of the patients. Registration No: ChiCTR2000029377(http://www.chictr.org.cn/showproj.aspx?proj=48704).

Effects of breathing re-education on clinical outcomes in patients with nonspecific chronic neck pain.

The present study evaluated the effectiveness of breathing re-education with routine physical therapy. This mixed method study was conducted at the District Headquarter Hospital Faisalabad, Faisalabad from April 2020 to July 2020. Fourteen participants (6men and 8 women) with chronic neck pain were recruited over a 16-week period and were equally divided into breathing re-education and routine physical therapy groups. The mean age of the patients was 38.48±5.92 years. Feasibility outcomes were recruitment, randomisation and retention rates of the participants. Clinical outcomes assessed for full trial were neck pain, cervical ROM, strength and endurance of neck muscles, quality of life and pulmonary functions. Outcomes were measured at baseline, fourth and eighth weeks. All the participants completed all the treatment sessions. No adverse events were reported. The breathing re-education group showed significant improvement in clinical outcomes. The results of this feasibility study provide supporting evidence for a future large-scale trial. Breathing re-education appears to be an effective treatment for chronic neck pain.

Reliability of hand-held dynamometer in measuring gluteus medius isometric muscle strength in healthy population.

Objectives: To determine the inter-rater and intra-rater reliability of the hand-held dynamometer in measuring isometric gluteus medius muscle strength in asymptomatic healthy population. Methods: It was a cross sectional study conducted at the department of physiotherapy, Sindh Institute of Physical Medicine and Rehabilitation from March 2021 to April 2021. Thirty healthy subjects aged 18 to 25 years of both sexes and no previous or current complaints of hip or knee pain were included through non-probability purposive sampling technique. The strength of the unilateral isometric gluteus medius muscle was measured using a hand-held dynamometer by two raters at the same day and a week later. Pearson Correlation coefficient was calculated to see the relationship of muscle strength measured by each rater within and between day's sessions. Intra-class correlation was calculated with 95% confidence interval and Standard error of measurements using reliability analysis. Results: In the present study there were thirty participants studied by two raters, the mean age of participants was 21.53 (SD=±1.40) years, the mean BMI was 24.05 (SD=±1.12) kg/m2 and 70% participants were female and 30% were males. This study showed the mean muscle measurement of participants within days was 12.92 (SD=±0.94), with intra-class correlation ICC (2,2) 0.94 and SEM 0.12 and mean muscle measurement of patients between days was 12.99 (SD=±0.91), with intra-class correlation ICC (2,2) 0.90 and SEM 0.12.. Conclusion: Hand-held dynamometer has shown excellent inter-rater and intra-rater reliability in measuring isometric strength of Gluteus Medius muscle among healthy population. It is convenient to be used in clinical settings and can be a useful outcome tool to assess strength in interventional studies.

Translation, cross-cultural adaptation and psychometric properties of the Urdu version of knee injury and osteoarthritis outcome score questionnaire for Pakistani population.

BACKGROUND: Knee injury and osteoarthritis outcome score questionnaire is a widely used tool for measuring short and long-term patient-relevant outcomes following knee injury. KOOS is neither translated nor examined for psychometric properties before. Therefore, the aim of this study was to translate, culturally adapt and check the psychometric properties of the KOOS in Urdu. METHODOLOGY: The translation and cultural adaptation was performed according to pre-defined guidelines. A total of 117 participants (54 males and 63 females) were recruited. The study had two steps: 1) Translation and cultural adaptation 2) Reliability and validity testing. The reliability (test-retest and internal consistency at (95% confidence interval) as well as the validity (Convergent validity) of final Urdu version of KOOS was tested. RESULTS: For all five domains, the KOOS Urdu version (KOOS-U) has demonstrated high test-retest reliability ICC = 0.90-0.96(CI = 95%). For all domains, the internal consistency was determined to be excellent (α = 0.82-0.96). There were no floor or ceiling impacts noted. Convergent validity was found to be good, as measured by Pearson's correlation coefficient. The findings revealed a strong negative association between the KOOS-U (QOL and pain) and the NPRS. And there was a low to high positive correlation between five KOOS-U domains and all SF-12 domains, i.e., there was a significant positive correlation between the pain domains of both KOOS and SF-12 with the r = 0.87(p < 0.05). CONCLUSION: The Urdu version of KOOS is a valid, reliable, and responsive instrument to assess functional disability of patients with Knee Osteoarthritis with excellent psychometric properties.

Effects of Virtual Reality with Motor Imagery Techniques in Patients with Parkinson's Disease: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Parkinson's disease (PD) is one of the most common neurological disorders, of insidious onset, with major motor symptomatology including bradykinesia, rest tremor, rigidity, and postural disturbances. Virtual reality (VR) and motor imagery (MI) are among the more innovative techniques for the rehabilitation of patients with PD which promote motor learning both through explicit and implicit processes. This study is unique in that it will examine the combined effects of VR and MI on motor function, balance and activities of daily living (ADLs) in patients with PD. OBJECTIVE: The aim of this work is to investigate the effects of VR with MI techniques in addition to routine physical therapy on motor function, balance, and ADLs in patients with PD. METHODS: This is a two-armed parallel design, single-blinded (assessor blinded), single-centered, randomized controlled trial, and the study protocol is based on SPIRIT guidelines. Thirty-four patients with PD (Modified Hoehn and Yahr stages I-III) will be randomly allocated with a 1:1 ratio into Group A (control group) and Group B (treatment group). Group A will be given routine physical therapy in 40-min sessions and 20 min of walking and cycling with a short period of rest, every alternate day (3 days per week) for 12 weeks, while for Group B routine physical therapy protocols along with VR and MI will be used in 60-min sessions, every alternate day (3 days per week) for 12 weeks. The primary outcome measures are as follows: (i) the Unified PD Rating Scale (UPDRS; part III), (ii) the Berg Balance Scale (BBS), and the Activities-Specific Balance Confidence Scale (ABC). The secondary outcome measure is the UPDRS (part II). Assessments will be recorded at baseline, the sixth and twelfth weeks of therapy, and 1 month after the discontinuation of therapy. Clinical Study Registration: This randomized controlled prospective study was registered with the Iranian Registry of clinical trials (IRCT20200221046567N1) on April 1, 2020 (https://www.irct.ir/trial/46073).

Ultrasonographic Features Associated with Diffuse Hepatosteatosis among Diabetic Obese and Normal Body Mass Index Patients.

BACKGROUND: The purpose of the study is to evaluate and compare the changes associated with hepatosteatosis in diabetic obese versus diabetic normal-weight patients through ultrasonography. It is estimated that with the prevalence of about 30%-75% of obese individuals accordingto the body mass index (BMI) criteria are at increase risk of developing simple fatty live. Besides obesity, diabetes mellitus is also considered to be one of the important causes of hepatosteatosis. METHODS: This prospective study was conducted in February 2015-December 2015 on a group of 181 diabetic patients, including 65 males and 116 females with an age range of 40-80 years. The patients were divided into two diabetic groups: those having a BMI ≥30 kg/m2 were included in the obese group (n = 116) and those with a BMI of 18.5-25 kg/m2 were included in the normal BMI group (n = 65). Ultrasound machine Esaote MyLab 50 equipped with a 3.5-5 MHz curvilinear multifrequency transducer was used to scan the liver. Independent samples t-test was performed to compare the liver span in the two groups. Chi-square tests were applied to compare the frequencies of fatty changes, border, and surface characteristics. RESULTS: The presence of fatty changes among obese groups was statistically significant in the diabetic obese group compared to the normal-weight individuals with P < 0.0001. Similarly, hepatic spans were found to be significantly greater in the diabetic obese group than the diabetic normal BMI group on independent samples t-test with P < 0.0001. Females were seen to develop hepatosteatosis more frequently compared to males in all diabetic individuals with P = 0.02. CONCLUSION: It is concluded that diabetic obese patients are more prone to develop hepatosteatosis as compared to normal BMI diabetic individuals.

Prevalence of refractive errors; an evidence from the public high schools of Lahore, Pakistan.

OBJECTIVE: To assess the magnitude of refractive errors among high school children. METHODS: The cross-sectional, descriptive study was conducted from April to August 2017 in four public-sector high schools in Lahore, Pakistan. Using multistage simple random sampling, all public sector high schools of the city were initially included. Screening of refractive errors was managed on the school premises. Data was collected on a pre-tested, structured questionnaire. SPSS 23 was used for data analysis. RESULTS: There were 1000 subjects with an overall mean age of 13.78±1.72 years (range: 10-18 years). Refractive errors were present in 244(24.4%) and myopia 127(52%) was the major type of refractive error followed by astigmatism 93(38.1%) and hypermetropia 24(9.8%). Differece in the prevalence of refractive errors in urban and rural settings was significant (p=0.00002). CONCLUSIONS: Uncorrected refractive errors were present in a considerable segment of public-sector high school students of Lahore.

Reliability of Ultrasound for the Detection of Rheumatoid Arthritis.

The aim of this review article was to investigate the pooled sensitivity and specificity of musculoskeletal ultrasound (MSUS) for the detection of synovitis and early bone erosion in the small joint in rheumatoid arthritis (RA). In addition, investigate the pooled sensitivity and specificity of Power Doppler ultrasonography (PDUS) for the detection of synovial hypervascularity in small joints in RA. A systematic literature search of PubMed, Wiley online library, Google Scholar, Research gate, E-book, BioMed Central, the Journal of Rheumatology and Springer Link were investigated from 2001 to 2017. Original researches related to the article written in English including RA, synovitis, bone erosion, grayscale, and PDUS were included in this study. The sample size, study design, sensitivity, and specificity were analyzed. The review summarizes the value of MSUS for the detection of RA as it is the first choice of modality. Results show the acceptable reliability of US for the diagnosis of early bone erosions, synovitis, and synovial hypervascularity.

Response to a Supervised Structured Aerobic Exercise Training Program in Patients with Type 2 Diabetes Mellitus - Does Gender Make a Difference? A Randomized Controlled Clinical Trial.

OBJECTIVE: Because of the globally increasing occurrence of diabetes mellitus (DM) in the population, exercise is becoming vitally important for prevention and disease management, along with medical and dietary interventions. This study was designed to test the hypothesis that women with DM would respond similarly to men with DM following supervised structured aerobic exercise training (SSAET) program. METHODS: This randomized, single blind, controlled clinical trial was conducted on 102 patients with T2DM with ranging in age from 40 to 70 years. All the participants were randomly allocated to either an experimental or a control group. The experimental group participated in an SSAET program, routine medication, and dietary plan, while the control group was treated with routine medication and dietary plan, for 25 weeks. Assessments of physical and biochemical variables were carried out at baseline and after 25 weeks' intervention and gender-based response to the SSAET program was analyzed. RESULTS: Both the male and female patients responded to 25 weeks of SSAET, routine medication, and dietary plan equally in the experimental group, whereas in the control group IL-6 and NOS-1 showed slight differences. All male and female patients in the experimental group treated with SSAET, routine medication, and dietary plan showed significant improvement in all variables (P < 0.05), while in the control group, deterioration or no change was noted except in HDL and LDL. CONCLUSION: SSAET is equally effective in both male and female patients with T2DM when compared with a non-exercise control group, but no gender-based difference was found. (Trial ID ISRCTN16466697/ http://orcid.org/0000-0002-6682-9896).

Effects of supervised structured aerobic exercise training programme on level of Exertion, dyspnoea, VO2 max and Body Mass Index in patients with type 2 diabetes mellitus.

OBJECTIVE: To determine the effects of supervised structured aerobic exercise training programme on level of exertion, dyspnoea, maximum oxygen consumption, and body mass index in type 2 diabetics. METHODS: The randomised, controlled trial was carried out at Riphah Rehabilitation and Research Centre, Islamic International medical College Trust, Pakistan Railways General Hospital, Rawalpindi, Pakistan, from January 2015 to June 2016, and comprised type 2 diabetics. Sedentary individuals of both genders, aged40-70 years, diagnosed on World Health Organisation's criteria were included. Participants were randomly divided into two groups, i.e. A (experimental) and B (control), by toss and trial method. Intervention in the experimental group were supervised structured aerobic exercise training programme, routine medication and dietary, while the control group was treated by routine medication and dietary plan for 25 weeks at 3 days per week for both groups. Level of exertion, dyspnoea, maximum oxygen consumption and body mass index were assessed and documented at baseline (0 week) and at the completion of intervention (after 25 weeks). SPSS20 was used for data analysis. RESULTS: Of the 102 participants, there were 51(50%) in each group. Pre- and post-intervention analysis showed that a 25-week training programme, routine medication, and dietary plan significantly improved level of exertion, dyspnoea, maximum oxygen consumption and body mass index (p<0.05)) in the experimental group compared to the control group treated with routine medication, and dietary plan. CONCLUSIONS: The supervised structured aerobic exercise training programme along with routine medication and dietary plan positively influenced level of exertion, dyspnoea, maximum oxygen consumption and body mass index than routine medication and dietary plan in patients with type 2 diabetes.

Effects of supervised structured aerobic exercise training program on fasting blood glucose level, plasma insulin level, glycemic control, and insulin resistance in type 2 diabetes mellitus.

OBJECTIVE: To determine the effects of supervised structured aerobic exercise training (SSAET) program on fasting blood glucose level (FBGL), plasma insulin level (PIL), glycemic control (GC), and insulin resistance (IR) in type 2 diabetes mellitus (T2DM). METHODS: Riphah Rehabilitation and Research Centre (RRRC) was the clinical setting for this randomized controlled trial, located at Pakistan Railways General Hospital (PRGH), Rawalpindi, Pakistan. Study duration was 18 months from January 1, 2015 to June 30, 2016. Patients of both genders ranging 40-70 years of age with at least one year of history of T2DM were considered eligible according to WHO criteria, while patients with other chronic diseases, history of smoking, regular exercise and diet plan were excluded. Cohorts of 195 patients were screened out of whom 120 fulfilled the inclusion criteria. Amongst them 102 agreed to participate and were assigned to experimental (n=51) and control (n=51) groups. Experimental group underwent SSAET program, routine medication and dietary plan, whereas the control group received routine medication and dietary plan, while both group received treatment for 25 weeks. The blood samples were taken at baseline and on the completion of 25 weeks. The investigation of fasting blood glucose level, plasma insulin level, and glycemic control was conducted to calculate IR. RESULTS: Patients with T2DM in experimental group (n=51) treated with SSAET program, routine medication and dietary plan significantly improved FBGL (pre-mean= 276.41±25.31, post-mean=250.07±28.23), PIL (pre-mean=13.66±5.31, post-mean=8.91±3.83), GC (pre-mean=8.31±1.79, post-mean 7.28±1.43), and IR (pre-mean=64.95±27.26, post-mean 37.97±15.58), as compared with patients in control group treated with routine medication and dietary plan in whom deteriorations were noted in FBGL (pre-mean=268.19±22.48, post-mean=281.41±31.30), PIL(pre-mean=14.14±5.48, post-mean=14.85±5.27) GC (pre-mean=8.15±1.74, post-mean=8.20±1.44, and IR (pre-mean=64.49±23.63. post-mean=70.79 ±23.30). Statistically at the baseline the results were not significant (p>0.05), but at the completion of 25 weeks intervention all the variable showed significant results (p<0.05. CONCLUSION: It is concluded that a 25 weeks SSAET program along with routine medical management is more effective treatment in the management of fasting blood glucose level, glycemic control, plasma insulin level and insulin resistance as compared with routine medical management and dietary plan in the management of T2DM.

Effects of supervised structured aerobic exercise training program on high and low density lipoprotein in patients with type II diabetes mellitus.

BACKGROUND AND OBJECTIVE: Hyperlipidemia and dyslipidemia are very common conditions among patients with Type-2 diabetes mellitus (T2DM) and associated with increased risk of coronary heart diseases. Physical activity and exercises along with medical management and dietary plan are common strategies to use for the management of deranged lipid profile in patients with T2DM. We aimed to determine the effects of supervised structured aerobic exercise training (SSAET) program on high and low density lipoprotein in patients with T2DM. METHODS: This randomized control trial study was conducted at Riphah Rehabilitation Research Centre (RRRC), Pakistan Railway General Hospital (PRGH) Rawalpindi from 1st January 2015 to 30th March 2016. The inclusion criteria was Type-2 diabetes patients of both gender aged between 40 to 70 years. Patients with severe complications like coronary artery diseases (CAD), and other serious complications like diabetic foot, and severe knee and hip osteoarthritis (OA) were excluded from the study. A total of 195 patients diagnosed with T2DM were screened out and 102 were selected for the study as per the inclusion criteria. All participants were randomly assigned into two groups, experimental 'A' (n=51) and control 'B' (n=51). Patients in group A were treated with SSAET program of 25 weeks at 3 days a week in addition to routine medical management, while patients in Group-B were on their routine medications and dietary plan. Serum LDL, and HDL were tested at baseline and after 25 weeks. The data was analysed through SPSS 20. RESULTS: Mean and standard deviation of LDL in group A (n=51) was 118.56±19.17 (pre) and 102.64±13.33 (post), while the mean and standard deviation for Group-B (n=51) was 116.50±18.45 (Pre) and 109.88±17.13 (post). Both groups showed improvement but, Group-A treated with SSAET along with RMM showed significantly higher (P Value ≤ 0.05) improvement as compared with group B treated with RMM alone. Mean and standard deviation of HDL in Group-A was 42.70±8.06 (pre) and 47.47±7.16 (post), while the mean and standard deviation of group B is 43.37±8.15 (Pre) and 44.41±7.91 (post). Both groups showed improvement but Group-A treated with SSAET program along with RMM showed significantly higher (P Value ≤ 0.05) improvement than group B treated with RMM alone. CONCLUSION: SSAET program along with RMM is more effective strategy for the management of deranged lipid profile in patients with T2DM.

Effects of Neurodynamic Mobilization on Health-Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial.

Purpose: Cervical radiculopathy is disorder of cervical spinal nerve root affecting large number of population. Previously many studies are conducted to design suitable protocol for management of this disorder, but they lack in quality. The purpose of this study was to compare the effects of neural mobilization and cervical isometrics on health-related quality of life and deep flexors endurance in cervical radiculopathy. Methods: A double-blinded randomized clinical trial was conducted at Mayo Hospital, Lahore, Pakistan. Eighty-eight patients within the age range of 35-50 years were included in the study after taking their consent. In the experimental group (n = 44), median nerve mobilization was applied along with cervical isometric exercises. The control group (n = 44) performed cervical isometric exercises alone. Muscle endurance was measured by craniocervical flexion test and quality of life on 36 items short form health survey SF-36 scale. Measurements were taken at baseline, at 2nd week, and at 4th week. For missing data, intention-to-treat analysis was used. Results: Within-group comparison with Friedman test showed a significant difference between pre, mid, and posttreatment scores on craniocervical flexion test and in all domains of SF 36 in both groups. While between-group comparison with Mann-Whitney U test showed all variables were similar at baseline but after 4 weeks there was a statistically significant improvement in craniocervical flexion test scores and all domains of SF 36 in the experimental group. But domain of pain showed mean rank of 49.43 after 4 weeks in the experimental group and 39.57 in the control group with p = 0.065 and d = 0.579, while for all the other 7 domains values were p < .05 and d > 0.25. Conclusion: Neural mobilization combined with cervical isometrics shows significant effects in improving quality of life and deep flexors endurance in patients with cervical radiculopathy than cervical isometrics alone.

Comparison of neural mobilization and conservative treatment on pain, range of motion, and disability in cervical radiculopathy: A randomized controlled trial.

OBJECTIVE: The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability. METHODS: It was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons. RESULTS: There was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05). CONCLUSIONS: The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy. TRIAL REGISTRATION: RCT20190325043109N1.

Effects of Supervised Structured Aerobic Exercise Training Program on Interleukin-6, Nitric Oxide Synthase-1, and Cyclooxygenase-2 in Type 2 Diabetes Mellitus.

OBJECTIVE: To determine the effects of supervised structured aerobic exercise training (SSAET) program on interleukin-6 (IL-6), nitric oxide synthase 1 (NOS-1), and cyclooxygenase-2 (COX-2) in type 2 diabetes mellitus (T2DM). STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: Riphah Rehabilitation and Research Centre, Railways General Hospital, Rawalpindi, from January 2015 to June 2016. METHODOLOGY: Patients of either gender of minimum one year history of T2DM ranging from 40-70 years of age were included. Those with chronic systemic diseases, history of regular exercise, smoking, and those on dietary plan were excluded. Atotal of 195 patients were screened; 120 were selected and 102 agreed to participate in the study. They were randomly placed into experimental and control groups. SSAETprogram, routine medication, and dietary plan were applied in experimental group; whereas, control group was managed with routine medication and dietary plan for 25 weeks. IL-6, NOS-1, and COX-2 were assessed at baseline and 25 weeks. RESULTS: SSAET program, routine medication and dietary plan showed significantly improved IL-6 (pre-mean=0.25 ±0.11ng/ml, post-mean=0.19 ±0.04 ng/ml), NOS-1 (pre-median=4.65 ng/ml, IQ range=1.04 ng/ml), (post-median=2.72 ng/ml, IQ range=1.60 ng/ml), and COX-2 (pre-mean=18.72 ±4.42 ng/ml, post-mean=15.18 ±2.63 ng/ml) in experimental group, as compared with control group managed by routine medication and dietary plan, where deterioration was noted in IL-6 (pre-mean=0.23 ±0.08 ng/ml, post-mean=0.27 ±0.08 ng/ml) and COX-2 (pre-mean=18.49 ±4.56 ng/ml, postmean=19.10 ±4.76 ng/ml), while NOS-1 slight improvement (pre-mean=4.99 ng/ml, IQ range=2.67 ng/ml), (postmean=4.56 ng/ml, IQ range=3.85 ng/ml). Statistically at the baseline the p-values were not significant (p>0.05) in both experimental and control groups for IL-6, COX-2 and NOS-1; while after 25 weeks of intervention, the experimental group showed significant improvement (p<0.05) in comparison with the control group. CONCLUSION: SSAET program, routine medication, and dietary plan had positive effect on IL-6, NOS-1, and COX-2 in T2DM patients.