Effects of whole-body Vibration therapy among Type II Diabetes Mellitus - A Pilot single blind randomized clinical trial

 

Ramachandran. S¹*, Jibi Paul², M.S. Sundaram³, Sureka Varalakshmi⁴, Selvaraj Sudhakar⁵

^1-2Professor, Faculty of Physiotherapy, Dr. M. G. R. Educational and Research Institute, Maduravoyal,

Chennai– 600095, Tamil Nadu, India.

³Professor, School of Physiotherapy, VELS Institute of Science, Technology and Advanced Studies, Pallavaram, Chennai - 600043, Tamil Nadu, India.

⁴Professor, Department of Physiology, A.C.S Medical College and Hospital, Velappanchavadi,

Chennai - 600077, Tamil Nadu, India.

⁵Associate Professor, Faculty of Physiotherapy, Dr. M. G. R. Educational and Research Institute, Maduravoyal, Chennai– 600095, Tamil Nadu, India.

 

ABSTRACT:

Introduction: Diabetes mellitus is a disease characterized by elevated glucose level in the blood. This study focused to find out the effects of whole-body vibration therapy and resisted exercise among type II diabetes mellitus. Materials and Methods:  Total 36 subjects both male and female were selected for this study with age group between (35 - 50 years). Subjects were divided into three groups. Group A received whole body vibration therapy and Group B received resisted exercise. Group C underwent conventional exercises. All three groups received an intervention for 12 weeks.  Pre and post HbA_1c and lipid profile were measured. Results: The study shows that there is a significant reduction in HbA_1c level and lipid profile in whole body vibration therapy followed by resisted exercise group and conventional therapy group. Conclusion: This study concluded that whole body vibration therapy can recommend for controlling blood glucose level effectively among type II diabetes mellitus subjects.

 

 

 

INTRODUCTION:

It is a common endocrine disorder characterized by elevated blood glucose level due to either decrease in function of insulin on decreased secretion of insulin in our body¹ Type 2 diabetes caused by so many factors includes stress, lack of exercise abnormal food habits, abnormal body mass index² Recent studies shows that prevalence of diabetes in worldwide currently affects 246 million people.

 

It will be increasing gradually by 380 million in the year of 2025 and majority of the case will be in Indian and China³. Uncontrolled diabetes will lead to so many complications like peripheral neuropathy, Nephropathy, Retinopathy, CVA and myocardial infarction and sometimes death.⁴ According to report ICMR-INDIANS (India diabetes) majority of the undiagnosed case present in rural area than urban area⁵ Increasing in incidence and prevalence which causes greater burden for the health care delivery system and also affects the quality of life among type 2 DM patients⁶

 

Various pharmacological treatments available to control diabetes. But exercise plays a major role in controlling as well as preventing the type 2 DM⁷. recent studies supports well-structured lifestyle modification and more in physical activity and reducing weight contributing in the delayed onset of type 2 DM.⁸ American diabetes association (ADA) recommends therapeutic strengthening exercise preventing cardiovascular disease which occurs as a complications of diabetes mellitus.⁹ Study supported uncontrolled type 2 DM leads to development of abnormal plasma lipids and lipoproteins levels leads to development of coronary artery disease and stroke etc.¹⁰ Various studies showing evidence of relationship between LDL size and coronary artery disease.¹¹ Exercise gives greater benefit to decrease body fat and to improve lean mass among Type 2 DM. ¹²

 

Arora et al (2009) concluded in their study regular exercise can decrease HbA₁C levels to 0.6%, whole body vibration therapy is a reason concept shows evidence in decreasing blood glucose level^14,15. Majority of patient when the age crosses above 45 all the degeneration started which preventing in performing the exercise like aerobic and resisted exercise. Hence this study wants to find out the effect of resisted exercise and the whole-body vibration therapy among Type 2 DM in the outcome HbA₁C level and lipid profile.

 

MATERIALS AND METHODS:

A total of 42 patients were screened in ACS medical college and hospital out of which 36 patients were included in this study who met inclusion criteria: Baseline HbA_1C value between 7 to 10.5, Patient who can come for the study regularly for 12 weeks and 3 days per week, Type 2 DM for more than 6 months and consent given by the general practitioner to attend the program. Exclusion criteria includes: Patient who receive insulin therapy, lipid lowering drugs, any major changes in oral hypoglycemic medication, patient under any antihypertensive drugs and blood pressure more than 160/95 mm hg. An informed consent was obtained from subject prior to the study and detailed explanation given. The study was approved by institutional review board. All the patients were randomized into three groups and each group consists of 12 patients. Group A subjects underwent whole body vibration therapy, Group B subjects underwent resisted exercise and Group C underwent conventional therapy.

 

Group A subjects undergone whole body vibration therapy with following parameters: amplitude 2mm and 30 Hz of vibration frequency for nine weeks. From 10^th to 12^th week the frequency increased 35 Hz for the duration of 20 minutes. Group B subjects underwent resisted exercise includes leg press, leg extension, seated leg flexion, seated calf rise, lateral pulley, horizontal chest press, butterfly and rowing. Subjects were taken intermittent rest after every set exercise to avoid critical blood pressure response. Epleys formula was used to calculate one repetition maximum (1RM). First 6 weeks subjects underwent 70% 1 RM with 12 repetitions, followed by 7^th- 9^th week subject undergone two sets consist of 12 repetitions at 70% 1RM and 10^th - 12^th week 80% 1RM was performed with three sets consist of 10 repetitions. Group C subjects underwent usual walking with comfortable clothes and shoes in a self-paced speed for 5 days per week for 12 weeks under supervision. Pretest was done before initiation of intervention and posttest was taken at end of 12^th Week. Dependent Variables includes HbA_1c and lipid profile.

 

Table 1: Demographic characteristics of the subjects recruited in Group A, Group B and Group C

 

The collected data were tabulated and analyzed using both descriptive and inferential statistics. All the parameters were assessed using statistical package for social science (SPSS) version 24. Shapiro-Wilk test was used for testing normality of data. One Way ANOVA includes of following test Homogeneity of Variance and Anova was adopted to find statistical difference between three groups.

 

Table-2: Comparison of Pre and Post HbA1C score values between Group A, Group B and Group C

 

Table 3: Comparison of Pre and Post Triglyceride score between Group A, Group B and Group C

 

Table 4: Comparison of Pre and Post HDL score using between Group A, Group B and Group C

 

 

Fig 1: Comparison of Pre and Post HbA1C score between Group A, Group B and Group C

 

GRAPH – II

 

Fig 2: Comparison of Pre and Post Triglyceride score between Group A, Group B and Group C

 

 

Fig 3: Comparison of Pre and Post HDL score between Group A, Group B and Group C

 

Fig 4: Comparison of Pre and Post HDL score between Group A, Group B and Group C

Table 5: Comparison of Pre and Post LDL score between Group A, Group B and Group C

 

RESULTS:

On comparing Mean values of Group A, Group B and Group C on HbA1_C, Triglyceride, Low density lipoprotein shows significant decrease in the Post test Mean values and high density lipoprotein shows significant increase in the Post test Mean values in which whole-body Vibration therapy (Group A) is effective than Resisted Exercise (Group B) and followed by conventional therapy (Group C) at P ≤ 0.05.

 

DISCUSSION:

Controlling the blood glucose level is the main focus on type 1 and type 2 diabetes mellitus. Blood glucose levels are directly proportional to diabetic complication. Hence all the treatment directed to decrease the blood glucose level. Selvin E et al conducted a study regarding correlation between reduce HbA₁c percentage and the incidence of cardiovascular complication, finally they concluded decrease HbA₁c level 1% can lead to 15% reduces the major cardiovascular complication and 37% of minor cardiovascular complication. The current study focused to find out the effectiveness of resisted exercise, whole body vibration therapy over conventional therapy on type 2 diabetes mellitus. For this study HbA₁c and lipid profile were taken as an outcome measure. table 1 reveals pre and post HbA₁c level among three groups and results shows that HbA₁c significantly decreases in whole body vibration therapy when compare to resisted exercise and conventional therapy. The possible mechanism of whole-body vibration therapy how controls the blood sugar level explained by Cardinale M et al. Vibration exercise stimulates the muscle spindle through signals from tendon and muscle, which initiates muscle action named tonic vibration reaction. The tonic vibration reaction causes firing of motor neuron leads to action of more motor units causes increase in muscular strength. In this study also pre and post HbA₁c level is reduced all the three groups but more efficiently in whole body vibration therapy. On the other hand the pre and post lipid profile includes Triglyceride, LDL, HDL also evaluated when comparing all the three groups. Whole body vibration therapy shows significant reduction in lipid profile among three groups. Gonzalez et al conducted a study about whole body vibration therapy on body fat and lean body mass and they concluded that whole body vibration therapy leads to decrease in upper limb body fat (p<0.05) and increases whole body lean mass¹⁸. So, the study is also coincides with this study. The results of the study suggest whole body vibration therapy as better outcome when compare to resisted exercise and conventional therapy. The whole-body vibration therapy involves 100% muscle work while other methods involve 40-60% muscle work. It involves less in time and variety of patient can use it, the patient who is having difficulty in performing resisted exercise and walking, they can use whole body vibration therapy to control their blood glucose level.

 

CONCLUSION:

This study concluded that whole body vibration therapy can be recommend for controlling blood glucose level among type II diabetes mellitus patients. Since, the whole-body vibration therapy involves less physical exertion. So, it can be recommended those who cannot able to perform any form of physical activities and resisted exercises.

 

ACKNOWLEDGMENT:

I would like to thank the management Members of Dr. MGR Educational and Research Institute for providing me with feasible environment to carry out this study successfully.

 

CONFLICT OF INTEREST:

Declared none.

 

 

ETHICAL CONSIDERATION:

The research protocol was approved by the university researchers and institutional ethics committee (2017/0149/PT17D004) and Helsinki declaration, revised 2013 guidelines was strictly followed in the study.

 

REFERENCES:

1.      Position statement Diagnosis and Classification of Diabetes Mellitus American Diabetes Association Diabetes Care 2009; 32(1):S62-S67.

2.      Nelson AG, Kokkonen J, Arnall DA. Twenty minutes of passive stretching lowers glucose levels in anat-risk population: an experimental study. J Physiother. 2011; 57(3): 173-8.

3.      International Diabetes Foundation. Diabetes: A Global Threat. Brussels, Belgium: International Diabetes Foundation, 2006, p. 1–15.

4.      Pavkov ME, Bennett PH, Knowler WC, Krakoff J, Sievers ML, Nelson RG. Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA 296: 421–426, 2006.

5.      Anjana RM, Ali MK, Pradeepa R, et al. The need for obtaining accurate nationwide estimates of diabetes prevalence in India—rationale for a national study on diabetes. Indian J Med Res 2011; 133: 369–80.

6.      Sadikot SM, Nigam A, Das S, et al, for Diabetes India. The burden of diabetes and impaired fasting glucose in India using the ADA1997 criteria: prevalence of diabetes in India study (PODIS). Diabetes Res Clin Pract 2004; 66: 293–300.

7.      Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leonetti F, Fallucca F. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications 20: 216–223, 2006.

8.      Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 26: 2977–2982, 2003.

9.      Dela F, Larsen JJ, Mikines KJ, Ploug T, Petersen LN, Galbo H. Insulin-stimulated muscle glucose clearance in patients with NIDDM. Effects of one-legged physical training. Diabetes 44: 1010–1020, 1995

10.   Galvao DA, Taaffe DR. Resistance exercise dosage in older adults: single- versus multi set effects on physical performance and body composition. J Am Geriatr Soc 53: 2090–2097, 2005.

11.   Hansen D, Dendale P, Berger J, van Loon LJ, Meeusen R. The effects of exercise training on fat-mass loss in obese patients during energy intake restriction. Sports Med 37: 31–46, 2007.

12.   Slentz CA, Aiken LB, Houmard JA, Bales CW, Johnson JL, Tanner CJ, Duscha BD, Kraus WE. Inactivity, exercise, and visceral fat. STRRIDE: a randomized, controlled study of exercise intensity and amount. J Appl Physiol 99: 1613–1618, 2005.

13.   Cardinal M, Rittweger J. Vibration exercise makes your muscles and bones stronger: fact or diction? Review. J Brit Menopause Society 2006; 12:43-9.

14.   Di Loreto C, Ran Chelli A, Lucidi P, et al. Effects of whole body vibration exercise on the endocrine system of healthy men. J Endocrinol Invest 2004; 27:323-7.

15.    Fenicchia LM, Kanaley JA, Azevedo JL Jr, Miller CS, Weinstock RS, Carhart RL, Ploutz-Snyder LL. Influence of resistance on glucose control in women with type 2 diabetes. Metabolism 53: 284–289, 200.

16.   Cardinale M, Bosco C. The use of vibration as an exercise intervention. Exerc Sport Sci Rev 2003; 31:3-7

17.   Di Loreto C, Ran Chelli A, Lucidi P, et al. Effects of whole body vibration exercise on the endocrine system of healthy men. J Endocrinol Invest 2004; 27:323-7

18.   González-Agüero A, Matute-Llorente A, Gómez-Cabello A, Casajus JA, Vicente-Rodriquez G. Effects of whole body vibration training on body composition in adolescents with Down syndrome. Res Dev Disabil 2013; 34: 1426e33.

19.   Cardinale M, Bosco C. The use of vibration as a exercise intervention. Exerc Sport Sci Rev. 2003; 31:3–7.

 

 

 

 

Accepted on 04.07.2020           © RJPT All right reserved

Research J. Pharm. and Tech 2021; 14(3):1465-1468.