The effect of modified otago exercises on metabolic variables, joint position sense, balance and health-related physical fitness parameters in individuals with diabetic neuropathy

Our study was planned to investigate the effects of modified Otago exercises on metabolic variables, joint position sense, balance and health-related physical fitness parameters in individuals with diabetic neuropathy. 38 patients between the ages of 45 and 65 who were diagnosed with Type 2 diabetes (T2D) were included in the study. Patients were randomly divided into Modified Otago Exercise Group (M-OEG: 19) and Control Group (CG: 19) and were followed for 8 weeks. All patients were asked to follow the moderate pace walking protocol for at least 30 minutes 5 days a week. In addition, modified Otago exercises were applied to M-OEG for 30-45 minutes 2 days a week in addition to walking. Metabolic variables were performed with a complete blood count; joint position sense (JPS) assessments of ankle and knee joint were performed with a digital inclinometer/goniometer. Timed Up and Go Test (TUG), Balance Error Scoring System (BESS) and International Fall Effectiveness Scale (FES-I) were used for balance; bioelectrical impedance method (Tanita BC-730 analyzer) for body composition; 6-minute walk test (6MWT) for functional exercise capacity; Sit-Reach Test (SRT) for flexibility; 30-second Sit-Stand Test (30-SST) for muscle strength and endurance; the Borg Scale for determination of perceived efford. After treatment, neuropathic pain score (p<0.001), metabolic variables (HbA1c: p=0.001; triglyceride: p=0.003; cholesterol: p=0.037; HDL: p=0.040), ankle JPS were observed in M-OEG (right ankle 10° DF: p=0.001; left ankle 10° DF: p=0.004; right and left ankle 15° PF: p<0.001), balance (TUG, total BESS, FES-I: p<0.001) and body composition (body weight: p=0.027) was found to be more effective in improving functional exercise capacity and muscle strength and endurance than just walking (p<0.001). There was also an improvement in neuropathic pain score (p=0.025), some parameters of metabolic variables (HbA1c: p=0.002; triglycerides: p=0.025), right ankle joint 10° DF (p=0.006) and left knee joint 30° knee flexion JPS (p=0.017) and balance (TUG: p=0.003) CG. The results of our study showed that modified Otago exercises applied in addition to walking were effective in improving metabolic variables (HbA1c, HDL, cholesterol, triglycerides), ankle joint position sensation, balance, reducing the risk of falls and health related physical fitness parameters (body weight, functional exercise capacity, muscle strength) in individuals with diabetic neuropathy. Modified Otago exercises, which can be applied without requiring equipment and designed specifically for the individual, will contribute to achieving protective and preventive physiotherapy and rehabilitation goals as an evidence-based practice in diabetic individuals. Key words: Balance, diabetes, functional performance, otago exercise programme, proprioception.