Home-based exercise program integrated with patient education for patients with type 2 diabetes mellitus: a study on feasibility and preliminary effectiveness

Background: Exercise has been considered one of the cornerstones in managing type 2 diabetes mellitus (T2DM). However, it is known as an underutilized approach in clinical practice. Considering the hectic schedule of healthcare providers in educating exercise for this population, we developed a home-based exercise program for T2DM patients to promote exercise involvement. Methods: A 3-phased study was conducted. Phase 1 was the development of the program involved systematic reviews to identify the exercise protocol and health belief model (HBM)-based education on exercise behavior. Phase 2 consisted of content validation of the program. In phase 3, T2DM patients were recruited to enroll in four 60-min education sessions. Two weekly supervised resistance exercise sessions for four weeks were followed by eight weeks of home-based resistance exercise. Simultaneously, the participants performed home-based aerobic exercises for 12 weeks. Process and scientific feasibility were analyzed for feasibility. Results: Of 15 participants who consented to partake, 11 participants completed the intervention (73%). The prescribed intensity of aerobic and resistance exercise was achieved by 46% and 82% of the participants, respectively. Adherence rates to home-based exercises ranged from 60% to 64%. No study-related severe adverse event was reported. Mean glycated hemoglobin (HbA1c) decreased from 7.9% to 7.7%, the six-minute walk test (6MWT) increased from 404.1 m to 465.4 m, muscle strength (handheld dynamometer) increased from 6.2 kg to 7.6 kg (elbow flexor); from 6.5 kg to 7.8 kg (knee extensor), muscle mass increased from 23.6% to 23.8%, and fat mass decreased from 35.6% to 35.2%. The participants showed improvement in exercise self-efficacy (ESE) (from 44.8 to 66.6) and Quality of Life (QoL) (from 45.7% to 32.4%). Conclusion: The program had a potentially positive outcome on glycemic control, aerobic capacity, muscle strength, body composition, ESE, and QoL in T2DM patients

Effects of patient education on the quality of life of patients with type 2 diabetes mellitus: a scoping review

Introduction: Patient education is an integral component of diabetes mellitus care. The emergence of different methods and characteristics of patient education has led to varying outcomes of quality of life (QoL). Herein, we systematically searched for published studies reporting patient education and its methods and characteristics for improving the QoL of patients with type 2 diabetes mellitus (T2DM). Methods: In this scoping review, eligible studies from six databases (PubMed, Scopus, Cochrane Library, Springer Link, Science Direct and Google Scholar) were identified. The keywords used in the search strategies were as follows: health education, health promotion, patient education, diabetes care, QoL, diabetes mellitus and type 2 diabetes mellitus. Two reviewers independently screened all references and full-text articles retrieved to identify articles eligible for inclusion. Results: A total of 203 articles were identified in the initial search. Of them, 166 were excluded after screening the titles and abstracts. Further full-text screening led to the subsequent removal of 22 articles, leaving 15 articles eligible for data extraction. Conclusion: There is a broad array of methods of patient education for improving the QoL of patients with T2DM. Self-management education with supplementary supervision and monitoring effectively improves QoL. Future studies must emphasise the application of holistic education covering psychological distress, diet plan, and physical health

Correlations between functional balance and gait parameters during timed up and go test under dual-task conditions among older adults

The combination of physical, cognitive, and sensory challenges can make outdoor walking difficult for older adults. This study aimed to determine whether the gait parameters during the Timed Up and Go (TUG) test under dual-task conditions correlate with the functional balance level. A total of 255 older persons participated in this cross-sectional study. Functional balance was assessed using the Berg Balance Scale (BBS) before the TUG test. The TUG test was conducted under single- and two dual-task conditions (dual-motor and dual-cognitive). The time and number of steps were used to quantify gait parameters. Spearman’s rank correlation coefficient was used to assess the relationship among variables. The gait parameters (time and number of steps) of the TUG test were significantly different between task conditions (both, p = 0.001). Post hoc analysis with the Wilcoxon signed-rank test showed that the gait parameters in dual-motor and dual-cognitive tasks were significantly longer than in single-task conditions (p = 0.001). A strong negative rank correlation was found between the time and the number of steps taken to complete the single task condition and functional balance (p = 0.001). There was a low negative correlation between the time taken to complete the dual-motor task and dual-cognitive task conditions and functional balance. These findings suggest that functional balance may be an influential domain of successful dual-task TUG in older adults

Tele-DM: development of a mobile health technology for non-invasive type-2 diabetes mellitus patients with assistive physical activities and vital signs monitoring

Health experts have identified tailored physical activity (PA) and heart rate measurement as critical components in assisting type-2 diabetes (T2D) patients in improving their health. When performing PA, heart rate monitoring can be useful in figuring out the right intensity level for diabetic patients, helping them to benefit from the non-invasive treatment. Previous research has shown that mobile health (mhealth) applications have emerged as a viable option for enhancing health outcomes during the rehabilitation process. Regrettably, the current mhealth applications have constraints in facilitating a bidirectional interaction between the healthcare provider (HPC) and the patient. Moreover, the majority of mhealth applications designed for T2D treatment cannot directly capture real-time heart rate data from smartwatches or medical wearable devices. As a result, users are compelled to manually input this data into the applications. Thus, in this study, a Tele-diabetes mellitus management (Tele-DM), a remote monitoring system consisting of a mobile application and a smartwatch is developed to address these challenges by using the Flutter framework, Nodejs, Express, Heroku, and database management system (DBMS) MongoDB. A feature has been implemented to provide healthcare professionals (HCPs) with an interactive feedback page. This page allows HCPs to review and comment on the progress of their patients, facilitating more effective remote monitoring. In addition, through the utilisation of a multi-platform approach, the heart rate can be obtained in real-time from commercially available smartwatches and subsequently synchronised with the Tele-Dm apps following PA. The HCPs can monitor the performance and progress of the patients in real-time using this method. Functionality tests of this app have shown a remarkable success rate of almost 100%. From the user acceptance rating, it received an average of 4.03 rating for a user-friendly mhealth application. Ultimately, the Tele-DM system is an innovative solution for tackling the difficulties associated with diabetes self-care. It provides personalised guidance and remote monitoring of heart rate during rehabilitation sessions

Effectiveness of exergames on balance and gait performance among post-stroke patients: A systematic review

Introduction: Recently, exergames have cropped up as a new form of intervention for stroke rehabilitation. This study reviews the effectiveness of exergames on balance and gait performance and determines the optimal dosage, duration, and types of exergames used to improve balance and gait performance among individuals with post-stroke. Methods: Searches were performed in Scopus, PubMed, MEDLINE via EBSCO, and ScienceDirect databases from 2015 to 2020. The protocol of this research was guided by using preferred reporting items for systematic reviews and meta-analyses. Results: : A total of 394 articles were selected and reviewed. Articles involving exergames as an intervention in the individuals with post stroke and evaluating balance and gait performance were selected in this research. Eleven studies have been selected in this review. However, half of the studies reported no significant differences between experimental and control groups. The dosages used in exergames to improve balance and gait in selected studies were inconsistent. Most of the studies used exergames for 30 minutes. Common exergames that had been used were Nintendo Wii Fit and Xbox Kinect. Conclusion: Exergames effectively improve balance and gait performance, and the effects were similar to conventional therapy among post-stroke patients. Types of exergames chosen mostly focused on games that involved lower extremities that stimulate balance and gait

Home-based physical activity in patients with type 2 diabetes mellitus: a scoping review

To promote optimal healthcare delivery in type 2 diabetes mellitus (T2DM) following the outbreak of coronavirus disease 2019, adopting home-based physical activity (PA) is being seriously considered. Therefore, this study aims to outline the characteristics of exercise protocols for home-based PA and the challenges and limitations in implementing home-based PA in patients with T2DM. This scoping review was carried out by identifying eligible studies in six different databases (Scopus, Cochrane Library, SpringerLink, ProQuest, Science Direct, and Google Scholar). The keywords used in the search strategies were: home-based physical activity, home-based exercise therapy, home-based physical exercise, home-based exercise, home-based exercise training, diabetes mellitus, and T2DM. Two reviewers independently screened all full-text articles to find articles that met the eligibility requirements. A total of 443 articles were identified in the search. Approximately 342 articles were excluded by screening titles and abstracts, which led to the selection of 44 articles relevant to the current study. Further screening of the full-text led to the subsequent removal of 34 other articles, leading to 10 studies that were eligible for data extraction. This review suggested that the exercise protocols for home-based PA include resistance exercise using free weight and own body weight with a frequency of two to three sessions per week at moderate intensity, along with aerobic exercise (particularly walking) with a frequency of three to five times per week at moderate intensity. A combination of resistance and aerobic exercise showed more significant benefits of PA in patients with T2DM. More studies regarding home-based PA in T2DM patients with metabolic disorders are warranted

The impact of diabetic peripheral neuropathy on spatiotemporal gait parameters in stroke survivors: A case-control study

The deterioration of gait performance following stroke is related to the impairment of sensorimotor function on the paretic side. Improper gait performance in post-stroke with additional diabetic peripheral neuropathy (DPN) on paretic and non-paretic legs may create destabilizing effects, including serious injuries and falls. Therefore, this study aimed to investigate the effect of DPN on spatiotemporal gait parameters in stroke survivors and determine the correlation of movement functioning and functional balance post-stroke with gait parameters. Ten stroke survivors with DPN, 10 stroke survivors without DPN and 10 healthy controls participated in this case-control study. Movement functioning and functional balance were assessed before the actual testing. Spatiotemporal gait parameters were recorded using the Nexus Vicon motion analysis system. Kruskal-Wallis test was used to analyze the gait parameters and Spearman’s rank-order correlation coefficient was used to identify the correlation between variables. Results showed that stroke survivors with DPN had longer stride time (temporal gait parameter, p = 0.001), lower cadence (p = 0.001) and greater gait variability than those without DPN and the healthy controls. The gait parameters were significantly correlated with movement functioning and functional balance in stroke survivors with DPN (p < 0.05). These findings suggested that DPN possibly affected the gait parameters in stroke survivors. DPN could also play a role in movement functioning and functional balance in stroke survivors

Level of self esteem among medical students in International Islamic University Malaysia (IIUM) and its association with religiosity

Self-esteem is an essential aspect of wellbeing1 particularly for medical students5 who are susceptible to mental disorders. In Islam, self-esteem is built with the combination of both revelation by Allah and human’s effort. 6 With the increasing study in terms of religiosity and self-esteem2,3,4, the role of religiosity as possible protective factor for Muslim medical students in their life, is a stepping stone towards becoming competent Muslim professionals