Physiotherapist-guided exercise supported by wearable device feedback may be associated with greater improvement in the 6-minute walk distance over a period of 6 months among outpatients with type 2 diabetes and diabetic kidney disease compared with standard care.
In the prospective, single-center, nonrandomized study, researchers recruited 58 outpatients who were allocated to an intervention group or a nonintervention group. The per-protocol analysis included 45 patients who completed 6 months of follow-up, including 25 in the intervention group and 20 in the nonintervention group.
The participants who agreed to wear a wrist-worn device and attend monthly face-to-face sessions with a physiotherapist were placed in the intervention group, while those who couldn't attend monthly sessions because of scheduling or time constraints continued standard multidisciplinary care from physicians, nurses, and registered dietitians in the nonintervention group. The primary endpoint was 6-minute walk distance.
The researchers found that the 6-minute walk distance increased from 512 m to 551 m in the intervention group, a 39-m gain, whereas the nonintervention group declined from 410 m to 407 m. In an adjusted linear mixed-effects model—adjusted for age, baseline 6-minute walk distance, glycated hemoglobin, estimated glomerular filtration rate, cardiovascular disease, and smoking status—the between-group difference in change was 42.4 m.
The intervention used the iAide wrist-worn device to record step count, heart rate, and estimated metabolic equivalents. Physiotherapists used the data during monthly counseling sessions to guide exercise frequency, intensity, time, and type. The participants were instructed to gradually increase activity by at least 500 steps above baseline.
Several exploratory secondary outcomes also differed between the groups. Glycated hemoglobin decreased by 0.89 percentage points relative to control. Weight-bearing index, phase angle, and skeletal muscle index also improved. The researchers cautioned that these secondary outcomes were exploratory and weren't formally adjusted for multiple comparisons.
No statistically significant between-group difference was observed in estimated glomerular filtration rate over the 6-month study period, and the estimated glomerular filtration rate slope also didn't differ significantly between the groups. The researchers noted that renal findings should be interpreted cautiously because creatinine-based estimates can be influenced by skeletal muscle mass.
Adherence appeared feasible in the intervention group: 20 of 25 patients maintained physiotherapist-guided exercise at least three times per week. No intervention- or device-related adverse events were observed, including no severe hypoglycemia episodes requiring medical assistance, injurious falls, musculoskeletal injuries leading to withdrawal, or cardiovascular events attributable to the intervention.
The study was limited by its single-center, nonrandomized design, modest sample size, and the possibility of selection bias related to differences in patient motivation. The design also didn't include a physiotherapist-guided group without wearable feedback, limiting conclusions about the independent contribution of the device. Detailed longitudinal activity data, including step counts and wear time, weren't retained for quantitative analysis, preventing dose-response assessment.
“In outpatients with type 2 diabetes, including those with [diabetic kidney disease], physiotherapist-led exercise guidance incorporating wearable feedback improved exercise capacity, muscle quality, and [hemoglobin A1c], but no short-term renoprotective effect was observed,” wrote lead study author Momo Takahashi of the Department of Rehabilitation at the Dokkyo Medical University Nikko Medical Center in Japan, and colleagues.
The researchers reported no conflicts of interest. Open access funding was provided by Dokkyo Medical University, with additional support from Japan’s Ministry of Education, Culture, Sports, Science, and Technology and the MANI Matsutani Medical Scholarship Foundation.
Source: Diabetology International
