Issue 20-2, 2021

Review article

https://doi.org/10.38025/2078-1962-2021-20-2-80-87

The Role of Physical Therapy in the Combined Treatment of Patients with Lower Extremities Diabetic Angiopathies

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1 ORCIDDenis V. Frolov

1 Russian Medical Academy of Continuing Professional Education, Moscow, Russian Federation


ABSTRACT

One of the most disabling complications of diabetes mellitus is angiopathy of the lower extremities. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with vascular complications of diabetes mellitus, which significantly aggravate the course of the disease and contribute to high mortality. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with the diabetes mellitus vascular complications that significantly aggravate the course of the disease and contribute to high mortality. Despite the improvement in the results of pharmacotherapy of diabetes mellitus, the problem of treating its vascular complications is far from being solved. Traditionally, therapeutic physical training is used among the methods of non-drug treatment of diabetes mellitus and its complications. As a method of pathogenetic focus on many risk factors for the development of diabetes and its complications, physical therapy exercises contribute to the correction of the syndrome of hypodynamia, obesity, and muscle atrophy. At the same time, there is insufficient data on how exercise therapy affects the quality of life of patients, functional characteristics of walking and objective indicators of blood flow in the lower extremities. This review identifies the main approaches to the application, advantages and disadvantages of individual methods of therapeutic physical training in the correction of functional disorders in patients with lower extremities diabetic angiopathies. We can currently talk about the proven safety of the physical therapy use in patients with diabetic angiopathies. Meanwhile, the scientific data on the high efficiency of this method is still insufficient.


KEYWORDS: diabetes mellitus, diabetic angiopathy, training walking, treadmill test, physical therapy

FUNDING: The study had no sponsorship

CONFLICT OF INTEREST: The authors declare no apparent or potential conflicts of interest related to the publication of this article

FOR CITATION: Frolov D.V. The Role of Physical Therapy in the Combined Treatment of Patients with Lower Extremities Diabetic Angiopathies (Literature Review). Bulletin of Rehabilitation Medicine. 2021; 20 (2): 80-87. https://doi.org/10.38025/2078-1962-2021-20-2-80-87

FOR CORRESPONDENCE:

Denis V. Frolov, e-mail: frolomed@mail.ru


References:

  1. International Diabetes Federation. IDF Diabetes Atlas. 9th ed. International Diabetes Federation, Brussels, Belgium 2019. Available at: https://diabete-satlas.org/en/ (accessed: 15.12.2020).
  2. Dedova I.I., Shestacovoj M.V., Mayorova A.U. Algorytmy specializirovannoj medicinskoj pomoschy bolniym saharniym diabetom [Algorithms of specialized medical care for patients with diabetes mellitus.] Moscow. 2019. https://doi.org/10.14341/DM221S1 (In Russ.).
  3. Kalashnikov V.U., Vikulova O.K., Zhelezniakova A.V., Isakov M.A., Bondarenko I.Z., Shestakova M.V., Dedov I.I. Epidemiologia serdechno-sosudistich zabo-levanij u bolnich sacharnim diabetom, po dannim Federalnogo registra Rossijskoj Federacii (2013-2016) [Epidemiology of cardiovascular diseases in patients with diabetes mellitus, according to the Federal register of the Russian Federation (2013-2016)]. Diabetes Mellitus. 2019; 22(2): 105-114. https:// doi.org/10.14341/DM10167 (In Russ.).
  4. Hsieh M.C., Tien K.J., Perng D.S., Hsiao J.Y., Chang S.J., Liang H.T., Chen H.C., Tu S.T. Diabetic nephropathy and risk factors for peripheral artery disease in Chinese with type 2 diabetes mellitus. Metabolism. 2009; 58(4): 504-509. https://doi.org/10.1016/j.metabol.2008.11.008
  5. Cimminiello C. PAD. Epidemiology and pathophysiology. Thrombosis Research. 2002; 106(6): 295-301. https://doi.org/10.1016/s0049-3848(01)00400-5
  6. Chen L., Magliano DJ., Zimmet P.Z. The worldwide epidemiology of type 2 diabetes mellitus - present and future perspectives. Nature Reviews Endocrinology. 2012; 8(4): 228-236. https://doi.org/10.1038/nrendo.2011.183
  7. American Diabetes Association. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020; 43(1): 111-134. https://doi.org/10.2337/dc20-S010
  8. Murabito J.M., D’Agostino R.B., Silbershatz H., Wilson W.F. Intermittent claudication. A risk profile from The Framingham Heart Study. Circulation. 1997; (96): 44-49. https://doi.org/10.1161/01.cir.96.1.44
  9. Sampson U.K., Fowkes F.G., McDermott M.M., Criqui M.H., Aboyans V., Norman P.E., Forouzanfar M.H., Naghavi M., Song Y., Harrell F.E. Jr., Denenberg J.O., Mensah G.A., Ezzati M., Murray C. Global and regional burden of death and disability from peripheral artery disease: 21 world regions, 1990 to 2010. Global Heart. 2014; 9(1): 145-158. https://doi.org/10.1016/j.gheart.2013.12.008
  10. Ametov A.S. Sacharnij diabet 2 tipa. Problemi I reshenija [Type 2 diabetes mellitus. Problems and solutions]. Moscow. Geotar-Media. 2011: 704 p. (In Russ.).
  11. Norgren L., Hiatt W.R., Dormandy J.A., Nehler M. R., Harris K.A., Fowkes F.G. TASC II Working Group, “Intersociety Consensus for the Management of Peripheral Arterial Disease (TASC II)”. European Journal of Vascular and Endovascular Surgery. 2007; 33(1): 1-75. https://doi.org/10.1016/j
  12. Jude E.B., Oyibo S.O, Chalmers N., Boulton A.J. Peripheral arterial disease in diabetic and nondiabetic patients: A comparison of severity and outcome. Diabetes Care. 2001; (24):1433-1437. https://doi.org/10.2337/diacare.24.8.1433
  13. Barberin J., Granizo J.J., Aguilar L., Alguacil R., Sainz F., Menendez M.A., Gimenez M.J., Martinez D., Prieto J. Predictive model of short-term amputation during hospitalization of patients due to acute diabetic foot infections. Enfermedades Infecciosas y Microbiolog^a Cimica. 2010; 28(10): 680-684.https://doi.org/10.1016/j.eimc.2009.12.017
  14. Dedov I.I., Shestakova M.V. Sacharnij diabet: rukovodstvo dlia vrachej [Diabetes mellitus: a guide for doctors]. Moscow. Universum Publishing. 2003: 455 p. (In Russ.).
  15. Dedov I.I., Udovichenko O.V., Galstian G.R. Diabetichescaia stopa [Diabetic foot]. Moscow. Practical medicine. 2005: 197 p. (In Russ.).
  16. Pullatt R.C., Silverman D.I., Heller G.V. Are long-term outcomes of medium - to high-risk patients undergoing vascular surgery affected by the ischemia evaluation strategy? Journal of the American College of Cardiology. 2010; 55(13): 1397-1398. https://doi.org/10.1016/j.jacc.2009.11.058
  17. Cosentino F., Hishikawa K., Katusic Z.S., Luscher T.F. High glucose increases nitric oxide synthase expression and superoxide anion generation in human aortic endothelial cells. Circulation. 1997; (96): 25-28. https://doi.org/10.1161/01.cir.96.1.25
  18. Clairotte C., Retout S., Potier L., Roussel R., Escoubet B. Automated ankle-brachial pressure index measurement by clinical staff for peripheral arterial disease diagnosis in nondiabetic and diabetic patients. Diabetes Care. 2009; 32(7): 1231-1236. https://doi.org/10.2337/dc08-2230
  19. Ametov A.S., Demidova T.U., Mkrtumian A.M., Dudinskaia E.N., Sizova E.E. Vizov sovremennoj endokrinologii: poiski kombinirovannoj terapii v uslovijah insulinorezistentnosti (lekcija) [The challenge of modern endocrinology: the search for combination therapy in conditions of insulin resistance (lecture)]. Endocrinology: News, Opinions, Training. 2020; V.9(1): 60-69. https://doi.org/10.33029/2304-9529-2020-9-1-60-69 (In Russ.).
  20. Ephimov A.S. Diabetichekje angioatii [Diabetic angiopathies]. Moscow. Medicina. 1989: 288 p. (In Russ.).
  21. Hossain P., Kawar B., El Nahas M. Obesity and diabetes in the developing world: a growing challenge. The New England Journal of Medicine. 2007; (356): 213-215. https://doi.org/10.1056/NEJMp068177
  22. Maranta F., Cianfanelli L., Cianflone D. Glycaemic Control and Vascular Complications in Diabetes Mellitus Type 2. Advances in Experimental Medicine and Biology. 2021; (1307): 129-152. https://doi.org/10.1007/5584_2020_514
  23. Paneni F., Mocharla P., Akhmedov A., Costantino S., Osto E., Volpe M., Luscher T.F., Cosentino F. Gene silencing of the mitochondrial adaptor p66 (Shc) suppresses vascular hyperglycemic memory in diabetes. Circulation Research. 2012; (111): 278-289. https://doi.org/10.1161/CIRCRESAHA.112.266593
  24. Shou Z., Zhao Y., Zhang Y., Li S. Risk factors for peripheral arterial disease in elderly patients with Type-2 diabetes mellitus: A clinical study. Pakistan Journal of Medical Sciences. 2020; 36(6): 1344-1348. https://doi.org/10.12669/pjms.36.6.2906
  25. Pokrovskij A.V. Angiologija i angiochirurgija: vozmozhnosti i problem [Angiology and angiosurgery: opportunities and challenges]. Medicinscij vestnik. 1997; (18): 10 p. (In Russ.).
  26. Smirnova E.N., Podtaev S.U., Mizeeva I.A., Zhukova E.A. Narushenije mehanizmov vazodiliatacii u bolnih saharnim diabetom 2 tipa pri provedenii kontralateral’noj holodovoj probi [Violation of the mechanisms of vasodilation in patients with type 2 diabetes mellitus during a contralateral cold test]. Regional Blood Circulation and Microcirculation. 2012; 1(41): 30-34 (In Russ.).
  27. Dedov I.I., Shestakova M.V. Saharnij diabet i arterialnaja gipertenzija [Diabetes mellitus and arterial hypertension]. Moscow. Medicinskoje informa-cionnoe agentstvo. 2006: 344 p. (In Russ.).
  28. Sergeenko E.U., Romashina O.M., Lobisheva A.A. Sochetannoe primenenie impulsnogo toka nizkoi chastotiy I vacuumnogo vozdeistviya v reabilitacii pacientov s diabeticheskoi polyneiropatieiy [Combined use of low-frequency pulsed current and vacuum exposure in the rehabilitation of patients with diabetic polyneuropathy]. Bulletin of Rehabilitation Medicine. 2019; 5(93): 40-46 (In Russ.).
  29. Galstian G.R., Starostina E.G., Jahno N.N., Gurjeva I.V, Churjukanov M.V., Strokov I.A., Tokmakova A.U., Kukushkin M.L., Martiynov A.I., Shestakova M.V. Di-agnostika i racionalnaja terapija bolevoi formi diabeticheskoj periferichescoj neiropatii: mezhdisciplinarnij consensus expertov [Diagnosis and rational therapy of the pain form of diabetic peripheral neuropathy: an interdisciplinary consensus of experts]. Diabetes Mellitus. 2019; 22(4): 305-327. https://doi.org/10.14341/DM9625 (In Russ.).
  30. Dedov I.I., Shestakova M.V. Saharnij diabet; diagnostika, lechenije, profikaktika [Diabetes mellitus: diagnosis, treatment, prevention]. Moscow. Medicin-skoje informacionnoe agentstvo. 2011: 361 p. (In Russ.).
  31. Makarova I.N. Reabilitacija pri zabolevanijah serdechno-sosudistoi sistemi [Rehabilitation for diseases of the cardiovascular system]. Moscow. GeotarMedia. 2010: 304 p. (In Russ.).
  32. Hayashino Y., Jackson J.L., Hirata T., Fukumori N., Nakamura F., Fukuhara S., Tsujii S., Ishii H. Effects of exercise on C-reactive protein, inflammatory cytokine and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metabolism. 2014; 63(3): 431-440. https://doi.org/10.1016/j.metabol.2013.08.018
  33. Mavros Y., Kay S., Simpson K.A., Baker M.K., Wang Y., Zhao R.R., Meiklejohn J., Climstein M., O’Sullivan A.J., de Vos N., Baune B.T., Blair S.N., Simar D., Rooney K., Singh N.A., Fiatarone Singh M.A. Reductions in C-reactive protein in older adults with type 2 diabetes are related to improvements in body composition following a randomized controlled trial of resistance training. Journal of Cachexia, Sarcopenia and Muscle. 2014; 5(2): 111-120. https://doi.org/10.1007/s13539-014-0134-1
  34. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003; 26(12): 3333-3341. https://doi.org/10.2337/diacare.26.12.3333
  35. Conte M.S., Pomposelli F.B., Clair D.G. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities management of asymptomatic disease and claudication. Journal of Vascular Surgery. 2015; (61): 2-41. https://doi.org/10.1016/j.jvs.2014.12.009
  36. Ahimastos A.A., Pappas E.P., Buttner P.G., Walker P.J., Kingwell B.A., Golledge J. A meta-analysis of the outcome of endovascular and noninvasive therapies in the treatment of intermittent claudication. Journal of Vascular Surgery. 2011; 54(5): 1511-1521. https://doi.org/10.1016/j.jvs.2011.06.106
  37. Lane R., Harwood A., Watson L., Leng G.C. Exercise for intermittent claudication. Cochrane Database of Systematic Reviews. 2017; 12(12): CD000990. https://doi.org/10.1002/14651858.CD000990.pub4
  38. Recomendacii EOK/EOSH po diagnostike i lecheniju zabolevanij perifericheskih arterij [2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the european society for vascular surgery (ESVS)]. Russian Journal of Cardiology. 2018; 23(8): 164-221. https://doi.org/10.15829/1560-4071-2018-8-164-221 (In Russ.).
  39. Schreuder T.H., Van Den Munckhof I., Poelkens F., Hopman M.T., Thijssen D.H. Combined aerobic and resistance exercise training decreases peripheral but not central artery wall thickness in subjects with type 2 diabetes. European Journal of Applied Physiology. 2015; 115(2): 317-326. https://doi.org/10.1007/s00421-014-3016-5
  40. Casey S.L., Lanting S.M., Chuter V.H. The ankle brachial index in people with and without diabetes: intra-tester reliability. Journal of Foot and Ankle Research. 2020; 13(1): 21. https://doi.org/10.1186/s13047-020-00389-w
  41. Hageman D., Gommans L.N., Scheltinga M.R., Teijink J.A. Effect of diabetes mellitus on walking distance parameters after supervised exercise therapy for intermittent claudication: A systematic review. Vascular Medicine. 2017; 22(1): 21-27. https://doi.org/10.1177/1358863X16674071
  42. Popplewell M.A., Bradbury A.W. Why do health systems not fund supervised exercise programmes for intermittent claudication? The European Journal of Vascular and Endovascular Surgery. 2014; (48): 608-610. https://doi.org/10.1016/j.ejvs.2014.07.008
  43. Merashli M., Chowdhury T.A., Jawad A.S. Musculoskeletal manifestations of diabetes mellitus. Quarterly Journal of Medicine. 2015; 108(11): 853-857. https://doi.org/10.1093/qjmed/hcv106
  44. Melnikova E.A., Rud I.M., Rassulova M.A. Stabilotrening s biologicheskoi obratnoi sviaziu v reabilitacii pacientov s zabolevaniiymi oporno-dvigatelnogo apparata [Stability training with biofeedback in the rehabilitation of patients with diseases of the musculoskeletal system]. Doctor.Ru. 2019; 1(156): 5358. https://doi.org/10.31550/1727-2378-2019-156-1-53-58 (In Russ.).
  45. Collins T.C., Lunos S., Carlson T., Henderson K., Lightbourne M., Nelson B., Hodges J.S. Effects of a home-based walking intervention on mobility and quality of life in people with diabetes and peripheral arterial disease: a randomized controlled trial. Diabetes Care. 2011; 34(10): 2174-2179. https://doi.org/10.2337/dc10-2399
  46. Hageman D., Fokkenrood H.J., Gommans L.N., van den Houten M.M., Teijink J.A. Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication. Cochrane Database of Systematic Reviews. 2018; 4(4): CD005263. https://doi.org/10.1002/14651858.CD005263.pub4
  47. Karakulova U.V., Filimonova T.A. Neurotroficheskaiya terapiya bolevoi formi diabeticheskoi polineuropatii [Neurotrophic therapy of the painful form of diabetic polyneuropathy]. Doctor.Ru. 2018; 9(153): 19-22. https://doi.org/10.31550/1727-2378-2018-153-9-19-22 (In Russ.).
  48. Clairotte C., Retout S., Potier L. Automated ankle-brachial pressure index measurement by clinical staff for peripheral arterial disease diagnosis in nondiabetic and diabetic patients. Diabetes Care. 2009; 32(7): 1231-1236. https://doi.org/10.2337/dc08-2230
  49. Guirro E.C., Guirro R.R., Dibai-Filho A.V., Pascote S.C., Rodrigues-Bigaton D. Immediate effects of electrical stimulation, diathermy, and physical exercise on lower limb arterial blood flow in diabetic women with peripheral arterial disease: a randomized crossover trial. Journal of Manipulative and Physiological Therapeutics. 2015; 38(3): 195-202. https://doi.org/10.1016/j.jmpt.2014.08.008
  50. Womack L., Peters D., Barrett E.J., Kaul S., Price W., Lindner J.R. Abnormal skeletal muscle capillary recruitment during exercise in patients with type 2 diabetes mellitus and microvascular complications. Journal of the American College of Cardiology. 2009; 53(23): 2175-2183. https://doi.org/10.1016/j.jacc.2009.02.042
  51. Perry B.D., Caldow M.K., Brennan-Speranza T.C., Sbaraglia M., Jerums G., Garnham A., Wong C., Levinger P., Asrar ul Haq M., Hare D.L., Price S.R., Levinger I. Muscle atrophy in patients with Type 2 Diabetes Mellitus: roles of inflammatory pathways, physical activity and exercise. Exercise Immunology Review. 2016; (22): 94-109.
  52. Gan Z., Fu T., Kelly D.P., Vega R.B. Skeletal muscle mitochondrial remodeling in exercise and diseases. Cell Research. 2018; 28(10): 969-980. https://doi.org/10.1038/s41422-018-0078-7
  53. Middlebrooke A.R., Elston L.M., Macleod K.M., Mawson D.M., Ball C.I., Shore A.C., Tooke J.E. Six months of aerobic exercise does not improve microvascu-lar function in type 2 diabetes mellitus. Diabetologia. 2006; 49(10): 2263-2271. https://doi.org/10.1007/s00125-006-0361-x
  54. Lyu X., Li S., Peng S., Cai H., Liu G., Ran X. Intensive walking exercise for lower extremity peripheral arterial disease: A systematic review and metaanalysis. Journal of Diabetes. 2016; 8(3): 363-377. https://doi.org/10.1111/1753-0407.12304
  55. Allen J.D., Stabler T., Kenjale A.A. Diabetes status differentiates endothelial function and plasma nitrite response to exercise stress in peripheral arterial disease following supervised training. Journal of Diabetes and its Complications. 2014; (28): 219-225. https://doi.org/10.1016/j.jdiacomp.2013.08.002
  56. Sixt S., Rastan A., Desch S. Exercise training but not rosiglitazone improves endothelial function in prediabetic patients with coronary desiase. European Journal of Cardiovascular Prevention and Rehabilitation. 2008; (15): 473-478. https://doi.org/10.1097/HJR.0b013e3283002733
  57. Kwon H.R., Min K.W., Ahn H.J., Seok H.G., Lee J.H., Park G.S., Han K.A. Effects of Aerobic Exercise vs. Resistance Training on Endothelial Function in Women with Type 2 Diabetes Mellitus. Journal Diabetes and Metabolism. 2011; 35(4): 364-373. https://doi.org/10.4093/dmj.2011.35.4.364
  58. Gardner A.W. Sex differences in claudication pain in subjects with peripheral arterial disease. Medicine and Science in Sports and Exercise. 2002; 34(11): 1695-1698. https://doi.org/10.1097/00005768-200211000-00001
  59. Gardner A.W., Parker D.E., Montgomery P.S., Blevins S.M. Diabetic women are poor responders to exercise rehabilitation in the treatment of claudication. Journal of Vascular Surgery. 2014; 59(4): 1036-1043. https://doi.org/10.1016/j.jvs.2013.10.058
  60. Gommans L.N., Scheltinga M.R., van Sambeek M.R., Maas A.H., Bendermacher B.L., Teijink J.A. Gender differences following supervised exercise therapy in patients with intermittent claudication. Journal of Vascular Surgery. 2015; 62(3): 681-688. https://doi.org/10.1016/j.jvs.2015.03.076



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