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IJCRR - 9(20), October, 2017

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Effect of Moderate and High Intensity Exercise on Maximum Oxygen Consumption and Health Related Quality of Life among Type 2 Diabetes Mellitus Participants-Pilot Study

Author: Jyoti Chakraborty, Gopal Nambi, Kalindi Dev, Shanmugananth

Category: Healthcare

Abstract:Aim: To determine the effectiveness of moderate and high intensity exercise on maximum oxygen consumption and health related quality of life among type 2 diabetes mellitus participants.
Method: In this study 10 individuals with type 2 diabetes mellitus were selected based on inclusion and exclusion criteria. They are divided into two groups by Odd and Even method. Group A content of 5 participants, received moderate intensity exercise and group B content of 5 participants, received high intensity exercise. Outcomes are maximum oxygen consumption and health related quality of life were taken at the baseline and 4 weeks after the treatment. Both the groups participants continued their medications during study period.
Results: The post-test mean \?SD value of VO2max for Group-A is 38.64\?4.18 and for Group-B is 47.98\?5.58 this shows that Group-B is greater than Group A with P value 0.0171(p

Keywords: Type 2 diabetes mellitus, Moderate intensity Exercise, High intensity Exercise, VO2max, HRQoL

DOI URL: 10.7324/IJCRR.2017.9204

Full Text:

INTRODUCTION

Diabetes mellitus is the one of the major chronic diseases, in that type 2 affect millions of people in the world. It is a metabolic disorder characterized by glucose intolerance. This systemic disease is caused by an imbalance between insulin supply and insulin demand^[1]. 422 million adults were living with diabetes in 2014 globally, compared to 108 million in 1980^[3]. In India, The prevalence of type 2 diabetes mellitus is 2.4% in rural population and 11.6% in urban population ^[2]. In Tamil Nadu 1 out of 10 people are diabetic, and every two persons in a group of 25 are in the pre-diabetic stage^[3]. The development of T2DM is caused by a combination of lifestyle and genetic factors. While some of these factors such as diet, obesity, increasing age, female gender, and genetics^[4].β-Cell dysfunction is initially characterized by an impairment in the first phase of insulin secretion during glucose stimulation and may antedate the onset of glucose intolerance in type 2 diabetes^[5]

Regular exercise has many beneficial effects other than improving blood glucose levels as it also improves cardio-respiratory fitness and psychological state of health in diabetic^[6]. Moderate-intensity aerobic activity means you're working hard enough to raise your heart rate (64%-76% HRmax) and break a sweat. One way to tell is that you'll be able to talk, but not sing the words to your favourite song. High-intensity aerobic activity means you're breathing hard and fast, and your heart rate (77%-95% HRmax ) has gone up quite a bit. If you're working at this level, you won't be able to say more than a few words without pausing for a breath.^[7,8,16]

Individuals with T2DM mellitus are at high risk for both micro and macrovascular complications. Microvascular including retinopathy, nephropathy and neuropathy and Macrovascular such as cardiovascular comorbidities^[9]. Environmental factors like obesity, an unhealthy diet and physical inactivity. The insulin sensitivity can be increased by doing regular exercise and patient can also maintain the blood glaucous at normal level^[10]. The regular exercise is always advised to type 2 diabetes mellitus patient, but they fail to do so. By the help of this study we can plan a particular intensity for them and we can reduce the burden and time duration for the type 2 diabetes mellitus patients.

Exercise is integral to the management of type 2 diabetes. Unfortunately, majority of the adults with type 2 diabetes mellitus do not engage in regular exercise. There are evidence that Aerobic exercise have beneficial effects on type 2 diabetes mellitus but there is lack of at what intensity the exercise should be performed ^[11]. So the need for the study is to check the effect of high intensity with moderate intensity exercise on maximum oxygen consumption, health related quality of life among type 2 diabetes mellitus.

METHODOLOGY

10 individuals with type 2 diabetes mellitus were selected based on inclusion and exclusion criteria. They are divided into two groups by Odd and Even method. Group A 5 participants, received moderate intensity exercise and group B 5 participants, received high intensity exercise. Outcome measures are taken at the baseline and 4 weeks after the treatment. Both of the groups are continued their medications during study period.

Study Setting: Saveetha Physiotherapy Clinic, Saveetha Medical College & Hospital, Saveetha University.

Inclusion criteria: Age group - 30 to 40 years, Both male and female were included, Participants not performed any aerobic exercise for last six weeks were included, Participants perform six minute walk test successfully were included, Participants willed to come continuously for 4 weeks.

Exclusion criteria: Uncooperative, Unstable angina, Any cardiovascular disorder, Any neurological disorder, Any musculoskeletal disorder, Any other systemic illness, Obesity (Body Mass Index 30 and above).

Materials used: Cycle ergometer, Two cone, Stopwatch, Inch tap, Digital pulse oximeter.

OUTCOME MEASURES

Maximum oxygen consumption (vo₂max)

VO₂maxis the maximum rate of oxygen consumption as measured during incremental exercise. Maximal oxygen consumption reflects the aerobic, physical fitness of the individual, and is an important determinant of their endurance capacity during prolonged, moderate exercise ^[12].Unite is ml/min/kg.VO₂max is calculated through 6 minute walk test, using cahalin formula

Cahalin formula [VO2max = 0.006 x 6MWD(feet) + 3.38]

(6MWD-six minute walk distance)

2. Health related quality of life

Health-related quality of life (HRQOL) is a multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning.

EuroQol five dimensions questionnaire (EQ-5D) is a standardized instrument for measuring generic health status^[13]

Treatment procedure:

Group A (n=5) Moderate intensity exercise

Warm up for 10 minutes(include heel digs, knee lift, shoulder rolls, knee bends, jumping jacks, stretching for calf, quadriceps, hamstring for 15 sec, 3repetition)

Cycling for 20 minutes, maintaining the heart rate percentage between 64% to 76% of maximum heart rate.

Cool down for 10 minutes (included relaxation, marching on spot, stretching for calf, quadriceps, hamstring for 15 sec, 3repetition).

Group B (n=5) High intensity exercise

Warm up-10 minutes(included heel digs, knee lift, shoulder rolls, knee bends, jumping jacks, stretching for calf, quadriceps, hamstring for 15 sec, 3repetition)

Cycling for 20 minutes maintaining the heart rate percentage between 77% to 96% of maximum heart rate.

Cool down for 10 minutes (included relaxation, marching on spot, stretching for calf, quadriceps, hamstring for 15 sec, 3repetition).

Treatment Protocol:(Both A & B Group)

Duration of each session : 40 minute s(Warm up-10minutes, Conditioning period-20minutes, Cool down-10minutes)

Sessions : 1 session/day

Frequency : 5 days/week

Duration : 4 weeks

Statistical method :

The collected data was tabulated and analyzed using descriptive and quartiles statistics. To all parameters mean and standard deviation (SD) was used. Parametric Paired t-test and Independent t test is used for intra and inter group comparison for VO₂max. Non parametric Wilcoxson Mann Whitney test is used for intra and inter group comparison for HRQoL score.

Result :

The pre-test mean+SD value of Group A Maximum Oxygen Consumption is 25.7±2.03 and post-test value is 38.64±4.18 this shows that Maximum Oxygen Consumption scores are gradually increased, with P value is 0.004,showing that there is significant difference between pre and post values of Maximum Oxygen Consumption score of Group A.

The pre-test mean ±SD value of Group B VO₂max is 25.88±1.95 and post-test value is 47.98±5.58 this shows that Maximum Oxygen Consumption scores are gradually increased, with P value is 0.001,showing that there is significant difference between pre and post values of Maximum Oxygen Consumption score of Group B.

The post-test mean±SD value of Group-A Maximum Oxygen Consumption is 38.64± 4.18 and for Group-B is 47.98±5.58 this shows that Group-B is greater than Group A with P value 0.0171 (p <.05),showing that there is significant difference between post values of Maximum Oxygen Consumption score of Group A and B.

The pre-test mean ±SD value of Group A Health Related Quality Of Life is 18.2±2.58 and post-test value is 9.8±1.92 this Health Related Quality Of Life scores are gradually decreased, with P value is 0.043,showing that there is significant difference between pre and post values of Health Related Quality Of Life score of Group A.

The pre-test mean ±SD value of Group B Health Related Quality Of Life is 17.6±2.3 and post-test value is 6.6±1.14 this Health Related Quality Of Life scores are gradually , with P value is0.043,showing that there is significant difference between pre and post values of Health Related Quality Of Life score of Group B.

The post-test mean±SD value of Health Related Quality Of Life in Group A is 9.8±1.92 and for Group-B is 6.6±1.14 this shows that Group-B is improved than Group-A with p value 0.012(p<.05),showing that there is significant difference between post values of Health Related Quality Of Life score of Group A and B.

Discussion:

Physical activity play a major role in prevention and management of T2DM, many of DM patient don’t remain regularly active. T2DM is a significant cause of premature mortality and morbidity related to cardiovascular disease (CVD), blindness, kidney and nerve disease, and amputation^[14,17].

The goal of treatment in T2DM is to achieve and maintain optimal BG, lipid, and blood pressure levels to prevent or delay chronic complications of diabetes^[15]. Many people with T2DM can achieve BG control by following a nutritious meal plan and exercise program, losing excess weight, implementing necessary self-care behaviours, and taking oral medications, although others may need supplemental insulin^[14].

The purpose of this study was to compare the effect of two exercise intensity (Moderate intensity exercise and High intensity exercise) among type 2 diabetes mellitus patients. The study was detailed and tailored on 10 type 2 diabetes mellitus participants to find the efficacy of which type of exercise intensity was comparatively better among the two groups comprising of 5 participants each group, Group A received Moderate intensity exercise and Group B received High intensity exercise, using two evaluating tools comprising of Maximum Oxygen Consumption (VO₂max) which is calculated based on 6 minute walk distance and Health related Quality of life which is evaluated using EQ-5D questioner.

In this study exercise was given in Cycle ergometer with the participant positioned in sitting position with back supported and foot is connected to the pedals. Before stating exercise warm up is given and after exercise cool down is given. Participants instructed to maintain the heart rate for 64% to 76% of maximum heart rate for Group A (moderate intensity exercise) and 77% to 96% of maximum heart rate for Group B (High intensity exercise).

Intra group comparison for VO₂max within group A and B was done with parametric paired t test. Inter group comparison for VO₂max between group A and B was done with parametric independent t test. Intra and inter group comparison for HRQoL score was done with nonparametric Wilcoxson Mann Whitney test. The baseline data are similar in both the group A and B. There was no significant difference between two group. They are equally distributed in age and gender distribution.

The results found in this study disclosed that after four week of treatment, both the groups attained a significant improvement in VO₂max with p=0.004 for group A and p=0.001 for group B (p<0.05).Moreover both the groups attained a significant improve in HRQoL with p=0.043 for group A and p=0.043 for group B, compared with the normal confidence interval value of p<0.05.

However when inter group comparison is done between two groups the result showed a significant difference with the p=0.02 for VO₂max and p=0.01 for HRQoL (p<0.05). So the null hypo H₀3 is rejected and rejected and alternate hypothesis H₁3 is accepted, suggesting that High intensity exercise is more effective than Moderate intensity exercise.

The result showed that high intensity exercise is a better strategy to improve maximum oxygen consumption and improve health related quality of life as compared to moderate intensity exercise. However, in the present study , the result of both intervention i.e. moderate intensity exercise and high intensity exercise, individually had a significant effect on improving maximum oxygen consumption and improve health related quality of life.

We only investigated the immediate effect of exercise hence it is not clear how long this improvement will last. Activities of daily lining, with exception of exercise training, were not controlled. Further long-term treatment and long term follow up is required.

Conclusion: The Statistical analysis made with the quantitative and qualitative data revealed statistically significant difference between the Group A and Group B and also within the group.

This study concludes that high intensity exercise is better intervention to improve Maximum Oxygen Consumption (VO₂max) and improve Health Related Quality of Life (HRQoL) in Type 2 diabetes mellitus as compared to moderate intensity exercise.

Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

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A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16

A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15

A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020

A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"

A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13

A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for Vol 12 issue 12

A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for Vol 12 issue 11

A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for Vol 12 issue 10

A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for Vol 12 issue 09

A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for Vol 12 issue 08

A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for Vol 12 issue 07

A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20

A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR

A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13

A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR

A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR.

A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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IJCRR

Effect of Moderate and High Intensity Exercise on Maximum Oxygen Consumption and Health Related Quality of Life among Type 2 Diabetes Mellitus Participants-Pilot Study

2. "Park's Textbook of Preventive and Social Medicine", by K. Park.23rd Edition. Date:10/04/17 Time:18.30 hrs

3."The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) Study: Methodological Details" by Ranjit Mohan Anjana.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192597/, Date:10/04/17 Time:19.30 hrs

4."Diabetes mellitus Type 2"https://en.wikipedia.org/wiki/Diabetesmellitustype2. Date:10/04/17 Time:20.00 hrs

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