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D.S. Blaise Williams III, Denis Brunt and Robert J. Tanenberg

The majority of plantar ulcers in the diabetic population occur in the forefoot. Peripheral neuropathy has been related to the occurrence of ulcers. Long-term diabetes results in the joints becoming passively stiffer. This static stiffness may translate to dynamic joint stiffness in the lower extremities during gait. Therefore, the purpose of this investigation was to demonstrate differences in ankle and knee joint stiffness between diabetic individuals with and without peripheral neuropathy during gait. Diabetic subjects with and without peripheral neuropathy were compared. Subjects were monitored during normal walking with three-dimensional motion analysis and a force plate. Neuropathic subjects had higher ankle stiffness (0.236 N·m/ deg) during 65 to 80% of stance when compared with non-neuropathic subjects (−0.113 N·m/deg). Neuropathic subjects showed a different pattern in ankle stiffness compared with non-neuropathic subjects. Neuropathic subjects demonstrated a consistent level of ankle stiffness, whereas non-neuropathic subjects showed varying levels of stiffness. Neuropathic subjects demonstrated lower knee stiffness (0.015 N·m/deg) compared with non-neuropathic subjects (0.075 N·m/deg) during 50 to 65% of stance. The differences in patterns of ankle and knee joint stiffness between groups appear to be related to changes in timing of peak ankle dorsiflexion during stance, with the neuropathic group reaching peak dorsiflexion later than the non-neuropathic subjects. This may partially relate to the changes in plantar pressures beneath the metatarsal heads present in individuals with neuropathy.

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Carolyn Jimenez, Mayra Santiago, Michael Sitler, Guenther Boden and Carol Homko

Context:

Little is known about the acute effects of resistance exercise on insulin sensitivity in people with type 1 diabetes.

Design:

Repeated-measures design with 2 independent variables: group (exercise and nonexercise control) and time (preexercise and 12 and 36 h postexercise).

Setting:

General Clinical Research Center, Temple University Hospital, Philadelphia, PA.

Patients:

14 physically active subjects (11 men and 3 women) with type 1 diabetes.

Intervention:

The exercise group completed 5 sets of 6 repetitions of strenuous (80% 1-RM) quadriceps and hamstring exercises while the control group performed only activities of daily Living.

Main Outcome Measures:

Insulin sensitivity was assessed with the euglycemic-hyperinsulinemic-clamp technique preexercise and 12 and 36 h postexercise.

Results:

Insulin-sensitivity values were not significantly different between the exercise and control groups (P = .92) or over time (P = .67).

Conclusions:

A single bout of strenuous resistance exercise does not alter insulin sensitivity in people with type 1 diabetes.

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Alessandra Paiva de Castro, José Rubens Rebelatto and Thaís Rabiatti Aurichio

Context:

Wearing inappropriate shoes can cause biomechanical imbalance, foot problems, and pain and induce falls.

Objective:

To verify the prevalence of wearing incorrectly sized shoes and the relationship between incorrectly sized shoes and foot dimensions, pain, and diabetes among older adults.

Design:

A cross-sectional study.

Participants:

399 older adults (227 women and 172 men) age 60 to 90 y.

Main Outcome Measures:

The participants were asked about the presence of diabetes, pain in the lower limbs and back, and pain when wearing shoes. Foot evaluations comprised the variables of width, perimeter, height, length, first metatarsophalangeal angle, the Arch Index, and the Foot Posture Index. The data analysis was performed using a 2-sample t test and chi-square test.

Results:

The percentage of the participants wearing shoe sizes bigger than their foot length was 48.5% for the women and 69.2% for the men. Only 1 man was wearing a shoe size smaller than his foot length. The older adults wearing the incorrect shoe size presented larger values for foot width, perimeter, and height than those wearing the correct size, but there were no significant differences between the groups with respect to the Arch Index and the Foot Posture Index. Incorrectly sized shoes were associated with ankle pain in women but not with diabetes. Men were more likely to wear incorrectly fitting shoes. The use of correctly sized shoes was associated with back pain in women.

Conclusions:

The use of incorrectly sized shoes was highly prevalent in the population studied and was associated with larger values for foot width, perimeter, and height and with ankle pain.

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Robert Kertzer, Ron Croce, Richard Hinkle and Collette Janson-Sand

Few studies have investigated the fitness levels of children and adolescents with insulin-dependent diabetes mellitus (IDDM), with no data presently available on such children’s level of motor proficiency. The present investigation was prompted by this lack of information. Twenty-one girls (mean age = 11.0 years, range = 7-14) and 23 boys (mean age =11.5 years, range = 8-15) with IDDM were tested on selected fitness and motor behavior parameters. Results indicated that children and adolescents with IDDM follow similar fitness and motor behavior profiles of their nondiabetic peers: Boys tended to be in better physical condition than girls of similar ages, particularly in the 12-15 year range. In the areas of body composition and abdominal strength/endurance, subjects displayed values below those obtained in studies of nondiabetic subjects. Subjects’ scores on the Bruininks-Oseretsky Test of Motor Proficiency for each age grouping were relatively high, indicating that children and adolescents with IDDM need not have diminished psychomotor skills.

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Column-editor : Mark A. Merrick

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Debra M. Vinci

Column-editor : Susan M. Kleiner

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Carolyn C. Jimenez

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Jeanine L. Jones

Column-editor : G. Monique Butcher Mokha

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Kris Berg, Marchell Cuppett and Michele Helzer-Julin