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Exercise-facilitated Neurorehabilitation in Diabetic Neuropathy

20 september 2019 uppdaterad av: VA Office of Research and Development

Exercise-Facilitated NeuroRehabilitation in Diabetic Neuropathy

This study will determine the type and combination of exercise needed to rehabilitate the neuro-compromised diabetic Veteran. Guided exercise protocols may prove to be practical therapeutic options for the prophylactic management of diabetic subjects with neuropathy.

Studieöversikt

Status

Avslutad

Betingelser

Detaljerad beskrivning

Purpose: A single-site, randomized, blinded, prospective clinical trial is proposed to determine the significance of a combined isokinetic strength and aerobic exercise training program on the rehabilitation of peripheral nerve function in Type 2 diabetic veterans and non-veterans with neuropathy. Background and Significance: Obesity is a major factor in the increasing rates of diabetes and its related complications. Diabetes affects greater than 7% of the population. Veterans are at even greater risk, with approximately 16% currently receiving treatment at Department of Veterans Affairs Medical Centers for diabetes. More than half of affected veterans experience debilitating complications of diabetes, including peripheral neuropathy (PN). Exercise training, in combination with pharmacologic intervention, is now recognized as a cornerstone of management for diabetes. Therapeutic interventions currently available for the treatment of PN in diabetic patients are limited, however, to pain management and stringent glycemic control. Exercise is reported to significantly decrease peripheral nerve microvascular complications common among chronic diabetics. Our preliminary findings demonstrate that exercise intervention improves peripheral nerve function in the diabetic veteran with PN. Intervention strategies, such as proposed in this application, offer a unique and novel therapeutic option for the rehabilitation of the neuro-compromised Type 2 diabetic veterans and non-veterans. Methods & Research Plan: One-hundred subjects will be recruited for this 24-week study. Subjects each will be randomly assigned to aerobic, isokinetic strength training, combined aerobic and strength training, or non-exercise (control) intervention groups. Isokinetic strength training (Biodex System 3), aerobic exercise training (treadmill), or the combination of strength and aerobic training will be administered 3x per week for the initial 12 weeks. Control subjects will receive 12 clinical visits over the course of the initial 12 weeks. The effects of exercise training type, compared with control subjects, on recovery of peripheral nerve function will be rigorously determined from baseline, 12- and 24-week testing using electrodiagnostic primary outcome measures, Quantitative Sensory Testing, and a battery of validated qualitative and quantitative secondary outcome measures that include an incremental symptom-limited treadmill test, peak torque, Total Neuropathy Score, visual analogue pain scale, and quality of life SF-36V Health Survey. Sustainability of effect will be determined at 24-weeks.The individual effects of exercise training type, compared with control subjects, on tissue oxygenation will be determined from baseline, 12- and 24-week testing by non-invasive quantitated infrared spectroscopy using an InSpectraTM Tissue Spectrometer. Expected Outcomes: This study will objectively and critically determine the type and combination of exercise needed to rehabilitate the neuro-compromised diabetic Veteran. Guided exercise protocols may prove to be practical therapeutic options for the prophylactic management of diabetic subjects with neuropathy.

Studietyp

Interventionell

Inskrivning (Faktisk)

45

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

    • Illinois
      • Hines, Illinois, Förenta staterna, 60141-5000
        • Edward Hines Jr. VA Hospital, Hines, IL

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

45 år till 80 år (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  • Clinical diagnosis of type 2 diabetes mellitus
  • stable blood glucose control
  • clinical findings consistent with length-dependent sensorimotor polyneuropathy, stage N2a

Exclusion Criteria:

  • foot ulceration
  • unstable heart disease
  • co-morbid conditions limiting exercise
  • disorders of the central nervous system causing weakness or sensory loss
  • received treatment with medications known to have neuropathy as a prominent side effect including vincristine, vinblastine, cis-platin, and paclitaxel
  • medical conditions that may be associated with neuropathies such as alcoholism, liver disease, kidney disease, toxic exposure, vitamin deficiency, autoimmune disorders, cancer, or hypothyroidism

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Behandling
  • Tilldelning: Randomiserad
  • Interventionsmodell: Faktoriell uppgift
  • Maskning: Enda

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Inget ingripande: Arm 1
Sedentary Control Group
Experimentell: Arm 2
Aerobic Exercise Group
Structured aerobic exercise (treadmill).
Structured isokinetic strength exercise (dynameter).
Experimentell: Arm 3
Isokinetic Strength Exercise Group
Structured aerobic exercise (treadmill).
Structured isokinetic strength exercise (dynameter).
Experimentell: Arm 4
Combined Aerobic and Isokinetic Strength Exercise Group
Structured aerobic exercise (treadmill).
Structured isokinetic strength exercise (dynameter).

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Sural Nerve Amplitude
Tidsram: Baseline, 12, and 24 weeks
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural (antidromic), median (antidromic to second digit), and ulnar nerves (antidromic to fifth digit).To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12, and 24 weeks
Sural Nerve Latency
Tidsram: Baseline, 12 wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural (antidromic), median (antidromic to second digit), and ulnar nerves (antidromic to fifth digit).To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 wks, 24 wks
Sural Nerve Conduction Velocity
Tidsram: Baseline, 12 wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural (antidromic), median (antidromic to second digit), and ulnar nerves (antidromic to fifth digit).To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 wks, 24 wks
Tibial Nerve Amplitude
Tidsram: Baseline, 12 weeks, 24 weeks
Maximal responses were obtained using percutaneous electrical stimuli. Distal motor nerve evoked compound muscle action potential (CMAP) potentials were recorded from tibial and peroneal nerves.To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 weeks, 24 weeks
Tibial Nerve Latency
Tidsram: Baseline, 12 weeks, 24 weeks
Maximal responses were obtained using percutaneous electrical stimuli. Distal motor nerve evoked compound muscle action potential (CMAP) potentials were recorded from tibial and peroneal nerves.To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 weeks, 24 weeks
Tibial Nerve Conduction Velocity
Tidsram: Baseline, 12 weeks, 24 weeks
Maximal responses were obtained using percutaneous electrical stimuli. Distal motor nerve evoked compound muscle action potential (CMAP) potentials were recorded from tibial and peroneal nerves.To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 weeks, 24 weeks
Sensory Median Nerve Amplitude
Tidsram: Baseline, 12, and 24 weeks
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural (antidromic), median (antidromic to second digit), and ulnar nerves (antidromic to fifth digit).To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12, and 24 weeks
Sensory Median Nerve Latency
Tidsram: Baseline, 12wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural (antidromic), median (antidromic to second digit), and ulnar nerves (antidromic to fifth digit).To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12wks, 24 wks
Sensory Median Nerve Conduction Velocity
Tidsram: Baseline, 12 wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural (antidromic), median (antidromic to second digit), and ulnar nerves (antidromic to fifth digit).To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 wks, 24 wks
Sensory Ulnar Nerve Amplitude
Tidsram: Baseline, 12 wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural (antidromic), median (antidromic to second digit), and ulnar nerves (antidromic to fifth digit).To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 wks, 24 wks
Sensory Ulnar Nerve Latency
Tidsram: Baseline, 12 wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural (antidromic), median (antidromic to second digit), and ulnar nerves (antidromic to fifth digit).To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 wks, 24 wks
Sensory Ulnar Nerve Conduction Velocity
Tidsram: Baseline, 12 wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Sensory nerve action potentials were recorded from sural (antidromic), median (antidromic to second digit), and ulnar nerves (antidromic to fifth digit).To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 wks, 24 wks
Peroneal Nerve Amplitude
Tidsram: Baseline, 12 wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Distal motor nerve evoked compound muscle action potential (CMAP) potentials were recorded from tibial and peroneal nerves.To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 wks, 24 wks
Peroneal Nerve Latency
Tidsram: Baseline, 12 wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Distal motor nerve evoked compound muscle action potential (CMAP) potentials were recorded from tibial and peroneal nerves.To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 wks, 24 wks
Peroneal Nerve Conduction Velocity
Tidsram: Baseline, 12 wks, 24 wks
Maximal responses were obtained using percutaneous electrical stimuli. Distal motor nerve evoked compound muscle action potential (CMAP) potentials were recorded from tibial and peroneal nerves.To minimize inter-examiner variability and maximize neurophysiologic test/retest reliability, the same experienced neurologist conducted all nerve conduction studies on days separate from all other testing activities. A dedicated TECA Synergy electromyograph system was used for all nerve conduction studies. The patients dominant side was chosen. In patients with definable differences between the two sides, the side with the most prominent clinical findings was chosen. In all cases, the same limb was used for all three (baseline, 12-weeks, 24-weeks) conduction studies.
Baseline, 12 wks, 24 wks

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Symptom-Limited TMT Blood Glucose Response
Tidsram: Initial entry into study, 12 and 24 weeks
Changes in blood glucose in response to modified Bruce Protocol treadmill test (TMT)
Initial entry into study, 12 and 24 weeks
Short Form-36V: Physical Component Score
Tidsram: Initial entry into study, 12 and 24 weeks
The short form-36Veterans (SF-36V) health survey questionnaire was used to measure health-related quality of life. This survey is comprised of eight subscales and two overall component scores, all of which have demonstrated high levels of internal consistency and discriminate validity when administered to groups of medically stable individuals. Patient aggregate responses for the eight distinct summary subscales and two component scores were compiled as a percentage of total points possible using the RAND 36-item health survey table. Data shown are expressed as a percentage of total possible score ranging from 0%-100% with 100% considered relatively good health and 0% considered poor health. Physical Component scores reflect perceived changes in physical health relative to the previous year.
Initial entry into study, 12 and 24 weeks
Voluntary Duration of Symptom-Limited TMT
Tidsram: baseline, 12-wks, 24-wks
Total time subjects voluntarily exercised while undergoing a modified Bruce Protocol treadmill test (TMT)
baseline, 12-wks, 24-wks
Symptom-Limited TMT Maximum Heart Rate
Tidsram: baseline, 12-wks, 24-wks
Peak heart rate achieved while undergoing a modified Bruce Protocol treadmill test (TMT)
baseline, 12-wks, 24-wks
Symptom-Limited TMT Maximum Systolic Blood Pressure
Tidsram: Baseline, 12-wk, 24-wk
Peak systolic BP achieved while undergoing a modified Bruce Protocol treadmill test (TMT)
Baseline, 12-wk, 24-wk
Symptom-Limited TMT Maximum Minute Ventilation (VE)
Tidsram: Baseline, 12-wks, 24-wks
Peak volume of air exchanged per minute achieved while undergoing a modified Bruce Protocol treadmill test (TMT)
Baseline, 12-wks, 24-wks
Symptom-Limited TMT Maximum Oxygen Uptake (VO2)
Tidsram: Baseline, 12-wks, 24-wks
Peak Oxygen uptake achieved while undergoing a modified Bruce Protocol treadmill test (TMT)
Baseline, 12-wks, 24-wks
Maximum Respiratory Exchange Ratio (RER) During TMT
Tidsram: Baseline, 12-wks, 24-wks
Peak RER achieved while undergoing a modified Bruce Protocol treadmill test (TMT). This is a mathematical ratio of maximally achieved (peak) VCO2 divided by maximally achieved (peak) VO2.
Baseline, 12-wks, 24-wks
Symptom-Limited TMT Maximum Carbon Dioxide Expelled (VCO2)
Tidsram: Baseline, 12-wks, 24-wks
Peak Carbon Dioxide expelled achieved while undergoing a modified Bruce Protocol treadmill test (TMT)
Baseline, 12-wks, 24-wks
Symptom-Limited TMT Maximum METS Achieved (MET)
Tidsram: Baseline, 12-wks, 24-wks
Peak metabolic rate equivalents (METS) achieved while undergoing a modified Bruce Protocol treadmill test (TMT). One MET is defined as the metabolic rate observed at rest, quantified as resting oxygen consumption of 250 ml/min (Male) or 200 ml /min (female). A value of 5 METS would represent a metabolic rate that is 5x that at rest and is considered an indicator of how hard a given individual is exercising. Data shown are expressed as a ratio at peak of exercise of oxygen consumed relative to normalized values for men or women at rest.
Baseline, 12-wks, 24-wks
Short Form-36V: Mental Component Score
Tidsram: initial entry into study, and at 12-wks and 24-wks
The short form-36Veterans (SF-36V) health survey questionnaire was used to measure health-related quality of life. This survey is comprised of eight subscales and two overall component scores, all of which have demonstrated high levels of internal consistency and discriminate validity when administered to groups of medically stable individuals. Patient aggregate responses for the eight distinct summary subscales and two component scores were compiled as a percentage of total points possible using the RAND 36-item health survey table. Data shown are expressed as a percentage of total possible score ranging from 0%-100% with 100% considered relatively good health and 0% considered poor health. Mental Component scores reflect perceived changes in emotional health relative to the previous year.
initial entry into study, and at 12-wks and 24-wks

Andra resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Height
Tidsram: baseline
Height of subjects upon entry into study
baseline
Weight
Tidsram: Baseline, 12-wks, 24-wks
Weight of subjects at baseline, 12-weeks, and 24-weeks
Baseline, 12-wks, 24-wks
Body Mass Index (BMI)
Tidsram: Baseline, 12-wk, 24-wk
BMI is calculated as a ratio of subject body mass (kg) divided by the square of subject height (m).
Baseline, 12-wk, 24-wk
Duration of Diabetes Mellitus
Tidsram: Baseline
Duration, in years, since first diagnosed with Diabetes Mellitus upon entry into study
Baseline
HbA1C Laboratory Values
Tidsram: Baseline, 12-wk, 24-wk
Laboratory values of subject HbA1C levels at Baseline, 12-wk, 24-wk
Baseline, 12-wk, 24-wk
Triglyceride Laboratory Values
Tidsram: Baseline
Laboratory triglyceride values at baseline entry into study
Baseline
Cholesterol Laboratory Values
Tidsram: Baseline
Laboratory total cholesterol, HDL-cholesterol, and LDL-cholesterol levels at baseline entry into study
Baseline
Creatinine Laboratory Values
Tidsram: Baseline
Laboratory creatinine values at baseline entry into study
Baseline
Blood Urea Nitrogen (BUN) Laboratory Values
Tidsram: Baseline
Laboratory Blood Urea Nitrogen levels at baseline entry into study
Baseline
Aspartate Aminotransferase Laboratory Values
Tidsram: Baseline
Laboratory values for Aspartate Aminotransferase (AST) at baseline entry into study
Baseline
Thyroid Stimulating Hormone Laboratory Values
Tidsram: Baseline
Laboratory values for Thyroid Stimulating Hormone (TSH) at baseline entry into study
Baseline
Age
Tidsram: at baseline
Age of participants at entry into study.
at baseline

Samarbetspartners och utredare

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Utredare

  • Huvudutredare: Evan Stubbs, Edward Hines Jr. VA Hospital, Hines, IL

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

14 januari 2010

Primärt slutförande (Faktisk)

14 november 2014

Avslutad studie (Faktisk)

14 november 2014

Studieregistreringsdatum

Först inskickad

6 augusti 2009

Först inskickad som uppfyllde QC-kriterierna

7 augusti 2009

Första postat (Uppskatta)

10 augusti 2009

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

2 oktober 2019

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

20 september 2019

Senast verifierad

1 september 2019

Mer information

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