[<< wikibooks] Exercise as it relates to Disease/The effects of functional exercise in older adults with diabetes
This page provides a critical appraisal of the research paper titled “Functional Exercise Improves Mobility Performance in Older Adults With Type 2 Diabetes: A Randomized Controlled Trial” by Kimberlee A. Gretebeck, Caroline S. Blaum, Tisha Moore, Roger Brown, Andrzej Galecki, Debra Strasburg, Shu Chen, and Neil B. Alexander.

== What is the background to this research? ==
Type 2 Diabetes is a chronic disease that results when a person’s insulin is unable to effectively regulate blood sugar levels. It is primarily attributed to excess body weight and physical inactivity. According to the World Health Organization (WHO), the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. (1) Type 2 Diabetes is on the rise and affecting a quarter of adults aged 65 and older, according to a report by Centers for Disease Control and Prevention as cited by Gretebeck et al. (2) For this reason, issues associated with this disease are important to address. One such issue is that of loss of mobility and independence and consequently a lower quality of life. As such, researchers have investigated how exercise can help to address concerns of mobility in older adults with diabetes in the paper “Functional Exercise Improves Mobility Performance in Older Adults With Type 2 Diabetes: A Randomized Controlled Trial”. The authors’ aim was to implement a physical activity program suitable for this population, in order to provide a framework for exercise programs that can be applied more widely to enhance the quality of life of older adults with diabetes.

== Where is the research from? ==
This research was published in Human Kinetics’ Journal of Physical Activity and Health in 2019.  Human Kinetics is a company dedicated to educating and empowering people to improve their health and fitness. (3) The research for this article was conducted in the Midwest of the US. The authors are based at universities across the US and specialise in geriatrics. The authors’ background in this field evidently informed and inspired the research they undertook.

== What kind of research was this? ==
The research conducted was a randomized controlled trial. Instead of having a completely unaffected control group the researchers chose to include two active comparison groups which involved different physical activity programs. Randomized controlled trials are the gold standard in clinical research to determine the effects of intervention programs. (4) As such, this research is of a credible design.

== What did the research involve? ==
This research involved recruiting 111 older adults from urban areas in the Midwest to participate in structured exercise groups. The key intervention group consisted of functional circuit training, with activities that corresponded to daily tasks, such as rising from a chair, taking large steps or reaching and carrying objects. An important aspect, intentionally taken into account, was that the exercise program would be moderate-intensity and focused on day-to-day activities, in order to be applicable for the population. This was a 10-week program followed by 10-weeks of maintenance, as participants were given an individualised program to follow at home, with 20-min telephone calls each week to promote physical activity. The second group, for comparison, participated in flexibility and toning sessions with mostly seated activities for the first 10 weeks. In the following 10 weeks they receive phone calls regarding heath status but without any discussion of physical activity. The third group also participated in the functional circuit training for the first 10 weeks and then in the following 10 weeks received calls, as with the previous group, without promotion of physical activity. The comparison groups were not given a home program to continue in the second 10-week period. Measures of physical function were recorded at the participants’ baseline, after the 10-week group intervention, and again after the 10-week home program. These measures were that of comfortable gait speed, 6-minute walk distance and total physical activity.

== What were the basic results? ==
The results showed that participants in all the groups improved in each of the measured outcomes. However, the results in the paper showed that the primary intervention did, as hypothesised, result in a significantly greater improvement in comfortable gait speed than the other interventions at the end of 20 weeks. Meanwhile, improvements in 6-minute walk and total physical activity were not significantly different from the other groups.

== What conclusions can we take from this research? ==
This research is helpful in extending beyond the knowledge that physical activity is important for people with diabetes and demonstrating specific impacts of specific interventions. It is worth noting a limitation of this research: that the participants were primarily white, well educated and living in urban areas. While the lack of diversity in the field of participants may affect the generalisability of these results some helpful conclusions can still be drawn. We can conclude that functional exercise is more effective than flexibility and toning activities in improving outcome in comfortable walking gait. Gait speed is a predictor of survival in older adults (5) and is therefore a significant outcome measure. This research can empower exercise physiologists and other health care professionals to create programs for older adults based on the results.

== Practical advice ==
In practical terms, older adults with Type 2 Diabetes based on this research can be advised to participate in regular exercise programs. Behaviour change is a necessary component of improvement when it comes to physical function outcomes. The conclusions drawn from this paper indicate the value of individualised home programs and promotion of physical activity. This paper inadvertently highlights the role of Exercise Physiologists in promoting health as they are professionals equipped to create and assist in implementing structured programs for individuals. The advice from this research paper would benefit aged care facilities as they provide resources for their residents, as well as for older adults living at home. A productive way aged care facilities can support their residents, who may suffer from chronic diseases such as diabetes, is to provide group exercise programs as a way for residents to be motivated to participate in activities that can improve their mobility. Alternatively, for those living at home, they could be encouraged by this research to seek guidance from an Exercise Physiologist, in creating a home-based functional exercise program.

== References ==
1. World Health Organisation. Diabetes. 2020.
2. Gretebeck KA, Blaum CS, Moore T, Brown R, Galecki A, Strasburg D, Chen S & Alexander NB. Functional Exercise Improves Mobility Performance in Older Adults With Type 2 Diabetes: A Randomized Controlled Trial. Journal of Physical Activity and Health. 2019. doi: 10.1123/jpah.2018-0240
3. Human Kinetics. About Us. 2020 
4. Kabisch M, Ruckes C, Seibert-Grafe M, Blettner M. Randomized Controlled Trials. Dtsch Arztebl Int. 2011. 108(39): 663–668. doi: 10.3238%2Farztebl.2011.0663
5. Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Branch J et al. Gait Speed and Survival in Older Adults. JAMA Network. 2011. doi: 10.1001/jama.2010.1923