1. Strength training in patients with diabetic neuropathy: Acute responses and long term adaptations Robert van Deursen 1, Alejandro Meana- Esteban 1, Patricia Price 2 and Keith Harding 2 1 Research Centre for Clinical Kinaesiology 2 Wound Healing Research Unit

2. Overview Background –Neuropathy –Strength training Study aims Methodology –Study design –Methods –Intervention

3. Introduction: Diabetes Definition: Metabolic disorder resulting in abnormally high blood sugar levels Damaged Nerves NEUROPATHY Type I Type II

4. Introduction: Neuropathy 1. Walking –Neuropathy –Muscular weakness –Reduced ROM 2.Poor circulation High foot pressures Tissue damage ULCERS

5. Why strength training in neuropathic patients? Why neuropathic patients –PA neuropathic patients = ??? Why strength training –PA guidelines –Strength training improves glycemic control –Muscle weakness –ST diabetic patients= ???

6. Aims To determine whether and to what extent ST has a positive effect in: –Gait characteristics (ROM, foot pressures, EMG) –Circulation Micro-circulation (Blood flow)

7. Study design Baseline studyInterventional study HEALTH DN 80 40 EX= 40 CON= 40 T1 T2 Pre- interventionPost- intervention INTERVENTION (16 weeks) 120

8. Methods Gait characteristics –F–Foot pressure: Pressure distribution platform –M–Muscular activities: EMG –R–ROM: Electrogiometers

9. Circulation –Micro-circulation: Near infrared spectroscopy VO rest Exercise Protocol VO Post- Exec

10. Intervention 4 times per week throughout 16 weeks –2 gym- based sessions (1 h) 2-3 sets of 8-10 rep (60-80% 1RM) Flexibility –2 home- based sessions (30min) ROM

11. THANK YOU VERY MUCH FOR YOUR ATTENTION!!!!!!!!