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    Combined exercise and visual gaze training improves stepping accuracy in people with diabetic peripheral neuropathy

    Handsaker, Joseph C, Brown, Steven J, Petrovic, Milos, Bowling, Frank L, Rajbhandari, Satyan, Marple-Horvat, Dilwyn, Boulton, Andrew JM and Reeves, Neil D (2019) Combined exercise and visual gaze training improves stepping accuracy in people with diabetic peripheral neuropathy. Journal of Diabetes and its Complications, 33 (10). p. 107404. ISSN 1056-8727

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    Introduction Patients with diabetes and diabetic peripheral neuropathy (DPN) place their feet with less accuracy whilst walking compared to their age-matched controls, which may contribute to the increased falls-risk in this population. This study examines the effects of a multi-faceted intervention on stepping accuracy, in patients with diabetes and DPN. Methods Forty participants began the study, of which 29 completed both the pre and post-intervention tests, 8 patients with DPN, 11 patients with diabetes but no neuropathy (D) and 10 healthy controls (C) for reasons unrelated to the study). Accuracy of stepping was measured pre- and post-intervention as participants walked along an irregularly arranged stepping walkway. Participants attended a one-hour session, once a week, for sixteen weeks, involving high-load resistance exercise and visual-motor training. Results Patients who took part in the intervention improved stepping accuracy (DPN: +45%; D: +36%) (p < 0.05). The diabetic non-intervention (D-NI) group did not display any significant differences in stepping accuracy pre- to post- the intervention period (−7%). Discussion The improved stepping accuracy observed in patients with diabetes and DPN as a result of this novel intervention, may contribute towards reducing falls-risk, although further research is required to confirm. This multi-faceted intervention presents promise for improving the general mobility and safety of patients with diabetes and DPN during walking and could be considered for inclusion as part of clinical treatment programmes.

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