Effects Of 7-week Shoulder Exercise Intervention On Joint Mobility, Strength, And Function In Diabetics And Non-diabetics

Sakiko Oyama,Araceli R Sosa,Jose M Romero

doi:10.1249/01.mss.0000476408.84368.16

Sakiko Oyama, Araceli R Sosa + Show 1 more

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https://doi.org/10.1249/01.mss.0000476408.84368.16

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Abstract

Diabetics have limited shoulder mobility and higher prevalence of shoulder pain and injuries due to accumulation of advanced glycation end products (AGEs) in soft tissue around the joint. AGEs stiffen collagen fibers, thereby limiting joint mobility and increasing risk of soft tissue lesions. Shoulder exercises can improve shoulder mobility, strength, and ability to perform activities of daily living. However, it is unknown if diabetes affect individuals’ responses to exercises. PURPOSE: To compare the effects of 7-week shoulder exercise program on shoulder range of motion (ROM), strength, and function between diabetics/pre-diabetics and non-diabetics. METHODS: Shoulder ROM, strength, and function were measured pre/post 7-week exercise intervention. Shoulder internal rotation (IR) and external rotation (ER) ROM were measured using a digital inclinometer. Muscle strength (elevation, retraction, IR, and ER) were measured using a handheld dynamometer. Shoulder function was assessed using Disabilities of the Arm, Shoulder, and Hand (DASH) and Shoulder Pain and Disability Index (SPADI). The improvements in variables in two groups were compared using mix-model ANOVAs. Participants with low compliance (<70%) or complaints of shoulder pain at the beginning/during the study period were excluded. METHODS: A total of 6 diabetics/pre-diabetics and 8 non-diabetics were included in the analyses. There were no significant group differences in intervention effects. In both groups, intervention resulted in improved ER ROM (p=.002), IR (p=.004) and ER strength (p=.010), DASH (p=.010) and SPADI (p=.025) scores. All four participants who were excluded due to shoulder pain were diabetics/pre-diabetics, but they were older (69.8±7.8 years) compared to the rest of the participants (55.1±8.2 years). DISCUSSION: Shoulder exercises were beneficial in improving shoulder mobility, strength, and function in diabetics and non-diabetics alike. Four participants with diabetes/pre-diabetes complained of shoulder pain at the beginning/during the study. However, this is likely attributed to the higher prevalence of shoulder pain in diabetics and in older individuals. Introduction of routine shoulder exercises at a younger age may be beneficial in improving shoulder function, regardless of individuals’ diabetes status.

Highlights

In the United States, the prevalence of diabetes has increased from 5.5% to 9.3% within past decades[1] with the disease currently affecting 29.1 million people.[2]
Two pre-diabetic participants were excluded from the study due to development of shoulder pain that disabled them from continuing to perform the exercises and perform postintervention strength testing
After excluding the above participants, we were left with 7 participants in the diabetes/pre-diabetes group (2 males/5 females, age: 56.0±5.7years, height: 167.4±6.8cm, Mass: 119.0±15.0kg, DASH: 22.5±22.0, Shoulder Pain and Disability Index (SPADI): 29.0±29.8) and 8 participants in the non-diabetic group (1 male/7 females, age: 56.6±10.4years, height: 158.4±11.1cm, Mass: 92.9±18.6kg, DASH: 23.5±19.6, SPADI: 23.3±20.3)

Summary

Introduction

In the United States, the prevalence of diabetes has increased from 5.5% to 9.3% within past decades[1] with the disease currently affecting 29.1 million people.[2] Diabetes is commonly associated with conditions such as cardiovascular disease and long-term negative effects on various organs in the body such as kidneys and eyes.[3] diabetes has been shown to affect the musculoskeletal system.[4,5,6,7,8,9] Diabetics are four times more likely to have musculoskeletal disorders compared to non-diabetics[6] with the shoulder being one of the joints most affected by the disease.[10] Previous studies show that diabetics have higher prevalence of shoulder pain and injuries compared to non-diabetics.[6,7,10,11,12,13,14] diabetics are 3–9 times more likely to have frozen capsulitis and 5 times more likely to have rotator cuff tears compared to non-diabetics.[4,12,15] diabetics are reported to have thickened supraspinatus and biceps tendons[16] along with decreased ROM in shoulder abduction and flexion[4,5] an impaired tendon-bone healing capacity[17] and difficulty regaining range of motion (ROM) after a surgery.[18,19]

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