Effects of Prescribed Physical Therapy Exercises on Blood Glucose, Metabolic and Hbaic Profiles in Prediabetes at Moi Teaching and Referral Hospital in Uasin Gishu County in Kenya

Abstract

Pre-diabetes is characterized by plasma glucose above the normal range (3-6mmollL) but below that of clinical diabetes (>9.0mmoVL). In Kenya the estimated prevalence of diabetes was 7.2% in 2014 which comes as a result of prediabetes. This has become a threat to national development both economically and socially because very often they result in long standing complications that are very costly to treat. This burden gradually drains the strength and resources of an individual rendering them unproductive and poor. Almost 30% of the people with diabetes go undiagnosed and by the time diabetes is diagnosed nearly 25% of them have micro-vascular complications. Therefore, every effort must be done to diagnose prediabetes and reverse the condition before it develops to full blown diabetes. The purpose of this study was to investigate the metabolic parameters of prediabetes and to provide evidence of prescribed physical therapy exercises that can be quantified and reproduced. It was hypothesized that effective means for delaying or even preventing onset of diabetes can be realized with prescribed physical therapy exercises. The study aimed at determining the metabolic profile (fasting glucose, triglycerides, low density lipoprotein, high density lipoprotein and HbAlc) levels of prediabetes at MTRH; to establish the intensity, duration and frequency of exercise needed to achieve change in metabolic profiles of prediabetes at MTRH; to determine which gender responds first after the administration of equivalent prescribed physical therapy exercises among prediabetes at MTRH. The study was a randomized controlled trial and it adopted experimental study design to select the study participants. The formula used by Zhong (2009) was adopted for calculating sample size in a randomized controlled trial having two comparison groups Experimental Group (EG) and Control Group (CG) with both groups having the same size of subjects (17 each). Blood samples and BMI data was collected from the participants at three time-periods: pre-training, mid-training (at end of 6 weeks), and post-training (at end of 12 weeks). Blood glucose test was done in the morning after an overnight fast of at least 8 hours whereby the Blood specimen was drawn from a vein and tested before the commencement of exercises. Thereafter prescribed physical therapy exercises were expended for 210 minutes per week. All experimental results were evaluated and means of two groups pre and post prescribed exercises and the association between variables was determined and compared using independent samples t-tests (relationship between physical therapy exercises and metabolic components). The significance level was set at p :S.05.Although the BMI in the EG decreased from 28.47±2.37to 26.51±2.26the difference was not statistically significant. During week six, FBG was significantly lower in the experimental group (mean difference: 0.46 mmollL, p=O.Ol). FBG level further decreased during 12 weeks of training in the experimental group (mean difference: 0.68 mmollL, p<O.OOOl)compared to the control. The results showed that training reduces FBG by 5% and 13%, in 6 and 12 weeks, respectively. The results showed HDL were significantly higher in the experimental than in the control group during post-training (z= -3.20.17, p=O.001). On the other hand the level of LDL decreased in the experimental group during both midtraining and post-training period relative to pre-training (z= -2.908.18, p=O.OOl). There was a significant reduction of HbAlc (of 3%) after six weeks and an even more marked drop (of 8%) after 12 weeks in EG compared to CG in which there was no drop in HbAlc levels. High correlation was found between FBG and HbAlc(r=0.95). All parameters at pre, mid and post training were not significantly different between males and females. It was concluded that PPTE exerted improvement on FBG, metabolic and HbAlc profiles in prediabetes. The knowledge of how much exercise is needed to impact change in disease progression would inform the prescription of exercise by physiotherapists to their clients.