IMPROVING BALANCE; THE EFFECT OF WOBBLE BOARD EXERCISES ON ANKLE MUSCLE STRENGTH AMONG INDIVIDUALS WITH DIABETIC PERIPHERAL NEUROPATHY

M. Aljawaee^1,2, M.D. Jones², J.M. Williams³

¹Princess Nourah bint Abdulrahman University, Faculty of Health and Rehabilitation Sciences, Riyadh, Saudi Arabia, ²Cardiff University, School of Engineering, Cardiff, United Kingdom, ³Bournemouth University, Faculty of Health and Social Sciences, Dorset, United Kingdom

Background: Diabetic peripheral neuropathy (DPN) is a condition that progressively causes deterioration in both sensory and motor nerves. Long term, DPN can result in significant skeletal muscle deficits, including neurogenic muscle atrophy and a loss of strength, power and endurance, which are associated with an increased risk of imbalance and falling. There is a negative correlation between the severity of DPN and muscle strength and the ankle dorsiflexors and plantarflexors are particularly associated with neuropathic decline. Since postural stability requires strength and motor and sensory coordination, there is an opportunity to design an intervention that simultaneously targets improvements in individuals with DPN.

Purpose: This study describes an experimental intervention, aimed at producing improvements in strength by utilising a wobble board (WB) training program. It is hypothesised that balance training with a WB will improve strength and coordination in the ankle muscles of individuals with DPN.

Methods: Twenty-seven participants with mild and moderate DPN received a WB training intervention programme, designed to improve muscle strength by producing imbalance perturbations.The specific nature of the intervention was tailored to an individual’s baseline-assessment of balance performance, which was measured using a proprioceptive-stabilometric-assessment machine (Prokin 252).Balance was progressed sequentially by increasing levels of imbalance, until failure was achieved. Manual muscle measurement of dorsiflexor, plantar flexor, evertor and invertor strength was conducted pre- and post-exercise intervention, using a digital handheld dynamometer (MicroFET®2, Hoggan Health Industries), repeated three times and the mean calculated. Change in muscle strength was assessed using paired t-tests and correlations explored using pearson’s correlation coefficient.

Results: After eight weeks of WB training, there was a significant increase in the strength of all ankle muscles for all participants. Strength increases included a 22% increase in right dorsiflexion and 21% in left dorsiflexion; a 28% increase in right plantarflexion and 24% in left plantarflexion; a 22% increase in right inversion and 29% left inversion; a 24% increase in right eversion and 26% left eversion. Correlation analysis demonstrated that larger gains were associated with weaker muscles at baseline.

Conclusions: Previous ankle strength studies demonstrated that progressive resistance training produced modest or greater strength gains, by performing 11 exercises, during 150 minutes of activity per week over 12 weeks. The current study reports similar gains, during just 45 minutes of WB training per week over four weeks (3 sessions of 15 minutes per week), where all ankle muscles were worked simultaneously; suggesting that a progressive WB program is an effective and time efficient way of increasing strength. The results demonstrate that for individuals with DPN, a simple WB training program can produce significant gains in strength and those with the poorest strength at baseline have the greatest response.

Implications: Due to the multi-model nature of WB training, it is possible that additional benefits were produced in proprioception and balance. Future studies should investigate these potential changes and the relationships between strength and balance changes. Clinicians can consider the prescription of WB training for individuals with DPN an effective and efficient intervention to strengthen ankle muscles.

Funding acknowledgements: The first author was funded by the Saudi Cultural Bureau in United Kingdom and Princess Nourah bint Abdulrahman University.

Keywords:
Diabetic peripheral neuropathy
Muscle
Strength

Topics:
Neurology

Did this work require ethics approval? Yes

Institution: Princess Nourah bin Abdulrahman University

Committee: Institutional Review Board

Ethics number: 22-0113