This mixed method study was intended to evaluate the effects of multifactorial IMT on postural stability and quality of life of patients with Type II diabetes.
A mixed methods study was conducted using a Randomized Controlled Trial (RCT) design for the quantitative component and semi-structured interviews for the qualitative component. A total of sixty-two patients with diabetes were randomly assigned to the IMT group (n=32) or the sham-IMT group (n=32). Both the groups followed ACSM exercise protocol and performed OTAGO exercises, along with which, the sham-IMT group performed IMT at 15% of baseline maximal inspiratory pressure (MIP) whereas IMT were trained at 50% of baseline MIP as an initial intensity, later on increased as per tolerance of patients. The home-based intervention lasted 12 weeks, with a supervised session conducted once every week. Primary quantitative outcome measures included balance (Biodex Postural Stability system) and quality of life assessed through Audit of Diabetes Dependent Quality of Life (ADDQoL) questionnaire. Quantitative data was analyzed using SPSS v26 at the significance level of 0.05. For the qualitative part, the patient’s perspective on the training was explored through semi structured interviews from 10 patients post intervention and the data was analyzed through thematic analysis.
The results demonstrate significant improvement (p 0.05) in dynamic, anticipatory, and reactive balance improved direction control and sensory integration. Whilst no significant changes (p >0.05) between groups were observed in quality of life and static balance, significant changes (p 0.05) within groups were observed in both groups. According to the qualitative data, the patients reported improvement in their quality of life perceived through improvement in their physical and mental health as well as their functional independence. While improvement in shortness of breath and walking capacity were the key facilitators of the exercise program; discomfort, initial difficulty in usage, and distraction in the home environment were the key barriers.
The study demonstrated that the multifactorial IMT intervention improved the dynamic, anticipatory, and reactive balance and also improved the patient's perceived quality of life in patients with Type II diabetes mellitus.
Given the multifaceted nature of diabetes management, an integrated approach encompassing various aspects of training is imperative. A home-based, easy-to-perform multifactorial training program comprising of Inspiratory Muscle Training (IMT), Otago exercise plan, and aerobic exercises as per ACSM guidelines offers a promising solution. This not only strengthens and enhances the endurance of breathing muscles, but also improves balance and postural stability, thereby improving the quality of life of patients with diabetes. Improvement of physical and functional performance & reduction in severity of complications enable the individuals to become active members of the community.
Postural Stability
Quality of Life
