【Background and objectives】Recently, efforts have been made to preserve the kidneys of patients with chronic kidney disease. Among them, patients with diabetic kidney disease (DKD) are attracting attention due to the high rate of dialysis use. Physical activity in patients with DKD is associated with renal function; thus, frequent physical activity is recommended. This requires an analysis of factors related to physical activity to clarify the targets of physiotherapy interventions. Therefore, the purpose of this pilot study was to elucidate factors of physical function related to physical activity in patients with DKD. 【Methods】Patient demographics, physical activity, knee extension strength, and fatigability were evaluated in a cross-sectional manner. Physical activity was evaluated for total physical activity-International Physical Activity Questionnaire (TPA-IPAQ) (kcal/week) using the IPAQ-short version. Knee extension strength and fatigability were evaluated using a muscle function evaluation exercise device. Fatigability was calculated as the rate of the decrease in torque during a dynamic fatigue task. 【Results】26 patients were enrolled in this study and 23 patients (n = 14 men, mean age 56.4 ± 6.3 years) were included in the analysis. As a result of analysis, physical activity was negatively correlated with fatigability alone (r = -0.416, p = 0.049). 【Discussion】This study suggests that fatigability is associated with decreased physical activity, which may also lead to decreased renal function in patients with DKD. Further research on factors related to physical activity, including an analysis of fatigability, is needed to develop exercise management programs to protect kidney functionality.

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【Background/Objective】Evaluation of physical activity have been recommended as part of routine care in hemodialysis patients. There are many direct ways to evaluate physical activity measured by a 3-axis acceleration sensor. Although, direct way to evaluate physical activity limit the feasibility or practicability. Therefore, it may be useful to simply measure the amount of physical activity through an interview with a questionnaire since this may be completed during the time required for dialysis treatment. The aim was to explore the relationship between the amount of indirectly measured physical activity (self-reported by questionnaire) and physical activity measured directly by an accelerometer. 【Method】Single center pilot study design was employed. Twenty-seven patients receiving outpatient dialysis completed the study. A 3-axis accelerometer assessed the number of steps, which was considered a direct measurement of physical activity. Indirect assessment of physical activity was measured using the International Physical Activity Questionnaire (IPAQ short form, IPAQ-SF) to find the total metabolic equivalents (METs). The relationship between the number of steps and METs was analyzed. 【Results】In all patients, no significant correlation was observed between the number of steps and total METs on both non-dialysis and dialysis days. However, when dividing the number of steps by 3700 steps on non-dialysis day, the ‘over 3700 steps’ group had a strong correlation between the number of steps and total METs on non-dialysis day (r = 0.81, p < 0.05). 【Discussion】This study showed that the relationship between indirect evaluation of physical activity by a questionnaire (IPAQ-SF) and direct evaluation of physical activity (step count) in hemodialysis patients. The IPAQ-SF may only be applicable to indirectly measure physical activity in elderly patients receiving dialysis who have activity levels over 3700 steps on non-dialysis days.

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【Background/Purpose】Patients with diabetic peripheral neuropathy (DPN) experience an increased risk of falls and decreased quality of life due to impaired balance and gait. This study aimed to identify factors associated with gait instability in DPN patients. 【Methods】Forty DPN patients (age: 58.8 ± 9.3 years; 16 males, and 24 females) admitted to our hospital for diabetic education were included in the study. The instability in gait was assessed using a triaxial accelerometer, which was affixed to the third lumbar spinous process reflecting the center of gravity. The root mean square (RMS) value was calculated from the data acquired during walking and corrected by the squared value of body weight. Electromyography was used to evaluate the co-contraction of lower leg muscles; the co-contraction index (CI) was calculated for the tibialis anterior and soleus muscles during walking. For each evaluation, data were obtained from a 10 m walk test at the patient’s comfortable speed. Pearson's correlation analysis was used to study the relationship between each parameter. In addition, multiple regression analysis was conducted with RMS as the dependent variable and vibration perception, CI, maximum ankle dorsiflexion muscle strength, and maximum ankle plantarflexion muscle strength as independent variables. Moreover, multiple regression analysis was performed with RMS as the dependent variable, CI as the independent variable, and adjusted for age, gender, and height. 【Results】The results showed that RMS was significantly correlated with the CI of lower leg muscles (β = 0.45, p < 0.01). Further, this relationship remained significant even after adjustment for age, gender, and height (β = 0.54, p < 0.01). 【Discussion】These results suggest that co-contraction of the lower leg muscles affects the overall stability during walking in DPN patients.

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【Objective】A significant risk factor for the development of diabetes mellitus in Japan is physical inactivity. As physical inactivity is also a risk factor for mortality, it is important that activity is maintained and promoted. The ecological model explains the complex environmental and psychosocial factors related to physical activity. The purpose of this study was to examine the psychosocial factors associated with multilevel interventions in an ecological model using a walking course guidance map in patients with diabetes from the viewpoint of motivation to exercise, and to clarify whether physical activity is promoted by instruction using a walking course guidance map. 【Methods】Seventeen patients admitted for diabetes education were included in this study. The Behavioral Regulation Exercise Questionnaire-2 was used to assess psychosocial factors; items with relatively high scores in the sub-items were used as representative regulation styles in motivating the patients to exercise. Physical activity was measured using an activity meter during the hospitalization period, and changes after instruction using a walking course guidance map were compared for each motivation style. A map of the hospital and the hospital grounds was used as the walking course guidance, and walking courses in the ward, the hospital, and hospital grounds were taught. The distance and estimated calorie consumption of each course were also indicated. 【Results】A significant increase in physical activity was observed in the patients with the identified regulation style after instruction using the walking course guidance map. 【Conclusions】In this study, the psychosocial factors that promote physical activity were examined in patients undergoing diabetes education in a hospital using a walking course guidance map. Physical activity was promoted in patients with the identified regulation style in comparison with other motivational regulation styles.

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【Background】Exercise therapy is very important for improving glycemic control in diabetes mellitus. Physical therapists should be actively involved in treating diabetes mellitus as specialists in exercise therapy; however, various issues, such as the lack of established evidence for exercise therapy, have prevented physical therapists from playing a larger role in the care of patients with diabetes mellitus. Therefore, the purpose of this study is to conduct a large-scale clinical study to obtain evidence supporting physiotherapy for diabetes mellitus. 【Methods】This is a large-scale multicenter study, which involves the participation of 200 facilities nationwide, and includes 10,000 patients with type 1 and type 2 diabetes mellitus. This exploratory study aims to evaluate the efficacy of physiotherapy and the need for the intervention of physical therapists from multiple angles over the course of 10 years. 【Discussion】As the number of Japanese diabetic patients continues to grow, so does the importance of exercise therapy as an option to treat diabetes mellitus. The knowledge and techniques of physical therapists are essential for providing optimal exercise therapy, and many healthcare professionals have high expectations regarding the role of physical therapists. Findings obtained from this study should provide evidence that increases awareness among physical therapists and encourages their participation in providing therapy for patients with diabetes. 【Trial registration】The trial registration number is UMIN-CTR (UMIN000044011).

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【Introduction】We present examples of home rehabilitation for cases with diabetic complications and analyze and discuss the challenges and problems in implementing physical therapy for physical therapy management science in such cases. 【Definition of physical therapy management science】In this paper, physical therapy management science is defined as "a discipline that studies the management of physical therapy so as to provide appropriate services efficiently and safely." There are five viewpoints of physical therapy management science: (1) multidisciplinary management, (2) risk management, (3) infectious disease management, (4) clerical management, and (5) educational management. 【conclusion】As disease patterns change, physical therapists will likely have more opportunities to cater to people with lifestyle-related diseases, especially diabetes. Labeling diabetes as a national disease is not an exaggeration, as it will continue to increase. Establishing comprehensive community care systems will require multifaceted "management" of the knowledge and skills in physical therapy, which is one of the modalities used for treating diabetes.

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【Background】The ankle joint plays a crucial role in basic movements, such as standing, sitting, or walking, and postural strategies. However, the range of motion (ROM) of the ankle joint may be affected by musculoskeletal and neurological diseases of the lower limbs, such as motor paralysis due to stroke or lumbar disc disease. Diabetic neuropathy is one such disease, characterized by an increased risk of developing foot lesions resulting in restricted ankle ROM. Therefore, the purpose of this study was to clarify the effect of the knee joint flexion angle on the ankle dorsiflexion active ROM. 【Methods】The subjects were 17 healthy young adult males (17 dominant legs). The effects of the relationship between the knee flexion and the ankle dorsiflexion active ROM at the following five condition of knee flexion 0° (extension 0°), knee flexion 30°, 60°, 90°, and 120° were examined. The ankle dorsiflexion active ROM was measured. The joint angle was calculated using Image-J, for the analysis of images taken by a digital single-lens reflex camera. For comparing the active ROM of ankle dorsiflexion between each knee joint angle, Friedman test was used followed by the Bonferroni multiple comparison test. 【Results】The ankle dorsiflexion active ROM was significantly restricted in the knee extension 0° compared with positions where the knee joint was flexed ≥60° (p value <0.05). Also, the ankle dorsiflexion active ROM was greater at 90°and 120°knee flexion than at 30° (p value <0.05). 【Discussion】The change in the ankle dorsiflexion active ROM with increasing knee joint flexion angle is affected by the extensibility of the gastrocnemius muscle, a two-joint muscle, when the knee joint is flexed <60°. It is considered that factors other than the extensibility of the gastrocnemius muscle affect the expansion of the active ROM of the ankle dorsiflexion when the knee joint is flexed at ≥90°.

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【Background and purpose】Inflammatory cytokines driven from the adipose tissue and liver are involved in glucose intolerance associated with obesity. However, the changes in the progression of obese type 2 diabetes remain unknown. This study aimed to investigate the changes in chronic inflammation-related cytokines in the adipose tissue and liver focusing on progression of obesity and glucose intolerance in Otsuka Long-Evans Tokushima fatty (OLETF) rats. 【Methods】Male OLETF and Long-Evans Tokushima Otsuka (LETO) rats were used as animal models of obese type 2 diabetes and non-obese diabetes, respectively. Expression level of inflammatory cytokines (IL-6, TNFα, IL-1β, and IL-10) in the epididymal adipose tissue and liver were measured at 8, 20, 30, and 60-week-old. 【Results】For the wet weight of epididymal adipose tissue and triacylglycerol levels in the liver, the values were significantly higher in OLETF rats than in LETO rats from 8 to 30-week-old. Conversely, the values were significantly lower in OLETF rats than in LETO rats at 60-week-old. Impaired glucose tolerance was confirmed in OLETF rats at 8-week-old, and deteriorated by 60-week-old. The expression level of IL-6 in the epididymal adipose tissue of OLETF rats significantly increased from 20 to 30-week-old and significantly decreased from 30 to 60-week-old. The expression level of TNFα in liver of OLETF rats significantly increased from 8 to 20-week-old and significantly decreased from 30 to 60-week-old. 【Discussion】Excessive visceral fat accumulation and increased ectopic fat could cause glucose intolerance in the early stage of type 2 diabetes. Additionally, TNFα driven from the liver and IL-6 driven from the adipose tissue could act as accelerators for glucose intolerance with progression of obesity.

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【Background/ objective】A successful weight-loss strategy for short-term hospitalizations has not been established, even though most type 2 diabetics have inadequate exercise habits for disease management. This study aimed to test the feasibility of using a mobile device for improving exercise compliance and weight reduction in hospitalized type 2 diabetes patients. 【Methods】The study participants were 14 patients with type 2 diabetes with no exercise habits with a body mass index of ≥ 25kg/m2 admitted to Handa City Handa Hospital to receive disease management education. Eight patients were assigned to a group using a mobile device for exercise support (Mobile health Application support Program: MAP). Six patients were assigned to a group not using a mobile device (Standard Program: SP). 【Results】The exercise compliance rate was 85% ± 13% in the MAP group and 22% ± 21% in the SP group; thus, it was significantly higher in the MAP group than in the SP group (p <0.001). Regarding the behavioral stages, all patients in the MAP group reached the execution stage; in contrast, four patients did not reach the execution stage in the SP group. The ratio of patients reaching the execution stage was significantly higher in the MAP group (p = 0.015). 【Discussion】For the MAP group, it is presumed that the notification function of a mobile device and the feedback of exercise execution contributed to the improvement of exercise compliance. This result suggested that using a mobile device for exercise support was feasible and could help improve exercise compliance rates and the behavioral stage in hospitalized diabetes education programs. However, further study is needed to describe the long-term effects of using a mobile device for weight reduction and follow-ups are required to monitor lasting behavioral changes.

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【Background/Purpose】The purpose of this study was to define the progression of atherosclerosis in patients with type 2 diabetes mellitus (T2DM) using brachial-ankle pulse wave velocity (ba-PWV) and to clarify the relationship between ba-PWV and body composition factors, muscle strength, and patient characteristics. 【Methods】Atherosclerosis indices such as ba-PWV (cm/s) and systolic blood pressure (SBP; mmHg), body composition such as weight (kg) and muscle mass (kg), anthropometric parameters such as body mass index (BMI; kg/m2) and leg circumference (cm), hematological data such as HbA1c (%), and background factors such as medical history and age (years) were evaluated. Statistical analysis was performed using Pearson’s product rate correlation coefficient, Spearman’s rank correlation coefficient, multiple regression analysis, logistic regression analysis, and ANCOVA (p < 0.05). 【Results】The mean age was 63.12 ± 11.96 years; BMI, 25.58 ± 4.35 kg/m2; ba-PWV, 1666.03 ± 368.19 cm/s; SBP, 139.36 ± 16.52 mmHg; disease duration, 11.25 ± 9.45 years; and HbA1c, 6.9 ± 0.72%. BMI, HbA1c (%), abnormal achilles reflex, leg circumference (%), sex, knee extensor strength (kgf-m/kg), and years of illness (years) were dependent variables, and age (years) and SBP were adjusted variables. BMI (odds ratio 0.84, 95% confidence interval [CI] 0.726 – 0.965, p < 0.001) was included in a binomial logistic regression analysis with other variables. The cut-off BMI value was 26.28 kg/m2 (area under the curve 0.71, 95% CI 0.60 – 0.82). In ANCOVA, when BMI was the group variable, ba-PWV was the dependent variable and age was the independent variable; there was no interaction between the group and independent variables (p = 0.246), and BMI and age were significant explanatory factors for ba-PWV (p < 0.05). 【Discussion】This study showed that BMI was related to the frequency of arterial stiffness in T2DM patients and proposed a cutoff BMI value. These results provide a starting point for the evaluation of arterial stiffness in home health care settings for T2DM patients.

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[in Japanese]

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