Efficacy of an aerobic and a combined aerobic resistance training intervention on middle aged type 2 diabetes mellitus people of Malaysia and Bangladesh - a cost effective approach

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Date
2018-01
Authors
Sultana, Faria
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Publisher
Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia
Abstract
This study compares the efficacy of a combined exercise training program over low - moderate level aerobic exercise training in improving the health status of sedentary middle–aged (40-60 years) individuals with T2DM and assess the cost effectiveness of those exercise interventions. This research was conducted in Kelantan, Malaysia and Dhaka, Bangladesh, based on 75 individuals with T2DM in Kelantan, Malaysia and 75 individuals with T2DM in Dhaka, Bangladesh. They were assessed and matched in the respective set-ups based on the extent of socioeconomic and physiological status through preliminary testing according to inclusion criterions. Participants were randomly categorized into three groups – control group (Group A), and two experimental groups - Group B (Aerobic exercise group subjected to low-moderate aerobic exercise -supervised walking at 40-60% HRmax) and Group C (Combined exercise group subjected to supervised walking at 40-60% HRmax and resistance training exercises) comprising of 25 participants in each of the group in Malaysia as well as in Bangladesh. After that pre –intervention assessment was done with EuroQol 5D-5L (EQ 5D-5L), Brunel Mood States (BRUMS), Glycosylated haemoglobin (HbA1c), Electromyography (EMG), Bender-Gestalt II (BG- II) and Skin Conductance (Sc). Protocol for the exercise interventions was scheduled as approximately 20-50 minutes/day; 3-4 days/ week;for 14 weeks. At the end of the 14th week, post intervention assessment was carried out following pre-intervention protocol. With an interval of 14 weeks of no exercise intervention, follow-up assessment was carried out on all the afore-mentioned variables to verify the extent of sustainability of the interventions. Wilcoxon signedrank test revealed that both Malaysian and Bangladeshi participants in group B (p = .002; p = .000) and group C (p = .001; p = .010) had significant improvement in the level of mobility. Two-way repeated measure of ANOVA/Mixed Factorial ANOVA revealed that both group B (p = .000; p = .000) and group C (p = .000; p = .000) had significant reduction in the level of Glycosylated hemoglobin (HbA1c) and improvement in overall perceived health status in both the countries. Aerobic (p = .000; p = .009) and combined (p = .008; p = .001) exercise interventions were found as effective phase wise in reducing fatigability and activating peroneus brevis muscle in Malaysian and Bangladeshi participants. Whereas, only combined exercise intervention (p = .001; p = .000) has shown improvement in autonomic response latency in Malaysian and Bangladeshi T2DM participants. Group C participants had significant improvement (p = .000; p = .000) in Visual Motor Abilities in Malaysia and Bangladesh. Finally, based on the cost incurred and perceived health status, combined exercise program (group C) was observed to be the most cost-effective among aerobic and no exercise program both in Malaysia and Bangladesh.
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Keywords
Exercise therapy , Economics , Malaysia
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