SLR - April 2014 - Paul Peterson
Reference: Madarshahian, F, Hasanabadi, M, Nikoo, MK. Cognitive Status and Self Foot Care Practice in Overweight Diabetics, Engaged in Different Levels of Physical Activity. Journal of Diabetes & Metabolic Disorders 13:31, 2014. Retrieved from: http://www.jdmdonline.com/content/13/1/31
Scientific Literature Review
Reviewed By: Paul Peterson, DPM
Residency Program: Mercy Hospital, Coon Rapids, MN
Podiatric Relevance: This research is relevant to the podiatric field because it discusses the change in cognitive function with relation to the ability of a patient to perform self foot care. It also offers the idea that physical activity may combat deterioration in cognitive function. This information could be used to assist the podiatric clinician in determining how compliant a particular diabetic may be based on physical activity level. Knowing this could aid in clinical decision-making and in outpatient self care recommendations for patients. This could be especially useful in a wound clinic setting.
Methods: A total of 160 patients from a single medical university were evaluated in this study. All of these patients were overweight diabetics (BMI 25-29.9). A Mini Mental Status Exam (MMSE) was performed on all patients. Exclusion criteria included a diagnosis of diabetes in the past year, illiterate patients and those with less than eight years of schooling, current smokers, severe vision and/or hearing problems, history of stroke, Alzheimer disease, endocrine disorders, and severe cardiovascular disease. Eighty (half) of the patients exercised for at least 15 minutes for three times a week for the past six months, and these patients were considered the active group. Two trained clinical nurses, who were unaware of the study objective, selected a total of 80 patients that did not exercise regularly. These 80 patients were placed in the control group to match the number of patients that were in the active group. Demographics, foot care routine, and physical activity level were assessed using questionnaire. BMI, age, sex, diabetes duration, HbA1C, and education were recorded and were used to match the two groups. Statistical analysis was done on the data, and included an independent t-test, chi-square test, Pearson correlation test, and logistic regression using the statistical package for social science, software version 16. P values less than 0.05 were considered statistically significant.
Results: Age of participants ranged from 55-80 with a mean of 63.38 +/- 6.60. In the active group, the mean minutes of physical activity per week was 173.18 +/- 70.79 minutes. Mean MMSE scores increased as time spent doing physical activity increased within the active group, and were higher overall on average than in the control group. There was no correlation noted between BMI and MMSE in the active group, but in the control group, a significant negative correlation was found. In regard to self foot exams, the active group performed more per week than the control group (4.77 +/- 0.77, and 4.45 +/- 0.83, respectively, P value 0.01).
Conclusions: The possible positive effects of exercise on cognition were demonstrated in this study. In those who were physically active, BMI did not have an impact on cognition test scores. However, increasing BMI in the control group did correlate with a decrease in cognition scores. This may useful to know when discussing the benefits of exercise with an overweight diabetic patient, and especially to encourage those who are not seeing results of weight loss to continue their exercise routine. Furthermore, since there was an increase in self foot care noted in this study with increased cognition scores, it could be suggested that increased physical activity may increase the likelihood of performing self foot care.