Exploring the effects of an exercise program on female diabetic patients$ health

Diabetes is a worldwide major health issue due to its increasing prevalence and devastating consequences. Poor diabetes control may lead to many chronic complications including macrovascular/microvascular diseases and neuropathy. Previous literature showed that diabetic neuropathy received less attention than diabetes-related macrovascular/microvascular diseases. Among varied system disturbances related to diabetic neuropathy, patients’ bladder dysfunctions/ lower urinary tract symptoms (LUTS) are a category that is not well studied. Information related to the incidence, associated factors, management strategies, or effects of available management strategies for diabetic patients’ bladder dysfunctions/LUTS is limited. Developing preventive strategies requires understanding multiple factors that affect diabetic patients’ bladder dysfunctions/LUTS reporting by patients from different backgrounds. Interventions related to modifiable factors such as behavioral interventions, exercise, and lifestyle changes have been reported as beneficial strategies to promote LUTS. However, current evidence shows that few studies had been conducted to explore the efficacy of common conservative treatments of LUTS on diabetic patients’ bladder dysfunctions/LUTS. The major aims of this study are to identify possible factors related to female diabetic patients’ bladder dysfunctions/LUTS, and to examine the effects of an exercise program on diabetes control, urinary tract health, quality of life (QOL), and knowledge about LUTS among female type 2 diabetic patients. The results of this study will contribute to knowledge about female diabetic patients’ bladder dysfunctions/ LUTS, and lead to appropriate interventions or management strategies for diabetic patients’ bladder dysfunctions/ LUTS. This study will continue our preliminary study to be conducted at 2 metabolism/endocrinology outpatient departments in 2 hospitals. Totally, 254 female diabetic patients will be recruited. Possible factors related to diabetic patients’ bladder dysfunctions/ LUTS will be explored. Consequently, 330 female type 2 diabetic patients with at least one type of LUTS will be invited to the intervention study. Participants will be randomly assigned to the intervention group 1, intervention group 2, or control group. For the intervention group 1, the intervention will include a 4-hour education program and a 12-month yoga exercise program and pelvic floor muscle training. Based on the information presented on participants’ diet/fluid logs and voiding diary, individualized suggestions related to scheduled voiding regimen will be provided. For the intervention group 2, the same intervention delivered to the intervention group 1 plus a 6-month individual treatment of transcutaneous electrical stimulation will be provided. For the control group, a 12-month body stretching section will be provided. Effects of the intervention on participants’ diabetes control, urinary tract health, QOL, and knowledge about LUTS will be examined. Intervention outcomes will be collected at 5 time points. Descriptive statistics will be used to demonstrate the incidence of bladder dysfunctions/LUTS and uroflowmetry data along with the distributions of participants’ individual characteristics, personal habits, and QOL. Logistic regression will be used to identify possible factors related to different bladder dysfunctions/LUTS. Paired t-tests will be used to examine the effects of the interventions on diabetes control (fasting plasma glucose, A1C, triglycerides, total cholesterol, HDL-C, LDL-C), urinary tract health (uroflowmetry data), QOL, and knowledge about LUTS. These intervention outcomes will be assessed by repeated measures analysis with linear mixed modeling procedures at 5 time points. Effects of the exercise program on urinary tract health, percentages of the presence of LUTS and participants’ self-reported improvement, and the presentations of voiding patterns on participants’ voiding diaries will be analyzed also.