title: The use and safety of combined resistance and aerobic training in a patient with complications related to type 2 diabetes: a case report.
abstract: OBJECTIVE
  No guidelines for tailoring exercise programs for patients with diabetic complications are available. The purpose of this case report is to report our experiences with a tailored exercise program including safety precautions for a patient with complications related to type 2 diabetes and exercise related regulation issues.
  
  
  METHODS
  A patient with multiple diabetic complications, poor glycemic control, and a history of foot ulceration participated in a 12-week exercise program with multiple safety precautions.
  
  
  RESULTS
  Hypoglycemic events required adjustments in training intensity and insulin dosage. Periodic foot screening revealed no ulceration. Target training intensity was achieved at the end of the program, although exercise load could not be increased according to the planned protocol. Training effects were observed in muscle strength increased, perceived limitations in daily functioning diminished and no change in sub maximal exercise capacity.
  
  
  CONCLUSIONS
  This patient with severe diabetic complications participated safely and successfully in an exercise program. Problems with glycemic control occurred but did not preclude adherence to incremental exercise. We recommend a medical screening, the availability of a network of specialists, and a physical therapist with sufficient knowledge of diabetic complications and exercise physiology to guide training in this patient population. [
  
  
  CONCLUSIONS
  • This case report demonstrates that physical functioning can be improved safely in a patient with multiple diabetic complications.• For safety precautions, a medical screening including a X-ECG and a foot screen prior to exercise, and the involvement of a diabetes specialist nurse, a podiatrist, an endocrinologist and a physiatrist in the rehabilitation team are recommended.• Sufficient knowledge of diabetic complications and exercise physiology is needed in supervising exercise programs for patients with multiple diabetic complications.]
authors.affiliation: Department of Rehabilitation, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands. n.m.otterman@amc.uva.nl
authors.forename: Nicoline M
authors.initials: NM
authors.lastname: Otterman
authors.forename: Marike
authors.initials: M
authors.lastname: van der Schaaf
authors.forename: Tessa E
authors.initials: TE
authors.lastname: Busch-Westbroek
authors.forename: Carine H M
authors.initials: CH
authors.lastname: van Schie
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D015444:Exercise; D005081:Exercise Therapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D010346:Patient Care Management / Q000379:methods; D016730:Program Development; D055070:Resistance Training / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin