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Exercise improves balance, lower limb strength and gait in older adults with diabetes

Chapman A, Meyer C, Renehan E, et al. Exercise interventions for the improvement of falls-related outcomes among older adults with diabetes mellitus: A systematic review and meta-analyses Journal of Diabetes and Its Complications. 2016; doi: 10.1016/j.jdiacomp.2016.09.015

Review question

Does exercise decrease falls and improve balance, strength and gait in older adults with diabetes?


The risk of diabetes, falling and injuries due to a fall all increase with age. People with diabetes have an increased risk of falling due, in part, to peripheral neuropathy (loss of feeling/movement in the foot and ankle). After a fall, a person may develop a fear of falling and reduce the amount they exercise. However, previous research shows that exercise may help to reduce the risk of falls in older adults.

How the review was done

This is a review of 16 studies including 889 participants. Of these, 10 randomized controlled trials were combined in a meta-analysis. All studies were published between 2003 and 2015.

  • The average age of participants was 68 years old. All participants had a diagnosis of diabetes.  
  • The amount of exercise in the included studies ranged from 90-180 minutes (1 ½ to 3 hours) per week with exercise sessions two to three times per week and 45-60 minutes per session. The shortest exercise period was four weeks; the longest was 2 years.
  • Exercise programs varied and included aerobic exercise, balance training, resistance exercise and/or strength training and tai chi programs. Most studies included balance and lower limb strength training.
  • All programs were centre-based, supervised by physiotherapists and/or members of the research team. Only one study also included a home-based program.
  • Researchers measured the risk of falling, number of falls, balance, gait and muscle strength among people in exercise programs.
  • Results were compared to people in control groups who had the usual care (no exercise training other than their usual amount of exercise) and/or received health education about diabetes management.

What the researchers found

People with diabetes who participated in supervised exercise programs showed significant improvements in balance, lower limb (knee and ankle) strength and gait compared to people in control groups. Exercise may also reduce the risk of falling among healthy older adults with type 2 diabetes.



Supervised exercise programs – such as strength and resistance training – improves balance, lower limb (knee and ankle) strength and gait in older adults with diabetes.



Control group
A group that receives either no treatment or a standard treatment.
Advanced statistical methods contrasting and combining results from different studies.
nerve pain
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.

Related Web Resources

  • Type 2 diabetes: Patient FAQ

    Canadian Task Force on Preventive Health Care
    Find answers to frequently asked questions about type 2 diabetes in this resource. Help prevent diabetes: eat a healthy diet and limit fat, salt and alcohol, control your blood pressure and cholesterol levels and do not smoke.
  • Type 2 diabetes: Patient FINDRISC

    Canadian Task Force on Preventive Health Care
    Use this risk calculator to find out your risk for type 2 diabetes and see if you should be tested. Many people with diabetes have no symptoms. Speak to your doctor if you notice diabetes symptoms such as unusual thirst, the need to pee a lot, lack of energy, blurred vision, tingling or numbness in your hands or feet.
  • Type 2 diabetes: Screening for adults

    Health Link B.C.
    People at average risk for type 2 diabetes should be tested every 3 years after age 40. You may need to be tested more frequently if you are at higher risk. Find out your risk with the Canadian Diabetes Risk Assessment Questionnaire (link in this resource).
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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