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Background <p>Evidence for wearable-guided physiotherapy in diabetic kidney disease (DKD) is limited. This study evaluated the effects of physiotherapist-supervised exercise supported by wearable device feedback in patients with type 2 diabetes, including those with DKD.</p> Methods <p>In this single-center, prospective study, 58 outpatients were allocated to an intervention group (IG) or non-intervention group (NIG). The per-protocol set included 45 participants completing six months (IG = 25, NIG = 20). IG wore a wrist-worn device and received monthly physiotherapist-led guidance; NIG received standard care. The primary endpoint was 6-min walk distance (6MWD); secondary outcomes included weight-bearing index (WBI), phase angle (PhA), HbA1c, and eGFR. Analyses used linear mixed-effects models adjusted for covariates.</p> Results <p>IG improved 6MWD from 512.0&#xa0;m to 551.0&#xa0;m (+ 38.7&#xa0;m), while NIG changed from 410.0&#xa0;m to 407.0&#xa0;m (− 3.7&#xa0;m). The group × time interaction was significant (<i>p</i> &lt; 0.001); adjusted between-group difference was + 42.4&#xa0;m (95% CI: 20.3–64.5). IG showed greater reductions in HbA1c (− 0.89%, 95% CI: − 1.53 to − 0.25; <i>p</i> = 0.008) and improvements in WBI and PhA (<i>p</i> &lt; 0.01). Changes in eGFR were not significant (0.65&#xa0;mL/min/1.73m<sup>2</sup>, 95% CI: -3.84 to 5.14; <i>p</i> = 0.78).</p> Conclusions <p>Monthly physiotherapist-led exercise supported by wearable feedback improved functional capacity and glycemic control in patients with DKD. This pragmatic, scalable model may enhance outpatient rehabilitation strategies.</p> Graphical abstract <p></p> <p>Values represent adjusted between-group differences in change from baseline to six months, estimated using linear mixed-effects models with group, time, and group × time interaction, adjusted for age, baseline 6-min walk distance, HbA1c, eGFR, cardiovascular disease, and smoking status. Error ranges indicate 95% confidence intervals. Arrows indicate direction of change favoring the intervention group.</p>

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Physiotherapist-guided, wearable-informed exercise improves 6-minute walk distance in patients with type 2 diabetes, including those with diabetic kidney disease: a prospective study

  • 期刊论文

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  • 发表日期：

    2026年4月22日

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  • Momo Takahashi,
  • Yuma Tamura,
  • Hajime Tamiya,
  • Masato Terashima,
  • Harunori Takahashi,
  • Nobuyuki Banba,
  • Yuki Nakatani,
  • Naoyuki Otani,
  • Asuka Ueno,
  • Takanori Yasu,
  • Yasuhiro Maejima

摘要

Background

Evidence for wearable-guided physiotherapy in diabetic kidney disease (DKD) is limited. This study evaluated the effects of physiotherapist-supervised exercise supported by wearable device feedback in patients with type 2 diabetes, including those with DKD.

Methods

In this single-center, prospective study, 58 outpatients were allocated to an intervention group (IG) or non-intervention group (NIG). The per-protocol set included 45 participants completing six months (IG = 25, NIG = 20). IG wore a wrist-worn device and received monthly physiotherapist-led guidance; NIG received standard care. The primary endpoint was 6-min walk distance (6MWD); secondary outcomes included weight-bearing index (WBI), phase angle (PhA), HbA1c, and eGFR. Analyses used linear mixed-effects models adjusted for covariates.

Results

IG improved 6MWD from 512.0 m to 551.0 m (+ 38.7 m), while NIG changed from 410.0 m to 407.0 m (− 3.7 m). The group × time interaction was significant (p < 0.001); adjusted between-group difference was + 42.4 m (95% CI: 20.3–64.5). IG showed greater reductions in HbA1c (− 0.89%, 95% CI: − 1.53 to − 0.25; p = 0.008) and improvements in WBI and PhA (p < 0.01). Changes in eGFR were not significant (0.65 mL/min/1.73m2, 95% CI: -3.84 to 5.14; p = 0.78).

Conclusions

Monthly physiotherapist-led exercise supported by wearable feedback improved functional capacity and glycemic control in patients with DKD. This pragmatic, scalable model may enhance outpatient rehabilitation strategies.

Graphical abstract

Values represent adjusted between-group differences in change from baseline to six months, estimated using linear mixed-effects models with group, time, and group × time interaction, adjusted for age, baseline 6-min walk distance, HbA1c, eGFR, cardiovascular disease, and smoking status. Error ranges indicate 95% confidence intervals. Arrows indicate direction of change favoring the intervention group.