# Effects of Lower Limb-Focused Low-Intensity Resistance Exercise Using Slow Movements on Locomotive Syndrome in Patients with Type 2 Diabetes Mellitus

## TL;DR

A 5-month lower limb exercise program improved mobility and muscle health in type 2 diabetes patients.

## Contribution

Demonstrated that slow, low-intensity resistance exercise improves locomotive syndrome in T2DM patients.

## Key findings

- HbA1c levels decreased significantly after the exercise program.
- Muscle mass and gait speed improved in patients with type 2 diabetes.
- LS stage distribution shifted toward less severe categories following the intervention.

## Abstract

Background and Objectives: Type 2 diabetes mellitus (T2DM) is a major public health issue worldwide that leads to reductions in skeletal muscle mass and lower-limb function, thereby increasing the risk of locomotive syndrome (LS), a mobility-limiting condition. This study investigated the effects of a 5-month, lower limb-focused, low-intensity resistance exercise program using slow movements (slow exercise) on LS in patients with T2DM. Materials and Methods: Nineteen patients with T2DM (69.3 ± 7.3 years, 10 men and 9 women) performed slow exercises three times per week for 5 months. The program consisted of bodyweight and machine-based exercises with a load of 30–50% one-repetition maximum using slow concentric–isometric–eccentric phases. Assessments included HbA1c, LS stage distribution (non-LS, LS-1, LS-2, LS-3), LS risk tests (two-step, stand-up, and GLFS-25), five-time sit-to-stand test, four-meter gait speed, and skeletal muscle mass index (SMI) and phase angle (PhA) by bioelectrical impedance analysis. Statistical comparisons were performed using repeated one-way ANOVA with Tukey’s post hoc test and Cochran’s Q test. Results: HbA1c decreased from 7.5 ± 0.7% to 7.2 ± 0.8% (p < 0.05). LS stage distribution improved significantly (stage 3: 4 to 0; non-LS: 1 to 5; each p < 0.05). The two-step test and GLFS-25 improved (1.17 ± 0.15 to 1.27 ± 0.17; 14.6 ± 13.1 to 7.6 ± 6.3; each p < 0.05). Five-time sit-to-stand time improved from 9.28 ± 2.53 s to 7.73 ± 1.54 s, and four-meter gait speed improved from 3.58 ± 0.95 s to 3.07 ± 0.55 s (each p < 0.05). SMI and PhA increased (6.82 ± 1.00 to 6.95 ± 0.92 kg/m2; 4.35 ± 0.67 to 4.56 ± 0.78 degrees; each p < 0.05). Conclusions: A 5-month slow exercise program significantly improved LS severity, muscle quantity and quality, and lower-limb function in patients with T2DM. Slow exercise may be a safe and effective intervention to improve mobility and maintain independence in this population.