increase
blood flow to the feet
- YES !
RELAXATION
TRAINING AND ITS ROLE IN DIABETES AND HEALTH
Birgitta
I. Rice, M.S., R.Ph., CHES Introduction This
series of articles will
provide information on the benefits of relaxation on health and
wellness, with a focus on peripheral circulation problems in diabetes
patients Part
2 Testing Methods—How The Results Were Recorded. The
first study was designed to see if people with diabetes would have the
same ability to increase peripheral blood flow in response to relaxation
training as people without diabetes. First people without diabetes
completed a pilot study to evaluate the relaxation technique and their
response to it. Then diabetic
subjects (N=40), ages 17-73, who were volunteers recruited through the
University of Wisconsin-La Crosse, the local ADA Chapter and a medical
clinic were signed up. A
'within-subjects' experimental design was used.
The subjects
served as their own controls, which provided complete control of one of
the most important sources of variation in educational experiments,
namely inter-subject variations. During
Phase1, all subjects used a self-selected relaxation method and recorded
toe temperatures daily. During
Phase2, the same subjects were taught a biofeedback assisted relaxation
technique designed to elicit sensations of warmth in the lower
extremities, thereby increasing blood circulation and temperature.
Subjects relaxed at home using a designated relaxation tape. They measured and recorded toe temperatures before and after
each relaxation session. Each
phase lasted four weeks. In
this study, subjects showed an improvement in their ability to increase
blood volume pulse (BVP) in the great toe after training. In fact, most
of the increase of BVP change scores, as indexed by the statistical
measure Eta2 = .71, which indicated that 71% of the increase
in BVP could be attributed to the biofeedback assisted relaxation
training. The toe temperature change scores were not only significantly
larger after training, but the average starting toe temperature also was
2.86oF higher at the end of Phase2 even though this time was
farther into the winter and the weather colder. Later
a multi site clinical trial aimed to test this relaxation technique
further was conducted. We wanted to see if the training would promote enough
additional blood flow to make a difference in the healing of chronic,
non-healing foot ulcers that often develop as a complication of
diabetes. Therefore medical care for patients with non-healing chronic
foot ulcers was combined with a standardized biofeedback-assisted
relaxation training program in the experimental group of this
prospective randomized study. The intervention was designed to increase
peripheral perfusion, thereby promoting healing. The
results: 14 out of 16 ulcers (87.5%) healed in the experimental group,
whereas 7 out of 16 ulcers (43.7%) healed in the control group (p <
.01). Other significant outcomes were that patients reported
experiencing less pain. We
also measured an increased sensory function of the large myelinated
fibers of the peroneal nerve. At the end of this study, patients in the experimental
group who had practiced biofeedback-assisted relaxation were able to
perceive the stimulus of an electric current (Current Perception
Threshold, CPT levels) at lower intensities than at the start of the
study. The
improvement in healing and sensory nerve function was due to better
oxygenation of nerve endings through increased micro vascular perfusion,
brought about by decreased sympathetic muscle tone and peripheral
vasodilation. Findings
have been published in peer reviewed medical journals and presented to
national audiences of the American Diabetes Association, American
Association of Diabetes Educators, Occupational Therapy Association,
etc. The WarmFeet®
program received the 1999 Paragon Award from the Society for Public
Health Education in Minnesota, for its innovative and local application.
Among
the published works are: Rice
BI, Kalker AJ, Schindler JV, Dixon RM:
Effect of Thermal Biofeedback Assisted Training on Foot Ulcer
Healing. J Am Podiatr Med Assoc, 91/3, p.132-41, 2001 Rice
BI: Increased Peroneal Nerve Function in People with Diabetes
Mellitus Following Biofeedback Assisted Relaxation Training.
Biofeedback and Self‑Regulation, 9/3, 1994 Rice
BI, Schindler JV: Effect of Thermal Biofeedback‑Assisted
Relaxation Training on Blood Circulation in the Lower Extremities of a
Population with Diabetes, Diabetes Care, 15/7,
p.853‑859, 1992 The
next section will present some case studies from clinical practice
situations. Birgitta I. Rice, MS, RPh, CHES received her education and pharmacy license in her native Sweden. She is a researcher, clinician and certified health education specialist at the University of Minnesota, Division of Epidemiology Clinical Research Center, Minneapolis, MN
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