Outcomes of a strength- and power-focused exercise program in an adult with multiple comorbidities due to type II diabetes mellitus: A case report.

Introduction. People with multiple significant comorbidities are commonly excluded from clinical trials of exercise and therefore less is known regarding the outcomes in this population. This case report describes the outcomes of strength- and power-focused exercise training in an adult with multiple comorbidities. Methods / Case description. A 40-year-old male with Type 2 Diabetes Mellitus resulting in stage 5 chronic kidney disease and left-sided below-knee amputation underwent a four-week program that consisted of four clinic-based and eight self-supervised exercise sessions. The design of the exercise training program was guided by principles of muscle power training while also informed by the interactive effects of his comorbid conditions, and personal and contextual factors. Results. Improvements in muscle strength (modified 5 repetition maximum: +15.88 kg), muscle power (Five Times Sit-to-stand Test: -3.17 s), functional mobility (Timed Up and Down Stairs: -30.39 s), spatiotemporal gait parameters including comfortable gait velocity (+0.24 m/s) and fast gait velocity (+0.21 m/s), and quality of life (4 out of 5 domains of the WHOQOL-BREF) were observed. The program was completed without any adverse events associated with the intervention. Discussion. Combined strength- and power-focused exercise training was safe and positive changes across multiple outcomes were demonstrated in an adult with multiple significant comorbidities. However, exercise program adherence was low, particularly during self-supervised sessions. Findings represent preliminary evidence of the value of this type of exercise training in this population and provide important groundwork for further testing (for example, in a cohort study). Use of optimal behavior change strategies may need to be built into the exercise program design to effectively anticipate and address barriers to exercise engagement.