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Exercise for Diabetic Nephropathy Individuals
Megha Nataraj1, G Arun Maiya2* and Shankar Prasad3
1,2Department of Physiotherapy, Centre for Diabetic Foot Care & Research (CDFCR), Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal-576104, Karnataka, India.<.
3Department of Nephrology, Kasturba Medical College & Kasturba Hospital, Manipal Academy of Higher Education (MAHE), Manipal-576104, Karnataka, India.
*Corresponding author:G Arun Maiya, Department of Physiotherapy, Dean- Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal-576104, Karnataka, India
How to cite this article:Megha N, G Arun M, Shankar P.Exercise for Diabetic Nephropathy Individuals During Covid-19. J Phy Fit Treatment & Sports.
2021; 8(4): 555748. DOI: 10.19080/JPFMTS.2021.08.555748
The COVID-19 pandemic imposes several health-related threats on individuals because of being confined within close indoors. This short communication article highlights the possible role of an exercise-based rehabilitation program to prove to be beneficial for those individuals with type 2 diabetes mellitus and nephropathy during the COVID-19 period.
The global coronavirus disease 2019 (COVID-19) pandemic, which demanded prolonged confinement with safe indoors, has raised several clinical concerns on its impact among individuals with underlying cardiovascular disease (CVD) risk factors leaving no exception to the diabetic nephropathy (DN) group. With the escalation of kidney function deterioration among DN individuals there exists a fast progression to serious kidney complications such as chronic kidney disease (CKD), end-stage renal disease (ESRD), and renal failure (RF). Thus, early screening and identification remain imperative along with the need to develop effective strategies that either delay or cease the physiological trajectory of renal function deterioration both during and after COVID-19 through exercise-based rehabilitation .
COVID-19 & Diabetic Nephropathy: The past viral pandemic outbreaks of influenza A (H1N1), SARS-CoV (Severe acute respiratory syndrome coronavirus), and MERS-CoV (Middle East respiratory syndrome coronavirus) have suggested diabetic
individuals be highly vulnerable to such infections due to persistent chronic systemic inflammation resulting in an immune-compromised state . Although the multi-organ involvement of COVID-19 continues to gain clarity with over months of the pandemic outbreak now, the damage to kidneys remains unclear with shreds of evidence suggestive of cytokine storm syndrome through sepsis and damage to renal tubular cells . The acute effects on kidneys among hospitalized COVID-19 affected individuals have been linked with destruction to the endothelial layer lining in the presence of macro-albuminuria or proteinuria and or hematuria  with elevated blood urea and creatinine levels. The pharmacological management of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) agents among diabetic, hypertensive, and proteinuric individuals remains controversial as the mechanism of action of COVID-19 infection on human kidney cells links with angiotensin-converting enzyme-2 receptors . The research community looks forward to verifying this inconclusive evidence as to how diabetes alone might produce health consequences through the mobilization of
pro-inflammatory monocytes and increased platelet reactivity
due to altered glycaemic levels and thereby pose a health risk for
those with pre-existing co-morbidities .
Role of Exercise-based rehabilitation program for Diabetic
Nephropathy: The likelihood of this pandemic to drift the DN
individuals into CKD or ESRD groups may largely alter their overall
physical functioning. Furthermore, the possibility of clinical
manifestations such as chronic fatigue syndrome (CFS), physical
inactivity, reduction in skeletal muscle mass, the decline in physical
functioning and performance, reduction in cardiorespiratory
fitness levels, changes in appetite, sleep, and energy levels among
DN may urge healthcare providers towards immediate recognition
of such symptoms and promptly address them using a detailed
assessment/evaluation followed by prescription of an exercisebased
rehabilitation program delivered through qualified physical
The anti-inflammatory, anti-oxidative , anti-glycaemic,
anti-sedative, and cardio-reno-protective effects obtained from
exercise-based rehabilitation program may result in optimal
energy expenditure, with improved health-related outcomes and
enhance synthesis and utilization of vitamin D  whose low
levels have also been linked to acquiring COVID-19. Moreover,
benefits obtained from an exercise training program may reduce
the excessive cardiac autonomic function activity (CAF) produced
through sympathetic overstimulation among them.
i. Early testing and diagnosis of kidney dysfunction among
type 2 diabetes mellitus individuals with nephropathy by the
ii. Engaging the patient as a critical member in the
decision-making process of the multidisciplinary team approach
of “Exercise-based rehabilitation” through addressing patient
queries, patient education, lifestyle & dietary modifications, and
inclusion for exercise.
iii. Identifying changes in the physical and mental health
function of an individual through a detailed evaluation and
assessment process by a physiotherapist.
iv. Initiating health promotion strategies through the
delivery of rehabilitation services provided by the physiotherapist.
v. Encouraging a team-based approach for decision making
to facilitate improved patient health-related outcomes.
vi. Feasibility, safety, and effectiveness of such exercisebased
rehabilitation programs need to be determined through
vii. Conclusion: The new normal world after the pandemic
involving kidney dysfunction will largely be impacted by the
unraveling effects of an exercise-based rehabilitation program
(Figure 1) for an independent healthy life free of symptoms, with
improved survival rates, and reduced mortality rate through the
overall enhancement of quality of life among DN group. For the
successful implementation of such exercise-based rehabilitation
programs, the synergistic efforts from the team of nephrologists/
physician, physiotherapist along with diet and nutrition specialists
would be indispensable.
We hereby acknowledge the Centre
for Diabetic Foot Care and Research (CDFCR), Department of
Physiotherapy, Manipal College of Health Professions (MCHP),
Manipal Academy of Higher Education (MAHE), Manipal – 576104,
Karnataka, India for extending their support.