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 Table of Contents  
Year : 2015  |  Volume : 15  |  Issue : 1  |  Page : 82-85

Effect of Swiss ball exercise in type II diabetes mellitus

1 Department of Physical Medicine and Rehabilitation, Orthopaedic Physiotherapist, Global Health City, Chennai, Tamil Nadu, India
2 Department of Physiotherapy, Physiotherapist, Dr. Kamakshi Memorial Hospital, Chennai, Tamil Nadu, India

Date of Web Publication19-Jan-2015

Correspondence Address:
Ravichandran Hariharasudhan
Department of Physical Medicine and Rehabilitation, Orthopaedic Physiotherapist, Global Health City, Chennai - 600100, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-6308.146347

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Aims and Objective of the Study: To study the effectiveness of exercises using Swiss ball in lowering waist circumference, fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and glycosylated Hemoglobin (HbA1c) among Type II diabetic patients. Scope of the Study: The outcome of this research study can be used for comprehensive diabetic management and preventive means by adopting at schools and colleges. Materials and Methods: Eighty Type II diabetic patients were divided in two groups. While both groups were treated with medication, group II were treated with set of exercises using Swiss ball. FBS, PPBS, HbA1c, and waist circumference were measured before and 12 weeks after the test, which was recorded and statistically analyzed. Results and Discussion: Reduction in waist circumference decreased with a probability level of 0.1%, reduction in fasting blood sugar at 5% level of probability, lowering of HbA1c at 0.1% of probability, and PPBS remained unaffected with P > 0.05. Conclusion: Hence, exercises using Swiss ball are effective in the management of diabetic patients and can be used as preventive means of diabetes among schools and colleges where Juvenile Diabetes, physical inactivity, life style changes, etc., predisposing to various medical ailments can better be utilized as part of physical education and fitness promotions.

  Abstract in Arabic 

أهداف و الهدف من الدراسة : لدراسة فعالية تمارين باستخدام الكرة السويسرية في خفض محيط الخصر، و الصيام السكر في الدم (FBS) ، بعد أكلي السكر في الدم (PPBS) ، و الهيموغلوبين الغليكوزيلاتي ( نسبة HbA1c) بين مرضى النمط الثاني من السكري.
نطاق الدراسة: إن نتائج هذه الدراسة البحثية يمكن أن تستخدم لإدارة السكري شاملة و سيلة وقائية من خلال اعتماد في المدارس والكليات.
المواد و الطرق: تم تقسيم النوع الثاني ثمانون مرضى السكري في مجموعتين. في حين تم التعامل مع المجموعتين الدواء، وعولج المجموعة الثانية مع مجموعة من تمارين باستخدام الكرة السويسرية. تم قياس FBS ، PPBS ، نسبة HbA1c ، ومحيط الخصر قبل وبعد 12 أسابيع من الاختبار، والتي تم تسجيلها وتحليلها إحصائيا.
النتائج والمناقشة : انخفض خفض محيط الخصر مع مستوى احتمال 0.1 ٪ ، وخفض نسبة السكر في الدم في الصيام عند مستوى 5 ٪ من الاحتمالات، و خفض نسبة HbA1c عند 0.1 ٪ من الاحتمالات، و PPBS ظلت ECTED unaff مع P> 0.05 .
الخلاصة: ومن هنا ، يمارس باستخدام الكرة السويسرية ECTIVE ممثل المؤسسة في إدارة مرضى السكري ، ويمكن استخدامها كوسيلة وقائية من مرض السكري بين المدارس والكليات حيث الأحداث السكري والخمول البدني ، والحياة
احداث تغييرات في نمط وغيرها، المهيئة ل أمراض طبية مختلفة يمكن أن تستخدم أفضل كجزء من
التعليم و اللياقة البدنية الترقيات .
الكلمات الرئيسية : الهيموجلوبين Glycelated والسكري من النوع 2، الكرة السويسرية

Keywords: Glycelated hemoglobin, type 2 diabetes, Swiss ball

How to cite this article:
Hariharasudhan R, Varunkumar V. Effect of Swiss ball exercise in type II diabetes mellitus. Saudi J Sports Med 2015;15:82-5

How to cite this URL:
Hariharasudhan R, Varunkumar V. Effect of Swiss ball exercise in type II diabetes mellitus. Saudi J Sports Med [serial online] 2015 [cited 2022 Aug 10];15:82-5. Available from: https://www.sjosm.org/text.asp?2015/15/1/82/146347

  Introduction Top

The prevalence of diabetes is rapidly rising all over the globe at an alarming rate .[1] In the last three decades, the status of diabetes has changed from being considered as a mild disorder of the elderly to one of the major causes of morbidity and mortality affecting the youth and middle-aged people. [2] India leads the world with the largest number of diabetic patients (40.9 million). [3] The most disturbing trend is the shift in age of onset of diabetes to a younger age in recent years, which could have long-lasting adverse effect on the nation's health and economy. [4]

Reduced physical activity, changes in dietary pattern, and sedentary occupational habits are the major causes for concern [5] The American diabetes association (ADA) recommends that individuals with Type 2 diabetes perform at least 150 minutes of moderate intensity aerobic exercises or at least 90 minutes of vigorous aerobic exercises per week. [6] Resistance exercise training is effective in improving glycemic control and can be used as an adjunct to standard care of Type 2 diabetic patients. [7] Vibration exercises are an effective, low time-consuming tool to enhance glycemic control in Type 2 diabetic patients. [8]

The objective of the study was to assess the effects of 12 weeks of moderate intensity resistance exercises using Swiss ball on glycemic control on male Type 2 diabetic patients, which is the first of its kind study among Indian population.

  Materials and methods Top

Settings and design

Subjects were recruited from the outpatient Department of Global health city, Perumbakkam, Chennai, India during December 2013. The study was conducted at the Department of Physical Medicine and Rehabilitation Department of Global Health City, Chennai, India between December 2013 and February 2014.

Eighty male Type 2 diabetic subjects between 30-60 years were randomly assigned to 12 weeks supervised control group (n = 40) or moderate intensity resistance exercises using Swiss ball (n = 40). Fasting blood sugar (FBS), Post-prandial blood sugar (PPBS), glycosylated hemoglobin (HbA1c), and waist circumference were measured before training (i.e. 0 week) and after 12 weeks of training.

Inclusion criteria

Established Type 2 diabetes

An inactive life style

Not insulin dependent and

Male between 30-60 years.

The eligible subjects underwent a medical screening and physical evaluation to exclude individuals with subjective or objective evidence of the following:

Uncontrolled hypertension

Coronary artery disease

Advanced retinopathy


Severe orthopedic conditions and

Restricting physical activity.


Subjects were randomly assigned to one of the two groups: Swiss ball exercise (SBE) group (n = 40) or Control group (n = 40). All subjects gave their written informed consent to participate in the study.

Outcome measures

The subjects were tested on two occasions by using the same protocols. Baseline measurement was taken before the intervention, and after the study, all the measurements were taken again.

Venous blood sample of all subjects were taken for analysis of FBS, PPBS, and HbA1c.

Anthropometric measures

Waist circumferences were measured in centimeters around iliac crest before and after the study.


Swiss ball exercise group

Subjects allotted to this group performed systemic supervised resistance training in line with American Diabetic Association (ADA) and American College of Sports Medicine (ACSM) guidelines. Subjects exercised for three times per week. Each session comprised 10 exercises for major muscle groups of lower extremities including lumbar spine extensors, abdominals, gluteus maximus, quadriceps femoris, hamstrings, and gastrocnemius. For 12 weeks, subjects performed three sets of five repetitions of each exercise per session. Progressive increase in intensity was designed in such a way that up to 4 weeks no holding of each physical activity, 5 seconds hold of each exercises from 4-8 weeks, and 10 seconds hold of each exercise from 8-12 weeks.

Concept of technique

All exercises performed were in the nature of isometric contraction of major muscle groups and closed kinematic chain exercises of both lower extremities. Hence, body weight of the subjects provided resistance to each activity and the peak torque produced with every physical activity was done using Swiss ball.

Care points

Subjects were advised not to hold their breath during exercises. Two hypoglycemic incidents occurred and were given due medical treatment. All subjects completed the training schedule of 12 weeks.

Control group

Subjects underwent no specific training other than their day-to-day routine physical activities. All subjects in Control and SBE groups continued their prescribed medication and daily routine activities.

  Results Top

Among SBE group, FBS post-mean value decreased by 22 and P < 0.05, PPBS post-mean value decreased by 36 and was significant at P < 0.05. HbA1c post-mean value lowered by 1.41 and was statistically significant at P < 0.001. Waist circumference post-mean value decreased by 2.33 and with statistical significance of P < 0.001.

Initial measurements and post-training changes were analyzed using paired t-test. Statistical tests were performed using SPSS software [Table 1]. As displayed in the above table, FBS had reduced by a mean value of 22 among the pre- and post-test mean scores among SBE group; hence, it is statistically significant at 5% probability level as P < 0.05.
Table 1: Results of paired t test among Swiss ball exercises

Click here to view

PPBS decreased following SBEs by a mean value of 36 among the pre- and post-mean scores of SBE group; therefore, it is significant statistically at 5% probability level as P < 0.05.

HbA1C mean values have decreased by 1.41% among pre- and post-mean values of SBE group; this is highly significant at 0.1% probability level with P < 0.001. Waist circumference decreased in the mean values of pre- and post-mean scores of SBE group by 2.33, indicating high statistical significance at 0.1% probability level with P < 0.001. Whereas among the control group subjects, FBS, PPBS, HbA1c, and waist circumference were statistically insignificant among their pre- and post-test scores.

  Discussion Top

This study confirms that following SBEs significant improvement was observed in HbA1c, FBS, PPBS, and waist circumference measures of SBE group compared to control group. Moderate intensity resistance training results in a mean reduction of HbA1c by 1-2%. [9] A reduction of 0.5-1% in HbA1c in response to resistance exercises among women Type 2 Diabetes has also been reported. [10] In this study, HbA1c among Swiss ball-based moderate resistance exercises has decreased by 1.41%. A 1% decrement in HbA1c following therapies to lower HbA1c can reduce the risk of diabetic complications such as myocardial infarction and microvascular diseases. [11],[12]

Leg exercises accelerate insulin absorption from the leg than arm exercises. [13] As the glycemic control of this study with reduction of HbA1c by 1.41% used only exercises of lower extremity, it supported better glycemic control among Type 2 diabetes subjects. Glycemic control improves with resistance training. [14] Resistance training involving major muscle groups has been shown to improve glycemic control and reduced FBS levels. [15] A better glucose control was observed due to improvement in insulin sensitivity and effects of glucose transporters due to muscular hypertrophy and blood flow. [16],[17]

Obesity is the most powerful determinant and risk factor for developing diabetes [18] Increase in waist circumference was demonstrated to increased risk to complications in Type 2 diabetic patients among Asian. [19] Among Indian diabetic patients, higher Body Mass Index and waist circumference were recorded. [20] Waist circumference measurements may be a stronger predictor than Body Mass Index for the identification of metabolic and cardiovascular disease-associated risk factors. [21] This study, where waist circumference has decreased by a mean value of 2.33 cm, indicates that SBE can be used to prevent many obesity-related diabetic complications.

  Conclusion Top

Along with diabetic medications and dietary restrictions, physical activities such as aerobic exercises, vibration exercises, resistance training exercises using dumbbells, bands etc., help to prevent obesity-related diabetic complications. This study using Swiss ball to provide a new form of resistance training exercises can be considered in the comprehensive management of diabetic type 2 patients. Exercises using Swiss ball were effective in glycemic control of male diabetic patients as well in body weight reduction and can be used in the comprehensive diabetic care, which is time-conserving and cost-effective.

Limitations and recommendations

With longer study period, more sample to be studied and a combination of Aerobic and SBEs may provide further evidence.

  References Top

Patel A, Macmohan S, Chalmers J, Neal B, Billot L. Intensive blood glucose control and vascular outcomes in patients with Type 2 Diabetes. N Engl J Med 2008;358:2560-72.  Back to cited text no. 1
Diabetes mellitus and exercise (Position statement). Diabetes Care 2002; Suppl 1:564-8.  Back to cited text no. 2
Baik I, Ascherio A, Rimme EB. Adiposity and mortality in men. Am J Epidemiol 2000;152:264-71.  Back to cited text no. 3
Baldi JC, Snawling N. Resistance training improves glycaemic control in obese Type 2 diabetic men. Int J Sports Med 2003;24:419-23.  Back to cited text no. 4
Castaneda C. A randomized controlled trial of resistance exercise training to improve glycaemic control in older adults with Type 2 diabetes. Diabetes Care 2002;25:2335-41.  Back to cited text no. 5
Chandalia. Obesity in Asian Indian men. J Clin Endocr Metab 1999;84:2329-35.  Back to cited text no. 6
Cuff DJ, Meneilly GS, Martin A, Froflich JJ. Effective exercise modality to reduce insulin resistance in women with Type 2 Diabetes. Diabetes Care 2003;26:2977-82.  Back to cited text no. 7
Ramachandran A. BMI and Waist Circumference in Type 2 diabetes. Int J Diabetes 1995;15.  Back to cited text no. 8
Dustan DW, Puddey, Burkey V. Effects of a short term circuit weight training programme in non insulin dependent diabetes mellitus. Diabetes Res Clin Pract 1998;40:53-61.  Back to cited text no. 9
Huizinga MM, Fothman RL. Addressing the diabetes pandemic: A comprehensive approach. Indian J Med Res 2006;124:481-4.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
Stratton IM, Cull CA, Adler AI, Mathews DR, Neil HA, Holman RR. Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes. Diabetologia 2006;49:1761-9.  Back to cited text no. 11
Sicree R, Show J, Zimmet P. Diabetes and impaired glucose tolerance, 3 rd ed. England, editor diabetes atlas. International diabetes federation. Belgium; 2006. p. 15-103.  Back to cited text no. 12
Klans B. Efficiency of vibration exercise for glycaemic control in Type 2 diabetes patients. Int J Med Sci 2007;4:159-63.  Back to cited text no. 13
Koiviste VA, Fligp. Effects of leg exercise on insulin. Engl J Med 1978;298:279-83.  Back to cited text no. 14
Misra A, Pandey RM, Dlvi JR, Sharma, Vikram NK, Khanna N. High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India. Int J Obesity Relat Metab Disorder 2001;25:1722-90.  Back to cited text no. 15
Ploug T, Ralston E. Exploring the whereabouts of GLUT4 in skeletal muscle. Molecular Membrane Biol 2002;19:39-49.  Back to cited text no. 16
Rattigan S, Wallis MG, Yond JM, Clark MG. Exercise training improves insulin-mediated capillary recruitment in association with glucose uptake in rat hind limb. Diabetes 2001;50:2659-65.  Back to cited text no. 17
Suresh S, Deepa R, Pradeepa R, Rema M, Mohan V. Large scale diabetes awareness and prevention in South India. Diabetes Voice 2005;50:11-40.  Back to cited text no. 18
The University of Calgary. Glycaemic control in type II diabetic patients increases with resistance training. University of Ottawa, Clinical Epidemiology Program, Ottawa Health Research.10/2007;147:357-69.  Back to cited text no. 19
WHO Expert Consultation, "Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies," The Lancet, vol. 363: 2004. p. 157-63.  Back to cited text no. 20
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.  Back to cited text no. 21


  [Table 1]

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