Effectiveness of a Self‑Stretching Exercise Program on Restless Leg Symptoms in Patients with Type 2 Diabetes Mellitus: A Pre-Post Intervention Analysis: Restless Leg Symptoms in Patients with T2DM: A Pre-Post Intervention Analysis

Nasir Mehmood; Maryam Iqbal; Mazahir Zia; Muhammad Asif; Waqas Ahmed

doi:10.54393/pbmj.v9i1.1328

Authors

Nasir Mehmood Department of Physical Therapy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
Maryam Iqbal Department of Physical Therapy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
Mazahir Zia Department of Health, Physical Education, and Sports Sciences, University of Karachi, Karachi, Pakistan
Muhammad Asif 3Department of Rehabilitation and Health Sciences, Nazeer Hussain University, Karachi, Pakistan
Waqas Ahmed Department of Rehabilitation Sciences, Dr. Ziauddin Hospital, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pbmj.v9i1.1328

Keywords:

Restless Legs Syndrome, Type-2 Diabetes Mellitus, Self-Stretching, Restless Legs Syndrome-Diagnostic Index, Non-Pharmacological Intervention

Abstract

Restless legs syndrome (RLS) symptoms, characterized by an urge to move the legs, unpleasant sensations, worsening during rest, and predominance at night, are prevalent sleep-disrupting complaints. Objectives: To evaluate the effectiveness of a home-based self-stretching exercise program in reducing RLS symptoms among adults with Type 2 Diabetes Mellitus. Methods: This experimental study recruited two hundred (200) adults aged 40–59 years with a confirmed diagnosis of T2DM (HbA1c >6.5%) via convenience sampling at District Headquarter Hospital, Lodhran, and Bahawal Victoria Hospital, Bahawalpur. Following baseline assessment, participants received standardized instruction and hands-on training in a daily lower-limb self-stretching program to perform at home for four weeks. Restless legs symptoms were quantified using the RLS Diagnostic Index (RLS-DI). Pre–and post-changes in RLS-DI Sum Score and Grand Total Score were examined with paired-samples t-tests; item-level frequency shifts were analyzed via chi-square tests (α=0.05). Results: The mean RLS-DI Sum Score decreased significantly from 7.39 ± 5.60 to –0.79 ± 6.25 (mean paired difference 8.17, 95% CI 7.06–9.28, t=14.56, p<0.001). The Grand Total Score fell from 3.31 ± 6.83 to –2.27 ± 6.74 (mean difference 5.57, 95% CI 4.38–6.76, t=9.20, p<0.001). Item-level analyses revealed significant reductions in frequency of urge to move (χ²=17.395, p=0.002), unpleasant sensations (χ²=13.671, p=0.008), worsening during rest (χ²=12.009, p=0.017), and sleep disturbance (χ²=22.665, p=0.001). Conclusions: A 4-week self-stretching program was associated with substantial reductions in restless leg syndrome symptoms among adults with T2DM. These findings position self-stretching as a feasible, low-cost, non-pharmacological strategy for managing RLS symptoms in routine outpatient diabetes settings.

References

Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW et al. Restless Legs Syndrome/Willis–Ekbom Disease Diagnostic Criteria: Updated International Restless Legs Syndrome Study Group (IRLSSG) Consensus Criteria–History, Rationale, Description, and Significance. Sleep Medicine. 2014 Aug; 15(8): 860-73. doi: 10.1016/j.sleep.2014.03.025. DOI: https://doi.org/10.1016/j.sleep.2014.03.025

Allen RP, Bharmal M, Calloway M. Prevalence and Disease Burden of Primary Restless Legs Syndrome: Results of a General Population Survey in the United States. Movement Disorders. 2011 Jan; 26(1): 114-20. doi: 10.1002/mds.23430. DOI: https://doi.org/10.1002/mds.23430

Gossard TR, Trotti LM, Videnovic A, St Louis EK. Restless Legs Syndrome: Contemporary Diagnosis and Treatment. Neurotherapeutics. 2021 Jan; 18(1): 140-55. doi: 10.1007/s13311-021-01019-4. DOI: https://doi.org/10.1007/s13311-021-01019-4

Walters AS, Frauscher B, Allen R, Benes H, Chaudhuri KR, Garcia-Borreguero D et al. Review of Diagnostic Instruments for the Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED): Critique and Recommendations. Journal of Clinical Sleep Medicine. 2014 Dec; 10(12): 1343-9. doi: 10.5664/jcsm.4298. DOI: https://doi.org/10.5664/jcsm.4298

Ning P, Mu X, Yang X, Li T, Xu Y. Prevalence of Restless Legs Syndrome in People with Diabetes Mellitus: A Pooling Analysis of Observational Studies. EClinicalMedicine. 2022 Apr; 46. doi: 10.1016/j.eclinm.2022.101357.

Anyfantakis D, Katsanikaki F, Symvoulakis EK. Diabetic Neuropathy and Restless Legs Syndrome: Can A Known Chronic Condition Slow Down Our Diagnostic Way of Thinking? A Case Report and a Short Literature Overview. Medicine and Pharmacy Reports. 2020 Jul; 93(3): 297. doi: 10.15386/mpr-1568. DOI: https://doi.org/10.15386/mpr-1568

Butt NI, Ghoauri MS, Waris U, Sabeh D, Qaisar F. Frequency of Restless Legs Syndrome in Pakistani Patients with Type 2 Diabetes Mellitus. Cureus. 2024 Jun; 16(6). doi: 10.7759/cureus.62624. DOI: https://doi.org/10.7759/cureus.62624

Kalra S and Gupta A. Diabetic Painful Neuropathy and Restless Legs Syndrome in Diabetes. Diabetes Therapy. 2018 Apr; 9(2): 441-7. doi: 10.1007/s13300-018-0376-6. DOI: https://doi.org/10.1007/s13300-018-0376-6

Mirghani H. Restless Legs Syndrome among Sudanese Patients with Type 2 Diabetes Mellitus: A Case-Control Study. Cureus. 2020 Aug; 12(8). doi: 10.7759/cureus.9635. DOI: https://doi.org/10.7759/cureus.9635

Pinheiro T, Thomas T, Devaraj U, Ramachandran P, Krishnaswamy UM. Prevalence of Restless Legs Syndrome and Quality of Sleep in Type 2 Diabetics. Journal of Diabetes and Its Complications. 2020 Dec; 34(12): 107727. doi: 10.1016/j.jdiacomp.2020.107727. DOI: https://doi.org/10.1016/j.jdiacomp.2020.107727

Koster MJ and Warrington KJ. In Reply—Giant Cell Arteritis: The Place of 18F-FDG PET/CT and Serum Haptoglobin Level. InMayo Clinic Proceedings. 2022 Jan; 97(1): 190. doi: 10.1016/j.mayocp.2021.11.015. DOI: https://doi.org/10.1016/j.mayocp.2021.11.015

Winkelman JW, Berkowski JA, DelRosso LM, Koo BB, Scharf MT, Sharon D et al. Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine. 2025 Jan; 21(1): 137-52. doi: 10.5664/jcsm.11390. DOI: https://doi.org/10.5664/jcsm.11390

Mortazavi M, Vahdatpour B, Ghasempour A, Taheri D, Shahidi S, Moeinzadeh F et al. Aerobic Exercise Improves Signs of Restless Leg Syndrome in End-Stage Renal Disease Patients Suffering Chronic Hemodialysis. The Scientific World Journal. 2013; 2013(1): 628142. doi: 10.1155/2013/628142. DOI: https://doi.org/10.1155/2013/628142

Song YY, Hu RJ, Diao YS, Chen L, Jiang XL. Effects of Exercise Training on Restless Legs Syndrome, Depression, Sleep Quality, and Fatigue among Hemodialysis Patients: A Systematic Review and Meta-Analysis. Journal of Pain and Symptom Management. 2018 Apr; 55(4): 1184-95. doi: 10.1016/j.jpainsymman.2017.12.472. DOI: https://doi.org/10.1016/j.jpainsymman.2017.12.472

Innes KE and Selfe TK. Trials of Yoga for Restless Legs Syndrome in Pregnant and Postpartum Women Are Warranted but Require Special Considerations. Journal of Clinical Sleep Medicine. 2020 May; 16(5): 829-30. doi: 10.5664/jcsm.8420. DOI: https://doi.org/10.5664/jcsm.8420

Innes KE, Selfe TK, Montgomery C, Hollingshead N, Huysmans Z, Srinivasan R et al. Effects of A 12-Week Yoga Versus A 12-Week Educational Film Intervention on Symptoms of Restless Legs Syndrome and Related Outcomes: An Exploratory Randomized Controlled Trial. Journal of Clinical Sleep Medicine. 2020 Jan; 16(1): 107-19. doi: 10.5664/jcsm.8134. DOI: https://doi.org/10.5664/jcsm.8134

Ahmed N, Aslam S, Iqbal Y, Lata P, Aziz M, Sandeela Ka et al. Impact of Online and Physical Training Programs on Postural Sway among Young Adults. Journal of Xi'an Shiyou University, Natural Sciences Edition. 2023; 16(12). doi: 10.31703/gsr.2022(VII-IV).03. DOI: https://doi.org/10.31703/gsr.2022(VII-IV).03

Omobomi O and Quan SF. A Requiem for the Clinical Use of the Epworth Sleepiness Scale. Journal of Clinical Sleep Medicine. 2018 May; 14(5): 711-2. doi: 10.5664/jcsm.7086. DOI: https://doi.org/10.5664/jcsm.7086

Modarresnia L, Golgiri F, Madani NH, Emami Z, Tanha K. Restless Legs Syndrome in Iranian People with Type 2 Diabetes Mellitus: The Role in Quality of Life and Quality of Sleep. Journal Of Clinical Sleep Medicine. 2018 Feb; 14(2): 223-8. doi: 10.5664/jcsm.6938. DOI: https://doi.org/10.5664/jcsm.6938

Harrison EG, Keating JL, Morgan PE. Non-Pharmacological Interventions for Restless Legs Syndrome: A Systematic Review of Randomized Controlled Trials. Disability and Rehabilitation. 2019 Aug; 41(17): 2006-14. doi: 10.1080/09638288.2018.1453875. DOI: https://doi.org/10.1080/09638288.2018.1453875

Akın S, Bölük C, Börü ÜT, Taşdemir M, Gezer T, Şahbaz FG et al. Restless Legs Syndrome in Type 2 Diabetes Mellitus. Primary Care Diabetes. 2019 Feb; 13(1): 87-91. doi: 10.1016/j.pcd.2018.08.006. DOI: https://doi.org/10.1016/j.pcd.2018.08.006

Harashima SI, Nishimura A, Osugi T, Wang Y, Liu Y, Takayama H et al. Restless Legs Syndrome in Patients with Type 2 Diabetes: Effectiveness of Pramipexole Therapy. British Medical Journal Supportive and Palliative Care. 2016 Mar; 6(1): 89-93. doi: 10.1136/bmjspcare-2014-000691. DOI: https://doi.org/10.1136/bmjspcare-2014-000691

Antelmi E, Rocchi L, Latorre A, Belvisi D, Magrinelli F, Bhatia KP et al. Restless Legs Syndrome: Known Knowns and Known Unknowns. Brain Sciences. 2022 Jan; 12(1): 118. doi: 10.3390/brainsci12010118. DOI: https://doi.org/10.3390/brainsci12010118

Ning P, Mu X, Yang X, Li T, Xu Y. Prevalence of Restless Legs Syndrome in People with Diabetes Mellitus: A Pooling Analysis of Observational Studies. E-Clinical Medicine. 2022 Apr; 46. doi: 10.1016/j.eclinm.2022.101357. DOI: https://doi.org/10.1016/j.eclinm.2022.101357

Aliasgharpour M, Abbasi Z, Razi SP, Kazemnezhad A. The Effect of Stretching Exercises on Severity of Restless Legs Syndrome in Patients on Hemodialysis. Asian Journal of Sports Medicine. 2016 Jun; 7(2): e31001. doi: 10.5812/asjsm.31001. DOI: https://doi.org/10.5812/asjsm.31001

Fauzi A and Triaswati R. The Effect of Intradialytic Stretching Training on Restless Legs Syndrome and Sleep Quality in Hemodialysis Patients. Korean Journal of Adult Nursing. 2021 Feb; 33(1): 37-43. doi: 10.7475/kjan.2021.33.1.37. DOI: https://doi.org/10.7475/kjan.2021.33.1.37