Effect of manual diaphragmatic release technique on exercise capacity and sleep quality in older adults with Type II diabetes: A randomized controlled trial

Elhamrawy, Mohammed Youssef and El-sherbini, Abd El-Hamied Ibrahim El-Sayed Moha and Elgayar, Saher Lotfy (2026) Effect of manual diaphragmatic release technique on exercise capacity and sleep quality in older adults with Type II diabetes: A randomized controlled trial. PHYSIOLOGY INTERNATIONAL, 113 (3). pp. 400-414. ISSN 2498-602X

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Abstract

Background: Reduced exercise tolerance, fatigue, and poor sleep negatively affect daily functioning and quality of life. Manual diaphragmatic release (MDR) has demonstrated benefits in respiratory rehabilitation; however, its effects in type 2 diabetes mellitus (T2DM) are unexplored. Objective: This study aimed to examine the impact of a six-week MDR program on exercise capacity, sleep quality, fatigue, and healthrelated quality of life in older adults with T2DM. Methods: In a single-blind, randomized controlled trial, 44 older adults with type 2 diabetes mellitus (T2DM) were assigned to an experimental group (n 5 22) receiving MDR plus guided breathing exercises or a control group (n 5 22) performing breathing exercises alone. Interventions were conducted three times per week for six weeks. The primary outcomes were exercise capacity (Six-Minute Walk Test, 6MWT) and sleep quality (Pittsburgh Sleep Quality Index, PSQI). The secondary outcomes included Fatigue Assessment Scale (FAS) and quality of life (SF-12). Assessments were performed at baseline and post-intervention. Results: The experimental group showed significantly greater improvement than the control group. The 6MWT distance increased by 24.2 m versus 4.6 m (P < 0.001, η2 5 0.516). The PSQI and FAS scores decreased significantly (P 5 0.001, η2 5 0.234; P < 0.001, η2 5 0.476), and the quality of life improved (P < 0.001, η2 5 0.413). Conclusion: A six-week MDR program combined with guided breathing exercises significantly improved exercise capacity, sleep quality, and quality of life and reduces fatigue in older adults with T2DM, supporting MDR as a promising non-pharmacological adjunct for older adults with well-controlled T2DM, with further research needed in broader diabetic populations.

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