Background: Effective glucose management using exercise modalities in older patients with type 2 diabetes and activities of daily living (ADL) disabilities are unknown.

Purpose: The study investigated the acute effects of motor-assisted cycling and functional electrical stimulation (FES) cycling on the 2-h postprandial glucose responses compared with sitting control in older adults with type 2 diabetes and ADL disabilities.

Methods: The study used a 3×3 crossover study design. Nine participants were randomly assigned to one of the three treatment sequences: ABC, BCA, and CAB. (A, motor-assisted cycling; B, FES cycling; C, sitting control). Linear mixed models (LMM) with Bonferroni post-hoc tests were used to test the mean differences for the 2-h postprandial glucose, estimated by the area under the curve (AUC) and incremental AUC (iAUC), between intervention and control treatments after adjustment for covariates (e.g., age, sex, and race).

Results: There were significant mean differences for iAUC (p = 0.005) and AUC (p = 0.038) across motor-assisted cycling, control, and FES cycling treatments. The FES cycling had a lower mean of 2-hour postprandial iAUC as compared with sitting control (iAUC 3.98 mmol∙h/L vs 6.92 mmol∙h/L, p = 0.006, effect size [ES] = 1.72) and the motor-assisted cycling (iAUC, 3.98 mmol∙h/L vs 6.19 mmol∙h/L , p = 0.0368, ES = 1.29), respectively. The FES cycling also had a lower mean of the 2-hour postprandial AUC as compared with sitting control (AUC, 18.29 mmol∙h/L vs 20.95 mmol∙h/L, p = 0.043, ES = 0.89), but had an AUC similar to the motor-assisted cycling (18.29 mmol∙h/L vs 20.23 mmol∙h/L , p = 0.183, ES = 0.19). There were no statistical differences in iAUC (6.19 mmol∙h/L vs 6.92 mmol∙h/L) and AUC (20.23 mmol∙h/L vs 20.95 mmol∙h/L) between the motor-assisted cycling and sitting control (all p>0.05).

Conclusion: Performing 30 minutes of FES cycling on a motor-assisted bike (40 Hz, 39 rpm, 25-29 mA) significantly decreased the 2-h postprandial glucose levels in older adults with type 2 diabetes and ADL disabilities. These findings suggested that FES cycling can be a promising exercise modality for glucose management in diabetic patients with ADL disabilities.