{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:56:56Z","timestamp":1792159016832,"version":"4.4.0"},"reference-count":28,"publisher":"Akademiai Kiado Zrt.","issue":"3","content-domain":{"domain":["www.akjournals.com"],"crossmark-restriction":true},"short-container-title":["PHYSINT"],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to examine the impact of a six-week MDR program on exercise capacity, sleep quality, fatigue, and health-related quality of life in older adults with T2DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a single-blind, randomized controlled trial, 44 older adults with type 2 diabetes mellitus (T2DM) were assigned to an experimental group (\n                      <jats:italic>n<\/jats:italic>\n                      = 22) receiving MDR plus guided breathing exercises or a control group (\n                      <jats:italic>n<\/jats:italic>\n                      = 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The experimental group showed significantly greater improvement than the control group. The 6MWT distance increased by 24.2 m versus 4.6\u2009m (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.516). The PSQI and FAS scores decreased significantly (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.234;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.476), and the quality of life improved (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.413).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A six-week MDR program combined with guided breathing exercises significantly improved exercise capacity, sleep quality, and\u00a0quality 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1556\/2060.2026.00899","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:20:16Z","timestamp":1789737616000},"page":"400-414","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":0,"title":["Effect of manual diaphragmatic release technique on exercise capacity and sleep quality in older adults with Type II diabetes: A randomized controlled trial"],"prefix":"10.1556","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5758-3468","authenticated-orcid":true,"given":"Mohammed Youssef","family":"Elhamrawy","sequence":"first","affiliation":[{"name":"Physical Therapy Department for Internal Medicine Disorders and Geriatrics, Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt"},{"name":"Department of Physical Therapy for Internal Medicine and Geriatrics, Faculty of Physical Therapy, Alsalam University in Egypt, Tanta, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7117-6976","authenticated-orcid":true,"given":"Abd El-Hamied Ibrahim El-Sayed Moha","family":"El-sherbini","sequence":"additional","affiliation":[{"name":"National Institute of Longevity Elder Sciences (NILES), Beni-Suef University, Beni Suef, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5284-6267","authenticated-orcid":true,"given":"Saher Lotfy","family":"Elgayar","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Allied Medical Sciences, Middle East University, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"key":"B1","series-title":"IDF diabetes atlas","author":"International Diabetes Federation","year":"2021","unstructured":"International Diabetes Federation. 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