Background  
The number of patients with type 2 diabetes mellitus with severe arrhythmias is increasing. The number of ablation procedures for these patients is increasing in Japan. Post-operative general malaise has been reported as a symptom of reduced daily activity.In this study, we applied the low-intensity physical activity management (PAM) technique to improve the symptoms of HIV and longCOVID.

Aim  
To report is the data and subjective evaluation of the progress of the application and appropriate use of low-intensity physical activity management techniques to improve the symptoms of daily inactivity due to general malaise experienced by myself.

Method  
The patient was 35 years old with type 2 diabetes mellitus. 19 years after the onset of the disease, A1C increased from 6.2% to 12%, SGLT2 was increased and lowered to 9.0%. Shortly afterwards he developed severe atrial fibrillation and underwent an ablation procedure in August at the age of 55. Postoperatively, the patient developed a right recurrent nerve palsy. Afterwards, the patient developed significant dyspnea, and oxygen was administered for 48 hours. Seventy-two hours after the operation, the patient was released from respiratory control and developed marked general malaise and fatigue immediately after movement.　PAM was performed using a POLAR M430 active tracker with 24-hour pulse and postural recording and a SPO2 meter. General malaise and daily inactivity were assessed using a 10-point scale, and the number of times per day that the heart rate increase immediately after an ADL activity exceeded 100 beats per minute (the number of spikes) was monitored. When HR 100 and SPO2: 85% or lower for all activities, PAM was performed for 2 months with a measure of 10 minutes of complete rest (based on left lateral recumbency).

Results  
After discharge from the hospital, the general malaise (M) was 9, the decrease in daily activity (PA) was 8, and the rapidity frequency (T) was 20. This was followed by 2 months of measure B, estimating preoperative ADL physical activity and selecting priority activities using the so-called spoon technique (SPT). M8, PA7, T15. no reduction in beta-blockers. 6 months later, M8, PA7, T12. no improvement in subjective malaise. 15 for 40 kcal/day. After 9 months, marked dyspnoea and pulmonary edema due to recurrent nerve palsy, SPO2 dropped to 82%. Off beta-blockers. Resting heart rate averaged(rHR) 70 to 90 bpm; M7, PA6, T15; A1C 12%. After this, exercise is taken off. After 12 months, M6, PA5, T10, resting HR level of 80 bpm. A1C of 11.5%. 15 months later, SPT for 2 months. M5, PA4, T8, rHR level of 70 bpm. A1C of 10%. PAM completed at 18 months. M3, PA3, T2. rHR66 bpm, A1C of 9.0%. Anxiety about developing motor fatigue associated with activities of daily living disappeared.

Discussion  
Low-intensity physical activity management techniques, together with glycaemic control, were effective in treating symptoms of reduced daily activity due to general malaise, using active trackers and SPO2 meters. We present an example of the use of low-intensity physical activity management as a method of improving these symptoms.



The usefulness of low-intensity physical activity management for malaise in type 2 diabetic patients after ablation