Are health care professionals advising patients with diabetes or at risk for developing diabetes to exercise more?

Prescribing Physical Activity for Cardiovascular and Metabolic Health

More than half of all Americans do not engage in regular physical activity of even moderate intensity, with nearly 1 in 4 reporting no leisure-time physical activity. Despite the well-known benefits of regular exercise, fewer than half of physicians counsel their patients on increasing physical activity. Aerobic exercise of a minimum intensity of only 30% to 40% of heart rate reserve is sufficient to improve cardiovascular fitness in most individuals, with a goal of gradually progressing to 60% to 80% heart rate reserve. Exercise duration and frequency are also gradually increased to maximize cardiovascular stimulus. The goal is a minimum weekly energy expenditure of 1000 kcal per week, and 2000 kcal per week or more may be needed for weight loss and/or management. Strength training 2 to 3 days per week is recommended as an adjunct to regular aerobic exercise, especially for those with impaired glucose/insulin metabolism. It is safe for most elderly individuals to follow these guidelines, including strength training, as long as appropriate precautions are taken.

Exercise for prevention and treatment of cardiovascular disease, type 2 diabetes, and metabolic syndrome

A considerable number of observational and intervention studies support the role of exercise as a cornerstone in prevention and treatment of cardiovascular disease (CVD), type 2 diabetes (T2D), and the metabolic syndrome. Physical activity and cardiorespiratory fitness are also associated with reduced mortality rates among persons with CVD, T2D, and metabolic syndrome. Exercise has definite acute effects on a number of risk markers for CVD and T2D, in addition to more substantial benefits with chronic training. Both aerobic and resistance exercise have therapeutic value, largely independent of weight loss, and should be included in excise programs.

Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003

OBJECTIVE

Given the risk of obesity and diabetes in the U.S., and clear benefit of exercise in disease prevention and management, this study aimed to determine the prevalence of physical activity among adults with and at risk for diabetes.

RESEARCH DESIGN AND METHODS

The Medical Expenditure Panel Survey is a nationally representative survey of the U.S. population. In the 2003 survey, 23,283 adults responded when asked about whether they were physically active (moderate or vigorous activity, > or =30 min, three times per week). Information on sociodemographic characteristics and health conditions were self-reported. Additional type 2 diabetes risk factors examined were age > or =45 years, non-Caucasian ethnicity, BMI > or =25 kg/m(2), hypertension, and cardiovascular disease.

RESULTS

A total of 39% of adults with diabetes were physically active versus 58% of adults without diabetes. The proportion of active adults without diabetes declined as the number of risk factors increased until dropping to similar rates as people with diabetes. After adjustment for sociodemographic and clinical factors, the strongest correlates of being physically active were income level, limitations in physical function, depression, and severe obesity (BMI > or =40 kg/m(2)). Several traditional predictors of activity (sex, education level, and having received past advice from a health professional to exercise more) were not evident among respondents with diabetes.

CONCLUSIONS

The majority of patients with diabetes or at highest risk for developing type 2 diabetes do not engage in regular physical activity, with a rate significantly below national norms. There is a great need for efforts to target interventions to increase physical activity in these individuals.

The Council on Chiropractic Education's new wellness standard: a call to action for the chiropractic profession

Background

The chiropractic profession has long considered itself to be a preventive science. Recently the Council on Chiropractic Education (CCE) has defined a set of standards that must be implemented at all US chiropractic colleges as of January of 2007. These are specific to wellness measures and health promoting efforts that should be performed by chiropractors. This will mandate traditional health promotion and prevention methods be taught to students at accredited colleges and to practicing chiropractors.

Objective

To present the idea of performing traditional health promotion and wellness-concepts in chiropractic practice as a call to action for clinicians and generate discussion on the topic.

Discussion

This manuscript discusses relevant topics of health promotion and prevention for chiropractors and other practicing clinicians that should be made priorities with patients in order to enhance both patient health and community and population health.

Conclusion

All practicing chiropractors, as well as other clinicians should take these new standards from the CCE as a call to action to begin helping patients address the removable causes of morbidity, disability and premature mortality where they exist, in addition to treating their painful spinal conditions.