Physical Activity and Mortality in Individuals With Diabetes Mellitus: A Prospective Study and Meta-analysis

Physical Activity of Workers in a Hospital

Purpose: This study aims to evaluate the physical activity of healthcare personnel and the affecting factors of physical activity (PA) in a hospital using an accelerometer device (Actigraph wGT3X-BT). Method: A total of 63 subjects (22 physicians, 19 nurses, and 23 supporting staff) participated and wore an accelerometer for seven days. Among the outputs, the mean counts for a minute, time spent for light, moderate, and vigorous intensity PA, and step count were extracted. As a secondary study, 16 subjects continued for one more week after feedback on their PA of the previous week and counseling to encourage PA. Result: Most of (62/63) the participants fulfilled the recommended amount of PA, which is more than 300 min of moderate to vigorous physical activity (MVPA). Physicians showed significantly less PA than nurses or supporting staffs: Mean counts per minute (210.4 vs. 476.0 and 441.8 respectively), time in MVPA per week (904.7 min vs. 1471.3 min and 1451.0 min), and step counts per week (69,029 vs. 87,119 and 84,700) (p < 0.001). Nurses and supporting staff were not statistically different. There was no significant difference in the PA of workers in the hospital regarding gender and marital status. However, the average calorie expenditure of the child raising group was significantly higher. There was no statistically significant difference in PA before and after counseling. No participants reported a vigorous degree of exercise intensity over the study period. Conclusion: Most of the healthcare personnel met the recommended PA, however, only 57% (36/63) recalled having engaged in MVPA during the study period. The group of physicians showed less PA compared to nurses or supporting staff. Single check-up and counseling were not found to increase PA.

PREDICTORS OF ARTERIAL HYPERTENSION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN AZERBAIJAN POPULATION

The presented study in Azerbaijan is carried out for the first time within State Programs on fight against a type 2 diabetes mellitus (DM2) and other noninfectious diseases.

Aim.To define predictors of arterial hypertension (AH) in patients with DM2 in Azerbaijan population.

Material and methods. In the single-step clinical-epidemiology cohort study were included 528 patients with DM2 at the age of 30-69 (30,5% — men and 69,5% — women) who answered questions using “ARIC” questioner to define AH and its risk factors.

Results.The prevalence of AH in women (72,4%) was 2,6 times more than in men (27,6%) and the frequent occurrence of AH was at the age of 60-69 (respectively, 26,7±2,1% vs 9,6±2,9%, p<0,001). It was not determined remarkable differences between AH level and occupation status, alcohol consumption, low physical activity, feeding disorder of the patients, at the same time in patients with AH smoking frequency was about 2 times often than in others (respectively, 19,3±1,9% vs 10,6±3,0%, p<0,05). In parents of AH patients AH rates, in comparison with eutonics, were occurred like these: (respectively, in fathers 21,9±2,0% vs 12,5±3,2%, p<0,05; in mothers 42,2±2,4% vs 26,9±4,3%, p<0,01), in mothers DM2 (respectively, 33,7±2,3% vs 221 ±4,1 %, p<0,05), overweight and obesity were watched much more often (95,0±1,1% vs 88,5±3,1%, p<0,05), at the same time these patients were suffered from abdominal obesity (respectively, 96,5±0,9% vs 89,4±3,0%, p<0,01). The mean values of systolic and diastolic arterial pressure (respectively, 148,3±1,1 vs 119,8±1,3 Hg, p<0,001 and 85,9±0,5 vs 74,8±0,8 Hg, p<0,001) were often determined in patients with AH, and on the other hand in these patients were noted prevalence of anxious syndrome (respectively, 78,5±2,0% vs 72,1±4,4%, p<0,05) and depression (68,2±2,3% vs 62,5±4,7%, p>0,05). Regardless of AH level in all patients was noted stress (respectively, 99,8±0,2% vs 100,0±0,0%, p>0,05), which changed for the worse life quality of the patients with AH significantly (respectively, 1,0±2,2% vs 61,5±4,8%, p<0,05).

Conclusion.For patients with DM2 in Azerbaijan cohort female sex, increasing of the age, body mass index, abdominal obesity and anxious conditions are significant risk factors for AH. Presence of AH in both parents and DM2 in mothers increase this risk significantly, which decrease life quality of these patients.

The nexus between health and time use among racially and ethnically diverse women

OBJECTIVES

Ethnic and racial health disparities have been well-documented in the scholarly literature. In recent years, evidence about time spent in physical (in)activity and its relationship to physical and mental health has also emerged. This study assesses if observed ethnic/racial health differences were associated with differences in time use.

DESIGN

Our analyses utilized baseline data from 510 Utah women who enrolled in one of two community-based, participatory research intervention studies between 2012 and 2015. The distinct racial/ethnic groups included African immigrants, African Americans, Latinas, Native Hawaiians/Pacific Islanders, American Indians/Alaskan Natives, and rural White, Non-Latina women. In the baseline survey, respondents reported the typical time they spent in paid employment, television/movie viewing, physical activity, food preparation/clean-up, and sleep. Cluster analysis was used to identify seven distinct patterns of time use within these five activities. We related these time use patterns along with race/ethnicity, socio-demographics, and other potentially contributing health-related factors (e.g. smoking status) to two health outcomes: (1) self-reported health status, and (2) depression.

RESULTS

Our time use clusters revealed heterogeneity by racial/ethnic groups, suggesting that some of the health effects that may have been previously ascribed to group membership should instead be attributed to (un)healthy patterns of time use. In particular, spending too much time in sedentary activities such as watching television/movies and too little time sleeping both linked to poor physical and mental health, independently of racial/ethnic group membership.

CONCLUSIONS

Researchers and policy makers designing culturally sensitive physical activity health-related interventions should consider patterns of time use that are associated with poor health. Programs designed to improve sleep time and reduce sedentary television-viewing time may be as important as interventions designed to increase physical activity time. These broader patterns of time use mediated the relationships between race/ethnicity and physical and mental health for the women in our study.

Aerobic exercise can modulate the underlying mechanisms involved in the development of diabetic complications

Diabetes mellitus is a highly prevalent metabolic disorder that affects many molecular pathways, causing a shift from a physiologic to a pathophysiologic state. Alterations in the molecular pathways promote diabetic complications and, thus, many medical and nonmedical therapies have been directed at preventing these complications. Despite the beneficial effects on moderating glycemic control, medical therapies may also have unfavorable side effects. This makes nonmedical therapeutic approaches more attractive due to lower pharmacological side effects of these strategies compared to medical agents. Aerobic exercise is now considered as a major nonmedical strategy that can promote beneficial and protective effects to counteract the development of diabetic complications via attenuation of the major molecular mechanisms involved in diabetes.

5. Lifestyle Management: Standards of Medical Care in Diabetes-2019

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Walking with Diabetes (WW-DIAB) programme a walking programme for Indonesian type 2 diabetes mellitus patients: A pilot randomised controlled trial

Objectives:

This pilot study aimed to examine the feasibility and effectiveness of a pedometer-based walking programme in Indonesian type 2 diabetes mellitus patients.

Methods:

Feasibility was assessed by monitoring participant recruitment, retention, and adherence to the step-monitoring and recording instructions. Effectiveness was assessed in a pilot randomised controlled trial. Participants were type 2 diabetes mellitus patients randomly assigned to a pedometer-only (PED-only) group (n = 22) and a pedometer with text message support (PED+) group (n = 21). Outcomes were step counts, self-reported physical activity, social cognitive constructs, glycaemic parameters, and health-related quality of life. These were assessed at baseline, 12-week intervention, and 12 weeks later. Longitudinal analyses using generalised estimating equations were carried out to assess treatment and time effects on study outcomes.

Results:

All but one participant (98%) attended 12- and 24-week data collection follow-ups. Throughout the study period, 82% of PED+ participants submitted their daily steps log. Daily steps increased in both groups (p < 0.001) but more in the PED+ group (2064 more steps at week 24, 95% confidence interval: 200–3925, p = 0.03). Self-reported physical activity levels and glycaemic parameters increased similarly in the two groups over time (p < 0.05). Improvements in social cognitive processes were seen only in the PED+ group (p < 0.05). There were no significant improvements in health-related quality of life.

Conclusion:

This study provides preliminary evidence that a pedometer-based walking programme, with or without additional support, is feasible and improves physical activity and glucose levels in Indonesian type 2 diabetes mellitus patients. Greater increases in step counts can result from the provision of text message support and education materials than from the provision of a pedometer only.

Are Older Adults With Symptomatic Knee Osteoarthritis Less Active Than the General Population? Analysis From the Osteoarthritis Initiative and the National Health and Nutrition Examination Survey

OBJECTIVE

To compare objectively measured physical activity in older adults with symptomatic knee osteoarthritis (OA) with similarly aged adults without osteoarthritis (OA) or knee symptoms from the general population.

METHODS

We included people ages 50-85 years with symptomatic knee OA from the Osteoarthritis Initiative (OAI, n = 491), and ages 50-85 years from the general population using National Health and Nutrition Examination Survey (NHANES, n = 449) data. A uniaxial accelerometer was worn for ≥10 hours/day for ≥4 days in the NHANES group in 2003-2004 and in the OAI group in 2008-2010. We calculated time spent in moderate-to-vigorous physical activity (MVPA in minutes/day) and described differences in MVPA and demographic variables between the samples. We conducted matched-pairs sensitivity analyses to further evaluate the role of potential confounders.

RESULTS

Both cohorts had similarly low levels of physical activity in age- and sex-specific strata. Time in MVPA ranged from a median of 1-22 minutes/day in people with symptomatic knee OA, and from 1-24 minutes/day in the general population without OA or knee pain. These results were similar in sensitivity analyses.

CONCLUSION

Time spent in MVPA was similarly low in those with symptomatic knee OA as in older adults without knee pain or OA.

Aerobic as well as resistance exercises are good for patients with type 1 diabetes

AIMS

To assess whether aerobic or resistance training has greater benefits in non-physically active men with a long lasting type 1 diabetes. The effects of exercise were evaluated in terms of diabetes control and risk factors for cardiovascular complications.

METHODS

21 male participants (mean age: 37 yrs, diabetes duration: 23 yrs, mean HbA1c: 7.4%) randomly assigned to 2 groups: 1-aerobic training (n = 10) and 2-resistance training (n = 11). All subjects participated in 60-min training sessions, either aerobic or resistance, twice a week for three months. At baseline and after 3 months: echocardiography, ECG and incremental exercise test, ECG and blood pressure monitoring, lipid profile, lactate and diabetes control parameters were assessed in all patients.

RESULTS

Baseline HbA1c was 7.44% in aerobic group and 7.36% in resistance group (p = 0.84). After 3 months there was no significant change in HbA1c value in any exercise group but a non-statistically significant downward trend was seen particularly in aerobic exercise group (p = 0.07) vs the resistance group (p = 0.15). There was no significant difference in body mass, risk of hypoglycemia and cardiovascular risk factors.

CONCLUSIONS

Both forms of exercise are safe in terms of glycemic control and cardiovascular risk factors in patients with quite well-controlled type 1 diabetes without advanced late complications.

Cardiovascular Risk Factors in Patients with Poorly Controlled Diabetes Mellitus

Introduction

Diabetes mellitus(DM) is considered an independent cardiovascular risk factor. Having in mind concomitant occurence of diabetes and other cardiovascular risk factors, it is expected that patients with poor glucoregulation will have more cardiovascular risk factors and higher cardiovascular risk than patients with good glucoregulation.

Aim

To compare cardiovascular risk and cardiovascular risk factors between patients with poorly controlled and patients with well-controlled Diabetes mellitus.

Material and Methods

Hundered ten patients aged 40-70 years suffering from Diabetes mellitus type 2 were included. Research is designed as a retrospective, descriptive study. Patients with glycosylated hemoglobin (HbA1c) > 7% were considered to have poorly controlled diabetes. The following data and parameters were monitored: age,sex, family history, data on smoking and alcohol consumption, BMI (body mass index), blood pressure, blood glucose, total cholesterol, triglycerides, LDL, HDL, fibrinogen, uric acid. For the assessment of cardiovascular risk, the WHO / ISH (World Health Organization/International Society of hypertension) tables of the 10-year risk were used, and due to the assessment of the risk factors prevalence, the optimal values of individual numerical variables were defined.

Results

Differences in the mean values of systolic, diastolic blood pressure, fasting glucose, total cholesterol, LDL cholesterol are statistically significant higher in patients with poorly controlled diabetes. Hypertension more frequently occurre in patients with poorly controlled DM. The majority of patients with well-controlled DM belong to the group of low and medium cardiovascular risk, while the majority of patients with poorly controlled DM belong to the group of high and very high cardiovascular risk. In our research, there was a significant difference in cardiovascular risk in relation to the degree of DM regulation, and HbA1c proved to be an important indicator for the emergence of the CVD.

Conclusion

There are significant differences in certain risk factors between patients with poorly controlled and well controlled DM. Patients with poorly controlled diabetes mellitus have a higher cardiovascular risk than patients with well controlled diabetes. The value of HbA1c should be considered when assessing cardiovascular risk.

Value-Added Electrodiagnostics: Targeting Interventions for Fall Risk Reduction

Walking confers numerous health benefits, particularly for middle-aged and older patients with diabetes and metabolic syndrome. Nevertheless, it brings a risk of injurious falls, especially among populations with diabetes and metabolic syndrome-related distal neuromuscular decline and frank neuropathy. Those who stand to benefit most from walking are at greatest risk. Development of practical clinical tools to more precisely quantify neuromuscular function and link it to mobility outcomes will help clinicians target interventions toward those at risk for falls. Electrodiagnosis, with inclusion of several newer techniques, serves as a promising tool for objective evaluation of distal neuromuscular function.

Why prescribe exercise as therapy in type 2 diabetes? We have a pill for that!

The majority of T2D cases are preventable through a healthy lifestyle, leaving little room for questions that lifestyle should be the first line of defence in the fight against the development of T2D. However, when it comes to the clinical care of T2D, the potential efficacy of lifestyle is much less clear-cut, both in terms of impacting the pathological metabolic biomarkers of the disease, and long-term complications. A healthy diet, high leisure-time physical activity, and exercise are considered to be cornerstones albeit adjunct to drug therapy in the management of T2D. The prescription and effective implementation of structured exercise and other lifestyle interventions in the treatment of T2D have not been routinely used. In this article, we critically appraise and debate our reflections as to why exercise and physical activity may not have reached the status of a viable and effective treatment in the clinical care of T2D to the same extent as pharmaceutical drugs. We argue that the reason why exercise therapy is not utilized to a satisfactory degree is multifaceted and primarily relates to a "vicious cycle" with lack of proven efficacy on T2D complications and a lack of proven effectiveness on risk factors in the primary care of T2D. Furthermore, there is a lack of experimental research establishing the optimal dose of exercise. This precludes widespread and sustained implementation of physical activity and exercise in the clinical treatment of T2D will not succeed.

Barriers and facilitators to physical activity among urban residents with diabetes in Nepal

INTRODUCTION

Physical activity is an important component of type 2 diabetes management. Physical activity level among general population in Nepal is reported to vary considerably. However, knowledge on physical activity in Nepali diabetics is very limited. Engagement in physical activity could be influenced by perception of barriers against adopting the behavior and benefits of adopting it. This study explores the prevalence of physical activity and factors that promote and hinder the behavior among urban residing diabetic patients from Nepal.

METHODS

A descriptive cross-sectional design was adopted using a simple random sampling of type 2 diabetic patients from two diabetes clinics at Lalitpur and Kaski districts of Nepal. Two hundred and seventy participants were surveyed to obtain information on physical activity using Global Physical Activity Questionnaire. Metabolic equivalent values were calculated and categorized into high, moderate and low levels of physical activity. The information on perceived facilitators and barriers was collected by Exercise Barriers and Benefits Survey scale. Odds ratios and 95% confidence intervals of the measures were estimated using multinomial logistic regression.

RESULTS

The study showed relatively high prevalence of physical activity among the urban Nepali diabetic patients; 52% were moderately active and 28% highly active. Travel and work-related activities were the major contributors. Male participants, educated and those living in extended families were more motivated for physical activity than their counterparts. Physical fitness, strength and flexibility, better sleep at night, social interaction and longevity, were identified as the major facilitators. Family responsibilities, busy schedule and family discouragement were identified as barriers against being physically active.

CONCLUSION

The diabetic patients were mostly moderately physically active. Future research could explore different context-specific ways of remaining physically active, apart from walking and doing household chores. More focus should also be placed on leisure time physical activity as it was found to be low. Interventions could be designed by promoting the facilitators and addressing the barriers of physical activity, which is likely to reduce the healthcare costs of management of diabetic complications.

Association of leisure-time physical activity with total and cause-specific mortality: a pooled analysis of nearly a half million adults in the Asia Cohort Consortium

BACKGROUND

Most previous studies evaluating the association between leisure-time physical activity (LTPA) and risk of death were conducted among generally healthy individuals of European ancestry. We investigated the association of LTPA with all-cause and cause-specific mortality among East Asian populations, including healthy individuals and those with existing chronic diseases, which has been less well characterized.

METHODS

We performed pooled analyses among 467 729 East Asian individuals recruited in nine prospective cohorts included in the Asia Cohort Consortium. Cox proportional hazards regressions were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs) associated with LTPA after adjusting for age, sex, education and marital and smoking status.

RESULTS

During a mean follow-up period of 13.6 years, 65 858 deaths were identified. Compared with those who reported no or less than 1 h of LTPA per week, an inverse association was observed between the amount of LTPA and all-cause and cause-specific mortality (P for trend < 0.001). The strength of the inverse association was stronger for death due to cardiovascular diseases and causes other than cancer deaths. An inverse association of LTPA with total mortality was observed among individuals with a severe and often life-threatening disease: cancer, stroke or coronary heart disease [hazard ratio (HR) = 0.81, 95% CI = 0.73-0.89 for high vs low LTPA) and those with other chronic diseases such as diabetes or hypertension (HR = 0.86, 95% CI = 0.80-0.93 for high vs low LTPA). No clear modifying effects by sex, body mass index or smoking status were identified.

CONCLUSIONS

Regular participation in LTPA is associated with reduced mortality in middle-aged and elder Asians regardless pre-existing health conditions.

The effect of 12 weeks of aerobic training on serum levels high sensitivity C-reactive protein, tumor necrosis factor-alpha, lipid profile and anthropometric characteristics in middle-age women patients with type 2 diabetes

AIMS

The aim of this study was to investigate the effect of 12 weeks of aerobic training on serum levels of high sensitivity C- reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), lipid profile and anthropometric characteristics in middle-aged women patients with type-2 diabetes.

METHODS

A quasi-experimental study, 20 women patients with type-2 diabetes (mean age, 50.25 ± 4.36 years, Body mass index, 25.51 ± 2.91 kg/m², and body fat percentage 23.67 ± 3.05%) were randomly categorized into two experimental and control groups. The protocol aerobic training included eight-minute jogging and eight-minute running with 75-85 percent maximum heart rate reserve in the first session. Per both sessions, one minute added to running time and it increased up to 32 min after 12 weeks. Blood sampling and anthropometric measurements, 24 h before and 48 h after the last training session were conducted.

RESULT

The result showed a significant reduction in hs-CRP and TNF-α in the experimental than control group (P = 0.01). Exercise training-treated patients showed a significant decrease in TG, LDL and increase HDL in comparison with baseline and the control group (P < .05). The results also showed a significant decrease in weight, body mass index, body fat percentage, and waist-hip ratio (P values 0.02, 0.03, 001, 0.04 respectively) following the 12 weeks aerobic training.

CONCLUSION

It seems that long-term aerobic training, improved some important anthropometric and biochemical parameters in patients with type-2 diabetes. These observations give a new insight into the mechanisms by which aerobic training can reduce the cardiovascular risk in diabetes.

Evolving Trends in the Epidemiology, Risk Factors, and Prevention of Type 2 Diabetes: A Review

Currently, the global prevalence of diabetes is 8.8%. This figure is expected to increase worldwide, with the largest changes projected to occur in low- and middle-income countries. The aging of the world's population and substantial increases in obesity have contributed to the rise in diabetes. Global shifts in lifestyles have led to the adoption of unhealthy behaviours such as physical inactivity and poorer-quality diets. Correspondingly, diabetes is a rapidly-increasing problem in higher- as well as lower-income countries. In Canada, the prevalence of diabetes increased approximately 70% in the past decade. Although diabetes-related mortality rates have decreased in Canada, the number of people affected by diabetes has continued to grow because of a surge in the number of new diabetes cases. Non-European ethnic groups and individuals of lower socioeconomic status have been disproportionately affected by diabetes and its risk factors. Clinical trials have proven efficacy in reducing the onset of diabetes in high-risk populations through diet and physical activity interventions. However, these findings have not been broadly implemented into the Canadian health care context. In this article we review the evolving epidemiology of type 2 diabetes, with regard to trends in occurrence rates and prevalence; the role of risk factors including those related to ethnicity, obesity, diet, physical activity, socioeconomic status, prediabetes, and pregnancy; and the identification of critical windows for lifestyle intervention. Identifying high-risk populations and addressing the upstream determinants and risk factors of diabetes might prove to be effective diabetes prevention strategies to curb the current diabetes epidemic.

Physical activity in patients with systemic sclerosis

OBJECTIVES

To compare self-reported levels of physical activity (PA) of systemic sclerosis (SSc) patients with the general population. To evaluate in SSc patients factors associated with PA levels and needs and preferences regarding PA.

METHODS

Fifty nine SSc patients completed the Short QUestionnaire to ASsess Health-Enhancing PA. The proportion of patients meeting the Dutch Recommendation for PA (= moderate PA for 30 min on ≥ 5 days/week) and total minutes of PA per week were calculated and compared with similar data from the Dutch population. Characteristics were univariately and multivariately compared between patients with low and high PA levels (either ≤ or > mean minutes/week of the Dutch population). Needs and preferences regarding PA promotion and guidance related to exercise were assessed by questionnaires.

RESULTS

Stratified for age (< 55 or ≥ 55 years) and gender, the proportion SSc patients meeting the Dutch recommendation for PA was not significantly different from the Dutch population. The total minutes of PA per week was significantly lower among SSc patients (1704 vs. 2614, P < 0.001). Multivariable analyses showed that in SSc patients the male gender, scleroderma health assessment questionnaire (SHAQ) and lack of energy were significantly associated with lower PA levels (P = 0.007; P = 0.042; P = 0.025). Two-third of patients required more information about PA.

CONCLUSION

In SSc patients, the total minutes of PA per week are significantly lower compared to the general population. The male gender, functional ability as reflected by SHAQ and lack of energy seem to interfere with PA. These results might guide health professionals in providing their patients with appropriate information on PA.

We Can Work (It) Out Together: Type 1 Diabetes Boot Camp for Adult Patients and Providers Improves Exercise Self-Efficacy

OBJECTIVES

This project aimed to use education sessions and exercise classes to improve exercise self-efficacy in individuals with type 1 diabetes and in diabetes care providers (DCPs).

METHODS

We recruited 12 adults with type 1 diabetes and 12 DCPs who participated in 4 weekly group sessions to learn about exercise physiology and to experience various exercise types. We provided participants who had type 1 diabetes with real-time continuous glucose monitors and heart rate monitors to enhance experiential learning. Both groups completed questionnaires before and after the study to assess confidence concerning exercise. Following the study, focus groups assessed the impact of the study on knowledge and self-efficacy.

RESULTS

There was an improvement in DCPs' attitudes toward exercise (p=0.004). DCPs' confidence in providing clients with advice regarding the time, type and intensity of exercise (p=0.005) and strategies for overcoming barriers to exercise (p=0.016) improved significantly. We found no significant changes in results in the questionnaires of participants with type 1 diabetes. Focus group analysis suggested that the study improved awareness of the importance of exercise as well as knowledge about the effects of exercise in type 1 diabetes by both DCPs and participants. Continuous glucose monitor use alleviated fear of hypoglycemia by participants with type 1 diabetes.

CONCLUSIONS

These findings suggest that a 4-week education- and exercise-focused program improves DCPs' self-efficacy in providing exercise advice to patients. People with type 1 diabetes did not experience an improvement in exercise self-efficacy; however, the study supports the use of continuous glucose monitoring and the grouping of DCPs and individuals with type 1 diabetes to facilitate experiential learning.

Mechanisms of Aerobic Exercise Impairment in Diabetes: A Narrative Review

The prevalence of diabetes in the United States and globally has been rapidly increasing over the last several decades. There are now estimated to be 30.3 million people in the United States and 422 million people worldwide with diabetes. Diabetes is associated with a greatly increased risk of cardiovascular mortality, which is the leading cause of death in adults with diabetes. While exercise training is a cornerstone of diabetes treatment, people with diabetes have well-described aerobic exercise impairments that may create an additional diabetes-specific barrier to adding regular exercise to their lifestyle. Physiologic mechanisms linked to exercise impairment in diabetes include insulin resistance, cardiac abnormalities, mitochondrial function, and the ability of the body to supply oxygen. In this paper, we highlight the abnormalities of exercise in type 2 diabetes as well as potential therapeutic approaches.

Cardiovascular disease risk reduction in diabetes through conventional and natural approaches

Type 2 diabetes mellitus (DM) is a significant cause of premature complications and mortality in patients with cardiovascular disease (CVD). In addition to lifestyle modifications, conventional treatment of DM consists of oral hypoglycemic agents, insulin sensitizers, and subcutaneous insulin. In diabetic individuals with or at risk for CVD, aspirin and statin therapy reduce CVD morbidity and mortality. Several natural or herbal supplements have shown potential benefit in patients with CVD and DM. We provide an overview of the current guidelines for treatment of DM and CVD. We then review the literature to describe the efficacy of natural approaches to CVD risk reduction in diabetic patients, with a focus on physical activity, dietary modification, and natural/herbal supplements. Activity and diet improve cardiovascular outcomes in patients with CVD and DM. Natural and herbal supplements have potential for benefit but require further research to determine their efficacy and safety.

Implementing Low-Cost, Community-Based Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes: What Are the Benefits for Glycemic Control and Cardiovascular Risk?

BACKGROUND

The purpose of this study was to analyze the effects of a long-term, community-based, combined exercise program developed with low-cost exercise strategies on glycemic control and cardiovascular risk factors in middle-aged and older patients with type 2 diabetes.

METHODS

Participants (n = 124; 63.25 ± 7.20 years old) engaged in either a 9-month supervised exercise program (n = 39; consisting of combined aerobic, resistance, agility/balance, and flexibility exercise; three sessions per week; 70 min per session) or a control group (n = 85) who maintained their usual care. Glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease were assessed before and after the 9-month intervention.

RESULTS

A significant time * group interaction effect (p < 0.001) was identified in the values of the glycated hemoglobin, fasting plasma glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, and the 10-year risk of coronary artery disease.

CONCLUSIONS

A long-term, community-based, combined exercise program developed with low-cost exercise strategies was effective in inducing significant benefits on glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease in middle-aged and older patients with type 2 diabetes. Clinical Trial Identification Number: ISRCTN09240628.

Sex-specific effects of leisure-time physical activity on cause-specific mortality in NHANES III

Associations between leisure time physical activity (LTPA) and all-cause mortality seem quite strong, however, less is known about the association of LTPA and cause-specific mortality. To examine this association data from the Third National Health and Nutrition Examination Survey (NHANES III), including 15,307 individuals of the non-institutionalized civilian United States population, were used. Data were collected from 1988 to 1994 with a mortality follow-up until 2006. LTPA was assessed during home interviews in which participants specified their LTPA and the performed frequency during the past month. Cox proportional hazards regression models were applied to analyze the risk of cause-specific mortality regarding LTPA. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed. An inverse association of LTPA with CVD mortality was observed for men and women combined for irregular (HR 0.66; 95% CI 0.51-0.85), and for regular activity (HR 0.58; 95% CI 0.47-0.72). An inverse association of LTPA with CVD mortality was observed only in women for irregular (HR 0.64; 95% CI 0.49-0.84) and for regular activity (HR 0.55; 95% CI 0.43-0.72). In men, no significant associations were seen. For mortality caused by respiratory diseases, a decreased mortality was also observed in the combined group (men and women) but after separating according to sex a decreased mortality was only observed in women. No statistically significant association of LTPA with cancer mortality was observed. Our data support an inverse association between LTPA and CVD and respiratory disease mortality in women, but not in men, and no associations with cancer.

Complex and Simple Clinical Reaction Times Are Associated with Gait, Balance, and Major Fall Injury in Older Subjects with Diabetic Peripheral Neuropathy

OBJECTIVE

The aim of this work was to identify relationships between complex and simple clinical measures of reaction time (RTclin) and indicators of balance in older subjects with and without diabetic peripheral neuropathy (DPN).

DESIGN

Prospective cohort design. Complex RTclin accuracy, simple RTclin latency, and their ratio were determined using a novel device in 42 subjects (mean ± SD age, 69.1 ± 8.3 yrs), 26 with DPN and 16 without. Dependent variables included unipedal stance time (UST), step width variability and range on an uneven surface, and major fall-related injury over 12 months.

RESULTS

In the DPN subjects, the ratio of complex RTclin accuracy to simple RTclin latency was strongly associated with longer UST (R/P = 0.653/0.004), and decreased step width variability and range (R/P = -0.696/0.001 and -0.782/<0.001, respectively) on an uneven surface. Additionally, the 2 DPN subjects sustaining major injuries had lower complex RTclin accuracy:simple RTclin latency than those without.

CONCLUSIONS

The ratio of complex RTclin accuracy:simple RTclin latency is a potent predictor of UST and frontal plane gait variability in response to perturbations and may predict major fall injury in older subjects with DPN. These short latency neurocognitive measures may compensate for lower limb neuromuscular impairments and provide a more comprehensive understanding of balance and fall risk.

Association of dietary nitrate with atherosclerotic vascular disease mortality: a prospective cohort study of older adult women

Background: Nitrate-rich vegetables lower blood pressure and improve endothelial function in humans. It is not known, however, whether increased consumption of nitrate-rich vegetables translates to a lower risk of atherosclerotic vascular disease (ASVD) mortality.Objective: The objective was to investigate the association of nitrate intake from vegetables with ASVD mortality.Design: A total of 1226 Australian women aged 70-85 y without prevalent ASVD and/or diabetes were recruited in 1998 and were studied for 15 y. We assessed demographic and ASVD risk factors at baseline (1998), and we used a validated food-frequency questionnaire to evaluate dietary intake. Nitrate intake from vegetables was calculated by use of a newly developed comprehensive database. The primary outcome was any death attributed to ASVD ascertained by using linked data that were provided via the Western Australian Data Linkage system. We used Cox proportional hazards modeling to examine the association between nitrate intake and ASVD mortality before and after adjustment for lifestyle and cardiovascular disease risk factors.Results: During a follow-up period of 15,947 person-years, 238 of 1226 (19.4%) women died of ASVD-related causes. The mean ± SD vegetable nitrate intake was 67.0 ± 29.2 mg/d. Each SD higher vegetable nitrate intake was associated with a lower risk of ASVD mortality in both unadjusted [HR: 0.80 (95% CI: 0.70, 0.92), P = 0.002] and multivariable-adjusted [HR: 0.79 (95% CI: 0.68, 0.93), P = 0.004] analyses. This relation was attenuated after further adjustment for diet quality [HR: 0.85 (95% CI: 0.72, 1.01), P = 0.072]. Higher vegetable nitrate intake (per SD) also was associated with a lower risk of all-cause mortality [multivariable-adjusted HR: 0.87 (95% CI: 0.78, 0.97), P = 0.011].Conclusions: Nitrate intake from vegetables was inversely associated with ASVD mortality independent of lifestyle and cardiovascular disease risk factors in this population of older adult women without prevalent ASVD or diabetes. These results support the concept that nitrate-rich vegetables may reduce the risk of age-related ASVD mortality. This trial was registered at www.anzctr.org.au as ACTRN12617000640303.

The essential role of exercise in the management of type 2 diabetes

Exercise is typically one of the first management strategies advised for patients newly diagnosed with type 2 diabetes. Together with diet and behavior modification, exercise is an essential component of all diabetes and obesity prevention and lifestyle intervention programs. Exercise training, whether aerobic or resistance training or a combination, facilitates improved glucose regulation. High-intensity interval training is also effective and has the added benefit of being very time-efficient. While the efficacy, scalability, and affordability of exercise for the prevention and management of type 2 diabetes are well established, sustainability of exercise recommendations for patients remains elusive.

Physical Activity for the Prevention of Cardiovascular Diseases

Over the last decade, the quantity and quality of scientific literature examining the relationship between physical activity (PA) and cardiovascular diseases (CVD) have significantly increased. Data from the literature now unequivocally show that physical inactivity is one of the major risk factors for CVD. It is believed that obesity, the prevalence of which has tripled over the last three decades, and physical inactivity among children are the main factors that will increase the prevalence of CVD in this century. The cardiovascular benefits of exercise are multifactorial and include important systemic effects on skeletal muscle, the peripheral vasculature, metabolism, and neurohumoral systems, as well as beneficial alterations within the myocardium itself. Thus, exercise does much more than change traditional risk factors, such as blood pressure, blood lipids, glucose tolerance and insulin resistance, metabolic syndrome, and overweight and obesity. Evidence from epidemiologic studies suggests that the preventive effects of PA may be achieved by 150 minutes of moderate PA a week, while increases in the intensity and volume of exercise lead to further health benefits. This dose–response gradient is curvilinear, with the largest gains from the first hour of weekly exercise. However, although much progress has been made in this field, existing studies performed on human subjects do not clearly show what type, intensity, and duration of exercise is most beneficial to cardiovascular fitness and metabolic optimization. Animal-based exercise studies may provide more information and help to elucidate the abilities of different training regimens to reduce the risk of CVD.

How to Tackle Key Challenges in the Promotion of Physical Activity among Older Adults (65+): The AEQUIPA Network Approach

The paper introduces the theoretical framework and methods/instruments used by the Physical Activity and Health Equity: Primary Prevention for Healthy Ageing (AEQUIPA) prevention research network as an interdisciplinary approach to tackle key challenges in the promotion of physical activity among older people (65+). Drawing on the social-ecological model, the AEQUIPA network developed an interdisciplinary methodological design including quantitative/qualitative studies and systematic reviews, while combining expertise from diverse fields: public health, psychology, urban planning, sports sciences, health technology and geriatrics. AEQUIPA tackles key challenges when promoting physical activity (PA) in older adults: tailoring of interventions, fostering community readiness and participation, strengthening intersectoral collaboration, using new technological devices and evaluating intervention generated inequalities. AEQUIPA aims to strengthen the evidence base for age-specific preventive PA interventions and to yield new insights into the explanatory power of individual and contextual factors. Currently, the empirical work is still underway. First experiences indicate that thenetwork has achieved a strong regional linkage with communities, local stakeholders and individuals. However, involving inactive persons and individuals from minority groups remained challenging. A review of existing PA intervention studies among the elderly revealed the potential to assess equity effects. The results will add to the theoretical and methodological discussion on evidence-based age-specific PA interventions and will contribute to the discussion about European and national health targets.

Physical Activity and the Effect of Multimorbidity on All-Cause Mortality in Older Adults

OBJECTIVE

To examine the stratified and joint associations of physical activity (PA) and the number of chronic conditions on long-term all-cause mortality.

PATIENTS AND METHODS

We used data from a cohort of 3967 individuals representative of the noninstitutionalized population 60 years and older in Spain (2000/2001). Information on self-reported PA (inactive, occasionally, monthly, weekly) and 11 chronic conditions diagnosed by a physician and reported by the study participants were recorded. Associations are summarized using hazard ratios (HRs) and Cox regression, after adjustment for covariates.

RESULTS

At baseline, 43.2%, 37.5%, 14.4%, and 4.9% of participants had 0, 1, 2, and 3 or more chronic conditions, respectively. Mean follow-up was 8.9 years (median, 10.8 years; range, 0.02-11.28 years), with 1483 deaths. The HRs (95% CIs) for all-cause mortality in participants with 1, 2, and 3 or more chronic conditions compared with those with none were 1.26 (1.05-1.39), 1.78 (1.51-2.09), and 2.27 (1.79-2.86), respectively. Being physically active (ie, doing any PA) was associated with a mortality reduction (95% CI) of 30% (14%-43%), 33% (18%-45%), 35% (16%-50%), and 47% (18%-66%) in participants with 0, 1, 2, and 3 or more chronic conditions, respectively. Compared with those with 0 chronic conditions who were physically active, participants with 2 (HR=2.63; 95% CI, 2.09-3.31) and 3 or more (HR=3.26; 95% CI, 2.42-4.38) chronic conditions who were physically inactive had the highest mortality risk.

CONCLUSION

Physical activity is associated with a reduction in increased risk of death associated with multimorbidity (ie, coexistence of ≥2 chronic conditions) in older individuals.

Are all people with diabetes and cardiovascular risk factors or microvascular complications at very high risk? Findings from the Risk and Prevention Study

AIMS

To verify whether it is possible, in people with diabetes mellitus (DM) considered at very high cardiovascular (CV) risk, stratify this risk better and identify significant modifiable risk factor (including lifestyle habits) to help patients and clinicians improve CV prevention.

METHODS

People with DM and microvascular diseases or one or more CV risk factors (hypertension, hyperlipidemia, smoking, poor dietary habits, overweight, physical inactivity) included in the Risk and Prevention study were selected. We considered the combined endpoint of non-fatal acute myocardial infarction and stroke and CV death. A multivariate Cox proportional analysis was carried out to identify relevant predictors. We also used the RECPAM method to identify subgroups of patients at higher risk.

RESULTS

In our study, the rate of major CV events was lower than expected (5 % in 5 years). Predictors of CV events were age, male, sex, heart failure, previous atherosclerotic disease, atrial fibrillation, insulin treatment, high HbA1c, heart rate and other CV diseases while being physically active was protective. RECPAM analysis indicated that history of atherosclerotic diseases and a low BMI defined worse prognosis (HR 4.51 95 % CI 3.04-6.69). Among subjects with no previous atherosclerotic disease, men with HbA1c more than 8 % were at higher CV risk (HR 2.77; 95 % CI 1.86-4.14) with respect to women.

CONCLUSIONS

In this population, the rate of major CV events was lower than expected. This prediction model could help clinicians identify people with DM at higher CV risk and support them in achieving goals of physical activity and HbA1c.

Exercise mediated protection of diabetic heart through modulation of microRNA mediated molecular pathways

Hyperglycaemia, hypertension, dyslipidemia and insulin resistance collectively impact on the myocardium of people with diabetes, triggering molecular, structural and myocardial abnormalities. These have been suggested to aggravate oxidative stress, systemic inflammation, myocardial lipotoxicity and impaired myocardial substrate utilization. As a consequence, this leads to the development of a spectrum of cardiovascular diseases, which may include but not limited to coronary endothelial dysfunction, and left ventricular remodelling and dysfunction. Diabetic heart disease (DHD) is the term used to describe the presence of heart disease specifically in diabetic patients. Despite significant advances in medical research and long clinical history of anti-diabetic medications, the risk of heart failure in people with diabetes never declines. Interestingly, sustainable and long-term exercise regimen has emerged as an effective synergistic therapy to combat the cardiovascular complications in people with diabetes, although the precise molecular mechanism(s) underlying this protection remain unclear. This review provides an overview of the underlying mechanisms of hyperglycaemia- and insulin resistance-mediated DHD with a detailed discussion on the role of different intensities of exercise in mitigating these molecular alterations in diabetic heart. In particular, we provide the possible role of exercise on microRNAs, the key molecular regulators of several pathophysiological processes.

Physical activity and type 2 diabetes mellitus risk: population studies review

Physical activity is one of the most important components of a healthy lifestyle. Regular physical activity helps to maintain normal blood glucose levels and reduce the risk of type 2 diabetes mellitus. This review presents population studies investigating physical activity as a factor for type 2 diabetes mellitus risk. A search using the keywords ‘physical activity’, ‘type 2 diabetes mellitus’ and ‘risk’ identified more than 40 relevant original studies and meta-analyses, which are presented in this review. Different types of physical activity have positive protective effects on type 2 diabetes mellitus risk and reduce the risk of death in patients with type 2 diabetes mellitus.

Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review

Obesity and a sedentary lifestyle are common challenges among individuals at risk of diabetic foot ulcers. While substantial research exists on physical activity interventions in adults with diabetes, those at greatest risk for foot ulceration were often excluded or not well represented. Both at-risk patients and their clinicians may be hesitant to increase physical activity because of their perception of diabetic foot ulcer risks. Physical activity is not contraindicated for those at risk of diabetic foot ulcer, yet patients at risk present with unique barriers to initiating increases in physical activity. This review focuses upon the physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers. Offloading, diabetic peripheral neuropathy, depression, pain, self-efficacy and social support, diabetic foot ulcer risk-specific beliefs and emotions, and research to date on exercise interventions in this population are all discussed. Additionally, recommendations for implementing and researching physical activity interventions for individuals at risk for diabetic foot ulcer are provided. Copyright © 2016 John Wiley & Sons, Ltd.

Prevalence of physical inactivity in Iran: a systematic review

Introduction: Physical inactivity is one of the most important risk factors for chronic diseases, including cardiovascular disease, cancer, and stroke. We aim to conduct a systematic review of the prevalence of physical inactivity in Iran.

Methods: We searched international databases; ISI, PubMed/Medline, Scopus, and national databases Irandoc, Barakat knowledge network system, and Scientific Information Database (SID). We collected data for outcome measures of prevalence of physical inactivity by sex, age, province, and year. Quality assessment and data extraction has been conducted independently by two independent research experts. There were no limitations for time and language.

Results: We analyzed data for prevalence of physical inactivity in Iranian population. According to our search strategy we found 254 records; of them 185 were from international databases and the remaining 69 were obtained from national databases after refining the data, 34 articles that met eligible criteria remained for data extraction. From them respectively; 9, 20, 2 and 3 studies were at national, provincial, regional and local levels. The estimates for inactivity ranged from approximately 30% to almost 70% and had considerable variation between sexes and studied sub-groups.

Conclusion: In Iran, most of studies reported high prevalence of physical inactivity. Our findings reveal a heterogeneity of reported values, often from differences in study design, measurement tools and methods, different target groups and sub-population sampling. These data do not provide the possibility of aggregation of data for a comprehensive inference.

The Impact of Physical Activity for Cancer Prevention: Implications for Nurses

OBJECTIVES

To discuss the significant issues surrounding the prescribing of physical activity as a first line of defense against the development of age-associated life-limiting illnesses such as cancer while providing strategic knowledge for clinicians regarding its prescription and management.

DATA SOURCES

Literature review on physical activity in cancer prevention.

CONCLUSION

There is growing evidence that reduced physical activity increases the risk of co-morbid conditions such as cancer, yet there is limited clinician education and subsequent prescription of physical activity.

IMPLICATIONS FOR NURSING PRACTICE

Nurses in partnership with other primary care clinicians have a unique opportunity to effect change of our nation's greatest modifiable public health threat, physical inactivity.

Gait Efficiency on an Uneven Surface Is Associated with Falls and Injury in Older Subjects with a Spectrum of Lower Limb Neuromuscular Function: A Prospective Study

OBJECTIVE

The objective of this study was to determine which gait measures on smooth and uneven surfaces predict falls and fall-related injuries in older subjects with diabetic peripheral neuropathy.

DESIGN

Twenty-seven subjects (12 women) with a spectrum of peripheral nerve function ranging from normal to moderately severe diabetic peripheral neuropathy walked on smooth and uneven surfaces, with gait parameters determined by optoelectronic kinematic techniques. Falls and injuries were then determined prospectively over the following year.

RESULTS

Seventeen subjects (62.9%) fell and 12 (44.4%) sustained a fall-related injury. As compared with nonfallers, the subject group reporting any fall, as well as the subject group reporting fall-related injury, demonstrated decreased speed, greater step width (SW), shorter step length (SL), and greater SW-to-SL ratio (SW:SL) on both surfaces. Uneven surface SW:SL was the strongest predictor of falls (pseudo-r = 0.65; P = 0.012) and remained so with inclusion of other relevant variables into the model. Post hoc analysis comparing injured with noninjured fallers showed no difference in any gait parameter.

CONCLUSION

SW:SL on an uneven surface is the strongest predictor of falls and injuries in older subjects with a spectrum of peripheral neurologic function. Given the relationship between SW:SL and efficiency, older neuropathic patients at increased fall risk appear to sacrifice efficiency for stability on uneven surfaces.

Gender differences in the association between lifestyle behaviors and diabetes distress in a community sample of adults with type 2 diabetes

BACKGROUND

The present study examined the association between moderate and severe diabetes distress (DD) and lifestyle behaviors (physical activity, smoking, alcohol consumption) in a community sample of adults with type 2 diabetes mellitus (T2DM).

METHODS

A total of 1971 adults with T2DM were recruited using mixed methods sampling. Participants were considered eligible if they had a doctor diagnosis of T2DM (≤10 years), were insulin naïve, aged 40-75 years, and were from Quebec, Canada. Participants provided information on DD, lifestyle behaviors, sociodemographic, and diabetes-related factors. Multinomial logistic regressions examined the association between moderate and severe DD and each lifestyle behavior, according to gender. Effect estimates can be interpreted as probability ratios (PR).

RESULTS

In females, physical inactivity was associated with an increased likelihood of moderate distress (PR 2.2; 95% confidence interval [CI] 1.49-3.24) and severe distress (PR 1.80; 95% CI 1.00-3.24). In males, only severe distress was associated with physical inactivity (PR 1.92; 95% CI 1.00-3.66). Current smoking was associated with a greater probability of severe distress in males (PR 3.0; 95% CI 1.54-5.84) and females (PR 1.32; 95% CI 0.67-2.60); however this effect was stronger in males. No association was found between alcohol consumption and DD in females. In males, frequent alcohol consumption was associated with a reduced probability of moderate (PR 0.56; 95% CI 0.34-0.91) and severe distress (PR 0.47; 95% CI 0.21-1.06).

CONCLUSIONS

The findings of this study suggest important gender differences in the association between DD and lifestyle behaviors.

Promoting community readiness for physical activity among older adults in Germany--protocol of the ready to change intervention trial

Background

Healthy ageing is an important concern for many societies facing the challenge of an ageing population. Physical activity (PA) is a major contributor to healthy ageing; however insufficient PA levels are prevalent in old age in Germany. Community capacity building and community involvement are often recommended as key strategies to improve equitable access to prevention and health promotion. However, evidence for the effectiveness of these strategies is scarce. This study aims to assess the community readiness for PA promotion in local environments and to analyse the utility of strategies to increase community readiness for reaching vulnerable groups.

Methods/Design

We designed a mixed method intervention trial comprising three study modules. The first module includes an assessment of community readiness for PA interventions in older adults. The assessment is carried out in a sample of 24 municipalities in the Northwest of Germany using structured key informant interviews. In the second module, eight municipalities with the low community readiness are selected from the sample and randomly assigned to one of two study groups: active enhancement of community readiness (intervention) versus no enhancement (control). After enhancing community readiness in the active enhancement group, older adults in both study groups will be recruited for participation in a PA intervention. Participation rates are compared between the study groups to evaluate the effects of the intervention. In addition, a cost-effectiveness analysis is carried out calculating recruitment costs per person reached in the two study groups. In the third module, qualitative interviews are conducted with participants and non-participants of the PA intervention exploring reasons for participation or non-participation.

Discussion

This study offers the potential to contribute to the evidence base of reaching vulnerable older adults for PA interventions and provide ideas on how to reduce participation barriers. Its findings will inform governmental authorities, professionals, academics, and NGOs with an estimate of resources necessary to achieve equitable access to physical activity programs for vulnerable older adults.

Trial registration

German Clinical Trials Register DRKS00009564 (Date of registration 03-11-2015)

Association between -308G/A TNFA Polymorphism and Susceptibility to Type 2 Diabetes Mellitus: A Systematic Review

Diabetes mellitus (DM) is considered to be a worldwide epidemic disease and its type 2 form comprises more than 95% of all cases. Tumor necrosis factor-alpha (TNF-α) is a proinflammatory cytokine. Its dysregulation has been implicated in a variety of human diseases, including type 2 diabetes mellitus (T2DM). The control of expression of this cytokine is associated with insulin resistance and has a strong genetic influence. In order to understand this relationship, the literature from all case-control studies since 2000 to date was reviewed. The genotypes frequency results presented in ten publications with different ethnicities were compared. The correlation between the TNFA promoter genotypes and the risk of developing T2DM remains controversial due to the many discrepancies between the different studies available. Ethnic differences may play a role in these conflicting results, since the distribution of TNFA promoter polymorphisms is distinctive between individuals of dissimilar racial origin. Hence, although the relationship between T2DM incidence and presence of polymorphisms at position -308 of the TNFA gene is not entirely clear, the results of these studies suggest the need for further investigation.

Effects of different exercise programs and minimal detectable changes in hemoglobin A1c in patients with type 2 diabetes

BACKGROUND

The incidence of diabetes mellitus is increasing worldwide, resulting in a global epidemic. The most common type, the type 2 diabetes mellitus, constitutes of 90-95 % of the cases and is characterized by the action of and/or impaired insulin secretion. Regular exercise is a recommended strategy in several studies and guidelines for type 2 diabetes control and complications associated with it. Therefore, we evaluated and compared the effects of aerobic and strength exercise programs on the glycemic control in patients with type 2 diabetes.

METHODS

The selected patients were divided into groups which performed moderate strength training (ST) and aerobic training (AT). The study lasted 20 weeks and was divided into two 10 week phases with anthropometric (body mass index, waist, abdomen and hips circumferences, waist/hip ratio) and biochemical (glycemic and lipid profile) assessments at baseline, 10 weeks and 20 weeks. For intra and inter analyses a mixed ANOVA model was used. Individual changes were calculated using the minimum detectable change, based on a 90 % confidence interval.

RESULTS

Eleven patients (five men and six women) completed the 20 weeks of training; five from the ST group and six from the AT. No significant changes were observed in any anthropometric variable in either group. Statistically significant differences were found in mean hemoglobin A1c in both groups between baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 10 weeks (AT: 7.2 ± 1.7; ST: 7.9 ± 1.2) (p = 0.03), and baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 20 weeks (AT: 7.5 ± 1.7; ST: 7.4 ± 0.9) (p = 0.01). For the minimal detectable changes, 40 % of the ST and 33 % of AT achieved these changes for hemoglobin A1c.

CONCLUSION

Both aerobic and strength exercises can help the metabolic control in patients with type 2 diabetes, even without significant changes in anthropometry over the 20 weeks of training. However, this period was sufficient to cause changes in hemoglobin A1c values and the estimated average glucose, which are important parameters in controlling diabetes, thus signaling an important consequence of adhering to an exercise routine for type 2 diabetic patients.

Physical Activity Level of Korean Adults with Chronic Diseases: The Korean National Health and Nutritional Examination Survey, 2010-2012

BACKGROUND

Proper physical activities are known to be helpful in the prevention and management of chronic diseases. However, the physical activity level of patients with chronic diseases is low. Therefore, this study aimed to investigate the physical activity compliance of patients with hypertension, diabetes, and dyslipidemia in Korea.

METHODS

This study analyzed the 2010-2012 Fifth Korean National Health and Nutrition Examination Survey data. We included 13,873 individuals in the analysis. The level of physical activity compliance was measured by performing multivariate logistic regression analyses.

RESULTS

In the univariate analysis, the subjects with hypertension or diabetes tended to comply with the physical activity guidelines less faithfully than their healthy counterparts. The proportion of subjects with hypertension who were insufficiently physically active was 65.4% among the men and 75.8% among the women. For diabetes, the proportions were 66.7% and 76.8%, respectively. No significant difference was found between the subjects with dyslipidemia and their healthy counterparts. In the multivariate logistic regression analysis, no significant difference in physical activity compliance was observed between the subjects with hypertension, diabetes, or dyslipidemia and their healthy counterparts for both sexes.

CONCLUSION

The patients with hypertension or diabetes tended to have lower physical activity prevlaence than their healthy counterparts. However, for dyslipidemia, no significant difference was found between the two groups. Given the significance of physical activities in the management of chronic diseases, the physical activities of these patients need to be improved.

Clinical effect of real time pulse rate monitoring with a portable pulsimeter on physical exercise therapy for male patients with type 2 diabetes

In patients with type 2 diabetes, it is recommended that exercise therapy is performed using heart rate as an index of exercise intensity. This study was designed to clinically evaluate whether continuous exercise therapy with a portable pulsimeter for self-monitoring of the pulse rate influences glycemic control in patients with type 2 diabetes. We randomly assigned 23 male patients to a pulse displayed group (in which the portable pulsimeter displayed a pulse rate) or a pulse non-displayed group (in which the portable pulsimeter only recorded the data and did not display a pulse rate). The patients then received exercise therapy for 1 month. Patients in the pulse displayed group were instructed to regulate their walking speed by maintaining their portable pulsimeter in the target pulse rate zone, whereas patients in the pulse non-displayed group were instructed to regulate their walking speed while taking their pulse rate and using the Borg scale to maintain the target pulse rate zone using the conventional method. We found the mean walking time within the target pulse rate zone during exercise therapy was significantly increased in the pulse displayed group (p < 0.01). Similarly, glycoalbumin and 1,5-anhydro-D-glucitol improved significantly in the pulse displayed group after 1 month of exercise therapy (p < 0.01, respectively). Our results suggest that this therapeutic device might be useful for improving glycemic control in patients with type 2 diabetes.

Change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance

Patients with pre-diabetes have a tenfold higher risk of developing Type 2 DM and a twofold higher risk of developing coronary heart disease compared to non-diabetics. Interventions targeted at those in an early stage of impaired glucose metabolism can delay or prevent diabetes. Effects of these interventions on cardiovascular outcome are unknown. This article aims to review current and available data on lifestyle intervention, specifically physical activity, on cardiovascular outcomes in populations at risk for diabetes. We searched PubMed database from 1990 to present with focus on more recent literature published over the last 2 years. Various permutations of keywords used included glucose intolerance, pre-diabetes, diabetes, lifestyle modifications, physical activity, and cardiovascular disease. Intensive glycemic control, specific medications, and lifestyle intervention including increase in physical activity have been evaluated in diabetes and pre-diabetes. Most studies we reviewed showed that these interventions prevented progression of pre-diabetes to diabetes and improved cardiovascular risk surrogate measures. Direct decrease in cardiovascular mortality, non-fatal stroke, and non-fatal myocardial infarctions was shown in one recent trial. Increase in physical activity has a positive effect on decreasing cardiovascular risk by modifying several important risk factors and may decrease risk of events in pre-diabetics. More randomized high power trials are needed to verify and characterize these effects.

Physical activity, sedentary behavior and all-cause mortality among blacks and whites with diabetes

PURPOSE

The study objective was to examine the role of physical activity (PA) and sedentary time (ST) on mortality risk among a population of low-income adults with diabetes.

METHODS

Black (n = 11,137) and white (n = 4508) men and women with diabetes from the Southern Community Cohort Study self-reported total PA levels and total ST. Participants were categorized into quartiles of total PA and total ST. Hazard ratios (HRs) and 95% confidence intervals (CIs) for subsequent mortality risk were estimated from Cox proportional hazards analysis with adjustment for potential confounders.

RESULTS

During follow-up, 2370 participants died. The multivariable risk of mortality was lower among participants in the highest quartile of PA compared with those in the lowest quartile (HR, 0.64; 95% CI: 0.57-0.73). Mortality risk was significantly increased among participants in the highest compared with the lowest quartile of ST after adjusting for PA (HR, 1.21; 95% CI: 1.08-1.37). Across sex and race groups, similar trends of decreasing mortality with rising PA and increasing mortality with rising ST were observed.

CONCLUSIONS

Although causality cannot be established from these observational data, the current findings suggest that increasing PA and decreasing ST may help extend survival among individuals with diabetes irrespective of race and sex.