Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: a systematic review and meta-analysis

DASH diet vs. DASH diet plus physical activity in older patients with type 2 diabetes and high blood pressure: A randomized clinical trial

BACKGROUND AND AIMS

To evaluate the effect of lifestyle modification by adopting a DASH diet, with and without physical activity guidance, on blood pressure, glycemic control, lipid profile, weight, and body composition in older patients with type 2 diabetes mellitus (T2DM) and hypertension.

METHODS AND RESULTS

For this randomized clinical trial, we recruited patients aged 60 years or older with T2DM and uncontrolled hypertension. One group (DASH) received only DASH dietary guidance, while the other group (DASHPED) received dietary guidance and encouragement to walk with a pedometer. Outcomes of interest were (1) blood pressure, (2) physical activity, (3) weight, body mass index (BMI), and body composition, and (4) biochemical variables. Measurements were taken at baseline and 16 weeks after the intervention. We included 35 patients in the analysis. At the end of the study, the DASHPED group had an mean increase in physical activity of 1721 steps/day. Both groups displayed significantly reduced weight, BMI, and waking diastolic pressures on ambulatory blood pressure monitoring after the intervention. A trend of reduced sleeping diastolic pressure was found in the DASHPED group. Changes in weight, BMI, muscle mass, body fat, waist-hip ratio, glycemic control, lipid profile, and insulin sensitivity did not differ between the groups.

CONCLUSION

There was no difference in outcomes between the group that only dieted and the group that also performed increased physical activity, despite a significant increase in exercise. This reinforces the importance of dietary changes in immediate blood pressure control.

The Role of Tele-Exercise for People with Type 2 Diabetes: A Scoping Review

BACKGROUND

Supervised exercise interventions tend to be more effective than unsupervised exercises or physical activity advice alone. However, people with type 2 diabetes may find it difficult to attend supervised exercise interventions due to several obstacles. Tele-exercise, or utilizing technology to deliver home-based exercise, might be a solution.

OBJECTIVE

This scoping review aimed to explore clinical trials investigating the impact of tele-exercise interventions in individuals with type 2 diabetes Methods: Four electronic databases were searched for the period up to January 2024 for clinical trials investigating the impact of tele-exercise on health-related outcomes in adults with type 2 diabetes.

RESULTS

Seven trials involving 460 individuals with type 2 diabetes met the inclusion criteria. In these trials, combined aerobic and resistance exercise programs were the main types delivered remotely. To deliver such programs, both synchronous (n = 4) and asynchronous (n = 3) delivery modes were adopted. Regardless of the delivery mode, all tele-exercise interventions led to improvements in various factors related to type 2 diabetes and its complications, including glycemic control, blood lipids, body composition, functional capacity, muscle strength, and quality of life. The improvements were also found to be as effective as those of supervised exercise.

CONCLUSIONS

Tele-exercise interventions seem to be feasible and as effective as supervised exercise interventions in terms of improving glycemic control, blood lipids, functional capacity, muscle strength, body composition, and quality of life for people with type 2 diabetes.

Exercise training modalities in prediabetes: a systematic review and network meta-analysis

Background

Lifestyle modification based on exercise intervention is still the primary way to delay or reverse the development of diabetes in patients with prediabetes. However, there are still challenges in setting up a detailed exercise prescription for people with prediabetes. This study mainly ranks exercise prescriptions by comparing the improvement of glucose and lipid metabolism and the level of weight loss in patients.

Method

All studies on exercise intervention in prediabetes were identified by searching five electronic databases. Risk assessment and meta-analysis were performed on eligible studies.

Results

Twenty-four studies involving 1946 patients with prediabetes and seven exercise intervention models were included in the final analysis. The meta-analysis showed that exercise of any type was more effective for glycemic control in prediabetes than no exercise. However, the changes in blood glucose were moderate. In prediabetes, combining moderate-intensity aerobic exercise with low-to moderate-load resistance training showed the most significant improvements in glycosylated hemoglobin (HbA1c), body mass index (BMI), body weight (BW), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL) (P-score=0.82; 0.70; 0.87; 1; 0.99), low-to moderate-load resistance training showed the most significant improvements in fasting blood glucose (FBG) (P-score=0.98), the vigorous-intensity aerobic exercise showed the most significant improvements in 2-hour post-meal blood glucose (2hPG) and systolic blood pressure (SBP) (P-score=0.79; 0.78), and moderate-intensity aerobic exercise showed the most significant improvements in diastolic blood pressure (DBP) (P-score=0.78).

Conclusion

In summary, moderate-intensity aerobic exercise, low-to moderate-load resistance training and the combination of both have beneficial effects on glycemic control, weight loss, and cardiovascular health in patients with prediabetes. These findings provide valuable guidance for rehabilitation clinicians and patients alike to follow.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD 42021284922.

Effect of Exercise Therapy on Incident Admission in Patients with Type 2Diabetes Mellitus Undergoing Inpatient Diabetes Self-manageme ntEducation and Support

BACKGROUND

Exercise therapy is the key to preventing admission of patients with type 2 diabetes mellitus (T2DM). However, a few studies have examined the effects of exercise therapy on patients with T2DM undergoing inpatient diabetes self-management education and support (IDSMES).

OBJECTIVE

This study investigated whether exercise therapy influenced the incidence of admission after discharge in patients with T2DM undergoing IDSMES.

METHODS

This retrospective cohort study included patients with T2DM who underwent IDSMES between June 2011 and May 2015. Overall, 258 patients were included in this study. The exercise therapy program was implemented in June 2013. Accordingly, patients diagnosed between June 2011 and May 2013 were categorized as the non-exercise therapy program group, while those diagnosed between June 2013 and May 2015 were categorized as the exercise therapy program group. Outcomes were incident diabetes-related and all-cause admissions within 1 year of discharge. Multiple logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the exercise therapy program's impact on the outcomes.

RESULTS

Within 1 year of discharge, 27 (10.5%) patients underwent diabetes-related admissions and 62 (24.0%) underwent all-cause admissions. Multiple logistic regression analyses showed a significant association of the exercise therapy program with incident diabetes-related and allcause admissions [OR: 0.22 (95% CI: 0.08-0.59) and 0.44 (95% CI: 0.22-0.86), respectively].

CONCLUSION

Exercise therapy programs significantly lowered the incidences of diabetes-related and all-cause admissions. This indicates that implementing exercise therapy during hospitalization may be important for preventing admissions of patients with T2DM receiving IDSMES.

Exercise mitigates age-related metabolic diseases by improving mitochondrial dysfunction

The benefits of regular physical activity are related to delaying and reversing the onset of ageing and age-related disorders, including cardiomyopathy, neurodegenerative diseases, cancer, obesity, diabetes, and fatty liver diseases. However, the molecular mechanisms of the benefits of exercise or physical activity on ageing and age-related disorders remain poorly understood. Mitochondrial dysfunction is implicated in the pathogenesis of ageing and age-related metabolic diseases. Mitochondrial health is an important mediator of cellular function. Therefore, exercise alleviates metabolic diseases in individuals with advancing ageing and age-related diseases by the remarkable promotion of mitochondrial biogenesis and function. Exerkines are identified as signaling moieties released in response to exercise. Exerkines released by exercise have potential roles in improving mitochondrial dysfunction in response to age-related disorders. This review comprehensive summarizes the benefits of exercise in metabolic diseases, linking mitochondrial dysfunction to the onset of age-related diseases. Using relevant examples utilizing this approach, the possibility of designing therapeutic interventions based on these molecular mechanisms is addressed.

High-glycemic index meal acutely potentiates blood pressure response to static handgrip exercise in healthy humans

Blood glucose levels acutely increase postprandially depending on the type of meal consumed. However, it remains unclear whether postprandial hyperglycemia temporally affects cardiovascular responses to static handgrip exercise (SHG-ex). Thus, this study aimed to examine whether increased blood glucose induced by consumption of a high-glycemic index (HGI) meal affects pressor response to SHG-ex. A total of 14 healthy participants (7 women and 7 men) consumed an HGI meal, a low-glycemic index (LGI) meal, or no meal (control). Participants performed 30% maximal voluntary contraction SHG-ex followed by a postexercise muscle ischemia (PEMI) test before the meal and 60 min after consuming the meal. Blood glucose, plasma insulin, and plasma triglyceride levels were measured, and the area under the curve until 60 min (AUC0-60 min) after meal consumption was calculated. The HGI and LGI groups showed higher blood glucose and insulin AUC0-60 min than the control group (P < 0.001). At 60 min after the meal, the changes in blood pressure during SHG-ex were significantly greater in the HGI group, but not in the LGI group, than in the control group. The changes in blood pressure at the onset and end of SHG-ex 60 min after the meal were positively correlated with blood glucose AUC0-60 min (r = 0.321, P = 0.038; r = 0.402, P = 0.008, respectively) and plasma insulin AUC0-60 min (r = 0.339, P = 0.028; r = 0.302, P = 0.052, respectively). However, no association was observed during PEMI. These data suggest that postprandial hyperglycemia and hyperinsulinemia acutely exaggerate pressor response during SHG-ex in healthy young adults.NEW & NOTEWORTHY Postprandial hyperglycemia following consumption of a high-glycemic index (HGI) meal potentiated blood pressure response to static handgrip exercise (SHG-ex) in healthy young adults. These findings provide important insight into the role of the diet on acute circulatory response to exercise in healthy adults.

Aquatic Aerobic and Combined Training in Management of Type 2 Diabetes: The Diabetes and Aquatic Training Study (DATS): A Randomized Clinical Trial

BACKGROUND

To compare the effects of aquatic aerobic and combined (aerobic more resistance) training on glycemic control and other cardiometabolic outcomes in patients with type 2 diabetes.

METHODS

Patients were randomized to an aquatic aerobic training (AERO, n = 19; 57.5 [7.4] y; 9 [47%] women), or an aquatic combined training (COMBI, n = 19; 60.9 [7.4] y; 10 [53%] women), or an aquatic active procedure control (n = 19; 58.6 [9.7] y; 10 [53%] women) in 3 weekly sessions (50 min each), during 15 weeks. Glycated hemoglobin was the primary outcome, whereas insulin resistance markers, lipid profile, systemic inflammation, renin concentration, blood pressure, physical activity levels, and sitting time were secondary outcomes.

RESULTS

Glycated hemoglobin was reduced in all groups (P = .021), although changes were more marked in AERO (-0.36%) and COMBI (-0.44%) than in active control (-0.26%) group. Lipid profile was similarly modified in all groups. Diastolic blood pressure and renin concentration were also reduced in all groups; however, renin showed more marked reductions in AERO (-17.7 uIU/mL) and COMBI (-15.1 uIU/mL) than in active control (0.2 uIU/mL) group. Fasting insulin, triglycerides, C-reactive protein, systolic blood pressure, walking time, and sitting time on weekends were not modified.

CONCLUSION

AERO and COMBI presented similar effect to improve glycemic control and some cardiometabolic risk factors in patients with type 2 diabetes.

Rehabilitation of Individuals With Diabetes Mellitus: Focus on Diabetic Myopathy

Diabetes mellitus (DM) is a chronic metabolic disease characterized by high blood glucose levels, causing serious damage to the cardiovascular, respiratory, renal and other systems. The prevalence of type 2 diabetes mellitus (T2DM) was 6.28% in 2017, considering all age groups worldwide (prevalence rate of 6,059 cases per 100,000), and its global prevalence is projected to increase to 7,079 cases per 100,000 by 2030. Furthermore, these individuals are often affected by diabetic myopathy, which is the failure to preserve muscle mass and function in the course of DM. This happens in type 1 diabetes mellitus (T1DM) and T2DM. As skeletal muscle plays a key role in locomotion and glucose homeostasis, diabetic myopathy may contribute to additional complications of the disease. In addition, chronic hyperglycemia is associated with lung functional changes seen in patients with DM, such as reduced lung volumes and compliance, inspiratory muscle strength, and lung elastic recoil. Thus, the weakness of the inspiratory muscles, a consequence of diabetic myopathy, can influence exercise tolerance. Thus, moderate strength training in T2DM can contribute to the gain of peripheral muscle strength. Although the literature is robust on the loss of mass and consequent muscle weakness in diabetic myopathy, triggering pathophysiological factors, the impact on functional capacity, as well as the prescription of physical exercise for this condition deserves to be further explored. This review aims to explore the consequences of diabetic myopathy and its implication in rehabilitation from prescription to safety in the practice of physical exercises for these individuals.

Protocol for a randomized controlled trial of sitting reduction to improve cardiometabolic health in older adults

Older adults with obesity spend the majority of their waking hours sedentary. Given substantial barriers to regular physical activity in this population, approaches to reduce sedentary time could be an effective health promotion strategy. We present the protocol of a randomized controlled trial to reduce sitting time in older adults with a body mass index of 30 kg/m² or above. Participants (N = 284) will be randomized to receive a sitting reduction intervention (termed I-STAND) or a healthy living focused attention control condition. I-STAND includes 10 contacts with a health coach (10 sessions total) and participants receive a wrist-worn prompting device and portable standing desk. The healthy living condition includes 10 sessions with a health coach to set goals around various topics relating to healthy aging. Participants receive their assigned intervention for 6 months. After 6 months, those receiving the I-STAND condition are re-randomized to receive five booster health coaching sessions by 'phone or no further contact; healthy living participants receive no further contact and those in both conditions are followed for an additional 6 months. Measurements initially included wearing an activPAL device and completing several biometric tests (e.g., blood pressure, HbA1c), at baseline, 3 months, 6 months, and 12 months; however, during the COVID-19 pandemic we shifted to remote assessments and were unable to collect all of these measures. The primary outcomes remained activPAL-assessed sitting time and blood pressure. Recruitment is anticipated to be completed in 2022.

Effects of recreational sports and combined training on blood pressure and glycated hemoglobin in middle-aged and older adults: A systematic review with meta-analysis

BACKGROUND

Combined resistance and aerobic training (CT) is the most suitable form of exercise training to simultaneously improve strength and cardiometabolic profile in middle-aged and older adults. Recreational sports (RS) emerge as an alternative to CT to improve these outcomes. We performed a meta-analysis on the effects of RS and CT on systolic blood pressure (SBP), diastolic blood pressure (DBP) and glycated hemoglobin (HbA1c) in middle-aged and older adults and to compare these exercise interventions to a non-exercising control group (CON).

METHODS

Search was conducted using the databases at PubMed, COCHRANE and SciELO between July and August 2020. Studies that included men and women aged ≥45 years, healthy or with values for SBP ≥130 mmHg or DBP ≥80 mmHg or with type 2 diabetes and performed RS or CT versus CON.

RESULTS

From 6017 records, 27 studies were included (9 RS and 18 CT). The analysis included 1411 participants with 55 ± 8 years. RS and CT were associated with reductions in SBP (RS: -7.2 mmHg, P = 0.03; CT: -3.6 mmHg, P < 0.001) and DBP (RS: -3.6 mmHg, P = 0.02; CT: -3.1 mmHg, P < 0.001) versus CON. Only CT was associated with a reduction in HbA1c versus CON (-0.47%; P < 0.001).

CONCLUSIONS

RS and CT are effective exercise interventions to improve BP in middle-aged and older adults. CT seems to be an excellent strategy to reduce HbA1c, and future studies are necessary to confirm the effectiveness of RS to improve HbA1c.

Balance and motion coordination parameters can be improved in patients with type 2 diabetes with physical balance training: non-randomized controlled trial

BACKGROUND

Type 2 diabetes (T2D) is a cause of multiple complications, including retinopathy and peripheral neuropathy. These complications are well understood and believed to contribute to gait instability. Poor balance control and increased falling risk have also been reported in people with diabetic peripheral neuropathy (DPN). Patients with DPN have increased risk of falling due to decreased proprioceptive feedback. Effective balance training should improve postural control in patients with DPN. For this purpose further evaluation was conducted and balance training was designed.

METHODS

The goal of our study was to determine values of proprioception, balance, muscle coordination and strength in patients with T2D and analyze whether biofeedback balance training with use of the Biodex Balance System could improve these parameters. To assess the fall risk the general stability index (GSI), the index of frontal-posterior (FPI) and medial-lateral (MLI) stability were evaluated. 37 patients with diagnosed type 2 diabetes mellitus were recruited to this study. Their results were compared with control group consisting of 41 healthy participants who were homogenic to the study group in terms of age and body mass index (BMI).

RESULTS

There were statistically significant differences between patients with diabetes compared to healthy subjects in GSI (2.79 vs 1.1), FPI (1.66 vs 0.7), MLI (0.88 vs 0.52) and risk of falling (5.18 vs 2.72) p < 0.05. There were also statistically significant changes before and after training in all stability indices (GSI: 2.79 vs 1.26, FPI: 1.66 vs 0.77, MLI: 0.88 vs 0.54 accordingly) p < 0.05 and risk of falling (5.18 vs 3.87) p < 0.05 in the study group who had undergone training with biofeedback.

CONCLUSIONS

This study found that there is a decreased balance and motor coordination and an increased risk of falling in patients with type 2 diabetes. These parameters improved in patients who have undergone training programme with biofeedback. Furthermore, an age-dependent deprivation of static balance was observed along with an increased risk of falling as a result of increasing BMI.

Relationship Between Long-Term Objectively Measured Physical Activity and Glycemic Control in Type 2 Diabetes Mellitus Patients: A Prospective Cohort Study

INTRODUCTION

Increasing physical activity (PA) improves glycemic control in patients with type 2 diabetes mellitus (T2DM). However, whether long-term objectively measured PA is related to glycemic control remains unclear. The aim of this study was to investigate the relationship between long-term objectively measured PA and glycemic control in T2DM patients.

RESEARCH DESIGN AND METHODS

This prospective cohort study recruited T2DM patients admitted to a hospital-based diabetes management and education program. The primary outcome was glycemic control by hemoglobin A1c at 6 months after discharge. We defined poor glycemic control according to the Japanese Clinical Practice Guidelines. The PA was objectively measured using a three-axis accelerometer during 6 months' period after discharge. The representative value of PA was the average daily steps during the measurement period and was divided into quartiles. To determine the relationship between the daily steps and poor glycemic control, we performed a multivariate logistic regression analysis.

RESULTS

Ninety-four participants were enrolled in the study. Their median age was 59 years, and 38 (40.0%) of them showed poor glycemic control. Multivariate logistic regression analysis showed that the first (Q1, ≤ 6106 steps/day) and second quartiles (Q2, 6107-8258 steps/day) had significantly elevated risks of poor glycemic control compared to Q4 (≥ 10,542 steps/day), with odds ratios of 8.55 [95% confidence intervals (CI) =1.43-51.23] and 15.62 (95% CI 2.63-92.87), respectively.

CONCLUSION

We found that lesser PA was significantly associated with poor glycemic control in T2DM patients. This finding may be beneficial for clinicians while providing long-term advice to diabetic patients.

Physical activity and the risk of heart failure: a systematic review and dose-response meta-analysis of prospective studies

Although physical activity is an established protective factor for cardiovascular diseases such as ischemic heart disease and stroke, less is known with regard to the association between specific domains of physical activity and heart failure, as well as the association between cardiorespiratory fitness and heart failure. We conducted a systematic review and meta-analysis of prospective observational studies to clarify the relations of total physical activity, domains of physical activity and cardiorespiratory fitness to risk of heart failure. PubMed and Embase databases were searched up to January 14th, 2020. Summary relative risks (RRs) were calculated using random effects models. Twenty-nine prospective studies (36 publications) were included in the review. The summary RRs for high versus low levels were 0.77 (95% CI 0.70–0.85, I² = 49%, n = 7) for total physical activity, 0.74 (95% CI 0.68–0.81, I² = 88.1%, n = 16) for leisure-time activity, 0.66 (95% CI 0.59–0.74, I² = 0%, n = 2) for vigorous activity, 0.81 (95% CI 0.69–0.94, I² = 86%, n = 3) for walking and bicycling combined, 0.90 (95% CI 0.86–0.95, I² = 0%, n = 3) for occupational activity, and 0.31 (95% CI 0.19–0.49, I² = 96%, n = 6) for cardiorespiratory fitness. In dose–response analyses, the summary RRs were 0.89 (95% CI 0.83–0.95, I² = 67%, n = 4) per 20 MET-hours per day of total activity and 0.71 (95% CI 0.65–0.78, I² = 85%, n = 11) per 20 MET-hours per week of leisure-time activity. Nonlinear associations were observed in both analyses with a flattening of the dose–response curve at 15–20 MET-hours/week for leisure-time activity. These findings suggest that high levels of total physical activity, leisure-time activity, vigorous activity, occupational activity, walking and bicycling combined and cardiorespiratory fitness are associated with reduced risk of developing heart failure.

Association Between Dissatisfaction With Care and Diabetes Self-Care Behaviors, Glycemic Management, and Quality of Life of Adults With Type 2 Diabetes Mellitus

PURPOSE

The purpose of the study was to examine the associations between patient dissatisfaction and diabetes outcomes among patients with type 2 diabetes.

METHODS

Primary data from 615 adults with type 2 diabetes from 2 adult primary care clinics completed validated questionnaires. Patient dissatisfaction was measured by asking participants to what degree over the past 12 months were they very dissatisfied with the care they received from their primary care provider. Diabetes outcomes included self-care behaviors, quality of life, and A1C. A1C was abstracted from the medical record. Multiple linear regression models were used to assess associations between patient dissatisfaction, self-care, blood glucose, and quality of life.

RESULTS

After adjusting for covariates, this study demonstrated that higher patient dissatisfaction was significantly associated with poor general diet, worse blood glucose levels, and lower mental component score for quality of life.

CONCLUSIONS

In patients with type 2 diabetes, patient dissatisfaction had a significant association with higher blood glucose levels, poor general diet, and low quality of life. Demographic factors driving patient dissatisfaction included young age, low income, and low health literacy. Future studies should investigate how to address patient satisfaction in an effort to improve health outcomes.

Beyond general resistance training. Hypertrophy versus muscular endurance training as therapeutic interventions in adults with type 2 diabetes mellitus: A systematic review and meta-analysis

Resistance training (RT) is a powerful first-line intervention for the management of type 2 diabetes mellitus (T2DM). Nonetheless, the effects of the most frequent RT (hypertrophy training [HT] and muscular endurance training [MERT]) employed for the management of T2DM, and which type of RT might exert superior effects, remain elusive. Thus, this review aims to assess the effects of HT and MERT on glycaemic control, physical fitness, body composition, lipid profile, blood pressure, C-reactive protein, and quality of life in patients with T2DM; to analyse which particular RT is more effective; to assess the effects of general RT; and to identify RT components, characteristics of patients, and medications that could mediate the effects of RT. Randomized controlled trials (RCT) and non-RCT (RT≥ 4 weeks) in adults with T2DM were selected. Both HT and MERT improved HbA1c, insulin levels and sensitivity, muscle strength, body mass index, waist circumference, and fat mass. Additionally, HT improved glucose, cardiorespiratory fitness, fat percentage, lean body mass, lipid profile, systolic blood pressure, and C-reactive protein, and MERT improved weight. Overall, HT and MERT exert beneficial effects well comparable with aerobic training. Both types of RT can be used as potent therapeutic interventions for the management of T2DM depending on patients' limitations/preferences.

Acute inspiratory muscle exercise effect on glucose levels, glucose variability and autonomic control in patients with type 2 diabetes: A crossover randomized trial

Inspiratory muscle exercise (IME) can be an alternative to conventional exercise. We aimed to evaluate the effect of IME on glucose, glucose variability, and autonomic cardiovascular control in type 2 diabetes. Fourteen diabetic subjects were randomly assigned to IME with 2% maximal inspiratory pressure (PImax) or 60% PImax wearing a continuous glucose monitoring system for three days. Glucose variability [glucose variance (VAR), glucose coefficient of variation (CV%), glucose standard deviation (SD), and mean amplitude of glycemic excursions (MAGE)] were evaluated. Glucose reduction was observed in 5 min (60% of PImax 33.2% and 2% of PImax 32.0%), 60 min (60% of PImax 29.6% and 2% of PImax 31.4%) and 120 min (60% of PImax 21.4% and 2% of PImax 24.0%) after IME (vs.1 h before the exercise), with no difference between loads. This reduction in glucose levels was observed in all moments of the IME protocol. Glucose variability was reduced after 12 h and 18 h of the IME (ΔCV: P < 0.001, ΔSD: P < 0.001 and ΔVAR: P < 0.001) for both loads. No difference was found in MAGE (P = 0.594) after IME. Mean arterial pressure and heart rate rose during the exercise session with 60% of PImax. Although sufficiently strong to induce cardiovascular changes, an inspiratory muscle exercise session with 60% of PImax in subjects with type 2 diabetes has failed to induce any significant improvement in glucose, glucose variability and autonomic control, compared to the 2% Plmax exercise session.

Quantification of an Exercise Rehabilitation Program for Severely Burned Children: The Standard of Care at Shriners Hospitals for Children®-Galveston

Currently, there are no clear guidelines for the implementation of rehabilitative exercise training (RET) in burned individuals. Therefore, we quantified the training logs for exercise intensity, frequency, and duration of 6 weeks of this program to develop a basic framework for outpatient RET in patients recovering from severe burns. Thirty-three children (11 female, [mean ± SD] 12 ± 3 years, 145 ± 18 cm, 40 ± 11 kg, 49 ± 31 BMI percentile) with severe burns (49 ± 15% total body surface area burned, with 35 ± 22% third-degree burns) completed our 6-week resistance and aerobic exercise training program. Cardiorespiratory fitness (peak VO2), strength, power, and lean body mass (LBM) were measured before and after RET. Outcome measures were analyzed as a relative percentage of values in age- and sex-matched nonburned children (11 female, 12 ± 3 years, 154 ± 20 cm, 49 ± 22 kg, 56 ± 25 BMI percentile). At discharge, burned children had lower LBM (77% of age-sex-matched nonburn values), peak torque (53%), power (62%), and cardiorespiratory fitness (56%). After 6 weeks of training, LBM increased by 5% (82% of nonburn values), peak torque by 18% (71%), power by 20% (81%), and cardiorespiratory fitness by 18% (74%; P < .0001 for all). Quantification of data in exercise training logs suggested that physical capacity can be improved by aerobic exercise training performed at five metabolic equivalents (>70% of peak VO2) at least 3 days/week and 150 minutes/week and by resistance training performed at volume loads (reps × sets × weight) of 131 kg for the upper body and 275 kg for the lower body for 2 days/week. We present for the first time the quantification of our RET and provide clear exercise prescription guidelines specific to children with severe burn injury.

The Role of Aerobic Training Variables Progression on Glycemic Control of Patients with Type 2 Diabetes: a Systematic Review with Meta-analysis

BACKGROUND

Aerobic training (AT) improves glycemic control in patients with type 2 diabetes. However, the role of the progression of training variables remains unclear. The objective of this review was to analyze the effects of progressive AT (PAT) and non-progressive AT (NPAT) on glycated hemoglobin (HbA1c) in patients with type 2 diabetes.

METHODS

Data sources used were PubMed, Cochrane Central, Embase, SPORTDiscus, and LILACS. Studies that evaluated the effect of at least 12 weeks of PAT and NPAT compared to a control condition on HbA1c levels in type 2 diabetes patients were eligible for analysis. Two independent reviewers screened the search results, extracted the data, and assessed the risk of bias. Effect sizes (ESs) were calculated using the standardized mean difference in HbA1c levels between the intervention and control groups using a random-effect model.

RESULTS

Of 5848 articles retrieved, 24 randomized clinical trials (825 participants) were included. Among the included studies, 92% reported to have performed a randomization process, 8% presented allocation concealment, 21% reported blinding of outcome assessment, and 38% reported complete outcome data. AT reduced HbA1c levels by 0.65% (ES: - 1.037; 95% confidence interval [CI]: - 1.386, - 0.688; p < 0.001). The reduction in HbA1c induced by PAT was 0.84% (ES: - 1.478; 95% CI - 2.197, - 0.759; p < 0.001), and NPAT was 0.45% (ES: - 0.920; 95% CI - 1.329, - 0.512; p < 0.001). Subgroup analysis of the different forms of progression showed a reduction in HbA1c levels of 0.94% (ES: - 1.967; 95% CI - 3.783, - 0.151; p = 0.034) with progression in volume, 0.41% (ES: - 1.277; 95% CI - 2.499, - 0.056; p = 0.040) with progression in intensity, and 1.27% (ES: - 1.422; 95% CI - 2.544, - 0.300; p = 0.013) with progression in both volume and intensity. Subgroup analysis of the different modalities of AT showed a reduction of 0.69% (ES: - 1.078; 95% CI - 1.817, - 0.340; p = 0.004) with walking and/or running and of 1.12% (ES: - 2.614; 95% CI - 4.206, - 1.022; p = 0.001) with mixed protocols while progressive training was adopted. In non-progressive protocols, a significant HbA1c reduction was only found with walking and/or running (- 0.43%; ES: - 1.292; 95% CI - 1.856, - 0.72; p < 0.001).

CONCLUSION

The effect of PAT on glycemic control was greater than that of NPAT, especially when volume and intensity were progressively incremented throughout the interventions.

Effect of a multifactorial intervention on the increase in physical activity in subjects with type 2 diabetes mellitus: a randomized clinical trial (EMID Study)

Background:

Regular physical activity is essential for metabolic control in type 2 diabetes mellitus.

Aims:

The aim of this study was to assess the short and long-term impact of a multifactorial intervention on physical activity and clinically relevant biochemical parameters in patients with type 2 diabetes mellitus.

Methods:

This randomised, controlled clinical trial (NCT02991079) included two parallel groups aged 25–70 years from a primary care health centre in Salamanca, Spain. The subjects were assigned randomly (1:1) to control and intervention groups, using Epidat 4.0 software. Both were counselled on the importance of physical activity and maintaining a healthy diet. The intervention group also took five low–moderate intensity 4 km nurse-guided walks, received a smartphone application to promote healthy habits and attended a diet workshop. Physical activity was measured objectively using a pedometer and subjectively using a shortened international physical activity questionnaire (at baseline, 3 and 12 months).

Results:

In total, 204 subjects were included (mean age 60.6 years, 45.6% were women). After 3 months, relative to the control group, the intervention group increased their daily number of steps by 1852, aerobic steps by 1623, distance walked by 994 m, and total metabolic equivalent minutes per week by 1297 and decreased sedentary time by 34.3 minutes per day. Differences from baseline persisted at 12 months, including mean increases of 1141 daily steps, 917 aerobic steps, and 1065 total metabolic equivalent minutes per week in the intervention group relative to the control group ( P<0.05 for all).

Conclusions:

The success of this multifactorial intervention should help inform future clinical approaches and application designs towards managing type 2 diabetes mellitus and improving patient outcomes.

Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC)

Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, vascular reactivity and cardiorespiratory fitness, particularly in type 2 diabetes mellitus patients with cardiovascular comorbidities, such as patients that suffered from an acute myocardial infarction, or after a coronary intervention such as percutaneous coronary intervention or coronary artery bypass grafting. The present position paper aims to provide recommendations for prescription of exercise training in patients with both type 2 diabetes mellitus and cardiovascular disease. The first part discusses the relevance and practical applicability of treatment targets that may be pursued, and failure to respond to these targets. The second part provides recommendations on the contents and methods to prescribe exercise training tailored to these treatment targets as well as to an optimal preparation and dealing with barriers and risks specific to type 2 diabetes mellitus and cardiac comorbidity.

A simple to implement and low-cost supervised walking programme in highly motivated individuals with or at risk for type 2 diabetes: An observational study with a pre-post design

This observational study with a pre-post design, conducted in two Dutch primary healthcare centres, aimed to evaluate the effect of a supervised walking programme in highly motivated individuals with or at risk for type 2 diabetes mellitus (T2DM). Those able and willing to walk at least 6 km, were invited for a 28-week walking programme (February to August 2017), in which participants walked in groups, once weekly under supervision of volunteer healthcare professionals. Changes in bodyweight, BMI, waist circumference, HbA1c, blood pressure, well-being, health status and patient activation were analysed using paired t-tests and the Wilcoxon signed-rank test. Fifty-six people were included (30 T2DM; 26 at risk), of whom 60.7% were female. Mean age was 60.6 years, median BMI 30.8 kg/m² and mean systolic blood pressure 146.9 mm Hg. Participants with T2DM had median HbA1c of 50.0 mmol/mol. Post-challenge, BMI had decreased to 29.7 kg/m², and waist circumference decreased 3.4 cm (95% CI 2.1-4.8), both p < 0.01. Systolic and diastolic blood pressure decreased significantly (mean difference 6.5 mm Hg (95% CI 1.6-11.3, p = 0.01) and 3.5 mm Hg (95% CI 1.0-6.0, p < 0.01), respectively). Participants with HbA1c >53 mmol/mol at baseline (n = 8), had median decrease in HbA1c of 6.5 mmol/mol (p = 0.03). Well-being, but not health status and patient activation, improved significantly. In conclusion, in highly motivated individuals with or at risk for T2DM, this simple to implement and low-cost, but intensive, volunteer-based supervised walking programme is favourable, and therefore, can be seen as an option for clinical programs to implement to support highly motivated patients.

Comparisons of the Health Benefits of Strength Training, Aqua-Fitness, and Aerobic Exercise for the Elderly

Objective

To compare strength training, aqua-fitness, and aerobic exercise programs to discern the differences in the benefits achieved by each of the activities in older people.

Design

Double-blind randomized trial.

Setting

Controlled clinical environment.

Participants

108 people: 54 female paired with a male of the same age (average age of 65.5 ± 5.6 years).

Interventions

Three exercise programs (aqua-fitness, aerobic exercise, and strength training) for six months.

Main Outcome Measures

Body Mass Index, Senior Fitness Test (which evaluated functional fitness), and the SF-12 Health Survey.

Results

Men showed greater positive changes in the aerobic exercise group for general self-perceived mental health, leg strength, and flexibility of legs and arms. The largest improvements in overall self-perceived physical health and upper limb strength were in the men of the strength training group. The women participants in the strength training group obtained greater benefits, especially in self-perceived mental and physical health and in the strength of the four limbs.

Conclusions

To maximise benefits, older people, in general, may want to consider participating in aerobic activity. Furthermore, older women would benefit greatly, both emotionally and physically, from exercise that includes strength training.

An Interactive Simulation to Change Outcome Expectancies and Intentions in Adults With Type 2 Diabetes: Within-Subjects Experiment

Background

Computerized simulations are underutilized to educate or motivate patients with chronic disease.

Objective

The aim of this study was to test the efficacy of an interactive, personalized simulation that demonstrates the acute effect of physical activity on blood glucose. Our goal was to test its effects on physical activity-related outcome expectancies and behavioral intentions among adults with type 2 diabetes mellitus (T2DM).

Methods

In this within-subjects experiment, potential participants were emailed a link to the study website and directed through 7 tasks: (1) consent; (2) demographics, baseline intentions, and self-reported walking; (3) orientation to the diurnal glucose curve; (4) baseline outcome expectancy, measured by a novel drawing task in which participants use their mouse to draw the expected difference in the diurnal glucose curve if they had walked; (5) interactive simulation; (6) postsimulation outcome expectancy measured by a second drawing task; and (7) final measures of intentions and impressions of the website. To test our primary hypothesis that participants’ outcome expectancies regarding walking would shift toward the outcome presented in the interactive simulation, we used a paired t test to compare the difference of differences between the change in area under the curve in the simulation and participants’ two drawings. To test whether intentions to walk increased, we used paired t tests. To assess the intervention’s usability, we collected both quantitative and qualitative data on participants’ perceptions of the drawing tasks and simulation.

Results

A total of 2019 individuals visited the website and 1335 (566 males, 765 females, and 4 others) provided complete data. Participants were largely late middle-aged (mean=59.8 years; standard deviation=10.5), female 56.55% (755/1335), Caucasian 77.45% (1034/1335), lower income 64.04% (855/1335) t₁₃₃₄=3.4, P ≤.001). Our second hypothesis, that participants’ intentions to walk in the coming week would increase, was also supported; general intention (mean difference=0.31/7, t₁₀₀₁=10.8, P<.001) and minutes of walking last week versus planned for coming week (mean difference=33.5 min, t₁₃₃₄=13.2, P<.001) both increased. Finally, an examination of qualitative feedback and drawing task data suggested that some participants had difficulty understanding the website. This led to a post-hoc subset analysis. In this analysis, effects for our hypothesis regarding outcome expectancies were markedly stronger, suggesting that further work is needed to determine moderators of the efficacy of this simulation.

Conclusions

A novel interactive simulation is efficacious in changing the outcome expectancies and behavioral intentions of adults with T2DM. We discuss applications of our results to the design of mobile health (mHealth) interventions.

Physical inactivity and cardiac events: An analysis of the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study

AIMS

Diabetes affects 29 million adults, and the majority have type 2 diabetes (T2D). Coronary artery disease (CAD) is the leading cause of death, and physical inactivity is an important risk factor. The aims of this study were to examine the contribution of physical inactivity to CAD events, and to identify the independent predictors of CAD events in a sample of older adults with T2D.

METHOD

A secondary data analysis of the prospective randomized screening trial "Detection of Ischemia in Asymptomatic Diabetics (DIAD)" study. Cox proportional hazard modeling was used to examine the outcome of CAD events.

RESULTS

During the five years of follow-up, the CAD event rate for all subjects (n = 1119) was 8.4% (n = 94). In unadjusted analysis, physical inactivity was significantly associated with development of a CAD event. In the final model, nine baseline variables were significant predictors (p < 0.05) of a CAD: physical inactivity, race, diabetes duration, hemoglobin A1c (HbA1c), peripheral numbness, insulin use, increasing waist-to-hip ratio, family history of premature CAD, and a higher pulse pressure. In men only, there were five predictors (p < 0.05) of a CAD event: diabetes duration, peripheral numbness, HbA1c, increasing waist-to-hip ratio, and higher pulse pressure. The final model in women included three independent predictors (p < 0.05) of a CAD event: diabetes duration, a family history of premature CAD, and higher pulse pressure.

CONCLUSION

Several variables predicted CAD events in this sample of older adults with T2D. Understanding baseline characteristics that heighten risk may assist providers in intervening early to prevent its occurrence.

Prevalence of Non-responders for Glucose Control Markers after 10 Weeks of High-Intensity Interval Training in Adult Women with Higher and Lower Insulin Resistance

Background: Exercise training improves performance and biochemical parameters on average, but wide interindividual variability exists, with individuals classified as responders (R) or non-responders (NRs), especially between populations with higher or lower levels of insulin resistance. This study assessed the effects of high-intensity interval training (HIIT) and the prevalence of NRs in adult women with higher and lower levels of insulin resistance. Methods: Forty adult women were assigned to a HIIT program, and after training were analyzed in two groups; a group with higher insulin resistance (H-IR, 40 ± 6 years; BMI: 29.5 ± 3.7 kg/m²; n = 20) and a group with lower insulin resistance (L-IR, 35 ± 9 years; 27.8 ± 2.8 kg/m²; n = 20). Anthropometric, cardiovascular, metabolic, and performance variables were measured at baseline and after 10 weeks of training. Results: There were significant training-induced changes [delta percent (Δ%)] in fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) scores in the H-IR group (-8.8, -26.5, -32.1%, p < 0.0001), whereas no significant changes were observed in the L-IR. Both groups showed significant pre-post changes in other anthropometric variables [waist circumference (-5.2, p < 0.010, and -3.8%, p = 0.046) and tricipital (-13.3, p < 0.010, and -13.6%, p < 0.0001), supra-iliac (-19.4, p < 0.0001, and -13.6%, p < 0.0001), and abdominal (-18.2, p < 0.0001, and -15.6%, p < 0.010) skinfold measurements]. Systolic blood pressure decreased significantly only in the L-IR group (-3.2%, p < 0.010). Both groups showed significant increases in 1RM_LE (+12.9, p < 0.010, and +14.7%, p = 0.045). There were significant differences in the prevalence of NRs between the H-IR and L-IR groups for fasting glucose (25 vs. 95%, p < 0.0001) and fasting insulin (p = 0.025) but not for HOMA-IR (25 vs. 45%, p = 0.185). Conclusion: Independent of the "magnitude" of the cardiometabolic disease (i.e., higher vs. lower insulin resistance), no differences were observed in the NRs prevalence with regard to improved HOMA-IR or to anthropometric, cardiovascular, and muscle performance co-variables after 10 weeks of HIIT in sedentary adult women. This research demonstrates the protective effect of HIIT against cardiometabolic disease progression in a sedentary population.

Biomarkers associated with sedentary behaviour in older adults: A systematic review

OBJECTIVE

Pathomechanisms of sedentary behaviour (SB) are unclear. We conducted a systematic review to investigate the associations between SB and various biomarkers in older adults.

METHODS

Electronic databases were searched (MEDLINE, EMBASE, CINAHL, AMED) up to July 2015 to identify studies with objective or subjective measures of SB, sample size ≥50, mean age ≥60years and accelerometer wear time ≥3days. Methodological quality was appraised with the CASP tool. The protocol was pre-specified (PROSPERO CRD42015023731).

RESULTS

12701 abstracts were retrieved, 275 full text articles further explored, from which 249 were excluded. In the final sample (26 articles) a total of 63 biomarkers were detected. Most investigated markers were: body mass index (BMI, n=15), waist circumference (WC, n=15), blood pressure (n=11), triglycerides (n=12) and high density lipoprotein (HDL, n=15). Some inflammation markers were identified such as interleukin-6, C-reactive protein or tumor necrosis factor alpha. There was a lack of renal, muscle or bone biomarkers. Randomized controlled trials found a positive correlation for SB with BMI, neck circumference, fat mass, HbA1C, cholesterol and insulin levels, cohort studies additionally for WC, leptin, C-peptide, ApoA1 and Low density lipoprotein and a negative correlation for HDL.

CONCLUSION

Most studied biomarkers associated with SB were of cardiovascular or metabolic origin. There is a suggestion of a negative impact of SB on biomarkers but still a paucity of high quality investigations exist. Longitudinal studies with objectively measured SB are needed to further elucidate the pathophysiological pathways and possible associations of unexplored biomarkers.

Physical Activity in Obese Type 2 Diabetes After Gastric Bypass or Medical Management

BACKGROUND

The purpose of this study was to compare effects of Roux-en-Y gastric bypass versus a multidisciplinary, group-based medical diabetes and weight management program on physical fitness and behaviors.

METHODS

Physical behavior and fitness were assessed in participants of the study Surgery or Lifestyle With Intensive Medical Management in the Treatment of Type 2 Diabetes (SLIMM-T2D) (NCT01073020), a randomized, parallel-group trial conducted at a US academic hospital and diabetes clinic with 18- to 24-month follow-up. Thirty-eight type 2 diabetes patients with hemoglobin A_1c ≥6.5% and body mass index 30-42 kg/m² were randomized to Roux-en-Y gastric bypass or the medical program. A 6-minute walk test to evaluate fitness, self-reported physical activity, standardized physical surveys, and cardiometabolic risk assessment were performed at baseline and after intervention.

RESULTS

Both groups similarly improved 6-minute walk test distance, with greater improvements in oxygen saturation and reduced heart rate after surgery. Self-reported physical activity improved similarly at 18-24 months after interventions, although exercise increased gradually after surgery, whereas early substantial increases in the medical group were not fully sustained. Self-reported total and physical health were similar by Short Form-36 but improved more in the Impact of Weight on Quality of Life survey after surgery. Improvement in cardiovascular risk scores, HbA_1c, and body mass index were greater after surgery.

CONCLUSION

In this small, randomized study, both interventions led to therapeutic lifestyle changes and improved objective and self-reported physical fitness. Greater improvements in heart rate, oxygen saturation, and perceived impact of weight on health were seen after surgery, which could be attributable to greater weight loss. The clinical importance of these improvements with greater weight loss warrants further investigation.

Low Levels of Usual Physical Activity Are Associated with Higher 24 h Blood Pressure in Type 2 Diabetes Mellitus in a Cross-Sectional Study

The aim of this study is to evaluate the association between usual physical activity and 24 h blood pressure (BP) profile in people with type 2 diabetes mellitus (DM). This is a cross-sectional study of 151 participants with type 2 DM. Usual physical activity was assessed by step counting and self-reported questionnaire. BP was measured in office and by 24 h ambulatory BP monitoring (ABPM; 24 h, daytime and nighttime). Mean participant age was 61.1 ± 8.4 years, 64% was women, and mean duration of diabetes was 14.3 ± 8.5 years. Ninety-two percent of participants had hypertension, and office BP was 138 ± 18/78 ± 10 mmHg. Inverse correlations were observed between step count and 24 h BP (systolic, r = -0.186; p = 0.022), daytime BP (systolic, r = -0.198; p = 0.015), and nighttime BP (pulse pressure, r = -0.190; p = 0.019). People were categorized into tertiles of daily step count, and the 1st tertile had higher 24 h systolic BP, daytime systolic BP, daytime mean BP, and daytime systolic BP load than those in the other tertiles, even after adjusting for age and HbA1c. Participants with type 2 DM and low levels of physical activity exhibit higher 24 h and daytime systolic ambulatory BP values as compared with those who performed more steps per day, even after adjustments for confounding factors.

Are glucose levels, glucose variability and autonomic control influenced by inspiratory muscle exercise in patients with type 2 diabetes? Study protocol for a randomized controlled trial

Background

Physical exercise reduces glucose levels and glucose variability in patients with type 2 diabetes. Acute inspiratory muscle exercise has been shown to reduce these parameters in a small group of patients with type 2 diabetes, but these results have yet to be confirmed in a well-designed study. The aim of this study is to investigate the effect of acute inspiratory muscle exercise on glucose levels, glucose variability, and cardiovascular autonomic function in patients with type 2 diabetes.

Methods/design

This study will use a randomized clinical trial crossover design. A total of 14 subjects will be recruited and randomly allocated to two groups to perform acute inspiratory muscle loading at 2 % of maximal inspiratory pressure (PImax, placebo load) or 60 % of PImax (experimental load).

Discussion

Inspiratory muscle training could be a novel exercise modality to be used to decrease glucose levels and glucose variability.

Trial registration

ClinicalTrials.gov NCT02292810.

Type 2 diabetes: cost-effectiveness of medication adherence and lifestyle interventions

INTRODUCTION

Type 2 diabetes is a major burden for the payer, however, with proper medication adherence, diet and exercise regime, complication occurrence rates, and consequently costs can be altered.

AIMS

The aim of this study was to conduct a cost-effectiveness analysis on real patient data and evaluate which medication adherence or lifestyle intervention is less cost demanding for the payer.

METHODS

Medline was searched systematically for published type 2 diabetes interventions regarding medication adherence and lifestyle in order to determine their efficacies, that were then used in the cost-effectiveness analysis. For cost-effectiveness analysis-required disease progression simulation, United Kingdom Prospective Diabetes Study Outcomes model 2.0 and Slovenian type 2 diabetes patient cohort were used. The intervention duration was set to 1, 2, 5, and 10 years. Complications and drug costs in euro (EUR) were based on previously published type 2 diabetes costs from the Health Care payer perspective in Slovenia.

RESULTS

Literature search proved the following interventions to be effective in type 2 diabetes patients: medication adherence, the Mediterranean diet, aerobic, resistance, and combined exercise. The long-term simulation resulted in no payer net savings. The model predicted following quality-adjusted life-years (QALY) gained and incremental costs for QALY gained (EUR/QALYg) after 10 years of intervention: high-efficacy medication adherence (0.245 QALY; 9,984 EUR/QALYg), combined exercise (0.119 QALY; 46,411 EUR/QALYg), low-efficacy medication adherence (0.075 QALY; 30,967 EUR/QALYg), aerobic exercise (0.069 QALY; 80,798 EUR/QALYg), the Mediterranean diet (0.057 QALY; 27,246 EUR/QALYg), and resistance exercise (0.050 QALY; 111,847 EUR/QALYg).

CONCLUSION

The results suggest that medication adherence intervention is, regarding cost-effectiveness, superior to diet and exercise interventions from the payer perspective. However, the latter could also be utilized by patients without additional costs, but medication adherence intervention requires trained personnel because of its complex structure. Interventions should be performed for >2 years to produce noticeable health/cost results.

Effects of the DASH Diet and Walking on Blood Pressure in Patients With Type 2 Diabetes and Uncontrolled Hypertension: A Randomized Controlled Trial

Data on the potential beneficial effects of combining diet and exercise on blood pressure (BP) are still scarce. A 4-week randomized controlled clinical trial was undertaken in 40 hypertensive patients with type 2 diabetes with uncontrolled blood pressure (BP) in office and daytime ambulatory BP monitoring (ABPM). Patients were assigned to follow a Dietary Approaches to Stop Hypertension (DASH) diet associated with advice to increase walking using a pedometer (intervention group) or a diet based on the American Diabetes Association recommendations (control group). The lifestyle intervention caused a greater ABPM (mm Hg) reduction in systolic 24-hour, diastolic 24-hour, nighttime systolic, daytime systolic, and daytime diastolic measurements than observed in the control group. In the intervention group there was a decrease in urinary sodium and an increase in urinary potassium, plasma aldosterone, and the number of steps per day (P<.05). The DASH diet and increased walking were associated with clinically significant reductions in ABPM values in hypertensive patients with type 2 diabetes.

Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life

In elderly populations, diabetes is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass. In addition, diabetes mellitus increases risk for accelerated aging and for the development of frailty syndrome. This disease is also associated with a polypathological condition, and its complications progressively affect quality of life and survival. Exercise interventions, including resistance training, represent the cornerstones of diabetes management, especially in patients at severe functional decline. This review manuscript aimed to describe the beneficial effects of different exercise interventions on the functional capacity of elderly diabetics, including those at polypathological condition. The SciELO, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched from 1980 to 2015 for articles published from original scientific investigations. In addition to the beneficial effects of exercise interventions on glycemic control, and on the cardiovascular risk factors associated with diabetes, physical exercise is an effective intervention to improve muscle strength, power output, and aerobic power and functional capacity in elderly diabetic patients. Thus, a combination of resistance and endurance training is the most effective exercise intervention to promote overall physical fitness in these patients. In addition, in diabetic patients with frailty and severe functional decline, a multicomponent exercise program including strength and power training, balance exercises, and gait retraining may be an effective intervention to reduce falls and improve functional capacity and quality of life in these patients.