Physical activity, obesity, nutritional health and quality of life in low-income Hispanic adults with diabetes

Associations of Sleep Quality and Physical Activity with Diabetes Quality of Life in Korean Americans with Type 2 Diabetes: A Cross-Sectional Study

The cross-sectional study aimed to examine the associations of sleep quality and physical activity with diabetes quality of life in Korean Americans with type 2 diabetes. A total of 119 Korean American adults with type 2 diabetes were recruited from Korean communities in Arizona, USA. The Pittsburgh Sleep Quality Index for sleep quality, the International Physical Activity Questionnaire for physical activity, and the Diabetes Quality of Life (DQOL) for quality of life were assessed. Descriptive statistics, bivariate correlations, and multiple linear regressions were conducted. The mean score of the total DQOL was 1.85 (SD = 0.28). Approximately 70% of those had poor sleep quality and a third showed low physical activity. The findings demonstrated that both sleep quality and low physical activity were independent predictors of overall DQOL scores, indicating that poor sleep quality and low physical activity are associated with reduced Diabetes Quality of Life in this demographic. Specifically, the satisfaction subscale of DQOL showed significant associations with low physical activity levels, suggesting that enhancing physical activity could potentially improve satisfaction within DQOL. Furthermore, the impact subscale was positively related to sleep quality, suggesting that better sleep quality might significantly lower the perceived negative impact of diabetes on daily life. No significant associations were found between sleep quality, physical activity, and the worry subscale of DQOL in the adjusted models. The study indicates that addressing sleep quality and promoting physical activity are essential components of diabetes management strategies aimed at improving the quality of life for Korean Americans with type 2 diabetes. This underlines the need for tailored interventions that consider cultural preferences and individual needs to enhance diabetes outcomes and quality of life in this population.

Peer-to-Peer Support and Changes in Health and Well-being in Older Adults Over Time

IMPORTANCE

Literature on peer-to-peer (P2P) programs suggests they improve health and well-being of older adults. Analysis from a previous study showed P2P to be associated with higher rates of hospitalization and no significant differences in rates of emergency department or urgent care visits; however, it is not known whether measures of health and well-being varied by group over time.

OBJECTIVE

To compare the association between receiving P2P support and secondary outcomes (ie, health status, quality of life, and depressive and anxiety symptoms) with receiving standard community services (SCS) over time.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study was conducted among a volunteer sample of older adults (≥65 years) who were new to P2P or were already receiving P2P and a corresponding control group. Participants were matched between groups on age, sex, and race/ethnicity. The study was conducted from March 2015 to December 2017 at 3 community-based organizations that delivered P2P in California, Florida, and New York. Data analysis was performed from October 2018 through May 2020.

EXPOSURES

P2P support, provided by trained older adult volunteers.

MAIN OUTCOMES AND MEASURES

Mental and physical components of the health status and quality of life measure and depressive and anxiety symptoms were collected over 12 months. The hypothesis was that older adults receiving P2P support would maintain higher health status and quality of life than the SCS group.

RESULTS

A total of 503 participants were screened, 456 participants were enrolled and had baseline data, and 8 participants only had baseline information with no follow-up data, leaving 448 participants (231 [52%] in the SCS group; 217 [48%] in the P2P group; 363 [81%] women; mean [SD] age, 80 [9] years). The P2P group had improvements in mental health (change at 12 months, 1.1 points; 95% CI, -0.8 to 3.0 points) and physical health (change at 12 months, 1.0 points; 95% CI, -0.7 to 2.8 points). However, the difference of differences between the 2 groups did not differ significantly from baseline to 12 months (mental health: 0.2 points; 95% CI -2.3 to 2.7 points; physical health: 1.7 points; 95% CI, -0.6 to 3.9 points). The P2P and SCS groups had a statistically significant difference of differences in anxiety symptoms of 0.36 points (95% CI, 0.04 to 0.61 points). There were no significant differences in depressive symptoms or mental and physical components of the health status and quality of life.

CONCLUSIONS AND RELEVANCE

These findings suggest that receiving P2P support did not slow the decline of health and well-being in older adults compared with those who received SCS. Baseline imbalance in key characteristics, even after adjusting for the imbalance using the propensity score method, may explain the results. Randomized trials are needed.

Social participation is an important health behaviour for health and quality of life among chronically ill older Chinese people

BACKGROUND

Health behaviours (physical activity, maintenance of a healthy diet and not smoking) are known to be beneficial to the health and well-being of chronically ill people. With China's ageing population and increased prevalence of people with chronic diseases, the improvement of unhealthy behaviours in this population has become crucial. Although recent studies have highlighted the importance of social participation for health and quality of life (QoL) among older people, no study to date has included social participation along with more traditional health behaviours. Therefore, this study aimed to identify associations of multiple health behaviours (social participation, physical activity, maintenance of a healthy diet and not smoking) with health and QoL outcomes (including cognitive and physical function) among chronically ill older adults in China.

METHODS

For this nationally representative cross-sectional study, wave 1 data from the World Health Organization's Study on global AGEing and adult health (China) were examined. In total, 6629 community-dwelling older adults (mean age, 64.9 years) with at least one chronic disease were included. Multivariate linear regression analyses were used to evaluate associations of health behaviours with health and QoL outcomes while controlling for background characteristics.

RESULTS

Greater social participation was associated with better QoL [β = 0.127, standard error (SE) = 0.002, p < 0.001], cognitive function (β = 0.154, SE = 0.033, p < 0.001) and physical function (β = - 0.102, SE = 0.008, p < 0.001). Physical activity was associated with better QoL (β = 0.091, SE = 0.015, p < 0.001) and physical function (β = - 0.155, SE = 0.062, p < 0.001). Sufficient fruit and vegetable consumption was associated with better QoL (β = 0.087, SE = 0.015, p < 0.001).

CONCLUSIONS

Our findings suggest that social participation is an important health behaviour for quality of life and cognitive function among chronically ill older people in China. Health promotion programmes should expand their focus to include social participation as a health behaviour, in addition to physical activity, maintenance of a healthy diet and not smoking.

"If my family is happy, then I am happy": Quality-of-life determinants of parents of school-age children

OBJECTIVE

Obesity is a public health concern for children and adults and effective obesity prevention programming is needed urgently. The effectiveness of health-related messaging and interventions is influenced by the way content is framed. HomeStyles is an obesity prevention program, which aims to promote health through the frame of improved quality of life.

METHODS

Thus, focus groups were conducted with English- and Spanish-speaking parents of school-aged children (ages 6-11) to identify key quality-of-life determinants as described by parents.

RESULTS

Parents (n = 158) reported that their quality of life was influenced by family happiness and parent and child health (e.g. adequate sleep, exercise, healthy diet). Many parents expressed that their busy schedules and lack of family time were detrimental to their quality of life. Work-life balance and financial stability were other factors commonly noted to impact quality of life. Spanish-speaking parents also reported being undocumented and feeling a lack of a sense of community negatively influenced their quality of life.

CONCLUSION

Considering parent-defined quality-of-life determinants when framing health-related messaging and developing interventions may increase participant interest and ultimately improve health-related behaviors. Next steps in the HomeStyles project include using parent-reported quality-of-life determinants to guide the development of intervention materials.

Food insecurity and overweight among government-backed economy restaurant workers

Abstract Objective The objective was to analyze the occurrence and the associated factors with food insecurity and overweight among government-backed economy restaurant workers in one of the biggest cities in Brazil. Methods A sample comprised of 180 individuals and represented 76.0% of all economy restaurant workers in the city of Belo Horizonte. Food insecurity was identified through the Brazilian Food Security Scale, and excess weight was identified by the body mass index. Data collection included sociodemographic and occupational information, and also health and quality of life perception. Logistic regression models were applied to identify the association. Results Food insecurity and overweight prevalence levels were 24.0% and 66.7%, respectively. The odds of identifying food insecurity were 2.34 times higher among workers that perceived their quality of life to be regular/poor/very poor and 62.0% and 74.0% lower among workers from the 2nd and 3rd tertile of per capita income, respectively. Individuals ≥40 years old (Odds Ratio=2.69, Confidence Interval 95%:1.33-5.43) and food handlers (Odds Ratio=3.62, Confidence Interval 95%:1.68-7.81) had higher odds of being classified as overweight compared to reference categories. Workers with higher per capita income presented lower odds of being classified as overweight (Odds Ratio=0.40, Confidence Interval 95%:0.17-0,96). Conclusion It was evidenced an occurrence of overweight among government-backed economy restaurant workers, which was associated with age, income and job position. Food insecurity prevalence was associated with income and quality of life perception. Although the sample work in a food and nutritional security promotion program, it is necessary to recommend actions aimed at the promotion of healthy eating habits.

Association of diabetes therapy-related quality of life and physical activity levels in patients with type 2 diabetes receiving medication therapy: the Diabetes Distress and Care Registry at Tenri (DDCRT 17)

AIM

To examine the association between diabetes therapy-related quality of life (DTR-QOL) and physical activity levels, and identify factors associated with high diabetes therapy-related quality of life.

METHODS

Cross-sectional data from 2970 patients with type 2 diabetes in a Japanese diabetes registry were assessed for independent correlations between DTR-QOL (domains 1-4) and high physical activity levels. Data collected by the International Physical Activity Questionnaire were analyzed by logistic regression and adjusted for potential confounders.

RESULTS

The mean patient age, BMI and HbA1c level were 65.8 years, 24.7 kg/m² and 7.6% (58.7 mmol/mol), respectively. Univariate analysis showed that DTR-QOL domain 1, 2 and 4 scores were significantly associated with physical activity levels (p = 0.0046, p = 0.0004 and p < 0.001, respectively, but domain 3 score was not (p = 0.5073). In a multivariable-adjusted logistic regression model, odds ratios (ORs) of DTR-QOL domains 1, 3 and 4 were independently associated with high physical activity (ORs for 2nd to 4th quartile and p for trend; [domain 1] 1.16, 1.56, 1.22, p = 0.032; [domain 3] 1.45, 1.55, 1.38, p = 0.049; [domain 4] 1.09, 1.30, 1.51, p = 0.001, respectively), but domain 2 was not (ORs for 2nd to 4th quartile and p for trend; 1.19, 1.26, 1.23, p = 0.096).

CONCLUSION

High diabetes therapy-related QOL scores were associated with high levels of physical activity in patients with type 2 diabetes. Because this is a cross-sectional study, further study is needed to evaluate the causal association between therapy-related QOL and physical activity.

The effect of educational program based on the precede-proceed model on improving self-care behaviors in a semi-urban population with type 2 diabetes referred to health centers of Bavi, Iran

AIMS

Self-care in patients with diabetes reduces the number of hospital admissions, costs and improves their quality of life so that just by training self-care to them can reduce 80 percent of diabetic complications. Therefore, this study aimed to investigate the effect of educational program based on precede-proceed model on improving self-care behaviors in patients with type 2 diabetes referred to health centers in city Bavi in 2016-2017.

MATERIALS AND METHODS

This quasi-experimental study, conducted on 110 patient women with type 2 diabetes referred to health centers in Bavi city in 2016-2017. The training program was designed based on Precede-Proceed Model. Data collection tools included the Precede researcher-made questionnaire and the Glasgow questionnaire. The duration of the training course was three months. After one month, the effect of this program, and the amount of improvement of the patients' self-care behavior were evaluated. Independent t-test, paired t-test, Chi-square and Fisher's exact tests were carried was used for data analysis.

RESULTS

After the intervention, the average score of predisposing factors (knowledge, attitude and self-efficacy), reinforcing factors, enabling factors and self-care behaviors, in the intervention group compared to the control group, significantly increased (P<0.05). After the training, the fasting blood sugar (FBS) and body mass index (BMI) decreased in the experimental group, but this reduction was not statistically significant (P>0.05).

CONCLUSION

The findings of this research showed that Precede-Proceed Model would be an appropriate framework to educate patients with type 2 diabetes as well as promote self-care behaviors.

Health behaviors of patients diagnosed with type 2 diabetes mellitus and their influence on the patients' satisfaction with life

Background

The diagnosis of type 2 diabetes mellitus (T2DM) carries with it a number of changes to the patient’s lifestyle. A healthy lifestyle, health and preventive behaviors, as well as healthy nutrition habits play a key role in treating T2DM as well as limiting its complications.

Materials and methods

The aim of this study was the analysis of the correlation of T2DM patients’ health behaviors and their influence on the patients’ quality of life. The study was performed on a group of 50 patients from the Kuyavian–Pomeranian Voivodeship. In this study, the Health Behavior Inventory and the Satisfaction with Life Scale were used. The results were statistically analyzed. The study was approved by the ethics committee.

Results

The intensity of severity of health behavior and satisfaction with life of T2DM patients depends on the gender of the patient (P<0.05). The analysis of the patients’ behaviors in four categories, proper eating habits (consuming vegetables, fruit, whole meal bread), health practices (daily physical activity, recreation, sleeping habits), preventive behaviors (including keeping to health recommendations), and positive mental attitude, showed substantial correlation of the Health Behavior Inventory and the Satisfaction with Life Scale (P<0.05).

Conclusion

The categorization of the prohealth behaviors shown by diabetics allowed us to measure the connection between the individual categories of satisfaction with life. Males with T2DM showed a higher satisfaction with life score than females with the same diagnosis. The analysis showed that patients with a higher intensity of health behaviors also had superior health behaviors. The resulting correlations prove a notable relationship.

Sociocultural construction of food ways in low-income Mexican-American women with diabetes: a qualitative study

AIMS AND OBJECTIVES

The aim of the study was to explore how low-income Hispanic women, with at least 10 years of having type 2 diabetes, successfully manage the disease within a sociocultural context, especially in relation to foodways.

BACKGROUND

Managing type 2 diabetes is challenging, particularly for underserved populations such as low-income Hispanic women. This population segment has higher rates of type 2 diabetes, diabetes-related complications, obesity, and sedentary lifestyles than the general U.S.

POPULATION

Dietary management is a critical aspect of diabetes care, but it is perhaps the most difficult health behaviour to modify.

DESIGN

A qualitative and ethnographically based study was used.

METHODS

Participant observation and individual interviews explored the interrelationships of culture, food habits and type 2 diabetes among 12 low-income Hispanic women residing in an impoverished rural community located on the Texas-Mexico border.

RESULTS

Hispanic women used unique strategies to adjust their diet, particularly portion control; for example, they emphasised the 'use of the fork', based on the notion that Hispanic finger foods are less healthy. Women categorised foods as bad or acceptable, depending on the context, such as important family or social gatherings. Those with years of diabetes experience confidently took charge of the disease based on knowledge of their bodies and a desire to avoid complications, while acknowledging brief infractions of dietary 'rules' and balancing various social roles and expectations.

CONCLUSIONS

Hispanic women manage their type 2 diabetes within a sociocultural environment. Those with expertise make changes in how they eat to care for their diabetes, but also continue to maintain traditional foodways.

RELEVANCE TO CLINICAL PRACTICE

Foodways are critical to most cultural groups and modifying dietary behaviours can be challenging. Clinicians must develop self-management guidance within the sociocultural context of the patient if diabetes outcomes are to improve and be sustained.

Asthma in Children With Comorbid Obesity: Intervention Development in a High-Risk Urban Community

This article describes formative work conducted to inform design of an intervention targeting asthma control in overweight/obese children. Using a PRECEDE-PROCEED framework and a community-based participatory research approach, investigators conducted key informant interviews and focus groups in a low-income urban community. Key informants (N = 18) represented schools and community agencies. Focus groups were conducted with caregivers (4 groups, N = 31) and children (3 groups, N = 30). Focus group participants were low-income and African American, Puerto Rican, or Mexican. Children were age 5 to 12 years and overweight or obese with a diagnosis of asthma; caregivers had a child meeting these criteria. A range of issues competed with families' day-to-day prioritization and management of asthma, with social limitations reported as the most important issue. Many school-level and individual-level barriers were described. Caregivers and children drew strong connections between asthma and obesity and described their need to comanage these conditions. The connection between the diseases was not as obvious for the key informants, many of whom control the services families receive. These results led to an understanding of key targets and components that are needed for a multilevel community-based intervention to be relevant and appropriate in low-income children with both asthma and obesity.

Sex Differences in Cardiovascular Disease Risk of Ghanaian- and Nigerian-Born West African Immigrants in the United States: The Afro-Cardiac Study

BACKGROUND

The number of African immigrants in the United States grew 40-fold between 1960 and 2007, from 35 355 to 1.4 million, with a large majority from West Africa. This study sought to examine the prevalence of cardiovascular disease (CVD) risk factors and global CVD risk and to identify independent predictors of increased CVD risk among West African immigrants in the United States.

METHODS AND RESULTS

This cross-sectional study assessed West African (Ghanaian and Nigerian) immigrants aged 35-74 years in the Baltimore-Washington metropolitan area. The mean age of participants was 49.5±9.2 years, and 58% were female. The majority (95%) had ≥1 of the 6 CVD risk factors. Smoking was least prevalent, and overweight or obesity was most prevalent, with 88% having a body mass index (in kg/m(2)) ≥25; 16% had a prior diagnosis of diabetes or had fasting blood glucose levels ≥126 mg/dL. In addition, 44% were physically inactive. Among women, employment and health insurance were associated with odds of 0.09 (95% CI 0.033-0.29) and 0.25 (95% CI 0.09-0.67), respectively, of having a Pooled Cohort Equations estimate ≥7.5% in the multivariable logistic regression analysis. Among men, higher social support was associated with 0.90 (95% CI 0.83-0.98) lower odds of having ≥3 CVD risk factors but not with having a Pooled Cohort Equations estimate ≥7.5%.

CONCLUSIONS

The prevalence of CVD risk factors among West African immigrants was particularly high. Being employed and having health insurance were associated with lower CVD risk in women, but only higher social support was associated with lower CVD risk in men.

Risk screening for cardiovascular disease and diabetes in Latino migrant farmworkers: a role for the community health worker

Diabetes and heart disease are two of the leading causes of death for Hispanics living in the United States (American Heart Association [AHA] in Circulation 123:e18-e209. doi: 10.1161/CIR.0b013e3182009701 , 2010). As the Hispanic population continues to grow, the need for low-cost, non-invasive methods to detect at risk populations for such diseases becomes more important. Once at risk individuals are detected, prevention strategies can be implemented. Studies have shown that Latino community health workers (CHWs) are effective educators, patient advocates and health promotion motivators for patients with known heart disease or diabetes. This pilot study examined the accuracy with which Latino CHWs could determine migrant farmworkers at risk for diabetes or cardiovascular disease (CVD) in rural Virginia. This quasi-experimental study supports the hypothesis that Latino CHWs can use non-invasive diabetes and CVD screening tools with similar accuracy as a registered nurse. The screening tools used were the American Diabetes Association's diabetes risk calculator and a non-laboratory screening tool for CVD risk designed by Gaziano et al. (Lancet 371:923-931, 2008). The terms Latino and Hispanic will be used interchangeably.

[Aspects of quality of life associated with self-rated health: a study of elderly women from a physical activity program in low-income neighborhoods in Curitiba in the state of Paraná, Brazil]

This study sought to analyze which aspects of quality of life (QoL; Physical, Psychological, Social Relationships and Environmental) are associated with the perception of health among elderly women from low-income neighborhoods in Curitiba in the state of Paraná. The sample comprised 450 elderly participants of the Elderly in Motion Program of the Boqueirão, Pinheirinho and Bairro Novo neighborhoods. The question "How do you rate your general health?" was used to assess the perceived health in the elderly, and the Whoqol-Bref questionnaire was used to identify the aspects of QoL. Descriptive statistics, the Mann-Whitney U test, Spearman's correlation test and binary logistic regression were used for data analysis. All aspects were significantly associated with perceived health (p < 0.05). However, after adjusting for confounding variables, only the Physical and Environmental aspects revealed significant associations. In other words, elderly women with a negative perception of these aspects were twice as likely to have a negative perception of health. The conclusion reached is that programs aimed at promoting health and QoL in low-income elderly women ought to concentrate their actions on the physical and environmental aspects of QoL.

Education based on precede-proceed on quality of life in elderly

Background and Objective:

One of the most important challenges in public health is to improve the quality of life in elders. Aging may cause various disorders such as disabilities, high risk conditions and some chronic disease. In this study the effect of educational intervention based on precede–proceed on quality of life in elders was examined.

Materials & Methods:

This semi experimental study was carried out on 128 elders over 60 years in Zahedan that were randomly selected by multi-stage sampling method and divided in to control and intervention groups. Data collection tool was a triploid questionnaire that included demographic data, questions of precede-proceed constructs and SF-36 questionnaire. The validity and reliability of questionnaire confirmed by experts and Cranach’s Alpha coefficient (76%). After primary data collecting, educational intervention was performed and after nine months data was collected again and analyzed in spss.16 soft-ware using descriptive and analytical statistics.

Results:

The results showed that mean score of quality of life in participants was low and more than 61% of them had a mean score less than 50%. After intervention the mean score of quality of life only in experimental group significantly increased from 47.72 to 58.90. Behavior and self-rated health were the strongest predictors for quality of life in this study.

Conclusion:

Implementation educational intervention based on precedes-proceed model can improve quality of life in elders. Elderly women and older elderly individuals compared with elderly men and younger elderly should be considering as an important risk factor for reducing HRQOL.

Investigating social ecological contributors to diabetes within Hispanics in an underserved U.S.-Mexico border community

Hispanics bear a disproportionate burden of diabetes in the United States, yet relations of structural, socio-cultural and behavioral factors linked to diabetes are not fully understood across all of their communities. The current study examines disparities and factors associated with diabetes in adult Hispanics of Mexican-descent (N = 648) participating in a population survey of an underserved rural U.S.-Mexico border community. The overall rate of diabetes prevalence rate in the sample, based on self-report and a glucose testing, was 21%; much higher than rates reported for U.S. adults overall, for all Hispanic adults, or for Mexican American adults specifically. Acculturation markers and social determinants of health indicators were only significantly related to diabetes in models not accounting for age. Older age, greater BMI (>30), greater waist-to-hip ratio as well as lower fruit and vegetable consumption were significantly related to increased likelihood of diabetes when all structural, cultural, behavioral, and biological factors were considered. Models with sets of behavioral factors and biological factors each significantly improved explanation of diabetes relative to prior social ecological theory-guided models. The findings show a critical need for diabetes prevention efforts in this community and suggest that health promotion efforts should particularly focus on increasing fruit and vegetable consumption.

A review about the effect of life style modification on diabetes and quality of life

The aim of this review is to examine diabetes and quality of life improvements through modifying life style. The data was collected by reviewing published articles from PubMed, Medline, Web of Science, and Google open access publications. The review identified prevention strategies can reduce the risk and complications of diabetes. Life style modification in relation to obesity, eating habit, and physical exercise can play a major role in the prevention of diabetes. Nowadays, there has been progress in the development of behavioural strategies to modify these life style habits and it is not easy to accept for long term basis. If people maintain a balanced diet and physical exercise this can have real and potential benefits for their prevention and control of complications from chronic diseases particularly for cardiovascular risk and diabetes. Healthy life style may best be achieved through public private partnerships involving government, partners organizations, health services providers, community and people living with diabetes. Effective strategies to reduce the incidence of diabetes globally and assist in managing the disease are urgently required.

Predictors of effects of lifestyle intervention on diabetes mellitus type 2 patients

The main aim of the study was to identify predictors of the effects of lifestyle intervention on diabetes mellitus type 2 patients by means of multivariate analysis. Data from a previously published randomised clinical trial, which compared the effects of a rehabilitation programme including standardised education and physical training sessions in the municipality's health care centre with the same duration of individual counseling in the diabetes outpatient clinic, were used. Data from 143 diabetes patients were analysed. The merged lifestyle intervention resulted in statistically significant improvements in patients' systolic blood pressure, waist circumference, exercise capacity, glycaemic control, and some aspects of general health-related quality of life. The linear multivariate regression models explained 45% to 80% of the variance in these improvements. The baseline outcomes in accordance to the logic of the regression to the mean phenomenon were the only statistically significant and robust predictors in all regression models. These results are important from a clinical point of view as they highlight the more urgent need for and better outcomes following lifestyle intervention for those patients who have worse general and disease-specific health.

Impact of physical activity and bodyweight on health-related quality of life in people with type 2 diabetes

PURPOSE

Increasing obesity prevalence rates in the general population are reflected in patients with type 2 diabetes. Health-related quality of life (HRQoL) is negatively affected in patients who are overweight or have diabetes, but physical activity (PA) is proven to have positive side effects on the perceived quality of life. Little is known about the relationship of PA with obesity, diabetes, and HRQoL. Therefore, the objective of the present study was to examine the relationship between HRQoL and PA in type 2 diabetics in association with the severity of overweight.

METHODS

This was a cross-sectional multicenter cohort study involving 370 outpatients with type 2 diabetes. Participants completed the SF-36 Health Survey (SF-36(®)) and the Freiburger Questionnaire for Physical Activity (FFkA). Endurance capacity was tested with a 2 km walking test. t-tests, analysis of variance, Pearson's correlation test, and multiple regression analyses were performed.

RESULTS

HRQoL is negatively affected by body mass index (BMI). The results show that patients with type 2 diabetes and grade II obesity (BMI > 35) have a lower HRQoL than overweight patients (BMI 25-29.99) and patients with grade I obesity (BMI 30-35). HRQoL decreases with decreasing PA in all dimensions of the SF-36. PA remains a significant predictor of physical composite summary (B = 0.09; β = 0.11; P < 0.05), physical function (B = 0.10; β = 0.13; P < 0.01), mental composite summary (B = 0.13; β = 0.20; P < 0.001), vitality (B = 0.15; β = 0.24; P < 0.001), and psychological well-being (B = 0.11; β = 0.18; P < 0.01) when controlling for age, sex, and BMI.

CONCLUSION

Because of the strong association between being overweight/obese and several risk factors for morbidity and mortality, reversing the obesity epidemic is an urgent priority. Based upon the results of this study and the available evidence of the efficacy of PA for preventing and treating those who are overweight or obese, health care professionals should continue to stress the importance of PA as a treatment option.