Effects of a community-based exercise and motivational intervention on physical fitness of subjects with type 2 diabetes

Adapted physical activity interventions and motivational levers: What benefits for type 2 diabetics? A systematic review

Background and Aims

Scientific research continues to advance and improve the medical management of type 2 diabetes. However, the importance of lifestyle management remains invaluable in treatment and tertiary prevention of this disease. Day-to-day sedentariness is the fourth most important risk factor for mortality in France. Numerous studies have demonstrated that physical activity is beneficial to people with type 2 diabetes and various recommendations have been made to encourage it. However, it is universally agreed that interventions that promote physical activity, while they may enhance its practice in the short term, do not impact on it over longer periods. It therefore seems essential to focus interventions on an individual's capacity to persist with physical activity in the long term. By looking at the literature, the aim of this review is to synthesize group and supervised physical activity interventions for people with type 2 diabetes using variables based on the following levers: motivation and self-efficacy.

Methods

The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) methodology examined studies in English or French that are registered in the PubMed, PsycINFO, and SportDiscus databases and were published between 2005 and 2023, according to the following keywords: Motivation OR self-efficacy AND physical activity AND type 2 diabetes AND intervention.

Results and Conclusion

Seven studies out of 1207 were included. Despite the pertinence of the concepts of motivation and self-efficacy and their complementarity in physical activity management programs, few studies have yet proposed a combined intervention for people with type 2 diabetes.

Evaluation of the Effectiveness of In-Hospital Exercise Rehabilitation in Middle-Aged and Elderly Patients with Type 2 Diabetes Mellitus Combined with Sarcopenia Effect of Lifestyle Management on Disease Status in Patients with Type 2 Diabetes Mellitus

OBJECTIVE

The aim of this study was to explore the effects of in-hospital exercise rehabilitation on glucose and lipid metabolism and healthy physical fitness in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM) combined with sarcopenia, and to provide a reference for the effective implementation of exercise rehabilitation for middle-aged and elderly patients with T2DM combined with sarcopenia in healthcare institutions.

METHODS

This study retrospectively included 122 patients with T2DM combined with sarcopenia treated at the General Hospital of Ningxia Medical University from August 2017 to August 2020 and randomly divided into a control group and an experimental group. The control group was given conventional treatment and the experimental group was given exercise rehabilitation in the hospital for 12 weeks to compare the indexes related to glucose and lipid metabolism and healthy fitness in the two groups.

RESULTS

After the intervention, the experimental group showed significant decreases in fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin resistance index (HOMA-IR), triglycerides (TG), total cholesterol (TC), low-density cholesterol (LDL-C) and body fat percentage (p < 0.05), while high-density cholesterol (HDL-C), grip strength, lower limb extension, lower limb flexion, peak oxygen uptake were significantly higher (p < 0.05) and were more significant at 12 weeks compared to the 6-week intervention (p < 0.05). However, there were no significant changes in any of the glucose metabolism indicators in the control group before and after the intervention. A two-way repeated measures ANOVA showed that at control baseline levels, HbA1c decreased significantly in the experimental group after both 6 and 12 weeks of intervention compared to the control group (p < 0.05). After 6 weeks of intervention, the experimental group showed a significant decrease in body fat percentage and a significant increase in grip strength. After 12 weeks of intervention, the experimental group showed an increase in glycemic control from 33.3% to 73.3%, a significant decrease in body fat percentage and a significant increase in grip strength, lower limb extension and lower limb flexion strength and peak oxygen uptake.

CONCLUSION

In-hospital exercise rehabilitation can effectively improve the glycemic and lipid profiles of patients with T2DM combined with sarcopenia and enhance their health fitness, with good clinical rehabilitation effects.

Exercise as a community treatment for obesity and the metabolic disease epidemic

The obesity epidemic has continued to rise at an alarming rate and has increased health complications in children, adolescents, and adults. Resistance training, aerobic training, and a combination of the two have been shown to be effective at reducing excess adiposity and improving outcomes of obesity. The continued development of programs, community centers, or medical exercise facilities prescribing these treatments is nearing an absolute necessity to slow the advancing nature of obesity and related metabolic diseases. In this brief review, we summarize the effectiveness of these three training paradigms from a population-centric perspective.

Diet, exercise, and pharmacotherapy for sarcopenia in people with diabetes

Diabetes prevalence is increasing rapidly in older people, and sarcopenia is prevalent as a novel complication, particularly in patients with type 2 diabetes mellitus (T2DM). Therefore, sarcopenia prevention and treatment in these people is necessary. Diabetes accelerates sarcopenia through several mechanisms, such as hyperglycemia, chronic inflammation and oxidative stress. The effects of diet, exercise, and pharmacotherapy on sarcopenia in patients with T2DM need to be considered. In diet, low intake of energy, protein, vitamin D, and ω-3 fatty acid are associated with sarcopenia risk. In exercises, although intervention studies in people, especially older and non-obese patients with diabetes, are few, accumulating evidence shows the usefulness of exercise, particularly resistance exercise for muscle mass and strength, and aerobic exercise for physical performance in sarcopenia. In pharmacotherapy, certain classes of anti-diabetes compounds have possibility of preventing sarcopenia. However, much data on diet, exercise, and pharmacotherapy were obtained in obese and non-elderly patients with T2DM, demanding actual clinical data on non-obese and older patients with diabetes.

Principles, tools and techniques for brief behaviour change interventions

Nurses are well placed to deliver brief opportunistic health promotion interventions during routine encounters with patients. Brief interventions have been shown to be effective in prompting behaviour change among people who engage in harmful drinking or substance misuse. Nurses can use their communication, relationship-building and partnership-working skills to support people to consider behaviour change. This article explains the concepts that underlie brief behaviour change interventions, which include motivational interviewing and the transtheoretical model of behaviour change. The article also describes practical tools and techniques that nurses can use to deliver such interventions.

Anthropometric Measurements, Metabolic Profile and Physical Fitness in a Sample of Spanish Women with Type 2 Diabetes

Background: Exercise training has proven to be effective for treatment of metabolic diseases, such as type 2 diabetes mellitus. The aims of this study were to compare anthropometric measurements, metabolic profile and physical fitness between active and sedentary women with type 2 diabetes, and to analyse relationships between anthropometry and metabolic profile and components of physical fitness (balance, flexibility, strength and endurance). Methods: Cross-sectional research on 28 women with type 2 diabetes. Amount of daily physical activity, BMI, waist circumference, HbA1c, fibrinogen, hs-CRP, tiptoe dynamic balance, static balance, finger floor distance, abdominal, upper and lower limb strength and walking cardiovascular endurance were recorded. Results: Age: 58.5 ± 7.8. Overall, 16 subjects were physically active and 12 were sedentary. Active subjects had lower BMI (p = 0.033) and better cardiovascular endurance (p = 0.025). BMI and waist circumference were not influenced by any physical fitness component. HbA1c, fibrinogen and hs-CRP were related with worse dynamic balance (p = 0.036, 0.006 and 0.031, respectively). Conclusions: Active women had lower BMI and showed a better performance in cardiovascular endurance. Tiptoe dynamic balance impairments were related to worse glycaemic control, hypercoagulation and inflammatory state.

Community-Based Exercise and Lifestyle Program Improves Health Outcomes in Older Adults with Type 2 Diabetes

BACKGROUND

The aim of this study was to assess the efficacy of Beat It-a community-based exercise and lifestyle intervention-in improving anthropometric and physical fitness outcomes in older adults with type 2 diabetes mellitus (T2DM).

METHODS

Australians with T2DM who were aged 60 years or older were included. These individuals were enrolled in Beat It, a twice-weekly supervised group exercise and education program conducted over 8 weeks. Anthropometric measurements and physical fitness parameters were assessed at baseline and completion. Physical fitness measures were then compared to validated criterion standards of fitness levels required by older adults to remain physically independent into later life.

RESULTS

A total of 588 individuals were included in the study. At baseline, a substantial proportion of the cohort had physical fitness measures that were below the standard for healthy independent living for their gender and age. Significant improvements in waist circumference and physical fitness were observed post program and resulted in an increase in the number of participants who met the standard for healthy independent living.

CONCLUSIONS

Participation in Beat It improved important health outcomes in older adults with T2DM. A longer-term follow-up is needed to determine whether these positive changes were maintained beyond the delivery of the program.

CaRE @ Home: Pilot Study of an Online Multidimensional Cancer Rehabilitation and Exercise Program for Cancer Survivors

BACKGROUND

Although facility-based cancer rehabilitation and exercise programs exist, patients are often unable to attend due to distance, cost, and other competing obligations. There is a need for scalable remote interventions that can reach and serve a larger population.

METHODS

We conducted a mixed methods pilot study to assess the feasibility, acceptability and impact of CaRE@Home: an 8-week online multidimensional cancer rehabilitation and exercise program. Feasibility and acceptability data were captured by attendance and adherence metrics and through qualitative interviews. Preliminary estimates of the effects of CaRE@Home on patient-reported and physically measured outcomes were calculated.

RESULTS

A total of n = 35 participated in the study. Recruitment (64%), retention (83%), and adherence (80%) rates, along with qualitative findings, support the feasibility of the CaRE@Home intervention. Acceptability was also high, and participants provided useful feedback for program improvements. Disability (WHODAS 2.0) scores significantly decreased from baseline (T1) to immediately post-intervention (T2) and three months post-intervention (T3) (p = 0.03 and p = 0.008). Physical activity (GSLTPAQ) levels significantly increased for both Total LSI (p = 0.007 and p = 0.0002) and moderate to strenuous LSI (p = 0.003 and p = 0.002) from baseline to T2 and T3. Work productivity (iPCQ) increased from T1 to T3 (p = 0.026). There was a significant increase in six minute walk distance from baseline to T2 and T3 (p < 0.001 and p = 0.010) and in grip strength from baseline to T2 and T3 (p = 0.003 and p < 0.001).

CONCLUSIONS

Results indicate that the CaRE@Home program is a feasible and acceptable cancer rehabilitation program that may help cancer survivors regain functional ability and decrease disability. In order to confirm these findings, a controlled trial is required.

Can an Exercise-Based Educational and Motivational Intervention be Durably Effective in Changing Compliance to Physical Activity and Anthropometric Risk in People with Type 2 Diabetes? A Follow-Up Study

AIMS

A nine-month motivational exercise-based intervention was previously offered to subjects with type 2 diabetes (T2D). A year after the end of the intervention, compliance to physical activity (PA) and anthropometric indices of participants were analyzed to evaluate the durability of its effects.

METHODS

PA levels, expressed as total energy expenditure per week, were assessed with the International Physical Activity Questionnaire (IPAQ). Changes in Body Mass Index (BMI), A Body Shape Index (ABSI), Hip Index (HI) z-scores, the relative mortality risk related to each of these measures, and a combined Anthropometric Risk Index (ARI) were also evaluated.

RESULTS

Of a total of the 52 subjects examined (67.9% males, mean age 61.8 ± 6.0), 46 (88.4%) were still sufficiently active as defined by IPAQ thresholds at follow-up. PA levels, anthropometric indices and related risks improved at follow-up in respect to the baseline and to the end of the intervention, although only PA levels, BMI and related measures, and ARI risk changed significantly. Habitual PA increased significantly after the intervention (p < 0.01) and this increase correlated with changes in BMI z-scores (r = -0.29, p = 0.04). BMI risk was significantly lower (p < 0.01) in participants still active at follow-up.

CONCLUSIONS

This study testifies to the persistence of compliance to PA and health benefits of a combined exercise-based and motivational intervention in subjects with T2D.