Make Your Diabetic Patients Walk

Abstract

OBJECTIVE -To establish the impact of different amounts of increased energy expenditure on type 2 diabetes care. RESEARCH DESIGN AND METHODS-Post hoc analysis of long-term effects of different amounts of increased energy expenditure (metabolic equivalents [METS] per hour per week) through voluntary aerobic physical activity was performed in 179 type 2 diabetic subjects (age 62 Ϯ 1 years [mean Ϯ SE]) randomized to a physical activity counseling intervention. Subjects were followed for 2 years and divided into six groups based on their increments in METs per hour per week: group 0 (no activity, n ϭ 28), group 1-10 (6.8 Ϯ 0.3, n ϭ 27), group 11-20 (17.1 Ϯ 0.4, n ϭ 31), group 21-30 (27.0 Ϯ 0.5, n ϭ 27), group 31-40 (37.5 Ϯ 0.5, n ϭ 32), and group Ͼ40 (58.3 Ϯ 1.8, n ϭ 34).RESULTS -At baseline, the six groups did not differ for energy expenditure, age, sex, diabetes duration, and all parameters measured. After 2 years, in group 0 and in group 1-10, no parameter changed; in groups [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and Ͼ40, HbA 1c , blood pressure, total serum cholesterol, triglycerides, and estimated percent of 10-year coronary heart disease risk improved (P Ͻ 0.05). In group 21-30, 31-40, and Ͼ40, body weight, waist circumference, heart rate, fasting plasma glucose, serum LDL and HDL cholesterol also improved (P Ͻ 0.05). METs per hour per week correlated positively with changes of HDL cholesterol and negatively with those of other parameters (P Ͻ 0.001). After 2 years, per capita yearly costs of medications increased (P ϭ 0.008) by $393 in group 0, did not significantly change in group 1-10 ($206, P ϭ 0.09), and decreased in group 11-20 (Ϫ$196, P ϭ 0.01), group 21-30 (Ϫ$593, P ϭ 0.009), group 31-40 (Ϫ$660, P ϭ 0.003), and group Ͼ40 (Ϫ$579, P ϭ 0.001). CONCLUSIONS -Energy expenditure Ͼ10METs ⅐ h Ϫ1 ⅐ week Ϫ1 obtained through aerobic leisure time physical activity is sufficient to achieve health and financial advantages, but full benefits are achieved with energy expenditure Ͼ20 METs ⅐ h Ϫ1 ⅐ week Ϫ1 . Diabetes Care 28:1295-1302, 2005W estern and developing countries face two serious health problems: the rising prevalence of obesity and diabetes and the fact that people no longer need to be physically active in their daily lives (1-4). Many studies have shown that regular physical activity improves quality of life, reduces the risk of mortality from all causes (1-4), and is particularly advantageous in subjects with impaired glucose tolerance (5,6) or type 2 diabetes (7-12). Physical activity counseling can motivate most diabetic subjects to increase their levels of voluntary energy expenditure (9 -11), but, at present, the relationship between amounts of physical activity and longterm beneficial effects in type 2 diabetes care is unknown. The American Diabetes Association emphasizes the benefits of regular physical activity in the prevention and treatment of type 2 diabetes, referring to proposals given to the general population by...

Physical Activity of Moderate Intensity and Risk of Type 2 Diabetes

“…A randomized trial of moderate-intensity physical activity in individuals with a family history of diabetes did not find a significant reduction in incidence of type 2 diabetes after 2 years, but compliance with the program was poor and the number of participants small (n ϭ 37 in the exercise program) (38). In a 2-year randomized controlled trial in 179 individuals with type 2 diabetes, counseling to achieve 10 MET h/ week of moderately intense physical activity resulted in significantly reduced body weight and fasting glucose and A1C concentrations (39). In a post hoc analysis, a significant reduction in A1C was observed for participants that increased 11-20 MET h/week, but greater beneficial effects were observed in those who increased their activity with 21-30 MET h/week (39).…”

“…In a 2-year randomized controlled trial in 179 individuals with type 2 diabetes, counseling to achieve 10 MET h/ week of moderately intense physical activity resulted in significantly reduced body weight and fasting glucose and A1C concentrations (39). In a post hoc analysis, a significant reduction in A1C was observed for participants that increased 11-20 MET h/week, but greater beneficial effects were observed in those who increased their activity with 21-30 MET h/week (39). Several randomized controlled trials tested the effects of brisk walking on glucose metabolism in individuals without diabetes (40 -42).…”

Increased Daily Walking Improves Lipid Oxidation Without Changes in Mitochondrial Function in Type 2 Diabetes

“…However, such moderate intensity exercise programs are difficult to implement and usually require close supervision. In contrast, unsupervised walking has been shown to produce significant improvements in long-term glucose control and is a sustainable behavior over long periods of time (2 years) (15). Little is known about how low-intensity physical activity interventions such as walking influence muscle metabolism in people with type 2 diabetes.…”

Walking and Type 2 Diabetes

“…f you need another reason to prioritize physical activity for your patients with type 2 diabetes, it is provided in the study by Di Loreto et al (1) published in this issue of Diabetes Care. Results from the study show that you can get impressive improvements in health and reductions in health care costs just by getting your patients with type 2 diabetes to make modest increases in physical activity.…”

“…The easiest way to start is to understand how much walking it would take to achieve these values. Walking was the activity of choice for most of the subjects in the study by Di Loreto et al (1), and it will be the activity of choice for most of your patients as well. Certainly you will have some patients who cannot walk and you can suggest other activities such as swimming or cycling.…”