Can Diabetes Patients Successfully Maintain Improved Physical Activity?

A randomized, clinical trial published in JAMA assessed the efficacy of behavioral interventions to improve physical activity in patients with type 2 diabetes. The researchers found that a behavioral intervention could in fact be impactful in increasing physical activity and decreasing sedentary time.

The Italian Diabetes and Exercise Study 2

The study was the Italian Diabetes and Exercise Study 2 (IDES_2) trial, an open-label, assessor-blinded, randomized clinical superiority trial. Between October 2012 and February 2014, researchers recruited 300 physically inactive and sedentary type 2 diabetes patients from three outpatient diabetes clinics in Rome. Patients were stratified by center, age, and diabetes treatment and randomized 1:1 to receive a behavioral intervention or standard care for three years. Patients were followed through February 2017.

All patients received American Diabetes Association guideline-approved usual care. The standard care group (n = 150) only received the usual care. The behavioral intervention group (n = 150) received standard care as well as one individual theoretical counseling session and eight individual biweekly theoretical and practical counseling sessions each year. The primary endpoints were sustained change in physical activity volume, time spent in light-intensity and moderate- to vigorous-intensity physical activity, and sedentary time; an accelerometer was used to measure the endpoints.

Of the 300 randomized patients (mean age, 61.6 years; 38.7% female), 267 successfully completed the trial—133 behavioral intervention patients and 134 standard care patients; median follow-up was three years. In the behavioral intervention group, patients accumulated 13.8 metabolic equivalent-h/wk of physical activity volume, compared to 10.5 h/wk in the standard care group (difference, 3.3 [95% CI, 2.2-4.4]; P < .001). The intervention group also spent more time engaging in moderate- to vigorous-intensity physical activity (18.9 vs. 12.5 min/dof; difference, 6.4 [95% CI, 5.0-7.8]; P < .001), as well as light-intensity physical activity (4.6 vs. 3.8 h/d; difference, 0.8 [95% CI, 0.5-1.1]; P < .001). The behavioral intervention group had less sedentary time than the standard care group (10.9 vs. 11.7 h/d; (difference, −0.8 [95% CI, −1.0 to −0.5]; P < .001). The between-group differences remained significant over the three-year period, but during the third year, the moderate- to vigorous-intensity physical activity between-group difference decreased by about half, going down to 3.6 min/d. Outside of sessions, the standard care group experienced more adverse events than the behavioral intervention group (59 vs. 41), while the behavioral intervention group sustained 30 adverse events during the sessions, the most common of which were musculoskeletal injury/discomfort and mild hypoglycemia.

The study authors called for further research to establish the generalizability of their findings.

Does Exercise Help Diabetes Outcomes?

Previous research supports exercise to help diabetes patients. According to a recent study published in the European Journal of Preventative Cardiology, which was conducted on behalf of the European Association of Preventive Cardiology (EAPC), patients with type 2 diabetes mellitus are at an increased risk of numerous cardiovascular outcomes, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity, and reduced cardiorespiratory fitness (CRF). Patients with T2DM and cardiovascular comorbidities are especially at risk of mortality, and exercise can help with insulin sensitivity, lipid profile, vascular reactivity, and CRF.

“Sedentary lifestyles and unhealthy diets are the most important drivers of the increasing number of patients with type 2 diabetes and cardiovascular problems such as heart attacks,” said study author Dr. Hareld Kemps, a cardiologist at Máxima Medical Centre, Veldhoven, the Netherlands, in a press release. “Diabetes doubles the risk of mortality but the fitter patients become, the more that risk declines. Unfortunately, the majority of patients do not engage in exercise [programs].”