Clinicians urged to do more to promote exercise in diabetes patients

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Clinicians need to do more to help people with type 2 diabetes stick to exercise regimes that can help them control blood glucose and improve heart health, according to a group of European experts. A position paper from the European Association of Preventive Cardiology highlights the benefits of physical activity for people with the condition. But the researchers make it clear that simply advising patients with type 2 diabetes to do more exercise is not enough. Instead, clinicians should help formulate tailored exercise plans and do more to motivate and encourage people to keep going, the researchers said.

Sedentary lifestyles and unhealthy diets are key factors in the increasing number of patients with type 2 diabetes and cardiovascular problems such as heart attacks, noted lead author Dr Hareld Kemps. “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,” added the Dutch cardiologist.

The position paper published in the European Journal of Preventive Cardiology sets out a number of practical recommendations for healthcare professionals on how to motivate patients to incorporate physical activity into their daily routines, set achievable and measurable goals, and design individual training programs.

“Just advising patents to exercise, which is what doctors typically do, is not enough. Patients must be assessed for co-morbidities, risks related to exercises, and personal preferences,” said Dr Kemps. He said this type of work would save money over time so should be funded by government, or through healthcare insurance.

The paper stresses the need to set achievable goals that will make a real difference to people’s lives and therefore motivate them to keep at it. “For an elderly person this could be climbing the stairs in their home or walking to the supermarket – achievements that will really improve their quality of life,” said Dr Kemps.

Being able to use less medication because of improved glycaemic control, was another strong incentive to make lifestyle changes, he added.

When it came to setting clinical targets and measuring success, he said cardiorespiratory fitness and glycaemic control were the “top two” as both improved with exercise and had a direct impact on wellbeing and health risks. Exercise could also help lower blood pressure and harmful blood lipids – other changes that could be measured. 

However, the paper cautions against using weight loss as a key goal of exercise regimes, because it is hard to lose weight through increased physical activity alone. “It’s difficult to lose weight with exercise only and if that is the main target patients may become demotivated and stop exercising. Weight loss is important but it needs to be part of a multidisciplinary intervention that includes nutrition,” said Dr Kemps.

In addition, the paper emphasises the importance of ensuring exercise regimes are carefully tailored to the needs of each patient. While “high intensity interval training” – such as alternating between normal and vigorous walking – has been shown to be most effective at boosting fitness and controlling blood sugar, it may not be safe for some patients. These include patients who develop arrhythmia – abnormal heart rhythms – while exercising and those with ischaemia – restricted blood flow to the heart.

“I can’t stress enough how effective even small increases in activity can benefit patients with type 2 diabetes and heart problems,” said Dr Kemps. “Interrupting sitting with brief bouts of walking improves glucose control, while two hours of brisk walking per week reduces the risk of further heart problems,” he added.

According to the paper, the fact that people tend to give up on training programs is “the main common problem of all exercise interventions aiming at long-term improvements” and this is severely affecting the outcome of many trials. 

“We should, therefore, consider the importance of motivation, improving self-management skills and integration of exercise into daily routine when designing exercise training programmes. This can very well be supported by multi-professional teams, including physicians, psychologists and counsellors in addition to dieticians and exercise scientists,” Dr Kemps concluded.