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Biweekly exercise counseling may increase physical activity, decrease sedentary time in type 2 diabetes
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Sedentary adults with type 2 diabetes increased their physical activity after attending biweekly counseling sessions with an exercise specialist for 3 years vs. patients assigned to usual care, according to findings published in JAMA.
“People with type 2 diabetes would benefit from a sustained increase in physical activity and reduction in sedentary time; however, there is no definitive evidence on whether and how an increase in physical activity and a reduction in sedentary time can be maintained lifelong in people with this disease,” Giuseppe Pugliese, MD, PhD, professor of endocrinology in the department of clinical and molecular medicine at La Sapienza University and chief of the diabetes unit at Sant’Andrea University Hospital, Rome, told Endocrine Today. “Our work shows that such a behavior change can be maintained in the long term if appropriate behavioral intervention strategies are applied. Additionally, we demonstrate that even nondramatic improvements in physical activity/sedentary behavior may translate into meaningful clinical advantage, such as a sustained increase in cardiorespiratory and muscular capacity.”
Pugliese and colleagues analyzed data from 300 patients with type 2 diabetes with a BMI between 27 kg/m² and 40 kg/m² who had a self-reported sedentary lifestyle for at least 6 months, defined as at least 8 hours of time awake spent in a sitting or reclining position, as part of the Italian Diabetes and Exercise study 2 (IDES-2; mean age, 62 years; 38.7% women). The participants, recruited between October 2012 and February 2014 from three outpatient diabetes clinics in Rome, were assigned to a behavior intervention group with theoretical and practical counseling (n = 150) or to a standard care group (n = 150). Participants in the behavioral care group participated in one individual theoretical counseling session conducted by a diabetologist and eight biweekly individual theoretical and practical counseling sessions conducted by an exercise specialist every year for 3 years. All participants wore an accelerometer from baseline through month 4 and then for the last week of the month every 4 months for 3 years, and they used a daily diary to report non-accelerometer activities. Researchers assessed participants for cardiorespiratory fitness at baseline and 1, 2 and 3 years.
Coprimary endpoints were changes in physical activity volume, time spent in light-intensity physical activity and moderate- to vigorous-intensity physical activity, and sedentary time from baseline to 3 years.
“This approach, derived from the original IDES protocol, was conceived to promote a two-step behavior change to decrease sedentary time by substituting it with a wide range of light-intensity physical activities and/or interrupting prolonged sitting with brief bouts of light-intensity physical activity and to reallocate sedentary time and/or light-intensity physical activity toward gradually increasing amounts of purposeful moderate- to vigorous-intensity physical activity,” the researchers wrote.
During the 3-year intervention, participants in the behavioral counseling group accumulated more metabolic equivalent hours per week of physical activity vs. the standard care group (mean, 13.8 vs. 10.5; P < .001), more minutes per day of moderate- to vigorous-intensity physical activity (mean, 18.9 vs. 12.5; P < .001) and more hours per day of light-intensity physical activity (mean, 4.6 vs. 3.8; P < .001), as well as fewer hours per day of sedentary time (mean, 10.9 vs. 11.7; P < .001). The between-group differences persisted throughout the study except for differences in moderate- to vigorous-intensity physical activity, which decreased during the third year from a mean of 6.5 minutes per day to 3.6 minutes per day.
Additionally, more participants in the behavioral counseling group achieved prespecified targets of physical activity volume, light-intensity physical activity, moderate- to vigorous-intensity physical activity and sedentary time at years 1, 2 and 3 vs. participants in the standard care group.
“This behavioral intervention strategy was successful in increasing physical activity volume by reallocating sedentary time to light-intensity physical activity and, to a lesser extent, moderate- to vigorous-intensity physical activity,” the researchers wrote. “Significant between-group differences were maintained throughout the study period for all the coprimary endpoints; however, the difference in moderate- to vigorous-intensity physical activity diminished during the third year, suggesting that moderate- to vigorous-intensity physical activity is more difficult to maintain with time and increasing age.”
The researchers noted that the effects of the behavioral intervention may be different in other settings, such as less-walkable areas, and that diet was not considered in the data analysis, although participants received dietary prescriptions. – by Regina Schaffer
For more information: Giuseppe Pugliese, MD, PhD, can be reached at the La Sapienza University, Department of Clinical and Molecular Medicine, Via di Grottarossa, 1035-1039-00189, Rome, Italy; email: giuseppe.pugliese@uniroma1.it.
Disclosures: Pugliese reports he has received lecture and/or consulting fees from Astra-Zeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dome, Mylan, Sigma-Tau and Takeda. Please see the study for the other authors’ relevant financial disclosures.
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