# Exercise as it relates to Disease/Physical activity counselling interventions in type II Diabetics
## Background to research

It is well documented that physical activity programs are beneficial to type II diabetic individuals. There are noted improvements in both physiological and biochemical factors with resistance and aerobic training. However a major area that has been neglected is physical activity adherence in the longer term. Whilst benefits are seen in the short term, these improvements are short lived due physical activity being ceased. A different approach needs to be taken to ensure that these physical activity life style choices are maintained.
Diabetic individuals are less likely to be involved in physical activity than the regular community, which may be attributed to a lack of physical activity advice and support received compared to other diabetic management areas such as diet. An obvious need to improve education and support as well as improving exercise adherence, led to the introduction of physical activity counselling interventions.

## Where is this research from

This research into physical activity counselling was conducted in Scotland and was funded by Tenovus medical research fund and the Royal Alexander Hospital Scotland. It was published in Diabetologia journal of The European Association for the Study of Diabetes in 2004. The authors A Kirk, N Mutrie, P Macintyre and M Fisher conducted a pilot study in 2001, which researched the effects of physical activity on exercise adherence and quality of life in diabetic individuals. Their 2004 piece builds on their pilot study by including biochemical and physiological measurements, ultimately providing a more in depth study on the total effects of exercise in diabetics. A Kirk and N Mutrie have since further built on their initial research and in 2007 developed and published guidelines based on supported evidence from their research on the best way to conduct physical activity counselling.

## What kind of research was this

The research was designed as a random control trial. It involved implementing a control group and an experimental group who undertook the physical activity counselling.

## What did this research involve

The research involved inviting 223 people from a diabetes out-patient clinic to be a part of the study. Participant had to be in the preparation or contemplation stages of wanting to change their physical activity behaviour and were randomly assigned into either a control group (35 people) or an experimental group (35 people). Each group undertook the following baseline assessments:
* Exercise screening
* Body Mass Index (BMI)
* Urine sample
* Fasting blood sample
* Blood pressure and 7-day physical activity recall interview.
| Control Group Treatment | Experimental Group Treatment |
| Baseline assessment and standard exercise leaflet | Baseline assessment, exercise consultation and standard exercise leaflet |
| Follow up phone calls 1 and 3 months | Follow up phone calls 1 and 3 months |
| Follow up 6 months: repeat baseline assessment and standard exercise leaflet | Follow up 6 months: repeat baseline assessment, exercise consultation, standard exercise leaflet |
| Follow up phone calls 7 and 9 months | Follow up phone calls 7 and 9 months |
| Follow up 12 months: repeat baseline assessment | Follow up 12 months: repeat baseline assessment |
The physical activity counselling is the crucial component of this research and was undertaken in accordance with previously established guidelines for health professionals conducting an exercise consultation. Physical activity counselling involves giving advice and helping the client problem solve ways to fit exercise into their life and explain what kind exercise is needed and importantly how to do it. The content of the consultation was also developed around the stages of the trans-theoretical model (pre-contemplation, contemplation, preparation, action and maintenance) that the client was in. This allows the skilled professional to tailor their approach and strategies to enhance physical activity to the individual.

## What were the basic results

The researchers found that the experimental group after 6 and 12 months had improvements in all of the following areas compared to the control group:
* Increased total activity per week
* Small favourable changes in blood pressure
* Decrease in HbA1c (glycated haemoglobin) → improved glycaemic control
* Decrease in total cholesterol levels
* Decrease in fibrinogen concentrations → glycoprotein that is a risk factor for cardiovascular disease

## How did the researchers interpret the result

The authors interpreted the results by concluding that physical activity counselling improved exercise adherence which in turn reduced cardiovascular risk factors and improved glycaemic control.

## What conclusions should be taken away from this research

Diabetic individuals do not receive enough physical activity support and are not shown how to incorporate physical activity into their diabetic management plan. This research shows that physical activity counselling is an evidence supported technique to increase physical activity adherence to decrease health complications in the future.

## What are the implications for this research

This research amplifies the importance of support in goal setting and breaking down physical activity barriers. Physical activity counselling should be included in diabetic management plans as it leads to a decrease in diabetic complications and cardiovascular disease development later in life. However the feasibility of rolling out such programs in communities has been questioned and the cost of employing trained physical activity counsellors must be taken into consideration. Conversely, the cost of diabetic and obesity management is rising, and the introduction of physical activity counselling interventions could potentially decrease the future economic burden of diabetic complications by instilling lifelong physical activity habits.

## Further reading

* Diabetes Australia
* Physical Activity Counselling Toolkit
* Transtheoretical Model
* Diabetes and Exercise
* ESSA Exercise Guideline for Type II Diabetics

## References

* ↑ Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, et al. American College of Sports Medicine position stand. Exercise and type 2 diabetes. Med Sci Sports Exerc 2000;32(7):1345-1360.
* ↑ Kirk A, Mutrie N, Macintyre P, Fisher M. Effects of a 12-month physical activity counselling intervention on glycaemic control and on the status of cardiovascular risk factors in people with Type 2 diabetes. Diabetologia 2004;47(5): 821-832.
* ↑ Krug L, Haire-Joshu D, Heady S. Exercise habits and exercise relapse in persons with non-insulin-dependent diabetes mellitus. The Diabetes Educator 1991;17(3): 185-188.
* ↑ Kirk A, Higgins L, Hughes A, Fisher B, Mutrie N, Hill S, MacIntyre P. A randomized, controlled trial to study the effect of exercise consultation on the promotion of physical activity in people with Type 2 diabetes: a pilot study. Diabetic Medicine 2001;18(11): 877-882.
* ↑ Kirk A, Barnett J, Mutrie N. Physical activity consultation for people with Type 2 diabetes. Evidence and guidelines. Diabetic Medicine 2007;24: 809-816.
* ↑ Loughlan C, Mutrie N. Conducting an exercise consultation: Guidelines for health professionals. Journal of the Institute of Health Education 1996;33(3): 78-82.
* ↑ Plotnikoff RC, Pickering MA, Glenn N, Doze SL, Reinbold-Matthews M, McLeod LJ, et al. The Effects of a Supplemental, Theory-Based Physical Activity Counseling Intervention for Adults With Type 2 Diabetes. Journal of Physical Activity and Health 2011 09;8(7):944-954.
* ↑ Davis WA, Knuiman MW, Hendrie D, Davis T. The obesity-driven rising costs of type 2 diabetes in Australia: projections from the Fremantle Diabetes Study. Intern Med J 2006 03;36(3):155-161