# Exercise as it relates to Disease/Does exercise consultation improve exercise outcomes in type 2 diabetics?

Reviewed Journal Article: Increasing Physical Activity in People With Type 2 Diabetes Alison Kirk, BSC, Nanette Mutrie, PHD, Paul MacIntyre, MD and Miles Fisher, MD

## Background to the Research

The goal of this journal article is to evaluate the effectiveness of exercise consultation on participants with type 2 Diabetes

### Type 2 diabetes

Diabetes mellitus type 2 (formerly noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes) is a metabolic disorder that is characterized by hyperglycemia (high blood sugar) in the context of insulin resistance and relative lack of insulin.

## Where is the Research From?

The research was conducted at the:
* Center for Exercise Science and Medicine, University of Glasgow, Glasgow, Scotland, U.K.
* Diabetes Center, Glasgow Royal Infirmary, Glasgow, Scotland, U.K

## Type of Research

The type of research involved in this journal article involved a total of 70 inactive people with type 2 diabetes were given standard exercise information and were randomized to receive an exercise consultation (n = 35) or not (n = 35). Of the 70 participants involved, 50 were overweight, 16 were obese, and 4 were of a normal weight.
The definition of diabetes was determined using an established criteria and controlled by a combination of dietary intake, oral hypoglycemic agents, and insulin. Participants in the study were chosen based on their intention to become more physically active (although none of the participants were meeting the current physical activity guidelines at the commencement of the study. Patients with concurrent medical conditions that inhibited there ability to exercise were excluded from the study.

## What the Research involves

The duration of the study was approximately 6 months from when the baseline measurements were taken. The participants receiving exercise consultation based on the translocation model which combines motivational theory, and cognitive behavioural strategies to create and individualised intervention. Testing was performed at the commencement and climax of the study, including the measurement physical activity capacity (including a 7 day recall, accelerometer test, cardio respiratory fitness, stage and process of change. Physiological variables included the measuring of blood pressure and Body mass index. Biochemical variables which include HBA 10, lipid profile, and fibrogen which have been shown to impact the complications involved in diabetes.

## Research Results

The main variables of that were taken into consideration include exercise time, systolic blood pressure, and fibrinogen.
| Variable | n | Baseline Mean | Mean Change | Difference in change |
| Exercise Time (min) Experimental: Control: | 30 31 | 9.42 ± 3.28 10.36 ± 4.39 | 1.56 (0.24 to 3.20) −0.28 (−1.30 to 0.37) | 56.6 to 231.5 |
| Systolic Blood Pressure (mmHg) Experimental: Control: | 32 31 | 149.4 ± 20.2 143.0 ± 19.5 | −3.67 (−15.53 to 8.20) 7.14 (−4.51 to 18.80) | −24.7 to −2.0 |
| Fibrinogen (mg/dl) Experimental: Control: | 22 21 | 310 ± 73.0 315 ± 54.7 | −3.59 (−25.48 to 18.30) 21.53 (0.01 to 43.06) | −57.2 to −4.3 |
Between-group differences were recorded for the change in minutes of moderate activity (P < 0.001) and activity counts (P < 0.001) per week. Experimental participants recorded an increase in activity counts per week and minutes of moderate activity per week (P < 0.001). The control group recorded no significant changes. More experimental participants increased stage of change (χ2 = 22.6, P < 0.001). Between-group differences were recorded for the change in total exercise duration and peak gradient (P < 0.005), HbA1c (P = 0.02), systolic BP (P = 0.02), and fibrinogen (P = 0.03).

## Interpretation of Results

The results provided were broken down into 3 different primary outcome measures and 5 secondary outcome measures; Primary outcomes that were measured include physical activity levels, behavioural change and cardiopulmonary testing. Secondary outcomes included Body mass index (BMI) and Blood pressure (BP), Glycemic control, lipid profile, and fibrinogen. Variables were considered significant if the 2 tailed p value was <0.05 ( meaning that significant change occurred between the experimental and the control). The variables that demonstrated significant difference include fibrinogen, Hbalc, and systolic blood pressure.

## Conclusions from Research

The primary outcomes of this study demonstrates that face to face exercise consultation is far more effective in promoting individuals with type 2 diabetes to engage in physical activity compared to providing an exercise leaflet. Between the experimental group and the control, the group receiving the exercise consultation increased their frequency of utilizing the four processes of change, and the greater proportion reported an increase in stage of change. Positive changes were also recorded in cardio-respiratory fitness as well as objective and subjective measures of physical activity. In comparison, the control group recorded no significant changes changes in the same recorded areas. Targeting people in the stages of preparation or contemplation has been criticized because it has a far greater chance of successfully promoting change in the individual.
Benefits that were received by the experimental group included improvements in glycemic control and cardiovascular risk factors. They also recorded a mean decrease in Hba10 whilst the control had a mean increase, which is consistent with the results of the meta anylsis of the Effects of exercise on glycaemic control and body mass in type 2 diabetes. Improvements in these areas are important as cardiovascular disease is the number 1 cause of morbidity in diabetics and the regulation of blood pressure and glycemic levels has been showed to reduce the risk of diabetes based complications and death.

## Implications of Research

Because of Restrictions to time and limited sample size, it was important to target a homogeneous group in regards to change in physical activity. If a larger variety of people in different stages were included, a larger sample would have been required for subgroup analyses of change in outcomes related to stage because change in physical activity may differ by stage. Therefore the application of exercise consultation to people in other stages of change requires further investigation in order to have a greater variety of comparisons and increase the validity of the study. No statistically significant changes in physical activity were found in the control group. Similar findings were recorded from a study evaluating the effectiveness of exercise consultation over a 5 week period in people with type 2 diabetes. This demonstrates that giving people with type 2 diabetes physical activity information in a supportive environment is not an effective solution by itself. Therefore the main takeaway message from this article is that physical activity interventions must be delivered via consultation in order for improvements to be made in individuals that suffer from unhealthy lifestyles.

## References

* ↑ Increasing Physical Activity in People With Type 2 Diabetes Alison Kirk, BSC, Nanette Mutrie, PHD, Paul MacIntyre, MD and Miles Fisher, MD
* ↑ Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Cotran, Ramzi S. ; Robbins, Stanley L. (2005). Robbins and Cotran Pathologic Basis of Disease (7th ed.). Philadelphia, Pa.: Saunders. pp. 1194–1195. ISBN 0-7216-0187-1
* ↑ Loughlan C, Mutrie N: Conducting an exercise consultation: guidelines for health professionals. J Inst Health Educ 33:78–82, 1995
* ↑ Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, Blair SN, Paffenbarger RS Jr: Physical activity assessment methodology in the Five-City Project. Am J Epidemiol 121:91–106, 1985
* ↑ Blood Viscosity, Lipid Profile, and Lipid Peroxidation in Type-1 Diabetic Patients with Good and Poor Glycemic Control Neetu Mishra, Neelima Singh N Am J Med Sci. 2013 September; 5(9): 562–566. doi: 10.4103/1947-2714.118925
* ↑ Increasing Physical Activity in People With Type 2 Diabetes Alison Kirk, BSC, Nanette Mutrie, PHD, Paul MacIntyre, MD and Miles Fisher, MD
* ↑ Whitehead M: How useful is the “stages of change” model? Health Edu J 56:111–112, 1997
* ↑ Boule NG, Haddad E, Kenny GP, Wells GG, Sigal RJ: Effects of exercise on glycaemic control and body mass in type 2 diabetes: a meta-analysis of controlled clinical trials. JAMA 286:1218–1227, 2001
* ↑ Kannel WB, McGee DL: Diabetes and car-diovascular disease: the Framingham Study. JAMA 241:2035–2038, 1979
* ↑ UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–853, 1998
* ↑ UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317:703–713, 1998
* ↑ Kirk AF, Higgins LA, Hughes AR, Fisher BM, Mutrie N, Hillis S, MacIntyre PD: 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. Diabet Med, 18:877–882, 2001