Pilot - Resistance Exercise for Inpatient Treatment in T2D

Type 2 Diabetes (T2D) is associated with prolonged hospitalization and an increased risk of readmission. Moreover, sedentary behavior and poor glycemic control may contribute to disease severity and mortality. The inactivity during hospitalization is particularly concerning in T2D patients, due to the negative effect on glucose metabolism and secondary loss of skeletal muscle mass, which can further disrupt glucose regulation. However, there are no exercise guidelines for hospitalized T2D patients. To address this gap, a feasibility study will be conducted examining the effectiveness of incorporating resistance training into hospital care for T2D patients. For the feasibility study, 24 patients with T2D or prediabetes will be recruited from the Department of Infectious Diseases at Rigshospitalet and Hvidovre Hospital and randomized to 4 weeks of resistance training for 30 minutes per day or standard treatment. If the participants are discharged they will be offered online-training sessions. During the hospitalization a continuous glucose monitor will be applied and an accelerometer during the full intervention. At baseline, discharge and at follow-up, extensive testing will be performed.

Patients will be invited to participate, preferably within the first 24 hours of admission, and randomized to either resistance-based bodyweight exercise or a control group. In total, 24 patients will be recruited, and distributed between the groups stratified for biological sex. At baseline, participants will have their medical history, social anamnesis, height, and weight assessed. At baseline a continuous glucose monitor will and accelerometer will be applied, to be worn until discharge and end of the intervention, respectively. Furthermore at baseline a multitude of questionnaires will be performed: International Physical Activity Questionnaire (IPAQ), Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F), Brief Illness Perception Questionnaire (BIPQ), 5-level EQ-5D version (EQ-5D-5L), WHO-5 Well-Being Index (WHO-5).

Intervention session A body-weight based resistance exercise program will be performed based on a booklet "Syg men sund og aktiv" Sick but healthy and active for 30 minutes per day. Described in more detail below.

Control session The control group will be placed in a seated position for 30 minutes corresponding to the time the intervention group is active.

Assessments before and after intervention/control sessions Before the sessions the EQ-5D-5L, the WHO-5 modified to a daily version, and an acute assessment of malaise, tiredness, nausea, dizziness, pain and breathlessness will be performed using numerical rating scales (NRS). After the session the NRS will be performed again.

Follow-up visit Two days after completion of the intervention, the participants will be invited for a follow-up visit at the Centre for Physical Activity Research, Rigshospitalet. This visit includes a qualitative interview, assessment of body composition, assessment of physical capabilities, ultrasound of the thigh, and blood samples. In case the patient is unable to attend the follow-up visit at the center, the daily operating manager will visit the patient at home. In this case, Ultrasound and muscle biopsy will not be performed. If the patient lives more than one hour away by car, the assessment will be performed online and will not include ultrasound, body composition and blood tests.

Eligibility Criteria:
Inclusion Criteria:

* T2D or prediabetes defined as at least one of the following

  * ICD-10 diagnosis of T2D (DE11.x)
  * HbA1c \> 48 at time of admission
  * Use of type 2 antidiabetic medicine (excluding SGLT2 inhibitors)
  * HbA1c ≥ 42 within 3 months of admission (prediabetes)
* Hospitalized with an infection
* Expected residual hospitalization time of at least three days
* At least 18 years of age
* Able to perform exercises in the booklet "Syg men sun dog aktiv"

Exclusion Criteria:

* Admitted to the hospital more than 5 days ago
* Unable to give written consent to participate
* Terminal illness
* Unstable or new onset angina
* Ventricular arrhythmia
* Aortic stenosis
* Sternotomy in conjunction with the current hospitalization
* Blood pressure greater than 180/120 mmHg
* Kidney failure requiring dialysis
* Unable to follow the 3-stage command of the Mini-Mental State Examination
* Known allergy or contact dermatitis to tape, and CGMs