Does home-based exercise improve body mass index in patients with type 2 diabetes?

Abstract

Aims

This feasibility trial evaluated the use, safety, and short-term benefits of a home-based exercise intervention designed to increase physical activity among adults with diabetes.

Methods

Participants with type 2 diabetes in a group practice were recruited and randomly assigned to the home-based exercise intervention or usual care. Participants were given diabetes self-management education, instructed to exercise 30 min 5 days/week, and were followed for 3 months. The intervention contained three exercise routines (aerobic and resistance exercises). Outcomes included changes from baseline at 3 months between groups in body mass index (BMI), quality of life, A1C, and blood pressure.

Results

Seventy-six sedentary adults completed the study: 49% intervention group, 68% women, 47% black, mean age 56.6 ± 9.6 years. Using intention to treat analysis, a trend towards improvement between groups for BMI (mean change −0.4 versus 0.1, respectively; P = 0.06) was identified. Thirty-eight percent of the intervention group adhered to 80% of the exercise recommendation and significantly improved BMI (−1.07; P < 0.05). No other differences were detected between groups.

Conclusions

Home-based exercise interventions have potential to reduce BMI in patients with diabetes. The results provide variance estimates necessary to power a larger study of longer duration.

Introduction

Increases in physical activity have been demonstrated to reduce the risk of developing diabetes [1]. Among patients with diabetes, the benefits of regular physical activity have been well documented: improved glycemic control and insulin sensitivity [2], [3], [4], [5], reduced visceral and total fat [6], [7], [8] and improved physical functioning [9], [10]. Studies have shown that many beneficial effects can be achieved with activities of moderate intensity such as walking [3], [8], [11].

Regular physical activity has been recommended for patients with type 2 diabetes [12]. Adherence to these recommendations could improve glycemic control, blood pressure and lipid levels of many patients and thereby potentially improve patient outcomes and reduce the high morbidity, mortality, and costs of the disease. Despite the known benefits of physical activity, adherence to these recommendations remains poor [13], [14], [15]. Personal and environmental barriers to patient adherence have been identified [16]. Personal barriers include temperament, time, physical ailments, pain or discomfort when exercising, fear of injury, and misconceptions about exercise [16], [17], [18], [19], [20], [21], [22], [23]. Environmental barriers include lack of physician guidance about exercise [24], lack of access to health clubs due to cost [23], [25], transportation problems [26], [27] and climate [18]. Randomized trials have revealed multiple benefits of physical activity [28]. Research is now needed to find effective methods of providing exercise ‘treatment’ that overcome barriers to exercise for patients with type 2 diabetes seeking care in primary care and community practice [29], [30], [31], [32].

To our knowledge, studies of the effect of coupling a simple home-based exercise video program with classroom education for improving cardiovascular risk factors have not been reported. We developed an exercise video intervention that overcame environmental and personal barriers, promoted benefits of exercise and provided realistic models and approaches to achieving exercise goals within the home. The purpose of this study was to conduct a feasibility trial for evaluation of the use, safety, and short-term benefits of this home-based exercise video program supplement to diabetes self-management education designed to increase physical activity among patients with type 2 diabetes.