Does home-based exercise improve body mass index in patients with type 2 diabetes?: Results of a feasibility trial☆
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.
Section snippets
Materials and methods
We conducted a randomized controlled clinical trial of sedentary adult patients with type 2 diabetes mellitus from June 2004 through August 2005. The study was approved by the Institutional Review Board on 11 May 2004 and monitored by an internal data safety monitoring committee. None of the authors have conflicts of interest with this study. Participants in the trial were recruited from outpatient settings in a large southern multi-specialty group practice. Inclusion criteria were age > 18
Results
Of the 155 patients screened, 94 met eligibility criteria and were randomized (using block randomization) to the intervention group (n = 45) or the usual care group (n = 49) (Fig. 1). Reasons for exclusion after screening included more than 150 min of physical activity a week (n = 43); co-morbid condition limiting physical activity (n = 7); participating in another clinical trial (n = 3); type 1 diabetes (n = 3); no interest in participating (n = 3), and no physician clearance for participation (n = 2).
Discussion
Despite an extensive body of evidence demonstrating health benefits of regular physical activity, a low percentage of patients with diabetes mellitus participate in routine physical activity, which can contribute to obesity and poor insulin sensitivity. The poor translation of research findings from randomized trials of physical activity into higher rates of physical activity may result from the inability of previous interventions to overcome personal and environmental barriers and improve
Limitations
The sample size was relatively small, and the intervention and follow-up period were of short duration. The results of this study provide the variance estimates necessary to power a larger study of longer duration. Although 38% of the intervention participants reported achieving at least 80% of the exercise recommendation with the use of the videotape, there are opportunities to improve this rate by increasing the variety, duration, and intensity of the exercise programs available on the
Acknowledgements
We thank the American Medical Group Association for their generous support of the project through the Models of Excellence Award program. Special thanks to Mackie Shilstone and the Audiovisual department at Ochsner for their efforts in developing and reproducing the exercise videotape. We are grateful for the assistance of Danielle Jenkins MPH and Ann Jannu PhD for their part in enrolling patients in the study. We also thank the Department of Endocrinology, Diabetes and Metabolic Diseases at
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Presented, in part, at the 47th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, American Heart Association, February 2007.