Physical activity - along with diet and medication - is a milestone in the treatment of diabetes.
For many years, in fact, physical activity and exercise have been recommended for the prevention and treatment of this chronic disease, as confirmed by several large randomized and controlled studies that follow the guidelines of ADA - ACSM.
Ides-2 - The Italian Diabetes and Exercise Study 2, is an example: a new study lasting three years, recently published in JAMA - Journal of American Medical Association, which seems to offer an innovative and effective strategy to make patients more active with type 2 diabetes. Technogym provided the ideal tools for measuring and managing the data collected on physical activity, which were then transferred via the web to mywellness, the Technogym platform for collecting data on physical training.
The importance of physical activity for the treatment of diabetes
Counselling interventions have been tested successfully in many studies in clinical settings and those focused only on exercise and Physical Activity appear to be more effective than those targeting multiple behaviors. Finally, growing evidence suggests that combined aerobic and resistance exercise is more effective than either one alone and should be the best exercise intervention strategy.
The strategy is clear, scientifically proven, and it might seem very simple: if you receive a structured exercise counselling aimed to improve your daily life physical activity and then you train twice a week into a supervised facility, you’ll get significant benefits. Almost all physicians and exercise specialists are aware of that, and certainly, most of them pass the message to their patients. However, considering the alarming increase of subjects with Type 2 diabetes we must admit that very few are adopting this winning strategy: a lifestyle based on both physical activity and structured exercise remains a dream for most patients.
Research proves the validity of some interventions and then there is not a translational effect into clinical practice and, ultimately, there is not a modification in the patient’s lifestyle.
There are many possible causes but certainly what works well when researching for a limited period it is difficult to replicate real-life conditions. Motivation of the patient is different, supervision is different, the economic effort is different (typically patients do not pay to exercise when being part of a study), etc.
As a result, long-term patient compliance with exercise recommendations is largely dependent on changes in quality of life associated with training that should be done on regularly. Increased physical activity is expected to improve quality of life and most epidemiological studies have demonstrated an association between exercise and quality of life, but why it works well when conducting a study but not in real life conditions? What we need are strategies that work in real-life conditions.
Ides-2, a new study of three years duration was recently published on JAMA; it seems to offer an innovative and effective strategy.
This strategy, derived from a previous study published in the Archives of Internal Medicine a few years ago (IDES-1), was conceived to promote a 2-step behavior change to decrease sedentary time by substituting it with a wide range of light-intensity physical activities and/or interrupting prolonged sitting with brief bouts of light-intensity physical activity and to reallocate sedentary time and/or light-intensity physical activity toward gradually increasing amounts of purposeful moderate-to vigorous-intensity physical activity.
Ides-2 for the prevention and treatment of type 2 diabetes
Two groups were compared: a standard care intervention group and a behavioral intervention group. Participants in the standard care group received only general physician recommendations for increasing daily physical activity and decreasing sedentary time.
Participants in the behavioral intervention group participated in:
- One individual theoretical counseling session conducted by a diabetologist.
- Eight biweekly individual theoretical and practical counseling sessions conducted by a certified exercise specialist: every year for 3 years.
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Physical activity helps in the treatment of type 2 diabetes: the results of research
Levels of moderate- to vigorous - intensity physical activity, light intensity physical activity, and sedentary time were measured with an accelerometer (mywellness Key, Technogym), which had been previously validated. Participants wore the accelerometer every day from baseline to the end of month 4, and then for the last week of the month every 4 months (i.e. the last week of month 8, 12, 16, 20, 24, 28, 32, and 36).
Physical Activity data were uploaded into the Technogym mywellness, a web-based platform that manages physical activity/exercise data.
With mywellness, you can manage your training data in the gym, at home, outdoors and on mobile devices. You can also integrate indoor training with your daily activities and outdoor training (running or cycling) directly via the GPS functions and the accelerometer on your smartphone. The platform can also be integrated with the most popular wearable devices and tracking applications such as Apple Health, Runkeeper and Strava.
Physical activity helps in the treatment of type 2 diabetes: the results of research
In this study, a behavioral intervention compared with standard care resulted in a sustained increase in physical activity and decrease in sedentary time in sedentary and physically inactive participants with type 2 diabetes.
This behavioral intervention strategy, based on only 8 practical exercise counseling sessions a year for three years was successful in increasing physical activity volume by reallocating sedentary time to light-intensity physical activity and, to a lesser extent, moderate- to vigorous-intensity physical activity.
The primary strength of this study is the application of an intervention targeting both physical activity and sedentary time based on theoretical grounds and using behavior change techniques.
Moreover, those results were obtained with very limited interaction between the health professionals and the patients making this model easily applicable in real conditions.
- Colberg SR, Sigal RJ, Yardley JE, et al., Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079.
- Balducci S et al. Effect of a Behavioral Intervention Strategy on Sustained Change in Physical Activity and Sedentary Behavior in Patients With Type 2 Diabetes: The IDES_2 Randomized Clinical Trial. JAMA. 2019 Mar 5;321(9):880-890.
- Balducci S al., Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES). Arch Intern Med. 2010;170(20): 1794-1803.
- Sieverdes JC, Wickel EE, Hand GA, Bergamin M, Moran RR, Blair SN., Reliability and validity of the Mywellness Key physical activity monitor. Clin Epidemiol. 2013;5:13-20.
