Exercise

Call for physical activity to be prescribed for people with type 2 diabetes

by Barbara Hewitt on January 21, 2019

People with type 2 diabetes should be prescribed physical activity to help them control blood sugar levels and improve their heart health, according to a new medical paper from European experts.

The European Association of Preventive Cardiology (EAPC), is warning that with one in 11 adults worldwide having diabetes, of which 90% is type 2 diabetes, nearly all are developing cardiovascular complications so this area of their health needs addressing.

Exercise

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‘Sedentary lifestyles and unhealthy diets are the most important drivers of the increasing number of patients with type 2 diabetes and cardiovascular problems such as heart attacks,’ said Dr Hareld Kemps, a cardiologist at Máxima Medical Centre in Veldhoven, the Netherlands.

‘Diabetes doubles the risk of mortality, but the fitter patients become, the more that risk declines. Unfortunately, the majority of patients do not engage in exercise programmes,’ he added.

The paper provides practical recommendations for doctors on how to motivate patients to incorporate physical activity into their daily routine, set achievable and measurable goals, and design individualised exercise training programmes to meet those goals.

Kemps explained that just advising people to exercise, which is what doctors typically do, is not enough and they need to be assessed for risks related to exercise, and personal preferences.

‘This will be cost effective in the long run so we have to wake up policy makers and healthcare insurers to pay for it. That needs clinicians to take the lead and call for programmes to be reimbursed,’ he added.

The paper suggests that people with type 2 diabetes should see their doctor for a personalised plan, and those with health insurance should ask if exercise programmes are covered, and there are also steps they can take without needing to see a doctor first, such as interrupting sitting time and doing moderate exercise like walking and cycling.

It also points out that long term adherence can be improved by setting early achievable goals that are measurable, and adapting exercise plans to patients’ preferences. Remote guidance also looks promising, with patients monitoring themselves with smartwatches then sending data to a health professional for feedback.

Practical and specific goals tend to be motivational. ‘For an elderly person this could be climbing the stairs in their home or walking to the supermarket, achievements that will really improve their quality of life. Being able to use less medication because of better glycaemic control is also an incentive,’ Kemps pointed out.

In terms of medical targets, the report says that cardiorespiratory fitness and glycaemic control are the top two and both improve with exercise training. Indeed, changes can be measured, and they are directly related to wellbeing, morbidity and mortality. Exercise also helps to lower blood pressure and harmful blood lipids.

It adds that the type and intensity of exercise, this needs to be personalised to each person. High intensity interval training, for example alternating moderate and vigorous walking, is most effective at boosting fitness and controlling blood sugar, but may be unsafe for patients who develop abnormal heart rhythm during exercise or have restricted blood flow to the heart.

‘I can’t stress enough how effective even small increases in activity can benefit patients with type 2 diabetes and heart problems. Interrupting sitting with brief bouts of walking improves glucose control, while two hours of brisk walking per week reduces the risk of further heart problems,’ Kemps concluded.

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