ACOFP Blog

by: Eric Yuschak, DO PGY2; Stacy Chase, DO, FACOFP; Furqan Haq, MD

An estimated 9.4% of the United States (U.S.) population has diabetes and 33.9% of U.S. adults 18 years and older have prediabetes (Center for Disease Control, 2017). A missed or underutilized opportunity for treatment in this population is education and motivation to part take in physical activity.

Being overweight and having a sedentary lifestyle are two modifiable risk factors for diabetes that can be reversed with proper lifestyle modifications including exercise. However, turning office visit education into effective motivation for change can be challenging. A lot of patients would rather take a pill then spend time exercising. Subsequently, when patients do decide to exercise, they commonly stick to low intensity aerobic exercises such as walking leisurely, which may not be as effective to achieve desired goals.

The second edition of the Physical Activity Guidelines for Americans which was released in 2018 is a great resource, providing overall minimum physical activity goals for all different age groups. For adults, the guidelines include a minimum of 150-300 minutes a week of moderate intensity aerobic activity (Piercy, 2018). Two days per week should include muscle strengthening of moderate intensity involving all major muscle groups (Piercy, 2018).

Additional benefits are also seen beyond the minimum requirements and extend beyond just glucose control and diabetes management. A brief list of other proven benefits of exercise include lower risk of all-cause mortality, falls, hypertension, eight cancer types, improved cognition, better sleep and bone health among many others (Piercy, 2018).

The Physical Activity Guidelines states, “Adults who regularly engage in aerobic activity of at least moderate intensity have significant lower risk of developing type 2 diabetes than do inactive adults.” (Piercy, 2018). Additionally, “Insulin sensitivity can be improved with just a single bout of physical activity. Physical activity also helps control blood glucose in people who already have type 2 diabetes.” (Piercy, 2018).

The key of moderate intensity was mentioned. This is defined as expenditure of at least three metabolic equivalents of task (METs). The Compendium of Physical Activities lists aerobic activities and approximated MET expenditure (Ainsworth BE, et al.). Of note, walking leisurely less than two miles per hour is light intensity while brisk walking is moderate intensity.

This is why it is important to educate patients on the proper aerobic exercise and also stress not to neglect the muscle strengthening component mentioned in the guidelines.

Incorporating effective exercise should both help prevent and treat diabetes. So how do we incorporate this evidence into practice? Several proposed concepts focus on improved verbal patient education and educational handouts.

• Incorporating the teach back method where the patient explains back to the physician what concept was reviewed to gain an appreciation of the patient’s understanding is effective.
• Developing handouts listing the exercise recommendations and a list of aerobic exercises and MET expenditure as well as muscle strengthening exercises helps the patients utilize a variety of exercises and activities that meet minimal requirements.
• Also, promoting a list of local parks, hiking trails, gyms, races, etc. to help provide the patient with opportunities to be active.
• Writing a physical “exercise prescription” for the patient to hold on to, in order to provide the constant reminder exercising is the physicians order.
• Asking the patient to keep an exercise log similar to a log they would keep for blood pressures, food or blood glucose. Including the type of aerobic or muscle strengthening exercises and total time and review the log with the patient at follow up visits. This log can keep the patient accountable and help identify areas of potential improvement.

Overall improving exercise compliance will help prevent burden of disease in diabetes and prediabetes and help promote a healthy lifestyle with many other physical, mental and spiritual benefits.

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.