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Ronald C. Plotnikoff, Michael A. Pickering, Nicole Glenn, Sandra L. Doze, Melissa L. Reinbold-Matthews, Laura J. McLeod, David C. W. Lau, Gordon H. Fick, Steven T. Johnson and Laura Flaman

Background:

Physical activity (PA) is a cornerstone in the management of type 2 diabetes (T2DM). This pilot investigation explores the effects of a standard diabetes education program compared with a supplemental PA intervention on diabetes-related health outcomes.

Methods:

Using a prospective 2-armed design, 96 adults with T2DM were randomly assigned to either standard care (diabetes education program; n = 49) or standard care supplemented with an 8-week, individualized-counseling and community-based PA component (n = 47). Measurements were taken at baseline, 3, 6, and 12 months. Primary outcomes were changes in PA (self-report) and HbA1c. Between group changes were compared using analysis of covariance (ANCOVA) and changes over time using repeated-measures ANOVA.

Results:

In comparison with standard care, the supplemental group demonstrated an increase in PA (Ps < 0.01) and cardiorespiratory fitness (Ps < 0.05) from baseline to all follow-up time-points. HbA1c levels declined (P < .05) from baseline to all time points in the standard care group. Reduction in cholesterol-ratio (P < .01), increase in HDL (P < .05), and reductions in blood pressure, resting heart rate and BMI (approaching statistical significance Ps < 0.10) were also reported for both groups.

Conclusions:

PA counseling in addition to standard care is effective for promoting PA behavior change and positive health-related outcomes among individuals with T2DM.

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Paul D. Loprinzi and Jeremy P. Loenneke

Objective:

Examine the association between grip strength and type 2 diabetes prevalence and severity.

Methods:

Using data from NHANES 2011–2012, objectively-determined hand grip strength was assessed using the Takei digital grip strength dynamometer, with diabetes assessed via physician diagnosis and glycohemoglobin A1C.

Results:

A 5 kg greater grip strength was associated with a 14% lower odds of having diabetes for men (ORadjusted = 0.86; 95% CI: 0.79 to 0.94; P = .002). Similarly, for women, a 5 kg greater grip strength was associated with an 18% lower odds of having diabetes (ORadjusted = 0.82; 95% CI: 0.69 to 0.97; P = .03). Grip strength was also associated with glycohemoglobin A1C among women with diabetes (βadjusted = –0.26, 95% CI: –0.39 to –0.12; P = .001), which suggests that grip strength is associated with diabetes severity among women.

Conclusions:

For both men and women, grip strength is associated with type 2 diabetes presence, and among women, grip strength is associated with severity of type 2 diabetes.

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Katherine M. White, Deborah J. Terry, Carolyn Troup, Lynn A. Rempel, Paul Norman, Kerry Mummery, Malcolm Riley, Natasha Posner and Justin Kenardy

A randomized controlled trial evaluated the effectiveness of a 4-wk extended theory of planned behavior (TPB) intervention to promote regular physical activity and healthy eating among older adults diagnosed with Type 2 diabetes or cardiovascular disease (N = 183). Participants completed TPB measures of attitude, subjective norm, perceived behavioral control, and intention, as well as planning and behavior, at preintervention and 1 wk and 6 wk postintervention for each behavior. No significant time-by-condition effects emerged for healthy eating. For physical activity, significant time-by-condition effects were found for behavior, intention, planning, perceived behavioral control, and subjective norm. In particular, compared with control participants, the intervention group showed short-term improvements in physical activity and planning, with further analyses indicating that the effect of the intervention on behavior was mediated by planning. The results indicate that TPB-based interventions including planning strategies may encourage physical activity among older people with diabetes and cardiovascular disease.

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Paul D. Loprinzi, Gina Pariser and Pradeep Y. Ramulu

Background:

To examine the association between accelerometer-assessed physical activity and visual acuity among a nationally representative sample of adults with evidence of diabetes.

Methods:

Six hundred seventy adult participants with diabetes (age 20 to 85) from the 2003–2006 NHANES cycles constituted the analyzed sample. Participants wore an accelerometer for 7 days to quantify time spent in sedentary behavior, light-intensity physical activity and moderate-to-vigorous physical activity. Visual acuity was objectively assessed for each eye.

Results:

In multivariable models, every 1-hour increment in daily sedentary behavior was associated with 23% greater likelihood (OR = 1.23; 95% CI: 1.01–1.52) of having uncorrected refractive error as opposed to normal sight. Performing more than 5 minutes of daily moderate-to-vigorous physical activity was associated with a 82% lower likelihood of having vision impairment as opposed to normal sight (OR = 0.18; 95% CI: 0.06–0.50) while every 1-hour increment in daily light-intensity physical activity was, after adjustments, independently associated with a 38% lower likelihood of vision impairment (OR = 0.62; 95% CI: 0.42–0.92).

Conclusion:

People with diabetes spending more time in sedentary behavior and less time performing light or moderate-to-vigorous physical activity are more likely to have poorer vision.

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Erica Rosenberger Hale, David C. Goff, Scott Isom, Caroline Blackwell, Melicia C. Whitt-Glover and Jeffery A. Katula

Background:

Physical inactivity contributes to metabolic syndrome (MetS) in overweight/obesity. However, little is known about this relationship in prediabetes.

Methods:

The study purpose is to examine relationships between physical activity (PA) and MetS in prediabetes. The Healthy Living Partnerships to Prevent Diabetes tested a community translation of the Diabetes Prevention Program (DPP). Three hundred one overweight/obese prediabetics provided walking minutes/week (WM) and total activity minutes/week (AM) via the International Physical Activity Questionnaire. MetS was at least 3 of waist (men ≥ 102 cm, women ≥ 88 cm), triglycerides (≥150 mg·dl), blood pressure (≥130·85 mm Hg), glucose (≥100mg·dl), and HDL (men < 40mg·dl, women < 50mg·dl).

Results:

The sample was 57.5% female, 26.7% nonwhite/Hispanic, 57.9 ± 9.5 years and had a body mass index (BMI) 32.7 ± 4 kg·m2. Sixty percent had MetS. Eighteen percent with MetS reported at least 150 AM compared with 29.8% of those without MetS. The odds of MetS was lower with greater AM (P trend = .041) and WM (P trend = .024). Odds of MetS with 0 WM were 2.08 (P = .046) and with no AM were 2.78 (P = .009) times those meeting goal. One hour additional WM led to 15 times lower MetS odds.

Conclusions:

Meeting PA goals reduced MetS odds in this sample, which supported PA for prediabetes to prevent MetS.

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Danielle M. Thiel, Fatima Al Sayah, Jeff Vallance, Steven T. Johnson and Jeffrey A. Johnson

Background:

The objective was to investigate the longitudinal relationship between physical activity and health-related quality of life (HRQL) in adults with type 2 diabetes.

Methods:

Data were from a prospective cohort of adults with type 2 diabetes. Weekly moderate-to-vigorous physical activity (MVPA) was reported using the Godin Leisure-Time Physical Activity Questionnaire, and HRQL was reported using the SF-12 and 5-level EQ-5D. Participants were categorized based on current weekly MVPA recommendations. Multivariable linear regression was used to explore associations between MVPA and HRQL, and multinomial logistic regression was used to assess the direction of change in HRQL after 1 year.

Results:

Mean age of participants (N = 1948) was 64.5 ± 10.8 years and 45% were female. Participants reported a mean of 84.1 ± 172.4 min of MVPA/week, and 21% (n = 416) met weekly MVPA recommendations. MVPA was associated with differences in the physical functioning (b = 5.42; P < .001), general health (b = 2.45; P = .037), and vitality (b = 2.83; P = .016) SF-12 dimensions. Participants who met recommendations were less likely to report a decline (vs. no change) in EQ-5D index score (OR = 0.75; 95% CI [0.57, 0.99]), and SF-12 physical component summary (OR = 0.67; 95% CI [0.50, 0.90]), compared with participants not meeting recommendations.

Conclusions:

Participants who met weekly MVPA recommendations reported better physical functioning and were more likely to maintain their physical and overall HRQL over time.

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Shaima Alothman, Abdalghani Yahya, Jason Rucker and Patricia M. Kluding

Background:

Many people with type 2 diabetes (T2D) are sedentary despite strong recommendations of regular physical activity (PA). Objective measures of PA provide accurate reflection of daily PA level. The purpose of this review was to analyze studies used pedometers or accelerometers to determine the outcome of interventions promoted daily PA in people with T2D.

Methods:

An electronic literature search was conducted using the PubMed and CINAHL databases (2000–2016), with search terms: sedentary, diabetes, pedometer, physical activity, and accelerometer. Only peer-reviewed, randomized clinical trials (RCTs) that used objective measurement of daily PA level were included. All studies design, participant characteristics, intervention, and key findings were evaluated systematically and summarized.

Results:

A total of 15 RCTs were identified investigated objectively measured daily PA in people with T2D. A significant increase in PA was found following exercise consultation, behavioral/cognitive consultation, continuous glucose monitoring counseling, and motivational phone calls promoting PA. However, this increase in daily PA level was evident only during the intervention period.

Conclusions:

Our systematic review of the literature indicated that a variety of interventions approaches were effective in increasing PA temporarily during the intervention period. Interventions that use objective methods in measuring PA and have long term improvement in overall PA are needed.

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Winnie Y.H. Lee, Bronwyn K. Clark, Elisabeth Winkler, Elizabeth G. Eakin and Marina M. Reeves

Background:

This study evaluated the responsiveness to change in physical activity of 2 self-report measures and an accelerometer in the context of a weight loss intervention trial.

Methods:

302 participants (aged 20 to 75 years) with type 2 diabetes were randomized into telephone counseling (n = 151) or usual care (n = 151) groups. Physical activity (minutes/week) was assessed at baseline and 6-months using the Active Australia Survey (AAS), the United States National Health Interview Survey (USNHIS) walking for exercise items, and accelerometer (Actigraph GT1M; ≥1952 counts/minute). Responsiveness to change was calculated as responsiveness index (RI), Cohen’s d (postscores) and Cohen’s d (change-scores).

Results:

All instruments showed significant improvement in the intervention group (P < .001) and no significant change for usual care (P > .05). Accelerometer consistently ranked as the most responsive instrument while the least responsive was the USHNIS (responsiveness index) or AAS (Cohen’s d). RIs for AAS, USNHIS and accelerometer did not differ significantly and were, respectively: 0.45 (95% CI: 0.26–0.65); 0.38 (95% CI: 0.20–0.56); and, 0.49 (95% CI: 0.23–0.74).

Conclusions:

Accelerometer tended to have the highest responsiveness but differences were small and not statistically significant. Consideration of factors, such as validity, feasibility and cost, in addition to responsiveness, is important for instrument selection in future trials

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Christian Lackinger, Sandra Haider, Lana Kosi, Juergen Harreiter, Yvonne Winhofer and Alexandra Kautzky-Willer

Background:

Although the infrastructure of Austrians’ sports clubs is well developed, exercise classes for people suffering from type II diabetes mellitus (T2DM) do not exist. This feasibility study evaluates factors for participating in target group specific exercise courses (TGSEC) and changes in physical activity.

Methods:

This intervention study was performed in 22 communities of Austria. Initial TGSEC were offered to T2DM patients over 2 months. Participants were surveyed at 4 time points with a questionnaire: before the program, 2, 6 and 12 months after the initial questionnaire.

Results:

881 patients aged 59.0 (SD: 9.6) years took part in TGSEC. At baseline a lack of suitable exercise groups prevented 51% from being active. 58% were encouraged by the medical sector. After 12 months the weekly time spent on exercise training was increased from 1.40 (SD: 2.55) hours to 2.15 (SD: 3.00) hours (P < .001). The dropout rate during the first 2 months was 12.9%. The rate of return for the 12 months questionnaire was 42%.

Conclusion:

TGSEC provided by sports clubs attract people suffering from T2DM and effectively enhance physical activity.

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Kian Peng Goh, Hwei Yee Lee, Dawn Pingxi Lau, Wilma Supaat, Yiong Huak Chan and Angela Fang Yung Koh

Objectives:

The primary aims of the study were to examine the effect of resveratrol on skeletal muscle SIRT1 expression and energy expenditure in subjects with Type 2 diabetes mellitus (T2DM).

Background:

Animal and in vivo studies indicate that resveratrol increases SIRT1 expression that stimulates PGC1α activity. Subsequent upregulation of AMPK and GLUT4 expression are associated with improved insulin sensitivity in peripheral tissues.

Methods:

Ten subjects with T2DM were randomized in a double-blind fashion to receive 3g resveratrol or placebo daily for 12 weeks. Secondary outcomes include measures of AMPK, p-AMPK and GLUT4 expression levels, energy expenditure, physical activity levels, distribution of abdominal adipose tissue and skeletal muscle fiber type composition, body weight, HbA1c, plasma lipid subfraction, adiponectin levels, and insulin sensitivity.

Results:

There was a significant increase in both SIRT1 expression (2.01 vs. 0.86 arbitrary units [AU], p = .016) and p-AMPK to AMPK expression ratio (2.04 vs. 0.79 AU, p = .032) in the resveratrol group compared with the placebo group. Although the percentage of absolute change (8.6 vs. –13.9%, p = .033) and percentage of predicted resting metabolic rate (RMR; 7.8 vs. –13.9%, p = .013) were increased following resveratrol, there was a significant reduction in average daily activity (–38 vs. 43.2%, p = .028) and step counts (–39.5 vs. 11.8%, p = .047) when compared with placebo.

Conclusions:

In patients with T2DM, treatment with resveratrol regulates energy expenditure through increased skeletal muscle SIRT1 and AMPK expression. These findings indicate that resveratrol may have beneficial exercise-mimetic effects in patients with T2DM.