Patients with type 2 diabetes should be prescribed physical activity to control their blood sugar and also to improve heart health, recommends a position paper from the European Association of Preventive Cardiology.
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 customised exercise-training programmes to meet these goals.
Increasing cardio-respiratory fitness (CRF) and glycemic control are key clinical targets of exercise training programmes in patients with type 2 diabetes with cardiac co-morbidities, the paper recommends. It adds that patients should be evaluated for CRF to classify them according to their risk and optimal exercise prescription.
Other clinical targets include controlling blood pressure, improving vascular function and dyslipidemia and reduction in inflammation. The paper (authored by a team of doctors led by Hareld Kemps, a cardiologist at the Máxima Medical Centre, Veldhoven, Netherlands) says, “Although a higher BMI is associated with worse prognosis, weight loss is not necessarily a relevant target of exercise training for these patients. Exercise alone is not enough for weight loss; a multidisciplinary intervention which includes nutrition is required to achieve this.”
Adherence is vital
According to the paper, adherence to an exercise programme is very important to achieve its desired effects. To improve adherence, the type, intensity and duration of activity need to be carefully adapted to the patient’s preferences and co-morbidities and adjusted to training progress over time.
High-volume moderate intensity training is recommended for improving body composition and lowering cardiovascular risk factors, preferably by combining training with dietary interventions and counselling/education. But it may not be safe for patients who develop arrhythmias during exercise or have ischemia, it says.
Corroborating the recommendations, C.N. Manjunath, Director of Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, says that while it is important to chalk out a customised exercise protocol for patients with diabetes, it is equally important that patients adhere to the protocol.
He says, “There are various studies that suggest regular exercise, even if it is walking, cycling, increases the life-expectancy of the person. More than the weight loss, a better motivational parameter is increasing exercise and physical fitness. Diabetes doubles the risk of mortality but the fitter patients become, the more that risk declines.”
Says K.M. Prasanna Kumar, former President of the Endocrine Society of India and Research Society for the Study of Diabetes in India, “There is no one size fits all approach in exercise prescription too. All patients cannot be advised to exercise 30 minutes a day or the standard 150 minutes per week. We should chalk out a personalised exercise programme for each patient depending on his/her age, complications, usual habits, acceptable, affordable and available facilities.”
Terming the position paper as “accurate and scientific”, he says, “A person with diabetes should undertake exercise which is permitted by his cardiologist. A person with diabetes who has knee, back or hip problems should consult an orthopaedic surgeon regarding the type and duration of exercise. A pregnant woman should consult an obstetrician regarding the type, severity and duration of exercises, which she can undertake during pregnancy with diabetes.”
Dr. Prasanna, who runs the Centre for Diabetes and Endocrine Care in Bengaluru, says, “In a nutshell, a patient should undertake exercise only after consulting his/her physician or consultant. The target goals of diabetes control, weight and glycated haemoglobin are measurable after the exercise. Any exercise should be started slowly and subsequently scaled up to to reach the target.”
Dr. Mullasari Ajit S., Director (Cardiology), Madras Medical Mission, Chennai, recommends encouraging practical exercises with achievable targets commensurate with the risk profiling of patients which includes age and associated co-morbidities. “Such an approach provides best outcomes in achieving blood sugar control,” he says.
He explains, “Exercise prescription should be gradually tailored to suit the individual patient’s physical ability, co-morbidities, home and workplace environment with measurable targets. If patients have significant coronary artery disease, they are advised to walk and not do any strenuous exercise. If patients have diabetes with osteoarthritis, they are advised stationary bicycle.”