Key Points from the Updated Guidelines on Exercise and Diabetes

Colberg, Sheri R.

doi:10.3389/fendo.2017.00033

Cited by 48 publications

(44 citation statements)

References 100 publications

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“…In addition, compared to those individuals with type 1 who are inactive, their active counterparts have lower levels of retinopathy and microalbuminuria [22], an increased likelihood of reaching HbA1c, blood pressure and BMI targets [19] and decreased total daily insulin needs [23]. With this in mind and in line with current guidance, PA should be undertaken, recommended and prescribed to all individuals with a metabolic condition as part of diabetes management and overall health [24].…”

Section: Introductionmentioning

confidence: 99%

How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation

Kime

Pringle

Zwolinsky

et al. 2020

BMC Health Serv Res

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Background: Physical activity is recognised as important for diabetes management and improved overall health of individuals with diabetes, yet many adults with diabetes are inactive. Healthcare professionals have been identified as key to promoting physical activity, including individuals with diabetes, but are ill-prepared to deliver this. Our paper evaluates the barriers/facilitators of healthcare professionals' delivery of physical activity guidance to adults with diabetes and aims to inform efforts to investigate and enhance their preparedness to promote physical activity. Methods: A sequential mixed method, two-phase design was adopted involving a purposeful sample of healthcare professionals. Phase one was an online pilot survey designed to test assumptions around healthcare professionals' knowledge, training and preparedness to deliver physical activity guidance. Phase two comprised eighteen semistructured interviews, thematically analysed to provide an in-depth exploration of healthcare professionals' experiences of delivering physical activity guidance to adults with diabetes. Results: Healthcare professionals are committed to promoting physical activity to adults with diabetes and are reasonably confident in giving basic, generic guidance. Yet, significant challenges prevent them from achieving this in their practice, including: lack of education and training around physical activity, diabetes and health; ignorance of recommended physical activity and diabetes guidelines; lack of awareness of referral options; limited time and accessibility to appropriate resources. Nevertheless, healthcare professionals believed discussions around physical activity needed to be an integral part of consultations, incorporating improved communication strategies for conveying key physical activity messages. Conclusions: HCPs have a key role in the promotion of physical activity to people with long-term conditions such as diabetes and they are identified within both the strategic policy context and national interventions for physical activity. Yet, this study indicated that HCPs face multiple and at times complex barriers to physical activity promotion generally and with diabetes patients. Conversely HCPs also reported what works, why and how, when promoting physical activity. Rich information derived from the day-today , working healthcare professional is integral to shaping future practices going forward. The bottom up, iterative design adopted in this study provides an approach to tap into this information.

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Section: Introductionmentioning

confidence: 99%

How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation

Kime

Pringle

Zwolinsky

et al. 2020

BMC Health Serv Res

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“…Patients with T1D and prevalent disabilities, or those at high risk of developing disabilities need to be better identified and offered interventions from a multi-professional team focused on the disability. Interestingly, physical exercise has been receiving increased attention and is highly recommended for patients with diabetes, because of its overall health benefits and effects in improving glucose management 135 . In addition, there has been increased focus on flexibility exercises, in order to improve the range of motion around joints, as LJM is more common with increasing age and diabetes duration 135 .…”

Section: Future Aspectsmentioning

confidence: 99%

Upper extremity impairments in type 1 diabetes in comparison to matched controls without diabetes : associations to the IGF-system, metabolic factors, disability and quality of life

Gutefeldt

2020

Linköping University Medical Dissertations

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Compared with the general population, people with type 1 diabetes (T1D) more often exhibit pathological alterations in musculoskeletal tissue (impairments). Some of these impairments involve the upper extremities, i.e., the shoulders, hands, and fingers. Although present in diabetes, these complications are underdiagnosed and not actively searched for during routine clinical examinations. Furthermore, much is still unclear about these impairments, specifically regarding their etiology, risk factors, and consequences on daily life activities and quality of life. The growth hormone (GH)/insulinlike growth factor (IGF)-system is known to be affected in diabetes, but whether this is involved in upper extremity impairments (UEIs) is unclear. The aim of this thesis was to describe the prevalence of UEIs in patients with diabetes compared with controls. Furthermore, we aimed to search for risk factors of UEIs, and elucidate the impact of UEIs on daily life activities and health-related quality of life (HRQOL). We used two cohorts; the LedIG cohort (papers I-III), a large population-based study in which all patients with a long duration of T1D (>20 years), aged <67 years, living in the southeast region of Sweden were invited to participate, as well as matched controls without diabetes. This study was based on questionnaires as well as blood samples from the participants. The last paper (IV) included a smaller cohort (n=69) of patients with T1D, who both completed a questionnaire and were the subjects of a clinical examination. Paper I: The UEIs were common in diabetes, with a prevalence of up to 48%. Hand paresthesia was the most common impairment, followed by shoulder pain and stiffness. The prevalence of UEIs was 2-4 times higher in patients than in controls and was associated with more activity limitations. Risk factors were heterogeneous for the different UEIs and included female sex, increasing age, longer duration of diabetes, and poor glycemic control. Paper II: The GH-IGF-axis is important for the growth and function of musculoskeletal tissues. We examined differences in the IGF system between patients with T1D on subcutaneous insulin treatment and controls. We found lower levels of IGF-I and insulinlike growth factor-binding protein (IGFBP)-3 and higher levels of GH and IGFBP-1 in patients with T1D than in controls. The largest difference was found in IGFBP-1, and this probably reflected insulin deficiency. The IGF-I levels were increased with increasing insulin doses. However, even at very high insulin doses (>1 U/kg) the IGF-I Z-score was subnormal, indicating that IGF-I cannot be normalized by subcutaneous insulin treatment. Residual endogenous insulin secretion counteracted these alterations. SF-36 Short Form Health Survey T1D Type 1 diabetes UEI(s) Upper extremity impairment(s) Insulin and its impact on the IGF system Under normal physiological conditions, insulin produced by the pancreas reaches the liver directly through the portal vein, thereby exposing the liver to much higher concentrations of insulin ...

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“…In the management of young subjects with T1D, it should be considered that fragility and stiffness of periarticular soft tissues induced by diabetes could be worsened by taking adapted postures and movements due to the practice of different sports. [43][44][45] While some kind of sports can require the execution of continuous isometric exercises or the use of a limited joint ROM, others can require the execution of wide movements by forcing the joints beyond the limits induced by diabetes stiffness. 25,46-49 Therefore, the muscle strength exerted in addition to speed and amplitude of movement in different sports could induce excessive stress and overuse on periarticular structures of young patients.…”

Section: Regarding the Relationship Between Ljm And Disease Duration Itmentioning

confidence: 99%

“…25,46-49 Therefore, the muscle strength exerted in addition to speed and amplitude of movement in different sports could induce excessive stress and overuse on periarticular structures of young patients. 25,26,45,50 Moreover, in sports such as soccer LJM may worsen due to the continuous trauma to which joints such as the ankle can undergo. 25,51,52 As a whole, the results show that diabetes significantly reduces AJM in young T1D subjects.…”

Section: Regarding the Relationship Between Ljm And Disease Duration Itmentioning

confidence: 99%

Type 1 diabetes, sport practiced, and ankle joint mobility in young patients: What is the relationship?

Francia

Toni

Iannone³

et al. 2018

Pediatr Diabetes

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Background/Objective It is known that patients with diabetes can develop limited joint mobility (LJM) and that this can depend on the metabolic control maintained and the duration of the disease. The aims of this study were to verify the presence of ankle joint mobility (AJM) deficits in both plantar and dorsiflexion in young type 1 diabetic patients (T1D) considering also the possible role of sport practiced as a further factor, able to modify AJM. Methods AJM was evaluated by an inclinometer in 82 T1D patients (M/F: 48/34), mean age 12.9 ± 2.6 years, body mass index (BMI) 19.7 ± 3.6 kg/m2, duration of diabetes 5.6 ± 3.3 years, mean HbA1c 7.5 ± 1.0% and in 226 healthy controls (M/F: 146/80), age‐, gender‐, and BMI‐matched practicing different sports (soccer, volleyball, basketball, and dance). Results The patients’ ankle range of motion was significantly lower than that in controls (132.7 ± 22.3° vs 126.1 ± 17.9°; P < .017). In particular, ankle plantar flexion was significantly lower in the patients group (31.6° ± 7.9° vs 28.5° ± 6.6°; P < .002). Soccer players showed lower AJM in both groups: patients (120.1 ± 15.9° vs 127.3 ± 18.1) and controls (119.4 ± 21.1° vs 142.0 ± 18.1; P < .0001) than subjects practicing other sports or who were sedentary. In both groups, patients and controls, age, sex, duration of disease, hemoglobin 1Ac, and BMI have not been shown to be correlated to the mobility assessed. Conclusions The results of this study, in addition to confirming the negative effect of diabetes on AJM of young T1D patients, suggest that during these evaluations the sport‐related effect should be considered because it can induce significant changes of AJM.

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Key Points from the Updated Guidelines on Exercise and Diabetes

Cited by 48 publications

References 100 publications

How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation

How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation

Upper extremity impairments in type 1 diabetes in comparison to matched controls without diabetes : associations to the IGF-system, metabolic factors, disability and quality of life

Type 1 diabetes, sport practiced, and ankle joint mobility in young patients: What is the relationship?

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