Patterns of physical activity determined by heart rate monitoring among diabetic children

Abstract

Background: Children with type 1 diabetes should be encouraged to participate in physical activity because exercise can benefit insulin sensitivity and improve known risk factors for atherosclerosis. Methods: Physical activity patterns of 127 children and adolescents with stable type 1 diabetes were investigated by 24 hour continuous heart rate monitoring. The percentage of heart rate reserve was used to measure the amounts of physical activity at different intensities. The results were compared with normative data. Results: Diabetic preschoolchildren accumulated 192.7 (78.1), 39.1 (24.3), and 21.3 (9.4) minutes/day (mean (SD)) of light, moderate, and vigorous physical activity, respectively. At the same activity levels, diabetic schoolchildren accumulated 168.9 (76.7), 37.9 (15.9), and 19.0 (14.8) minutes/day, and diabetic teenagers accumulated 166.3 (67.5), 45.6 (26.9), and 25.2 (15.3) minutes/day. Diabetic schoolchildren were significantly more active than healthy peers when considering moderate activity; diabetic teenagers were significantly more active when considering moderate and vigorous activity. There was a negative correlation between the most recent glycated haemoglobin and the time spent in light activities in schoolchildren, and a negative correlation between mean glycated haemoglobin for one year and time spent in light and moderate activities in schoolchildren. Conclusion: The majority of our diabetic patients meet the classical paediatric guidelines for physical activity and compare favourably with their healthy peers.

Levels and Patterns of Physical Activity in Children and Adolescents With Type 1 Diabetes and Associated Metabolic and Physiologic Health Outcomes

“…In respect of previous research involving young people with type 1 diabetes, the PA levels of our participants partly concur with the recent findings of Massin et al 6 and Valerio et al 7 who reported that children with type 1 diabetes have PA levels below the recommended threshold. More detailed analysis of our data identified gender differences in the daily accumulation of MVPA with girls demonstrating lower mean levels (44 minutes·D -1 ) than boys (62 minutes·D -1 ).…”

“…1 A bout of PA can acutely lower blood glucose levels and therefore hypothetically repeated bouts over time may impact on chronic glycemic control. There have, though, been conflicting reports regarding the relationship between habitual PA and glycemic control with some studies reporting a negative relationship 6,7 and others reporting no association. 5,12 In addition to the metabolic benefits, performing adequate PA in type 1 diabetes is paramount as it has the potential to ameliorate known cardiovascular disease risk factors, such as adiposity, to which this population have an increased susceptibility.…”

“…Objective methods such as continuous heart rate monitoring and triaxial accelerometry provide more valid data than self-reports of PA. 8 This is particularly so in children, as they are less conscious of time than adults and engage in PA which is chaotic both in time and intensity. 9 Only Särnblad et al 5 and Massin et al 6 have reported objective data, using uniaxial accelerometry and heart rate monitoring respectively. However, the reliability of PA data are affected by the number of days assessed and Massin et al recorded only 1 day of heart rate data per child thus compromising the reliability of their data.…”

“…[5][6][7] Särnblad et al 5 found that adolescent girls with type 1 diabetes approached the recommended level of 60 minutes of at least MPA per day. In direct contrast, Massin et al 6 reported daily moderate-to-vigorous intensity PA (MVPA) levels of just 20 to 25 minutes in boys and girls with type 1 diabetes, and Valerio et al 7 found 75% of their sample did not reach a target of 60 minutes of at least MPA 5 or more times a week. It is therefore unresolved as to whether the PA habits of children with type 1 diabetes are sufficient for immediate and future health benefits, or are in fact insufficient to the extent that they may contribute to adverse health outcomes.…”

“…Hormonal changes that occur during adolescence create additional difficulties for controlling HbA 1c which may counter the salutary effects of PA. Cross-sectional and interventional studies have demonstrated that PA positively impacts on glycemic control in children up to the age of 12 years 6,34 but not in teenagers. 35 In accord with previous research therefore, we speculate, that differences in glycemic control according to activity status may be more readily apparent in younger children not undergoing pubertal hormone fluctuations, but limited numbers in this study precluded further analyses by age while the confounding effects of insulin dose and regimen and calorie intake were controlled for.…”