Increasing physical activity is a cornerstone in the treatment of Type 2 diabetes and in general practice it is a challenge to achieve long-term adherence to this lifestyle change….
The aim of this study by Danish researchers from the Department of Public Health, University of Copenhagen, was to investigate in a non-randomized design whether the introduction of motivational interviewing combined with fitness tests in the Type 2 diabetes care program was followed by a change in cardio-respiratory fitness expressed by VO2max, muscle strength of upper and lower extremities, hemoglobin A1c (HbA1c) and HDL-cholesterol.
This was an uncontrolled 18-month intervention study with follow-up and effect assessment every 3 months in a primary care unit with six general practitioners (GPs). Of 354 eligible patients with Type 2 diabetes, 127 (35.9%) were included. Maximum work capacity was tested on a cycle ergometer and converted to VO2max. Muscle strength was measured with an arm curl test and a chair stand test. The results were used in a subsequent motivational interview conducted by one of the GPs. Patients were encouraged to engage in lifestyle exercise and simple home-based self-managed exercise programs.
The results showed that, at end of study, 102 (80.3%) participants remained in the intervention. Over 18 months, VO2max increased 2.5% (p = 0.032) while increases of 33.2% (p < 0.001) and 34.1% (p < 0.001) were registered for the arm curl test and chair stand test, respectively. HDL-cholesterol increased 8.6% (p < 0.001), but HbA1c remained unchanged (p = 0.57) on a low level (6.8%). Patients without cardiovascular disease or pain from function limitation increased their VO2max by 5.2% (p < 0.0001) and 7.9% (p = 0.0008), respectively.
Clinical implementation of increased physical activity in the treatment of Type 2 diabetes is still far from being standard practice. The results indicate that physical testing combined with motivational interviewing can be done in a primary health care setting. Here, a fitness consultation tailored to the individual patient, his/her comorbidities and conditions in the local area can be incorporated into the diabetes program to improve patients’ muscle strength and cardio-respiratory fitness. The extra workload caused by fitness consultations in primary care could for instance be carried by practice nurses.
In this 18-month study, the results showed that, participants who had repeated fitness consultations, including physical testing and motivational interviewing to improve physical activity, improved VO2max, muscle strength, and lipid profile.