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Fitness Consultations in Care of Type 2 Patients Improves Outcomes

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.

BMC Family Practice. 2010;11