Alternative Forms of Exercise Associated With Better Diabetes Outcomes

A new study followed patients who used exercise videogames (EVG) to help lower their HbA1c rather than traditional means of exercise. 

Type 2 diabetes continues to be one of the most debilitating diseases in the United States. Usually, medications can help to treat the disease, but that does not mean that the patient is healthy again. Patients with type 2 diabetes almost always have to make lifestyle changes if they wish to be healthy again. Diet is one major change that has to happen once someone is diagnosed with type 2 diabetes, but exercise is a change that people with diabetes often have a hard time adding into their lives. Millions of people are diagnosed with prediabetes and they will almost certainly progress to diabetes if they are unable to make lifestyle interventions. Prior to this research, exercise videogames had never been studied to see if they could have a positive effect on a person’s average daily exercise time as well as their HbA1c.

 The participants included in this study had to be older than 18 years of age, generally healthy, did not own any video game consoles, and had no health conditions that would interfere or limit their ability to exercise. Baseline measures of average exercise time, BMI, and HbA1c were recorded. Patients also had to complete surveys that were derived from Social Cognitive Theory and Self-Determination Theory. These theories have been widely used to predict a person’s physical activity output based on the psychosocial factors of the patient. Participants were put into one of three groups: Exercise videogame, traditional exercise, or a control group that would receive weekly information about health topics that were not related to diet or exercise, such as health screenings. The main outcome of this study was to see if HbA1c would change at the end of treatment. Other measures of the study included how long on average participants spent on moderate to vigorous physical activity, lipid levels, body composition, as well as other individual measurements. A 7-day Physical Activity Recall (PAR) interview was also used during treatment and up to 6 months following the end of treatment. The PAR is a reliable way of assessing different activities that the participant performed (i.e., hours of sleep, time spent on moderate to vigorous exercise, time spent watching tv, as well as other activities)

The average age of the participants was 51.4 years old, 80% were female, and 83% were non-Hispanic white. EVG participants had significant changes in HbA1c compared to the other two groups. HbA1c, on average, was lower in the exercise videogame group by 0.16 when compared to the control group. Similarly, when compared to the traditional exercise group, the exercise videogame group had, on average, a lower HbA1c of 0.15. EVG participants experienced a drop in HbA1c by 2%, on average, compared to the other two groups, which experienced an average drop in HbA1c of 0.6%. As far as physical activity is concerned, EVG participants spent more time per week exercising compared to the two other groups. EVG participants spent, on average, 17 more minutes exercising per week versus the traditional exercise group and 54 more minutes per week than the control group.

 There were some limitations to this study, however. One of the major limitations of this study was that confounding variables were not taken into consideration so it is hard to say that the results were based solely on which group the participants were placed in. Other social factors such as diet and smoking could have also affected the results of this trial.

Practice Pearls:

•  Exercise videogames can be an effective alternative to traditional exercise in patients who currently have diabetes or are at risk of getting diabetes
• Exercise videogames have shown to decrease HbA1c and increase the amount of time spent on moderate-vigorous exercise more than in those patients who utilize standard forms of exercise.
• Further studies need to be conducted to solidify the association between exercise videogames and better HbA1c and physical activity outcomes

Bock, Beth C., and et al. “Reduction in HbA1c with Exercise Videogames among Participants with Elevated HbA1c: Secondary Analysis of the Wii Heart Fitness Trial.” Diabetes Research and Clinical Practice, Elsevier B.V., 22 June, 2019, https://doi.org/10.1016/j.diabres.2019.06.011.

Joel John, Pharm.D. Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences