How Many Steps Are Needed to Improve Quality of Life for 70-Year-Olds?

Older adults with diabetes may be able to benefit from specific exercise recommendations.

Type 2 diabetes is associated with a 30% lower risk of prevalence when there is moderate-intensity physical activity (PA) and brisk walking versus a sedentary lifestyle. But when many individuals were diagnosed with diabetes, they were exercising less, when they may have needed it more, even in people who are elderly. Physical activity benefits should not be underestimated.

In a cross-sectional cohort from the Clinical Diabetes journal, 1,872 70-year-old residents of Umeå municipality, Sweden were studied based on the effects of physical activity on their risk for type 2 diabetes. Because this study wanted to reflect the general population, it did not have any exclusion criteria, except during the analyses. Participants who either reported prior stroke or myocardial infarction were excluded. The subjects were first placed into four groups based on their fasting blood glucose and diabetes diagnosis, whether these participants had diabetes/prediabetes or not, and if they either knew it or not. Then all four groups were combined into just two (“no diabetes” and “diabetes”) for most of the study’s results. The International Physical Activity Questionnaire–short form (IPAQ-SF) was an externally valid form used by the patients to self-report their physical activity (PA). The participants’ PA was also objectively measured with triaxial accelerometers (GT3X+, Actigraph, Pensacola, Fla.).1

In addition to self-reported PA data, accelerometers were used to objectively measure PA. “Accelerometers are motion sensors that detect duration and intensity of PA by measuring accelerations in three dimensions.”1 The data from the accelerometers were translated into activity counts in the study “downloaded with Actilife software 6.6.3 (Actigraph) into epoch lengths of 60 seconds.”1 Data was analyzed using the SPSS 23.0 software. The t test (for continuous variables) and the χ2 test for (dichotomous variables) were used to compare data between participants with diabetes and those without diabetes. Pearson’s correlation coefficients (r values) were used to differentiate self-reported and accelerometer-generated data.

There was no statistically significant correlation found between visceral adipose tissue (VAT) mass and PA when sex, smoking, adolescent PA level, and VAT mass were adjusted for with logistic regression when comparing PA data with diabetes occurrence.  The analyses’ P-values were considered significant at <0.05.

“All measures of self-reported and accelerometer-derived PA levels were significantly higher in adults without diabetes than in those with diabetes (P <0.01 for all).”1 This should be of concern if people with diabetes can benefit from exercise. The individuals who knew they had diabetes at baseline were exercising over 20% less than those without diabetes. Additionally, the study demonstrated that the participant’s step count was higher when the individual did not have diabetes: “(7,375 ± 3,065 steps/day) than among those with diabetes detected in the study (6,359 ± 3,302 steps/day, P <0.05) and those with previously diagnosed diabetes (5,754 ± 2,941 steps/day, P <0.001; Figure 1a).” Statistics showed that there was a “nonlinear relationship between diabetes prevalence and PA.” The amount of 6,000 steps a day was able to best identify the differences between the participants with diabetes and without diabetes at baseline “(OR 0.36, 95% CI 0.26–0.48), in unadjusted as well as fully adjusted models (OR 0.50, 95% CI 0.36–0.69; Figure 1d and Table 2).”1

Incidence of PA benefits for people who are 70 years of age with type 2 diabetes was demonstrated in this cross-sectional cohort study, which identifies an association that needs to be studied more in depth with more diverse populations before it can be applied externally. Nonetheless, this study emphasizes the importance of recommending to most patients with type 2 diabetes to increase their physical activity. Even those who are elderly would benefit from PA in many ways, including “increased insulin sensitivity, increased glucose control, and weight loss,”1 just to name a few.

Since this study was cross-sectional, it does not allow us to localize the cause and effect.3  Internally, this may have been valid, but a limitation of this study is that it has only been done in one city in one country, for one specific age, and on only individuals of Caucasian ethnicity. There are other ways in which this study was limited. This study consisted of a very small population of only 1,872 people. pulation of adults in their 70’s? The global population? The parameters were not clear. This study may be inspiration for different populations, and it could be useful to consider more diverse studies to be conducted on this topic, as well as on PA adherence.

Practice Pearls:

• Individuals in their 70’s who have diabetes are less likely to exercise than those who have not been diagnosed with diabetes.
• A cut point of 6,000 steps/day demonstrated the greatest discrimination between PA in people with diabetes and PA in people without diabetes.
• PA should be encouraged in older adults with diabetes, and even stronger studies should be conducted.

References:

Hult, Andreas; Johansson, Jonas; Nordström, Peter; Nordström, Anna. “Objectively Measured Physical Activity in Older Adults With and Without Diabetes.” Clinical Diabetes. 2018 Oct. doi.org/10.2337/cd18-0041. 5 January 2019.

Jeon CY, Lokken RP, Hu FB, van DAm RM. “Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review.” Diabetes Care 2007;30:744–752. https://www.ncbi.nlm.nih.gov/pubmed/17327354. 6 January 2019.

Mann, C J. “Observational research methods. Research design II: cohort, cross sectional, and case-control studies.” BMJ Journals. https://emj.bmj.com/content/20/1/54. 5 January 2019.

Annahita Forghan, Pharm.D. Candidate 2019, LECOM College of Pharmacy