Exercise Protocol Improves Outcomes in T2D

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Exercise regimens were prescribed based on individual disease states: diabetes without complications, diabetic retinopathy, diabetic nephropathy, diabetic autonomic neuropathy, or diabetic peripheral neuropathy.

Exercise protocol algorithms are cost-effective tools that can be used to individualize exercise regimens to encourage behavioral changes in patients with type 2 diabetes (T2D) and obesity, according to research presented at the American Association of Nurse Practitioners (AANP) 2017 National Conference, held from June 20 to June 25 in Philadelphia, Pennsylvania.

Geraldine Q. Young, DNP, FNP-BC, CDE, a member of the graduate nursing department at the Cora S. Balmat School of Nursing at Alcorn State University in Natchez, Mississippi, set out to develop a primary care-focused, evidence-based diabetes exercise protocol for use by healthcare providers when prescribing an exercise program for patients with T2D.

Thirty patients with T2D (mean age, 57.53 years; 80% women; 96% African American) participated in the intervention under the guidance of 4 primary care clinicians, including physicians, physician assistants, and nurse practitioners.

Baseline data obtained included body mass index (BMI), waist circumference, and hemoglobin A1c (HbA1c) level; participants also completed questionnaires intended to assess patient attitudes toward the benefits of and barriers to exercise, self-efficacy, and previous behaviors.

Each participant was prescribed an exercise regimen based on their specific condition:

Diabetic Retinopathy: walking, swimming, stationary bike

Diabetic Nephropathy: walking, swimming, exercise equipment for mild to moderate intensity

Diabetes Without Complications: brisk walking, water aerobics, bicycling, tennis, ballroom/line dancing

Diabetic Peripheral Neuropathy: swimming, stationary bike, rowing machine

Diabetic Autonomic Neuropathy: walking, swimming, treadmill

After 8 weeks, posttest questionnaires were completed by participants (n=24 who completed intervention; 75% women; mean age, 58.83 years). Follow-up measures of BMI, waist circumference, and HbA1c level were also collected.

Overall, 54% of participants experienced an average decrease of 0.38 in HbA1c; 25% had increased HbA1c levels following the 8-week intervention (P =.049). BMI and waist circumference decreased in 50% of participants. Data from the posttest questionnaires showed that 54% and 62.5% of patients experienced an increase in their perceived level of self-efficacy and benefits with regard to exercise, respectively; 75% noted a decrease in barriers to exercise.

Over the 8-week period, Dr Young noted that “utilization of the diabetes exercise protocol … to individualize regimens … unveiled a positive effect on glycemic control along with an increase [in] perceived benefits of exercise and decrease in perceived barriers to exercise.”

“Having a protocol algorithm can be of assistance … as it is a cost-effective tool that can be utilized for improving health outcomes of patients with [T2D] through safely directing exercise-related behavior change,” Dr Young concluded.

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Young GQ. Diabetes exercise protocol based on comorbidities in primary care. Presented at: American Association of Nurse Practitioners (AANP) 2017 National Conference; June 20-25, 2017; Philadelphia, PA.