39 research outputs found
Relationship of exercise volume to improvements of quality of life with supervised exercise training in patients with type 2 diabetes in a randomised controlled trial: the Italian Diabetes and Exercise Study (IDES)
Get PDFA positive impact of exercise intervention programmes on quality of life (QoL) may be important for long-term patient compliance to exercise recommendations. We have previously shown that QoL improves significantly with supervised exercise, whereas it worsens with counselling alone, in patients with type 2 diabetes from the Italian Diabetes and Exercise Study (IDES). Here, we report data on the relationship between changes in QoL and volume of physical activity/exercise in these individuals. Methods This multicentre parallel randomised controlled, open-label, trial enrolled sedentary patients with type 2 diabetes (n0606 of 691 eligible) in 22 outpatient diabetes clinics.
Patients were randomised by centre, age and diabetes reatment using a permuted-block design to twice-a-week supervised aerobic and resistance training plus exercise counselling (exercise group) versus counselling alone (control group) for 12 months. Health-related QoL was ssessed by the 36-Item Short Form (SF-36) Health Survey. Results In the exercise group (n0268 of 303 randomised), there was a trend for increasing QoL with increasing exercise volume, with significant improvement of the hysical component summary (PCS) measure only above 17.5 metabolic equivalents h−1 week −1 and a clear volume-relationship for the mental component summary (MCS) measure. A relationship with volume of physical activity also was observed in the control group (n0260 of 303 randomised), despite overall deterioration of all scores. Independent correlates of improvements in both PCS and MCS were exercise volume, study arm and, inversely, baseline score. Conclusions/interpretation This large trial shows a relationship between changes in physical and mental health-related QoL measures and volume of physical activity/exercise, with supervised exercise training also providing volume independent benefits
Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES)
No full textBackground: This study aimed to assess the efficacy of an intensive exercise intervention strategy in promoting physical activity (PA) and improving hemoglobin A1c (HbA1c) level and other modifiable cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM). Methods: Of 691 eligible sedentary patients with T2DM and the metabolic syndrome, 606 were enrolled in 22 outpatient diabetes clinics across Italy and randomized by center, age, and diabetes treatment to twice-a-week supervised aerobic and resistance training plus structured exercise counseling (exercise group) vs counseling alone (control group) for 12 months. End points included HbA1c level (primary) and other cardiovascular risk factors and coronary heart disease risk scores (secondary). Results: The mean (SD) volume of PA (metabolic equivalent hours per week) was significantly higher (P < .001) in the exercise (total PA [nonsupervised conditioning PA + supervised PA], 20.0 [0.9], and nonsupervised, 12.4 [7.4]) vs control (10.0 [8.7]) group. Compared with the control group, supervised exercise produced significant improvements (mean difference [95% confidence interval]) in physical fitness; HbA 1c level (-0.30% [-0.49% to -0.10%]; P < .001); systolic (-4.2 mm Hg [-6.9 to -1.6 mmHg]; P=.002) and diastolic (-1.7mmHg [-3.3 to -1.1 mm Hg]; P=.03) blood pressure; high-density lipoprotein (3.7 mg/dL [2.2 to 5.3 mg/dL]; P < .001) and low-density lipoprotein (-9.6 mg/dL [-15.9 to -3.3 mg/dL]; P=.003) cholesterol level; waist circumference (-3.6 cm [-4.4 to -2.9 cm]; P < .001); body mass index; insulin resistance; inflammation; and risk scores. These parameters improved only marginally in controls. Conclusions: This exercise intervention strategy was effective in promoting PA and improving HbA1c and cardiovascular risk profile. Conversely, counseling alone, though successful in achieving the currently recommended amount of activity, was of limited efficacy on cardiovascular risk factors, suggesting the need for a larger volume of PA in these high-risk subjects. Trial Registration: isrctn.org Identifier: ISRCTN-0425274
Effect of High- versus Low-Intensity Supervised Aerobic and Resistance Training on Modifiable Cardiovascular Risk Factors in Type 2 Diabetes; The Italian Diabetes and Exercise Study (IDES)
No full textBackground: While current recommendations on exercise type and volume have strong experimental bases, there is no clear evidence from large-sized studies indicating whether increasing training intensity provides additional benefits to subjects with type 2 diabetes. Objective: To compare the effects of moderate-to-high intensity (HI) versus low-to-moderate intensity (LI) training of equal energy cost, i.e. exercise volume, on modifiable cardiovascular risk factors. Design: Pre-specified sub-analysis of the Italian Diabetes and Exercise Study (IDES), a randomized multicenter prospective trial comparing a supervised exercise intervention with standard care for 12 months (2005-2006). Setting: Twenty-two outpatient diabetes clinics across Italy. Patients: Sedentary patients with type 2 diabetes assigned to twice-a-week supervised progressive aerobic and resistance training plus exercise counseling (n = 303). Interventions: Subjects were randomized by center to LI (n = 142, 136 completed) or HI (n = 161, 152 completed) progressive aerobic and resistance training, i.e. at 55% or 70% of predicted maximal oxygen consumption and at 60% or 80% of predicted 1-Repetition Maximum, respectively, of equal volume. Main Outcome Measure(s): Hemoglobin (Hb) A(1c) and other cardiovascular risk factors; 10-year coronary heart disease (CHD) risk scores. Results: Volume of physical activity, both supervised and non-supervised, was similar in LI and HI participants. Compared with LI training, HI training produced only clinically marginal, though statistically significant, improvements in HbA(1c) (mean difference -0.17% [95% confidence interval -0.44,0.10], P = 0.03), triglycerides (-0.12 mmol/l [-0.34,0.10], P = 0.02) and total cholesterol (-0.24 mmol/l [-0.46, -0.01], P = 0.04), but not in other risk factors and CHD risk scores. However, intensity was not an independent predictor of reduction of any of these parameters. Adverse event rate was similar in HI and LI subjects. Conclusions: Data from the large IDES cohort indicate that, in low-fitness individuals such as sedentary subjects with type 2 diabetes, increasing exercise intensity is not harmful, but does not provide additional benefits on cardiovascular risk factors
Level and correlates of physical activity and sedentary behavior in patients with type 2 diabetes. a cross-sectional analysis of the italian diabetes and exercise study-2
Get PDFObjective Patients with type 2 diabetes usually show reduced physical activity (PA) and increased sedentary (SED)-time, though to a varying extent, especially for low-intensity PA (LPA), a major determinant of daily energy expenditure that is not accurately captured by questionnaires. This study assessed the level and correlates of PA and SED-time in patients from the Italian Diabetes and Exercise Study-2 (IDES-2). Methods Three-hundred physically inactive and sedentary patients with type 2 diabetes were enrolled in the IDES-2 to be randomized to an intervention group, receiving theoretical and practical exercise counseling, and a control group, receiving standard care. At baseline, LPA, moderate- to-vigorous-intensity PA (MVPA), and SED-time were measured by accelerometer. Physical fitness and cardiovascular risk factors and scores were also assessed. Results LPA was 3.93±1.35 hours·day-1, MVPA was 12.4±4.6 min·day-1, and SED-time was 11.6 ±1.2 hours·day-1, with a large range of values (0.89±7.11 hours·day-1, 0.6±21.0 min·day-1, and 9.14±15.28 hours·day-1, respectively). At bivariate analysis, LPA and MVPA correlated with better cardiovascular risk profile and fitness parameters, whereas the opposite was observed for SED-time. Likewise, values of LPA, MVPA, and SED-time falling in the best tertile were associated with optimal or acceptable levels of cardiovascular risk factors and scores. At multivariate analysis, age, female gender, HbA1c, BMI or waist circumference, and high-sensitivity C reactive protein (for LPA and SED-time only) were negatively associated with LPA and MPA and positively associated with SED-time in an independent manner. Conclusions Physically inactive and sedentary patients with type 2 diabetes from the IDES-2 show a low level of PA, though values of LPA, MVPA, and SED-time vary largely. Furthermore, there is a strong correlation of these measures with glycemic control, adiposity and inflammation, thus suggesting that even small improvements in LPA, MVPA, and SED-time might be associated with significant improvement in cardiovascular risk profile
The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review
No full textObjective: To examine the clinical effectiveness of patient education models for adults with Type 2 diabetes.Data sources: Electronic databases were searched from 2002 to January 2007.Review methods: A systematic review of the literature on educational interventions in diabetes was undertaken. This was an update of a previous systematic review.Results: Including studies identified in the previous systematic review, there were 13 published studies. Eight studies of education on multiple aspects of diabetes self-management were identified that provided education that was focused on a particular aspect of self-management. The quality of reporting and methodology of the studies was variable. Studies of multi-component educational interventions yielded mixed results. Some trials reported significant improvements on measures of diabetic control but others did not. Positive effects may be attributable to longer-term interventions with a shorter duration between the end of the intervention and the follow-up evaluation point. There may also be an effect of having a multi-professional team delivering the educational programme. Studies of focused educational interventions did not yield consistent results. Some effects were shown on measures of diabetic control in studies that focused on diet or exercise alone. Although the effects shown were generally small, those that were present did appear to be relatively long-lasting. This update review does not substantially alter the conclusions of the previous systematic review; for each outcome, the proportion of studies that demonstrated significant effects of education was similar.Conclusions: Based on the evidence, it would seem that education delivered by a team of educators, with some degree of reinforcement of that education made at additional points of contact, may provide the best opportunity for improvements in patient outcomes. Educators need to have time and resources to fulfil the needs of any structured educational programme. There is also a need for education to have a clear programme at the outset. From the evidence reported it is unclear what resources would need to be directed at the educators themselves to ensure that they can deliver programmes successfully. Any future research should consider patient education within the context of overall diabetes care and as such follow guidelines for the development and evaluation of complex interventions. Good-quality, longer-term studies would be desirable, but these would require careful consideration around the nature of any control group. Information is needed to clarify the sensitivity of diabetes education programmes to the performance of the diabetes educators, in order to ensure success and cost-effectiveness of education programmes.<br/
Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2)
No full textObjective.
In
the Italian Diabetes and Exercise Study_2, a behavioral counseling promoted a sustained increase in physical activity
(PA) volume (+3.3 metabolic equivalents-hour·week-1), moderate-to-vigorous-intensity PA (MVPA, +6.4 min·day-1), and light-intensity PA
(LPA, +0.8 hours·day-1) and decrease in sedentary time (SED-time,
-0.8 hours·day-1). Here, we investigated the
relationships of changes in PA/SED-time with changes in physical fitness and
cardio-metabolic risk profile in individuals with type 2 diabetes.
Research Design and Methods. In this 3-year randomized clinical trial, 300
physically inactive and sedentary patients were randomized 1:1 to receive
one-month theoretical and practical counseling once-a-year or standard
care. Changes in physical fitness and cardiovascular risk
factors/scores according to quartiles of accelerometer-measured changes in
PA/SED-time were assessed, together with univariate and multivariable
associations between these parameters, in the whole
cohort and by study arm.
Results. Physical
fitness increased and HbA1c and coronary heart disease 10-year risk
scores decreased with quartiles of MVPA and SED-time change. In quartile IV of MVPA increase and SED-time
decrease, cardiorespiratory fitness increased by 5.23 and 4.49 ml·min-1·kg-1
and HbA1c decreased by 0.73 and 0.85%, respectively. Univariate correlations confirmed these
relationships and mean changes in both MPVA and SED-time predicted changes in
physical fitness and cardiovascular risk factors/scores independently of one
another and of other confounders.
Similar findings were observed with LPA and PA volume and in each group
separately.
Conclusions.
Even modest increments in MVPA
may have a clinically meaningful impact and reallocating SED-time to LPA may
also contribute to improve outcomes, possibly by increasing total energy
expenditure.</p
Do UK based weight management programmes cause weight loss maintenance in adults? A systematic review
Get PDFThe aim of this dissertation was to examine whether UK based weight management programmes promote weight loss maintenance (follow up of 12 months to assess effectiveness of intervention in weight loss) in adults through the process of a systematic review. The World Health Organisation (WHO) has described obesity as a "global epidemic". Weight management comprises two phases; weight loss and weight loss maintenance. The latter phase is the true goal for obesity and the most difficult element of weight management to achieve. However much less is know about this as compared with the weight loss phase. There is little purpose in committing time and money to reducing obesity if the weight is regained. This is counter-productive and weight loss maintenance is essential to combat the obesity epidemic. Searches were made for relevant information from a variety of scientific online databases and journals,. Seven articles met the inclusion criteria and were analysed in the review. All studies incorporated a multi-component (diet, exercise, behaviur modification) intervention approach. All control and internvetion groups reported weight loss at 12 months when compared with baseline. All groups recieved an intervention. One study reported a significant difference (P<0.05) between groups. Four studies reported on at least one component (diet, physical activity, behaviour modification) however there was not enough information to conclude whether they complied with national guidelines (NICE CG43 and SIGN 115). High attrition rates and loss to follow up are problematic for each study except one. Analysis on an intention to treat basis was common however this is problematic and there are alternative methods which may be more suitable for dealing with missing data
Avaliação dos parâmetros bioquímicos, estado nutricional e condição de estresse, em indivíduos com doenças crônicas, considerando a participação dos mesmos em um programa de prevenção para doenças cardiovasculares
Get PDFDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Farmácia, Florianópolis, 2009.Este trabalho foi realizado em 2008, em parceria com o Núcleo Interdisciplinar de Pesquisa, Ensino e Assistência a Dislipidemia do Hospital Universitário da Universidade Federal de Santa Catarina e com o processo holístico hidroterapêutico, técnica watsu/halliwick e biodanza®, oferecido a 26 indivíduos que apresentavam doenças crônicas. Os indivíduos integrantes deste trabalho tiveram atendimento cardiológico, nutricional e foram classificados de acordo com os fatores de risco para doenças cardiovasculares. O monitoramento terapêutico foi realizado a cada 4 meses por meio de questionários de estresse e de exames bioquímicos. Utilizou-se a ANOVA para estatística multivariada de medidas repetidas. As variáveis quantitativas deste estudo foram expressas em média ± desvio padrão ou percentagens. A análise estatística foi subdividida de forma descritiva e longitudinal. Foram realizadas 48 sessões da referida modalidade de tratamento, e cada sessão teve duração de 2 horas e meia. Os resultados desta pesquisa mostraram que 69,2% tinham idade como fator de risco. A prevalência inicial e final do tratamento diferenciado evidenciou uma amenização da hipertensão arterial (de 42,30% para 34,61% dos pacientes), do diabetes (de 30,76% para 23,07%), sedentarismo (de 23,07% para 0,00%) e do tabagismo (de 3,84% para 0,00%). Pelo Escore de Risco de Framingham estratificou-se o risco de desenvolver doença arterial coronariana no grupo intencional, na qual os resultados foram inicialmente 65,4% dos que apresentavam baixo risco, aumentando para 76,9% e finalizando com a elevação para 88,5%. Se a ênfase for dada ao grupo de alto risco, pode-se notar que houve uma redução de 7,7% para 3,8%. No primeiro período, 53,84% dos pacientes tinham 6 ou mais fatores de risco associados, sendo que ao final houve uma diminuição para 15,38%. Na adesão ao tratamento nutricional apenas 34,61% controlavam sua dieta e por meio da conscientização educativa elevou-se este número para 88,46%. Houve uma redução nos valores de IMC, sendo que 78,56% tinham sobrepeso ou obesidade e depois do tratamento esses valores passaram para 69,22%. No tocante a condição de estresse 80,76% dos indivíduos tinham diestresse e ao final do tratamento este valor atenuou-se para 19,23% além da diminuição da utilização de fármacos antidepressivos. Com relação aos parâmetros bioquímicos, constatou-se um aumento estatisticamente significativo no HDL-C (p=0,001), para classificação da dislipidemia no grupo estudado, houve uma preponderância na hipercolesterolemia isolada, contrastando com a atenuação da hipertrigliceridemia isolada e aos valores constantes da hiperlipidemia mista. Houve também uma redução substancial da quarta classificação, pois nesta, inicialmente 10 pacientes ou 38,46% tinham diminuição isolada da fração HDL-C ou associação ao aumento do TG ou LDL-C, chegando ao final do tratamento com apenas um paciente na mesma condição. No início do tratamento a maioria dos pacientes apresentou a glicemia de jejum, o ácido úrico, a creatinina, a ALT e a microalbuminúria dentro da faixa de normalidade. Ao longo do tratamento houve uma minimização nos valores destes parâmetros, sendo que para AST, houve valor estatisticamente significativo (p=0,000), entre a diferença das médias. Por conseguinte, dos eletrólitos analisados (Na, K, Mg, Ca e Cl), somente o cálcio teve uma redução nas médias. Conclui-se que o programa oferecido aos pacientes que participaram deste projeto proporcionou de maneira geral, melhora na maioria nos parâmetros bioquímicos analisados, estado nutricional e no estresse psicológico. Estes indivíduos ampliaram o nível de conscientização sobre seu modo de viver, sobretudo no que diz respeito ao estabelecimento de metas reais alcançáveis.This study was conducted in 2008 in partnership with the Interdisciplinar Nucleus for Teaching, Research and Care on Hyperlipidemia at the Hospital in Santa Catarina State University, and with the holistic process hydrotherapeutic, technical watsu/halliwick and biodanza®, offered to 26 individuals have chronic diseases. Individuals members of this study were cardiac care, nutrition and were classified according to risk factors for cardiovascular disease. The therapeutic monitoring was performed every 4 months using questionnaires of stress and biochemical tests. We used a multivariate ANOVA for repeated measures. Quantitative variables of this study were expressed as mean ± standard deviation or percentages. Statistical analysis was divided in a descriptive and longitudinal. Were carried out 48 sessions of this treatment modality, and each session lasted 2 hours and half. Our results showed that 69,2% were age as a risk factor. The prevalence of initial and final differential treatment showed a softening of hypertension (from 42,30% to 34,61%of patients), diabetes (from 30,76% to 23,07%), lifestyle (from 23,07% to 0,00%) and smoking (from 3,84% to 0,00%). At Risk Score Framingham stratified the risk of developing coronary artery disease in the intentional group, in which results were initially 65,4% of those with low risk, increasing to 76,9% and ending with the rise to 88,5%. If the emphasis is given to high-risk group, may be noted that there was a reduction of 7,7% to 3,8%. In the first period 53,84% of patients had 6 or more associated risk factors, and the end there was a decrease to 15,38%. In adherence to nutritional treatment only 34,61% controlled their diet and through awareness education increased this figure to 88,46%. There was a reduction in BMI, while 78,56% were overweight or obese and after treatment these figures were 69,22%. As the stress condition 80,76% of subjects had diestress and after the treatment attenuated this value to 19,23% in addition to reducing the use of antidepressants. Regarding the biochemical parameters, there was a statistically significant increase in HDL-C (p=0,001), for classification of dyslipidemia in the study group, there was a preponderance in isolated hypercholesterolemia, in contrast to the attenuation of isolated hypertriglyceridemia and the values shown in mixed hyperlipidemia. There was also a substantial reduction in the fourth classification, for this, initially 10 patients or 38,46% had isolated reduction in HDL-C or association with the increase of TG and LDL-C, reaching the end of treatment with only one patient in the same condition. At the beginning of treatment most patients had fasting blood glucose, uric acid, creatinine, ALT and microalbuminuria within the normal range. During the treatment there was a minimization in the values of these parameters, and for AST, there was a statistically significant (p=0,000) between the difference of means. Therefore, analysis of electrolytes (Na, K, Mg, Ca and Cl), only calcium had a reduction in the average. Concluded that the program offered to patients who participated in this project provided in general, improvement in the majority in the biochemical analysis, nutritional status and psychological stress. These individuals increased the level of awareness about their way of life, especially with regard to the establishment of real goals achievable
A dietary interventional study moderating fat intake in Saudi subjects with metabolic disease
Get PDFThe gut-derived bacteria, endotoxin (lipopolysaccharide), have been observed to be raised in patients with type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) which appears to represent a source of diet induced inflammation exacerbating metabolic disease. To further the current studies on endotoxin induced inflammation investigations examined a cohort of adult Saudi Arabian women with obesity/weight gain and or T2DM to ascertain (1) the impact of a post-prandial high SFA rich meal on systemic inflammation; (2) the direct effect of a 3 month diet intervention on cardiometabolic health (3) and assess how subtle changes in dietary interventions can impact on metabolic risk in different patient groups and what dietary components appear important.
A total of 92 Saudi adult women with varying metabolic states [18 nondiabetic (ND) control subjects (Age 24.4±7.9 years; BMI 22.2±2.2 Kg/m2), 24 overweight-plus obese (overweight+) subjects (Age 32.0±7.8 years; BMI 28.5±1.5 Kg/m2) and 50 T2DM patients (Age 41.5±6.2 years; BMI 35.2±7.7 Kg/m2)] were recruited for this 3-month intervention study. Anthropometric data and fasting blood samples were taken at pre- and 3 months post-intervention with glucose, insulin, HOMA-IR, lipid profile and endotoxin measured. To establish whether a high-fat meal alters circulating endotoxin in different metabolic disease states, all subjects were given a high fat standardized meal (75g fat, 5g carbohydrate, 6g protein) after an overnight fast of 12–14 h. Blood samples were drawn via cannula at baseline (0 hour) and post-prandially (1, 2, 3, and 4 hours). For the dietary intervention, participants were prescribed a 500Kcal deficit energy diet less than their daily recommended dietary allowances. Targeted macronutrient composition was 20%-30% fat, <10% of saturated fatty acids, 50%-60% carbohydrates, 15%-20% protein and at least 15g of fibre per 1000 kcal.
At baseline and with the exception of HDL-cholesterol, all anthropometric, glycemic parameters, lipid profile and endotoxin were significantly higher in the T2DM group. For the high fat challenge, the most notable changes were the postprandial increases in the triglycerides, insulin, HOMA-IR and endotoxin levels, and subsequent significant decrease in HDL-cholesterol in all groups (p<0.05). These same patterns of changes were observed after 3 months in the overweight+ and T2DM group. Endotoxin was found to be significantly and positively associated with total and LDL-cholesterol (p<0.05), modestly with triglycerides and inversely with HDL-cholesterol (p=NS). For the dietary intervention, significant improvements were noted in all anthropometric measures in the T2DM group and BMI in the overweight+ group (p<0.01). The noted weight loss was secondary to the significant decrease in carbohydrates, fats and total caloric intakes (p<0.05) which translated to a better cardiometabolic health in both groups noted clearly through lipid profile changes. Endotoxin was found to be inversely associated with fiber intake (p<0.05). Fiber intake was found to be positively associated with HDL-cholesterol (p<0.05), which appeared to be an important dietary component to be associated with health improvements.
This current thesis expanded our knowledge and understanding on how a high fat oral challenge exacerbates cardiometabolic and inflammatory conditions (including endotoxemia) in Saudi Arabian women with different metabolic states, and how a 3-month caloric restriction may induce weight loss that leads to improved cardiometabolic health. Observations from the present thesis highlight strategies that may potentially be of clinical use in future dietary intervention studies in patients with T2DM and obesity in the Middle Eastern region
Health technology assessment review: remote monitoring of vital signs - current status and future challenges
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