Exercise reduces mortality in patients with diabetes

Washington: According to a new study, patients with type 2 diabetes should be prescribed physical activity to control blood sugar and improve heart health.

The recommendations were given in a position paper (1) of the European Association of Preventive Cardiology (EAPC), a branch of the European Society of Cardiology (ESC). The paper has been published in the European Journal of Preventive Cardiology, a journal of the ESC.

Speaking about the study, lead author Hareld Kemps said that sedentary lifestyles and unhealthy diets are the most important drivers of the increasing number of patients with type 2 diabetes and cardiovascular problems such as heart attacks. The cardiologist at Maxima Medical Centre, Veldhoven, the Netherlands added, “Diabetes doubles the risk of mortality but the fitter patients become, the more that risk declines. Unfortunately, the majority of patients do not engage in exercise programmes.”

The study notes that one in 11 adults worldwide have diabetes, of which 90 per cent is type 2 diabetes. Nearly all patients with type 2 diabetes develop cardiovascular complications, which are the leading causes of death in this group.

The paper further provides practical recommendations for doctors on how to motivate patients to incorporate physical activity into their daily routine. It further talks about setting achievable and measurable goals.

Patients should see their doctor for a personalised plan, and those with health insurance should ask if exercise programmes are covered, said Dr Kemps. “There are also steps patients can take without needing to see a doctor first, such as interrupting sitting time and doing moderate exercise like walking and cycling.”

Long-term adherence can be improved by setting early achievable goals that are measurable, and adapting exercise plans to patients’ preferences. Remote guidance also looks promising, with patients monitoring themselves with smartwatches then sending data to a health professional for feedback.

Practical and specific goals tend to be motivational, said Dr Kemps. “For an elderly person this could be climbing the stairs in their home or walking to the supermarket – achievements that will really improve their quality of life. Being able to use less medication because of better glycaemic control is also an incentive.”

As for clinical targets, cardiorespiratory fitness and glycaemic control are the top two. Both improve with exercise training, the changes can be measured, and they are directly related to wellbeing, morbidity and mortality. Exercise also helps to lower blood pressure and harmful blood lipids.

Dr Kemps further said, “I can’t stress enough how effective even small increases in activity can benefit patients with type 2 diabetes and heart problems. Interrupting sitting with brief bouts of walking improves glucose control, while two hours of brisk walking per week reduces the risk of further heart problems.”