Endocrine Abstracts (2004) 7 P74

Exercise instruction in patients with type 2 diabetes and obesity: a randomised controlled trial

A Tuthill1, A Quinn2, D McColgan3, M McKenna1, D O'Shea1 & TJ McKenna1

1Department of Endocrinology and Diabetes Mellitus, St Vincent's University Hospital, Dublin, Ireland; 2Physiotherapy Department, St Columcille's Hospital, Dublin, Ireland; 3Department of Nutrition and Dietetics, St Vincent's University Hospital, Dublin, Ireland.

High levels of physical inactivity contribute to the development of obesity. We aimed to evaluate the benefits of exercise instruction in obese patients with type 2 diabetes who have demonstrated difficulty with weight management since diagnosis. Ethical approval was obtained from the local committee.

Sixty-six patients were recruited from the diabetes out-patient clinics. All patients underwent treadmill-testing prior to randomisation. Patients were matched for gender and insulin treatment. Mean age was 56plus/minus10years, body mass index (BMI) was 35.4plus/minus4.4Kg per meter squared (mean plus/minus SD). After randomisation the exercise group (n equals 28) were provided with heart-rate monitors and received instruction from an exercise physiotherapist at monthly group-sessions. They were advised to exercise 3-5 days per week at 55-90% maximum heart rate, for longer periods than their current practice, and received dietetic advice. The controls (n equals 29) also received information about healthy eating but no specific exercise advice.

Evaluation of laboratory and anthropometric measurements performed at baseline and at three-months revealed significant differences (p less than 0.05) in percentage weight change (minus2.7% vs minus0.4%) and percentage BMI change (minus2.2% vs minus0.4%) favouring the exercise-instruction group. Systolic blood pressure was also significantly reduced in the exercise group compared to the control group (minus8mmHg vs 0.8mmHg), however there were no significant changes in HbA1c, waist circumference or lipoprotein levels. When the data were analysed according to whether patients had actually increased their activity, significant differences were obtained for waist circumference ( minus2.3cm vs minus0.5cm, p < 0.05) and for HbA1c (minus0.3% vs 0.2%, p < 0.001) favouring those whose activity had increased.

These data confirm that exercise instruction can result in weight reduction in obese patients with type 2 diabetes. This can be provided effectively at monthly intervals in group-sessions. Exercise confers additional benefits on glycaemic control and hypertension in these patients.

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