Physical activity in type 2 diabetes. Itsrole and the current care pattern: a

survey of diabetes health careprofessionals in the UK

F. Berlanga, A. Eltringham-Cox, W.A. Burr, D.K. Nagi*

ABSTRACTThis survey was conducted to ®nd out the views of health care professionals in diabetes, on the bene®ts and currentcare patterns with regard to physical activity. The survey shows a clear gap between the knowledge about the bene®ts ofphysical activity in type 2 diabetes, and the current advice being offered to patients. Another striking ®nding of thissurvey was the feeling amongst health professionals, that most patients are capable of increasing their physical activitylevels and that the advice given at present is inadequate and unlikely to have an impact on the uptake of physicalactivity in people with type 2 diabetes. We feel that spending a signi®cant time on education on bene®ts of physicalactivity may be a resource issue, further research is needed to ®nd innovative ways to promote physical activity inpeople with diabetes, as this group is likely to bene®t the most. Copyright # John Wiley & Sons, Ltd.

Practical Diabetes Int 2000: 17(2); 60±61

KEY WORDSphysical activity; exercise; survey; education; type 2 diabetes

Physical activity is advocated to be animportant component of lifestyle mea-sures used in the management of type2 diabetes. Physical activity in peoplewith type 2 diabetes has a number ofbene®ts1,2 and is recommended byvarious professional organisations.3

Despite this few people with diabetestake regular physical activity.4

We undertook this survey, with thehelp of the British Diabetic Associ-ation (BDA), to explore professionalviews about the role of physicalactivity in the management of type 2

diabetes and to ®nd out the patternof advice given currently to peoplewith this disorder. A detailed ques-tionnaire was given to delegates at theBDA meeting in Harrogate in 1998.A total of 117 health care profes-sionals completed the questionnaire(response rate 30%) of whom 31%were doctors, 36% Diabetes NurseSpecialists (DNS), 16% dietitians,5% others and 16% did not identifythemselves.

ResultsA majority of health care professionalsfelt that physical activity has animportant role in the management ofdiabetes, in particular its impact onglycaemic control, cardiovascular riskfactors, weight maintenance and areduction in pharmacological treat-ment (Table 1). Most health profes-sionals felt that most patients withtype 2 diabetes are capable of takingsome form of physical activity.

Education regarding physical activ-ity was provided by most diabetes

teams as a part of general diabeteseducation. Most indicated that thetime spent speci®cally on educationfor physical activity was very little anddepended upon the personal interestof health care professionals. Thesurvey revealed that the current educa-tion about exercise was being providedby anybody within the diabetes teamand was unstructured. One third ofrespondents felt that advice aboutexercise should be a team approach.Two thirds felt that the current advicegiven was grossly inadequate andunlikely to have an impact on theuptake rates of physical activity.

This survey highlights that althoughmost health professionals are clearabout the bene®ts of physical activity,yet few spent enough time to educatepatients about its potential bene®ts.Most feel that the current advice isinadequate and could be improved ifthe potential bene®ts are to be rea-lised. We acknowledge a low responserate to the questionnaire, but feel thatit is more than likely that those who

F. Berlanga, A. Eltringham-Cox, W.A. Burr,

D.K. Nagi, Edna Coates Centre, Pinder®elds

Hospital, Wake®eld, UK

A. Eltringham-Cox, Diabetes Care services,

British Diabetic Association, UK

*Correspondence to:

Dr D.K. Nagi, Consultant Physician

Pinder®elds General Hospital, Aberford

Road, Wake®eld WF1 4DG.

Submitted: 17 December 1999

Accepted: 18 January 2000

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60 Pract Diab Int March/April 2000 Vol. 17 No. 2 Copyright # 2000 John Wiley & Sons, Ltd.

actively promote physical activity mayhave been more inclined to respond,suggesting that the real situation islikely to be worse than is apparent inthis survey.

Although the optimal educationpackage for physical activity stillneeds to be de®ned, this surveyrevealed a clear gap between know-ledge about bene®ts of physical activ-

ity and the advice currently beingoffered to our patients with type 2diabetes. In our view, the general lackof efforts to promote physical activity,apparent in this survey is not due tolack of knowledge about the bene®tsof physical activity but is more likelyto be a resource issue related to lack oftime as well as expertise to promotephysical activity.

References1. Schneider SH, Morgado A. Effects of ®tness and

physical training on carbohydrate metabolism andassociated cardiovascular risk factors in patientswith diabetes. Diabetes Reviews 1995; 3: 378±407.

2. American Diabetes Association. Exercise andNIDDM (Technical Review). Diabetes Care1990; 13: 785±789.

3. American Diabetes Association. Diabetes mellitusand exercise (position statement). Diabetes Care1990; 13: 804±805.

4. Samaras K, Ashwell S, Mackintosh A-M, Camp-bell LV, Chisholm DJ. Exercise in NIDDM: Arewe missing the Point?. Diab Med 1996; 13:780±781.

Table 1. Responses to the knowledge questionnaire, about the impact of regular physical activity on glycaemic control and other diabetesrelated variables

Question asked YES NO Don't Know Data missing% % % %

Improves short term glycaemic control 100Improves long term glycaemic control 76 3 7 14Reduces need for oral hypoglycaemic treatment 92 0 7 1Helps in weight maintenance 70 8 19 3Improves dyslipidaemia 76 6 13 5Lowers blood pressure 96 0 2 2Lowers overall mortality 78 2 17 3Bene®cial effect on microvascular disease 77 0 20 3Detrimental effect on microvascular disease 28 10 55 7

The Diabetes Research & Wellness Foundation is pleased to announce the winners of their

1999 Research Grant Awards

This year, two grants have been awarded in the category of Targeted Research, because two applications were deemed to be exceptionally worthy of theFoundation’s support. This has been done in lieu of a broader sweep of support across other grant categories, with the exception of an award in the categoryof Equipment.

TARGETED RESEARCH1. Derek W R Gray DPhil MRCP FRCSLecturer/Honorary Consultant in Transplantation, NuYeld Department of Surgery, John RadcliVe Hospital, Oxford OX3 9DU

For: Examination of the rejection response to islet tissue, making use of modern genetic engineering techniques.

It is becoming possible to create experimental replicas of islet rejection in the laboratory and, using genetic engineering, to create changes in various parts ofthat rejection response. The eVects seen can give powerful information about how the immune system normally works. The project will use this approach tore-examine the workings of the rejection response, as it applies to transplanted islet tissue. The eventual goal is to understand the mechanisms that underlieimmunological tolerance and to use this knowledge to make pancreatic islet transplantation a reliably successful, curative treatment for diabetes.

2. Sue M Swift MPhil PhDDepartment of Surgery, Leicester Royal Infirmary, Leicester LE2 7LX

For: Improvement in the prospects for successful islet transplantation by reduction of cell death during human islet cell isolation.

This work will complement Dr Swift’s research on insulin-producing cell lines, ’trigger’ molecules for diabetes, and the nature and control of the rejectionresponse to islets. The end result should be an improvement in the quality and quantity of isolated human islets and another step towards finding a cure fordiabetes through islet transplantation.

EQUIPMENT GrantRichard Smith BA(Hons) BM BCh MRCP PhDLecturer in Renal Medicine, Southmead Hospital, Bristol BS10 5NB

For: Upgrade of the microscope used for studying ways in which pancreatic islets can be manipulated before transplantation in order to minimise the immuneresponse they elicit. This will ensure optimum use of the pancreatic tissue available to the researchers.

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Physical activity in type 2 diabetes

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