medwireNews: A behavioral intervention has lasting effects on physical activity levels, fitness, and vascular risk in people with type 2 diabetes, show the 3-year results of the randomized Italian Diabetes and Exercise Study 2.
Study participants who received the intervention maintained higher levels of light-intensity physical activity throughout follow-up, the investigators report in JAMA, although initial effects on moderate-to-high intensity activity diminished over the third year of the study.
This suggests “that moderate- to vigorous-intensity physical activity is more difficult to maintain with time and increasing age,” say Giuseppe Pugliese (“La Sapienza” University, Rome, Italy) and co-researchers.
But despite the decrease in more vigorous activity and the relatively small differences between the groups overall, people in the intervention group significantly improved their cardiorespiratory fitness and lower body strength, whereas these declined in those in the control group. The differences persisted for the entire 3-year study period.
Moreover, the intervention was associated with small but significant improvements in fasting glucose (but not glycated hemoglobin), systolic blood pressure, and 10-year total and fatal coronary heart disease risk over the course of the study.
The 300 study participants, who had been diagnosed with type 2 diabetes a median of 8 to 9 years before enrollment, continued to receive their randomly allocated intervention throughout the 3 years of follow-up. Per year, people in the intervention group received one counseling session with a diabetologist and eight sessions, conducted biweekly, with an exercise specialist. Attendance remained high, with 95.9% of participants attending the year 3 sessions.
The team previously reported that the intervention resulted in increased activity and reduced sedentary time over the first 4 months, relative to the standard care received by people in the control group.
These differences remained stable for 2 years, but reduced overall during the third year, due to the between-group difference in moderate or vigorous physical activity declining from 6.5 to 3.6 minutes/day. Differences in light-intensity activity and sedentary time persisted, however.
Averaged over the whole 3-year follow-up, the intervention resulted in an additional 3.3 MET-h/week of total physical activity (13.8 vs 10.5 MET-h/week), comprising an additional 6.4 minutes/day of moderate or vigorous physical activity and 0.8 hours/day of light-intensity activity. This resulted in an equivalent 0.8 hours/day less sedentary time. All differences were statistically significant.
The researchers note that “there was a wide range of responses to the intervention” among the study participants, but stress that “a substantial proportion” did adjust their approach to physical activity.
“The present findings support the need for interventions targeting all domains of behavior to obtain substantial lifestyle changes, not limited to moderate- to vigorous-intensity physical activity, which has little effect on sedentary time,” they conclude.
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