Saturday, January 26, 2019

Exercise training programs in type 2 diabetes should be adapted to the patient’s preferences and commodities

Patients with type 2 diabetes should be prescribed physical activity to control their blood sugar and also to improve heart health, recommends a position paper from the European Association of Preventive Cardiology.

The position paper emphasizes that simply advising patients to exercise is not enough. Patients must be asked for their personal preferences as far as the type of exercise is concerned and an individualized exercise training program, taking into consideration the risk status, must be designed for them to reach the desired goals. The target goals must be achievable and measurable.

Here are some key recommendations from the position paper published in the European Journal of Preventive Cardiology.

·         Increasing cardiorespiratory fitness (CRF) and glycemic control are key clinical targets of exercise training programs in patients with type 2 diabetes with cardiac comorbidities. Patients should be evaluated for CRF to classify them according to their risk and optimal exercise prescription.
·         Other clinical targets include BP control, improvement in vascular function and dyslipidemia and reduction in inflammation.
·         Although a higher BMI is associated with worse prognosis, weight loss is not necessarily a relevant target of exercise training for these patients. Exercise alone is not enough for weight loss; a multidisciplinary intervention which includes nutrition is required to achieve this.
·         More than the weight loss, a better motivational parameter is increasing exercise and physical fitness.
·         Adherence to exercise program is very important to achieve its desired effects. To improve adherence, the type, intensity and duration of activity needs to be carefully adapted to the patient’s preferences and comorbidities and adjusted to training progress over time.
·         High-volume moderate intensity training is recommended for improving body composition and cardiovascular risk factors, preferably by combining training with dietary interventions and counseling/education. But, it may not be safe for patients who develop arrhythmias during exercise or have ischemia.
·         Patients with long-standing type 2 diabetes should be carefully monitored for cardiac autonomic neuropathy and hypoglycemia in particular.
·         At-risk patients or severely detrained patients should start exercising at low intensity, with each increment to be supervised closely, aiming at integration of regular physical activity into daily routine.

(Source: ESC news release, Jan. 15, 2019; Eur J Prev Cardiol. 2019 Jan 14:2047487318820420)

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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