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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