A clinical survey on the compliance of exercise therapy for diabetic outpatients

doi:10.1016/0168-8227(95)01032-9

Diabetes Research and Clinical Practice

Volume 27, Issue 2, February 1995, Pages 141-145

https://doi.org/10.1016/0168-8227(95)01032-9 Get rights and content

Abstract

To clarify the present state of exercise therapy for diabetes mellitus, we conducted a survey of 570 diabetic outpatients by written questionnaires. The results revealed that approximately 30% of the patients did not implement the prescribed exercise regimen. The principal reasons for low compliance were ‘lack of time to do’ and ‘lack of mind to do’. ‘Lack of time to do’ was particularly numerous in male patients. Other reasons were ‘lack of guidance by physician’, ‘lack of interest’, ‘lack of understanding of procedure’. These findings indicated that the patients should be motivated adequately when they are diagnosed as having diabetes and subsequently encouraged to reinforce their intentions by the physician and co-medical staff. Furthermore, they showed that specific approaches suitable for each individual patient and not standardized guidelines should be devised. As regards the daily environment of patients, the cooperation of the patient's family would be effective and the exercise facilities and the exercise guidance personnel should be augmented.

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Motivational, volitional and multiple goal predictors of walking in people with type 2 diabetes
2016, Psychology of Sport and Exercise
Citation Excerpt :
To achieve a balance between these two items, a sample size of 500 patients was required. As previous research has shown compliance with physical activity to range from 19 to 30% (midpoint: 25%) (Kamiya et al., 1995; Kravitz et al., 1993), this allowed estimation of adherence with physical activity of 25% with precision within ±3.8% (95% CI 21.2%–28.8%). Previous research in community samples indicated a 50% response rate was likely, therefore 1000 questionnaires were mailed to achieve the target of 500 evaluable responses.
Type 2 diabetes is a major public health problem. Effective diabetes self-management involves people engaging in multiple health behaviours, including physical activity. Walking is an effective, accessible and inexpensive form of physical activity, yet many people with Type 2 diabetes do not meet recommended levels. The present study aimed to: 1) identify demographic, motivational and volitional factors predictive of walking in people with Type 2 diabetes mellitus, and 2) test whether accounting for the perceived impact of other goal pursuits (goal facilitation and goal conflict) improved the prediction of walking.
A theory-based cross-sectional study using the Health Action Process Approach was conducted in adults with Type 2 diabetes across Scotland. Assuming a 50% response rate 1000 questionnaires were mailed to achieve the target sample size (N = 500). Demographic information was collected, and intentional (outcome expectations, social support, risk perceptions), motivational (intention, self-efficacy), volitional (action planning, action control) and multiple goal (goal conflict, goal facilitation) factors were assessed as predictors of physical activity in general and walking specifically.
The final sample comprised 411 respondents. The majority (60%) were non-adherent to physical activity recommendations. Of 411 respondents, 356 provided walking data. Body Mass Index and age were the only demographic and anthropometric factors predictive of walking (overall R² = 0.04). When motivational factors were added, intention and self-efficacy added to the prediction (overall R² = 0.07). When volitional factors were added, only action control was predictive of walking (overall R² = 0.08). Finally, goal facilitation explained an additional 7% variance in walking when added to the model (final overall R² = 0.15).
There was low adherence with physical activity recommendations in general and walking in particular. When testing predictors of motivational, volitional and competing goal constructs together, action control and goal facilitation emerged as predictors of walking. Future research should consider how walking can be embedded synergistically alongside other goal pursuits and how action control may help to ensure that they are pursued.
Bile acid sequestration normalizes plasma cholesterol and reduces atherosclerosis in hypercholesterolemic mice. No additional effect of physical activity
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Citation Excerpt :
Furthermore, the running-induced increase in fecal bile acid secretion coincided with a reduction in atherosclerotic lesion size development in hypercholesterolemic mice [17], demonstrating that physical activity beneficially modulates atherosclerosis by enhancing cholesterol turnover in mice. However, despite the recognized benefits of physical activity in the prevention and management of cardiovascular diseases, regular physical activity programs are frequently reported to be underutilized, adherence to these programs proofs poor or engagement in physical activity is not frequent enough [19,20]. Moreover, physical activity will not result in adequate improvements in individuals presenting with more aggressive cardiovascular derangements.
Bile acid sequestrants (BAS) and physical activity (RUN) decrease incidence of cardiovascular events. Both treatments are often prescribed, yet it is not known whether their beneficial effects are additive. We assessed the effects of BAS treatment alone and in combination with RUN on cholesterol metabolism, heart function and atherosclerotic lesion size in hypercholesterolemic mice.
Male Ldlr-deficient mice remained either sedentary (CONTROL), were treated with Colesevelam HCl (BAS), had access to a running wheel (RUN), or were exposed to BAS and RUN (BAS RUN). All groups were fed a high cholesterol diet for 12 weeks. Then, feces, bile and plasma were collected. Atherosclerotic lesion size was determined in the aortic arch and heart function by echocardiography.
BAS RUN ran more than RUN (6.4 ± 1.4 vs. 3.5 ± 1.0 km/day, p < 0.05). BAS and BAS RUN displayed ∼3-fold reductions in plasma cholesterol levels (p < 0.001), ∼2.5-fold increases in fecal neutral sterol (p < 0.001) and bile acid (p = 0.01) outputs, decreases in biliary secretions of cholesterol (∼6-fold, p < 0.0001) and bile acids (∼2-fold, p < 0.001) vs. CONTROL while no significant effects were observed in RUN. Compared to CONTROL, lesion size decreased by 78% in both BAS and BAS RUN, (p < 0.0001).
BAS reduce atherosclerosis in Ldlr-deficient mice, coinciding with a switch from body cholesterol accumulation to cholesterol loss. RUN slightly modulated atherosclerotic lesion formation but the combination of BAS and RUN had no clear additive effects in this respect.
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A clinical survey on the compliance of exercise therapy for diabetic outpatients

Abstract

Prevention of type II diabetes by physical training. Epidemiological considerations and study methods

Diabetes Care

Role and management of exercise in diabetes mellitus

Diabetes Care

Practical method of physical exercise for diabetic patients

Asian Med. J.

Exercise in therapy and prevention of type II diabetes. Implications for blacks

Diabetes Care

Prevention of non-insulin dependent diabetes mellitus with physical activity

Med. Sci. Sports Exerc.