Increasing Physical Activity Among People With Diabetes: The Physician’s Role

It can be difficult for anyone to achieve the recommended 150 minutes of weekly exercise. For people with diabetes, especially those who are sedentary, creating a more active lifestyle can seem overwhelming.

Barriers to physical activity

Physical activity is essential to diabetes management because it improves cardiovascular health, provides glycemic control, reduces stress levels and offers many other benefits. However, Sheri Colberg, PhD, Professor Emerita from Old Dominion University, says people with diabetes are often hindered by fears about becoming hypoglycemic or developing an injury. She also points out that people with diabetes face barriers due to related health conditions, such as peripheral neuropathy or depression.

One study of patients with Type 2 diabetes found the most significant barriers to engaging in physical activity were a negative self-image, followed by a lack of support.1 Fortunately, this study also found that physicians can play a key role in providing reassurance, training and long-term guidance to patients trying to become more active. As long as it is tailored to the patient’s specific needs, motivations and barriers, physicians should consider a prescription for physical activity as seriously as any drug prescription.

Physicians can positively influence the lifestyle changes of their patients, even before diabetes develops. A study of people with prediabetes found that those respondents who had received advice about physical activity from their health-care provider were more likely to report increasing their activity levels.2

Patient-focused guidance

Although medical professionals generally understand the importance of physical activity, not nearly enough are advising their patients to change their sedentary lifestyles. A 2017 report cited data that found just 32 percent of patients who saw their physician received advice about physical activity, and only about half of people with diabetes were given such advice.3

Many physicians face their own barriers to providing education and support to sedentary patients, Dr. Colberg notes, including time constraints, uncertainty about how best to approach the topic and what types of exercise to prescribe.

Physicians are more likely to have a positive influence on activity levels if they help the patient develop their own goals, based on individual concerns and motivations, notes Dr. Margaret Powers, PhD, RD, CDE, a research scientist with the International Diabetes Center at Park Nicollet. “Often, patients know what to do, and our job as clinicians is to help reduce barriers and facilitate factors that enable change,” she says.

Physicians who can understand the patient’s perspective gain valuable insights about past interest in exercise, current capabilities and any gaps in knowledge. Physicians can then provide a more individualized activity plan that factors in any other health concerns, thereby helping to avoid injury and loss of motivation.

Health-care providers should try to steer patients away from setting goals based on extrinsic reasons such as losing weight, according to Beth Lewis, PhD, Director of the School of Kinesiology at the University of Minnesota-Twin Cities. Rather, she says, encourage those living with diabetes to focus on intrinsic reasons, such as having more energy or improving mood levels.

Create achievable goals

People with diabetes, especially those who are sedentary, must develop goals that are achievable and sustainable, advises Dr. Colberg. Instead of sticking to generic guidelines, physicians should encourage patients to incorporate more movement into their daily activities. “Simply having people stand up more and take more daily steps is an easy way to start building foundational fitness that can lead to more activity,” she says.

Take the stairs instead of an elevator, park further away from the store, walk to a coworker’s office instead of sending an email; these basic lifestyle habits are not only easier to sustain, but they provide more opportunities for patients to feel successful in their endeavors to be more physically active.

The American Diabetes Association guidelines recommend that people with diabetes engage in five types of activity each week:

• aerobic (or cardio) exercise, with no more than two days in a row of inactivity;

• flexibility, two to three times per week;

• balance, two to three times per week;

• incorporating more daily movement, such as standing more often; and,

• resistance exercises, at least twice on non-consecutive days per week.

For sedentary patients, it is advisable to begin with just one of these. Dr. Colberg recommends focusing on resistance training to limit the loss of muscle mass over time.

Utilize technological and human support

Fitness tracking technology, such as Fitbit or MyFitnessPal, can be useful for patients who are interested. “There is some evidence that apps are effective for increasing physical activity; however, many of the research-based apps are not available commercially,” Dr. Lewis says. More research needs to be done, particularly on whether such technologies continue to motivate over time. Alternatively, people living with diabetes can simply track their glucose level to measure the positive impact of increased activity.

No matter the technology, anyone who is trying to reach a goal is more likely to be successful with the support of others. Dr. Powers recommends asking patients about which family members or friends could support their goals. Depending on the patient, support can take on many forms: A friend could become a bowling partner; a daughter could drive her father to the mall to walk safely; or, a sibling might purchase a gym membership as a birthday present.

While apps and supportive friends can provide day-to-day encouragement, physicians fill a unique need for people with diabetes. Health-care providers are generally well-respected, their advice is taken seriously and they typically see their patients on a regular basis.3 Health-care providers who engage in a patient-centered approach to increasing physical activity can create an even stronger rapport that enhances patient motivation, Dr. Powers says: “Help each patient be successful by setting reasonable, achievable goals. And remember to acknowledge all positive changes, even if it is ‘thinking more’ about being more active.”

If you don’t already encourage physical activity in your patients, now is the time to discuss physical activity goals, offer encouragement and talk to patients about other support that may assist them in becoming more physically active.

Access additional resources and practical information to enhance the care and treatment of your diabetes patients.

About our expert

Nicola DaviesNicola Davies, PhD, health psychologist and author of I Can Beat Obesity! Finding the Motivation, Confidence and Skills to Lose Weight and Avoid Relapse

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