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Strict Exercise Regimen Beats Back Blood Sugar - pdf attached
 
 
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"Our results demonstrate that in patients with type 2 diabetes, structured aerobic, resistance, or combined exercise training is associated with a HbA1c decline of -0.67%. Our analyses also demonstrate that structured exercise duration of more than 150 minutes per week was associated with greater benefit (0.89% reduction in HbA1c ) than structured exercise duration of 150 minutes or less per week (0.36% reduction in HbA1c). Structured exercise training was associated with a more pronounced HbA1c reduction compared with physical activity advice. A recommendation to increase physical activity was beneficial (0.43% HbA1c reduction), but only if combined with dietary recommendations........In univariate meta-regression, baseline HbA1c level, exercise frequency, total time spent in exercise during the study, and weekly exercise duration of more than 150 minutes per week or of 150 minutes or less per week partially explained heterogeneity between structured exercise training studies
 
MedPage Today
Published: May 04, 2011
 
Having a structured exercise program to stick to can help diabetes patients lower their blood glucose levels, researchers say.
 
A meta-analysis found that any regular regimen of physical activity -- be it aerobic exercise, resistance training, or a combination of the two -- was associated with about a 0.67% decrease in glycated hemoglobin levels compared with controls (P<0.001), according to Beatriz Schaan, MD, ScD, of Hospital de Clinicas de Porto Alegre in Brazil, and colleagues.
 
They reported their findings in the May 4 issue of the Journal of the American Medical Association.
 
Action Points
 
* Explain that any regular regimen of physical activity -- be it aerobic exercise, resistance training, or a combination of the two -- was associated with about a 0.67% decrease in glycated hemoglobin levels compared with controls.
 
* Note that doing more than 150 minutes of exercise per week was associated with better reductions in HbA1c than doing 150 minutes or less.
 
Currently, guidelines recommend 150 minutes per week of moderate intensity aerobic exercise, as well as resistance training three times a week.
 
That's because regular exercise has been shown to improve glucose control, but it's been unclear as to which exercise interventions are best, the researchers said.
 
So they conducted a review and meta-analysis of trials of structured exercise training programs -- aerobic, resistance, or both -- as well as those that simply included physical activity advice with or without dietary intervention, on changes in HbA1c status.
 
Ultimately, their analysis included 47 trials totaling 8,538 patients.
 
Schaan and colleagues found that structured aerobic exercise programs alone were associated with a reduction in HbA1c (a 0.73% drop, P<0.001), as were structured resistance training regimens alone (a 0.57% drop, P<0.001).
 
When those programs were combined, they were associated with a 0.51% reduction in HbA1c levels compared with controls (P<0.001).

 
The researchers also found that doing more than 150 minutes per week of any structured exercise program was associated with a greater reduction in glycated hemoglobin than 150 minutes or less (0.89% versus 0.36%, P<0.001).
 
When restricted to interventions that merely gave advice about physical activity, the researchers did find a reduction in HbA1c levels, but it wasn't significant in sensitivity analyses.
 
Those analyses revealed that when the advice about exercise was given in conjunction with dietary advice, there was a significant reduction in blood sugar levels compared with controls (a 0.58% drop, P=0.007).
 
"This highlights the need for a combined recommendation of these lifestyle interventions," the researchers wrote.
 
They noted that the study was limited by the quality of the included studies -- which, they said, was low. It was also limited by the fact that data extraction was unblinded, they said.
 
In an accompanying editorial, Marco Pahor, MD, of the University of Florida, wrote that despite these limitations, the results were "largely consistent with regard to the benefits of exercise and physical activity, which suggests the findings of the meta-analysis merit confidence."
 
Pahor said that some healthcare programs offer monthly gym memberships for a reduced cost or at no extra charge, and cost-benefit analyses of these programs could find in favor of this practice -- as some studies have shown that those who visit a health club more frequently end up spending less on healthcare.
 
Thus, Pahor concluded that it "may be time to consider insurance reimbursement for structured physical exercise programs."
 
He noted, however, that the "type of supported program and the target population eligible ought to be carefully assessed," which calls for further research.
 
The study was partially supported by Conselho Nacional de Desenvolvimento Cientifico e Tecnologico and Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior.
 
The editorialist is supported by grants from the National Institutes of Health.
 
Neither the researchers nor the editorialist reported any conflicts of interest.
 
Primary source: Journal of the American Medical Association
Source reference:
Umpierre D, et al "Physical activity advice only or structure exercise training and association with HbA1c levels in type 2 diabetes" JAMA 2011; 305(17): 1790-1799.
 
Additional source: Journal of the American Medical Association
Source reference:
Pahor M "Consideration of insurance reimbursement for physical activity and exercise programs for patients with diabetes" JAMA 2011; 305(17): 1808-1809.
 
 
 
 
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