Type 2 diabetes (T2DM) affects 25.8 million people in the U.S., and the prevalence and incidence is increasing. The benefits of physical activity in T2DM management have been well demonstrated, with lower glycemic control achieved when patients follow a structured exercise program in a research setting. Given the known benefits of dietary changes in T2DM, nutrition referrals are common in current clinical practice. Despite the similarly known benefits of exercise, physical activity referrals are not readily available in the clinical setting. The current American Diabetes Association (ADA) guidelines recommend that individuals with T2DM should engage in both aerobic and resistance training activity, with at least 150 minutes of moderate-intensity aerobic activity per week and resistance exercises 3 times per week. Most (~70%) T2DM patients do not exercise at recommended levels (38%) or at all (31%). While the efficacy of such intensive physical activity interventions among diabetics in a highly structured research setting has been proven, practical approaches to translating and extending these findings into the clinical setting are needed. While most other translational studies have explored adapting physical activity interventions to other community settings (e.g., YMCA), we uniquely propose institutionalizing physical activity resources within a clinical setting, as this conveys an implicit endorsement of physical activity by a patient's health care team. With the recent (2006) addition of resistance training to the ADA guidelines, it is especially important to provide supervision and support for exercise, to prevent injury and maximize health benefits. In order to address these needs, we propose to implement a three-arm RCT to compare the clinical effectiveness, patient centered outcomes, and cost- effectiveness of adding a specialized physical activity component to an established Shared Medical Appointment for T2DM. Shared Medical Appointments (SMAs) are 60-90 minute group appointments (6-12 patients) which are endorsed by the American Academy of Family Practice and the American College of Physicians, and have been implemented in a variety of clinical settings. The proposed Physical Activity for Diabetes SMA (PAD-SMA) will involve structured group exercise sessions in a clinical setting at varying levels of frequency (once vs. three times per week), compared to usual care. The proposed study seeks to test an innovative approach for adoption of physical activity to improve glycemic control. The goal of the Initiate and Maintai Physical Activity in Clinics (IMPACT) Diabetes Study is to translate the known benefits of supervised physical activity in a clinical setting.

Public Health Relevance

Type 2 diabetes affects 25.8 million people in the U.S. and the prevalence and incidence of type 2 diabetes is increasing. Despite the research proven benefits of exercise, physical activity referrals are not yet readily available in the clinical seting, and translational studies are needed to improve the uptake and effectiveness of physical activity recommendations among the general clinical type 2 diabetes patient population. The proposed study seeks to test an innovative approach for adoption of physical activity as an essential self-management strategy to improve glycemic control in a real-world setting.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (ZDK1-GRB-1 (J1))
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Bremer, Andrew
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Palo Alto Medical Foundation Research Institute
Palo Alto
United States
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