The purpose of this secondary analysis was to determine changes in physical inactivity from baseline to 5 years and to identify factors associated with and predictive of physical inactivity among individuals with type 2 diabetes enrolled in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study.
Methods
DIAD was a prospective randomized screening trial that assessed the prevalence of silent ischemia in asymptomatic patients with type 2 diabetes. Subjects were recruited from diabetes and primary care practices at 14 centers throughout the United States and Canada. This is a secondary data analysis of the physical activity data (type and hours/week) collected. No intervention was conducted.
Results
In all subjects, physical inactivity rose from 24% at baseline to 33% at 5 years (S = 28.93; P < .0001). This change was significant in both men (S = 11.44; P < .0001), increasing from 23% to 31%, and women (S = 18.05; P < .0001), increasing from 25% to 36%. Gender differences were noted in several factors associated with baseline physical inactivity as well as in factors predictive of physical inactivity at 5 years. Important factors associated at both time points included lower level of education, current employment, presence of peripheral and autonomic neuropathy, and indicators of overweight/obesity. Baseline physical inactivity was strongly predictive of physical inactivity at 5 years (odds ratio, 3.27; 95% confidence interval, 2.36-4.54; P < .0001).
Conclusions
Gender-related differences were noted in factors associated with and predictive of physical inactivity.
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References
1.
WhitingDGuariguataLWeilCShawJ. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311-321. doi:10.1016/j.diabres.2011.10.029.
2.
MorratoEHHillJOWyattHRGhushchyanVSullivanPW. Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care. 2007;30(2):203-209.
3.
BrownRRiddellMMacphersonACanningKKukJ. All-cause and cardiovascular mortality risk in U.S. adults with and without type 2 diabetes: influence of physical activity, pharmacological treatment and glycemic control. J Diabetes Complicat. 2013. doi:10.1016/j.jdiacomp.2013.06.005.
4.
DeshpandeADBakerEALovegreenSLBrownsonRC. Environmental correlates of physical activity among individuals with diabetes in the rural Midwest. Diabetes Care. 2005;28(5):1012-1018.
5.
WadenJTikkanenHForsblomC. Leisure time physical activity is associated with poor glycemic control in type 1 diabetic women: the FinnDiane study. Diabetes Care. 2005;28(4):777-782.
6.
HuGJousilahtiPBarengoNCQiaoQLakkaTATuomilehtoJ. Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes. Diabetes Care. 2005;28(4):799-805.
7.
MoraSCookNBuringJERidkerPMLeeIM. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation. 2007;116(19):2110-2118.
8.
KokkinosPMyersJNylenE. Exercise capacity and all-cause mortality in African American and Caucasian men with type 2 diabetes. Diabetes Care. 2009;32(4):623-628.
9.
BruceDGDavisWADavisTM. Longitudinal predictors of reduced mobility and physical disability in patients with type 2 diabetes: the Fremantle diabetes study. Diabetes Care. 2005;28(10):2441-2447.
10.
GargPKLiuKTianL. Physical activity during daily life and functional decline in peripheral arterial disease. Circulation. 2009;119(2):251-260.
11.
WackersFJTYoungLHInzucchiSEChyunDADaveyJA, for the DIAD Study Investigators. The prevalence of silent myocardial ischemia in asymptomatic patients with type 2 diabetes mellitus: results of the DIAD study. Diabetes. 2003;52(A56).
12.
WackersFJYoungLHInzucchiSE. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care. 2004;27(8):1954-1961.
13.
YoungLHWackersFJChyunDA. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA. 2009;301(15):1547-1555.
14.
PolitDBeckC. Nursing Research: Principles and Methods. 7th ed.Philadelphia, PA: Lippincott, Williams & WIlkins; 2004.
15.
KannelWBSorlieP. Some health benefits of physical activity. The Framingham study. Arch Intern Med. 1979;139(8):857-861.
16.
KellarSKelvinE. Munro’s Statistical Methods for Health Care Research. 6th ed.Philadelphia, PA: Lippincott Williams & Wilkins; 2013.
17.
NelsonKMReiberGBoykoEJ, NHANES III. Diet and exercise among adults with type 2 diabetes: findings from the third national health and nutrition examination survey (NHANES III). Diabetes Care. 2002;25(10):1722-1728.
18.
NamS. Predictors of exercise intervention dropout in sedentary individuals with type 2 diabetes. J Cardiopulm Rehab Prev. 2012;32(6):370.
19.
VoulgariCPsallasMKokkinosAArgianaVKatsilambrosNTentolourisN. The association between cardiac autonomic neuropathy with metabolic and other factors in subjects with type 1 and type 2 diabetes. J Diabetes Complications. 2011;25(3):159-167.
20.
PagkalosM. Heart rate variability modifications following exercise training in type 2 diabetic patients with definite cardiac autonomic neuropathy. Br J Sports Med. 2008;42(1):47-54.
21.
DaviesM. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518-1522.
22.
KludingPMPasnoorMSinghR. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications. 2012;26(5):424-429.
23.
HoganPDallTNikolovP. Economic costs of diabetes in the US in 2002. Diabetes Care. 2003;26(3):917-932.
24.
DzewaltowskiDAEstabrooksPAGlasgowRE. The future of physical activity behavior change research: what is needed to improve translation of research into health promotion practice?Exerc Sport Sci Rev. 2004;32(2):57-63.
25.
DzewaltowskiDAEstabrooksPAKlesgesLMBullSGlasgowRE. Behavior change intervention research in community settings: how generalizable are the results?Health Promot Int. 2004;19(2):235-245.
26.
NishitaCUeharaDTomT. Self-perceptions on the impact of diabetes among working adults: insights into disability prevention. J Primary Prev. 2011;32(5-6):299-309.
27.
WolfASiadatyMCrowtherJ. Impact of lifestyle intervention on lost productivity and disability: improving control with activity and nutrition. J Occup Environ Med. 2009;51(2):139-145.
28.
YatesTDaviesMGorelyTBullFKhuntiK. Effectiveness of a pragmatic education program designed to promote walking activity in individuals with impaired glucose tolerance: a randomized controlled trial. Diabetes Care. 2009;32(8):1404-1410.
29.
BalducciSZanusoSNicolucciA. Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian diabetes and exercise study (IDES). Arch Intern Med. 2010;170(20):1794-1803.
30.
De FeoPSchwarzP. Is physical exercise a core therapeutical element for most patients with type 2 diabetes?Diabetes Care. 2013;36(suppl 2):S149-S154.
31.
DiLoretoCFanelliCLucidiP. Validation of a counseling strategy to promote the adoption and the maintenance of physical activity by type 2 diabetic subjects. Diabetes Care. 2003;26(2):404-408.
32.
BarrettJPlotnikoffRCourneyaKRaineK. Physical activity and type 2 diabetes: exploring the role of gender and income. Diabetes Educ. 2007;33(1):128-143.
33.
EgedeLPostonM. Racial/ethnic differences in leisure-time physical activity levels among individuals with diabetes. Diabetes Care. 2004;27(10):2493-2494.
34.
SchweikertBHungerMMeisingerCKonigHHGappOHolleR. Quality of life several years after myocardial infarction: comparing the MONICA/KORA registry to the general population. Eur Heart J. 2009;30(4):436-443.
35.
LloydCEDyerPHBarnettAH. Prevalence of symptoms of depression and anxiety in a diabetes clinic population. Diabet Med. 2000;17(3):198-202.
36.
GlasgowREAskewSPurcellP. Use of RE-AIM to address health inequities: application in a low-income community health center based weight loss and hypertension self-management program. Transl Behav Med. 2013;3(2):200-210.
37.
PeekMETangHAlexanderGCChinMH. National prevalence of lifestyle counseling or referral among African-Americans and whites with diabetes. J Gen Intern Med. 2008;23(11):1858-1864.
38.
American Association of Diabetes Educators. Diabetes and physical activity. Diabetes Educ. 2012;38(1):129-132.
