Diabetes Prevention: The Importance of Addressing Exercise in Patient Encounters

When screening patients at risk for diabetes, clinicians should incorporate a discussion regarding increasing daily physical exercise, as exercise has been found to promote insulin sensitivity, increase muscle mass, and decrease pancreatic and visceral fat — which may contribute to beta cell dysfunction — according to research presented at the American Academy of Physician Assistants (AAPA) Annual Meeting, held May 18 to 22, 2019, in Denver, Colorado.

Robyn Stuhr, vice president of Exercise Is Medicine at the American College of Sports Medicine in Indianapolis, Indiana, discussed the importance of participating in regular physical activity for the prevention of type 2 diabetes and how clinicians can incorporate questions that assess engagement in physical activity into patient visits. Along with increased insulin sensitivity and improved beta cell function, participating in high-intensity interval training (HIIT) physical activity prevents weight gain and regain, increases energy expenditure, and improves blood pressure and lipid levels.

The National Diabetes Prevention Program, an initiative of the Centers for Disease Control and Prevention, is a 16-week lifestyle intervention that provides a framework for diabetes prevention efforts. It incorporates weekly weigh-ins as well as activity tracking, and includes follow-up with a lifestyle coach for 6 months after completion of the program. The program also serves as a useful guide for those who may be uninformed about nutrition but embarking on a program independently, without the influence of a clinician.

Exercise Is Medicine is a global health initiative created to promote the prescribing of exercise in a similar fashion to other treatment modalities and to treat exercise as a patient vital sign. The optimal dosage of exercise is 150 minutes per week for adult patients and 60 minutes per day for pediatric patients. The primary goal of Exercise Is Medicine is to conduct a routine assessment and promotion of physical activity in the healthcare setting; this is best conducted by following the Screening, Brief Intervention, and Referral to Treatment (SBIRT) method. Providers should ask patients to describe their current level of physical activity, provide counseling, prescribe exercise, and refer them to helpful resources.

Providers should enforce that exercise is a privilege, not a punishment, and should be a champion of exercise for their patients. By doing so, patients have the potential to reduce their risk for diabetes and increase their overall quality of life. ­

Reference                                                         

Stuhr R. Exercise is medicine in diabetes prevention. Presented at: The American Academy of Physician Assistants (AAPA) Annual Meeting; May 18-22, 2019; Denver, CO. Presentation DV9044.