Dobrosielski, D. A., Gibbs, B. B., Ouyang, P., Bonekamp, S., Clark, J. M., Wang, N.-Y., H. Silber., E. Shapiro., Stewart, K. J. (2012). Effect of Exercise on Blood Pressure in Type 2 Diabetes: A Randomized Controlled Trial. Journal of General Internal Medicine, 27(11), 14531459. http://doi.org/10.1007/s11606-012-2103-8 This study focuses on the importance of lowering blood pressure to reduce risk of cardiovascular disease in patients with diabetes. Exercise is one of the ways in which blood pressure could be significantly reduced. The goal of this study was to use a supervised exercise intervention and observe the effects of it on the blood pressure of diabetic patients. Participants for this study were men and women between the ages of 40 and 65, diagnosed with diabetes and high blood pressure who had not been diagnosed of cardiovascular disease. Participants had to attend endurance and aerobic training sessions three times a week for 26 weeks. Results showed no significant reduction of blood pressure in the participants with type 2 diabetes. However, the results did show that participants had increased fitness, decreased fat body composition, and better glycemic levels. The results led researchers to conclude that the lack of change in blood pressure may be due to changed artery structures due to diabetes and that these structural changes cannot be reversed through exercise. Researchers also reached the conclusion that perhaps drug therapy is the best way to reduce blood pressure in diabetic patients. A major shortcoming of this study is that it did not select against participants who were on hypertensive medication. This medication could have covered the possible effects of exercise on blood pressure. While exercise did not reduce blood pressure, it still provided other health benefits that are important to positive health outcomes in diabetic patients. This study provided even more evidence that exercise can help diabetic patients decrease or maintain their body weight and control their glucose levels. Fowles, J. R., Shields, C., Barron, B., Mcquaid, S., & Dunbar, P. (2014). Implementation of Resources to Support Patient Physical Activity Through Diabetes Centres in Atlantic Canada: The Effectiveness of Toolkit-Based Physical Activity Counselling. Canadian Journal of Diabetes, 38(6), 415-422. doi:10.1016/j.jcjd.2014.02.020 This quantitative study recognizes that physical activity is very important for patients with type 2 diabetes. These researchers developed a toolkit composed of a physical activity manual and education program for diabetes educators to use as an intervention during patient visits. The purpose of this type of intervention was to observe if it resulted in better physical activity practices compared to the standard care practice. Participants were divided into two groups: one that received information from the diabetes educator from the toolkit provided complete with brochures, self-management tools, and evidence-based physical activity information and one that received a standard visit with no additional materials regarding physical activity. Participants were asked to answer questions regarding their own and their diabetes educators ability to motivate and monitor physical activity quantity. They also reported data regarding the amount of physical activity they engaged in after the appointment. The diabetes educators also collected clinical variables such as blood glucose levels and weight before the intervention and 6 months after the intervention. Data analysis found no significant effects on the variables measured, which led researchers to conclude that a single physical activity counseling visit using the toolkit provided was not enough to motivate and encourage patients to change their behaviors towards a healthier lifestyle. One of the major limitations of this study was that the time commitment of each diabetes educator and the exact content they gave patients was not standard so not every participants received the same counseling. These findings relate to the problem I proposed as a Nurse Practitioner because it demonstrates that better counseling techniques need to be developed to encourage patients to be more active in their health and engage in greater amounts of physical activity. Lackinger, C., Haider, S., Kosi, L., Harreiter, J., Winhofer, Y., & Kautzky-Willer, A. (2015). Potential of a Sports ClubBased Exercise Program for Improving Physical Activity in Type 2 Diabetes Mellitus. JPAH Journal of Physical Activity and Health, 12(9), 1221- doi:10.1123/jpah.2014-0199 This quantitative study emphasizes that while there are thousands of fitness facilities in many countries very few of them work with the healthcare system to provide fitness services and support for people with type 2 diabetes mellitus. The writers state hope that their study will encourage facilities to develop fitness programs for patients with type 2 diabetes mellitus. Both women and men, 30 years or older, diagnosed with T2DM participated in this study. Researchers recruited a local outpatient clinic and sport club to provide patients with diabetes a two-month combined endurance, strength, and flexibility exercise program. The main goal was to observe if participating in this program targeted for patients with diabetes had any positive effects on their health and physical activity quantity. Data for this study was collected utilizing surveys that asked about satisfaction with the program, quality of life, and quantity of physical activity, among others. Results showed that due to the cooperation of both the medical and fitness sectors, patients were able to participate in an exercise program and their quantity of physical activity increased 12 months after the program. Researchers concluded that the program is cost-effective and can help many people with diabetes lead healthier lifestyles. Major limitations in this study include self-reported data, which is not the most reliable, and also a high dropout rate of participants. This research is significant to the diabetes problem I presented as a Nurse Practitioner because it shows that with regular exercise, patients with diabetes can lead healthier lifestyles and the healthcare system needs to work together with sport facilities to provide targeted programs to patients. S??n??chal, M., Johannsen, N. M., Swift, D. L., Earnest, C. P., Lavie, C. J., Blair, S. N., & Church, S. (2015). Association between Changes in Muscle Quality with Exercise Training and Changes in Cardiorespiratory Fitness Measures in Individuals with Type 2 Diabetes Mellitus: Results from the HART-D Study. PLOS ONE PLoS ONE, 10(8). doi:10.1371/journal.pone.0135057 Exercise training has been found to be crucial in helping prevent and manage type 2 diabetes. While both resistance and aerobic training have been found to have positive effects, this study aimed to study the importance of muscle mass quality for helping diabetic patients manage their diabetes. More specifically, researchers were trying to see if performing aerobic training had different effects on cardiorespiratory fitness on diabetic patients than performing resistance training. This intervention was tested on sedentary individuals between the ages of 30 and 75 who had type 2 diabetes. The intervention lasted nine months and consisted of either 150 minutes per week of aerobic training or 3 days per week of resistance training or both. Researchers tested muscle quality, cardiorespiratory fitness, and body composition. Results showed positive changes in all measures and the group that had the greatest increase in muscle quality was the group that performed both resistance and aerobic training. Researchers concluded that a positive change in muscle quality was associated with an increase in cardiorespiratory fitness. The importance of this finding is that we now know of another factor that needs to be considered as a contributor to positive health outcomes in patients with type 2 diabetes. Knowing that muscle quality is different from muscle strength, as this study suggests, can help researchers and healthcare professionals design interventions that can increase muscle quality to help increase cardiorespiratory fitness thus helping reduce risk for cardiovascular complications associated with diabetes. A bias of this study is that muscle quality is a concept presented by the researchers with a definition and method of measuring it that was developed for this study. The paper does not cite any other study using this concept of muscle quality, which raises the question of this measure being valid and operational. The present study is relevant to my research because it demonstrates that a combination of two different exercise regimens can have maximum positive effects on the fitness of a diabetic individual and thus can lead to positive health outcomes.
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