Diabetologia

, Volume 31, Issue 12, pp 902–909 | Cite as

Exercise in a behavioural weight control programme for obese patients with Type 2 (non-insulin-dependent) diabetes

  • R. R. Wing
  • L. H. Epstein
  • M. Paternostro-Bayles
  • A. Kriska
  • M. P. Nowalk
  • W. Gooding
Originals

Summary

Two studies were conducted to determine whether adding exercise to a diet programme promotes weight loss or glycaemic control in Type 2 (non-insulin-dependent) diabetic subjects. In Study 1, 25 subjects were randomly assigned to diet plus moderate exercise or diet plus placebo exercise. All subjects exercised twice a week as a group and once a week on their own; the diet plus moderate exercise group walked a 3-mile route at each session while the diet plus placebo exercise group did very low intensity exercises such as stretching and light calisthenics. All subjects followed a calorie-counting diet and were taught behaviour modification strategies. Weight losses and improvements in glycaemic control did not differ significantly between the two treatment groups at the end of the 10-week treatment or at 1-year follow-up. In Study 2, more extreme conditions were compared: a diet only group and a diet plus exercise group. The diet plus exercise group walked a 3-mile route with the group 3 times/week and once a week on their own, while the diet only group was instructed to maintain their current low level of activity. Both groups received comparable diet and behaviour modification instruction and therapist contacts. The diet plus exercise group had significantly (p<0.01) better weight losses than the diet only condition at the end of the 10 week programme (−9.3kg vs −5.6kg) and at 1 year follow-up (−7.9kg vs −3.8 kg). Both groups had similar improvements in glycosylated haemoglobin, but reductions in medication were more frequent and greater in magnitude in the diet plus exercise group. Finally, analyses were conducted collapsing across studies and across treatment groups and comparing subjects who reported low, medium, or high levels of exercise at 1 year. Self-reported exercise was related to weight loss and to improvements in glycosylated haemoglobin, even after adjusting for weight loss. These data suggest that the combination of diet and exercise improves weight loss and glycaemic control compared to diet only in Type 2 diabetic patients.

Key words

Type 2 (non-insulin-dependent) diabetes exercise diet behaviour modification weight loss 

References

  1. 1.
    Doar JWH, Wilde CE, Thompson ME, Sewell PFJ (1975) Influence of treatment with diet alone on oral glucose-tolerance test and plasma sugar and insulin levels in patients with maturity onset diabetes mellitus. Lancet I: 1263–1266Google Scholar
  2. 2.
    Olefsky J, Reaven GM, Farquhar JW (1974) Effect of weight reduction on obesity: studies of lipid and carbohydrate metabolism in normal and hyperlipoproteinemic subjects. J Clin Invest 53: 64–76Google Scholar
  3. 3.
    Reaven GM (1983) Introduction: the role of insulin resistance in the pathogenesis and treatment of non-insulin dependent diabetes mellitus. Am J Med 74: 1–2Google Scholar
  4. 4.
    Wing RR (1985) Improving dietary adherence in patients with diabetes. In: Jovanovic L, Peterson CM (eds) Nutrition and diabetes. Liss, New York, pp 161–186Google Scholar
  5. 5.
    Dahlkoetter J, Callahan EJ, Linton J (1979) Obesity and the unbalanced energy equation: exercise vs eating habit change. J Consult Clin Psychol 47: 898–905Google Scholar
  6. 6.
    Harris MB, Hallbauer ES (1973) Self-directed weight control through eating and exercise. Behav Res Ther 11: 523–529Google Scholar
  7. 7.
    Stalonas PM, Johnson WG, Christ M (1978) Behaviour modification for obesity: the evaluation of exercise, contingency management, and programme evaluation. J Consult Clin Psychol 46: 463–469Google Scholar
  8. 8.
    Epstein LH, Wing RR, Koeske R, Valoski A (1984) Effects of diet plus exercise on weight change in parents and children. J Consult Clin Psychol 52: 429–437Google Scholar
  9. 9.
    Reitman JS, Vasquez B, Klimes I, Nagulesparan M (1984) Improvement of glucose homeostasis after exercise training in non-insulin-dependent diabetes. Diabetes Care 7: 434–441Google Scholar
  10. 10.
    Schneider SH, Amorosa LF, Khachadurian AK, Ruderman NB (1984) Studies on the mechanism of improved glucose control during regular exercise in Type 2 (non-insulin-dependent) diabetes. Diabetologia 26: 355–360Google Scholar
  11. 11.
    Trovati M, Carta Q, Cavalot F, Vitali S, Banaudi C, Lucchina PG, Fiocchi F, Emanuelli G, Lenti G (1984) Influence of physical training on blood glucose control, glucose tolerance, insulin secretion, and insulin action in non-insulin-dependent diabetic patients. Diabetes Care 7: 416–420Google Scholar
  12. 12.
    Bjorntorp P, Holb G, Jacobson B, Schiller-deJounge K, Lundeberg P, Sjostrom L, Smith U, Sullivan L (1977) Physical training in human hyperplastic obesity IV. Effects on the hormonal status. Metabolism 26: 319–328Google Scholar
  13. 13.
    DeFronzo RL, Ferrannini E, Koivisto V (1983) New concepts in the pathogenesis and treatment of non-insulin-dependent diabetes mellitus. Am J Med 74: 52–81Google Scholar
  14. 14.
    Wood PD, Haskell WL (1979) The effect of exercise on plasma high density lipoproteins. Lipids 14: 417–427Google Scholar
  15. 15.
    Bogardus C, Ravussin E, Robbins DC, Wolfe RR, Horton ES, Sims EAH (1984) Effects of physical training and diet therapy on carbohydrate metabolism in patients with glucose intolerance and non-insulin-dependent diabetes mellitus. Diabetes 33: 311–318Google Scholar
  16. 16.
    Kaplan RM, Wilson DK, Hartwell SL, Merino KL, Wallace JP (1985) Prospective evaluation of HDL cholesterol changes after diet and physical conditioning programmes for patients with Type 2 diabetes mellitus. Diabetes Care 8: 343–348Google Scholar
  17. 17.
    Saltin B, Lindgarde F, Houston M, Horlin R, Nygaard E, Gad P (1979) Physical training and glucose tolerance in middle-aged men with chemical diabetes. Diabetes 28 [Suppl 1]: 30–32Google Scholar
  18. 18.
    American College of Sports Medicine (1980) Guidelines for Graded Exercise Testing and Exercise Prescription. Lea and Febiger, PhiladelphiaGoogle Scholar
  19. 19.
    National Diabetes Data Group (1979) Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 28: 1039–1057Google Scholar
  20. 20.
    American Diabetes Association (1979) Principles of nutrition and dietary recommendations for individuals with diabetes mellitus: 1979. Diabetes 28: 1027–1029Google Scholar
  21. 21.
    Metropolitan Life Insurance Company (1983) Metropolitan height and weight table. Stat Bull Metrop Insur Co 64: 2–9Google Scholar
  22. 22.
    Cohen JD, Grimm RH, Smith WM (1981) Multiple risk factor intervention trial (MRFIT) VI. Intervention on blood pressure. Prev Med 10: 501–518Google Scholar
  23. 23.
    Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC (1974) Enzymatic determination of total serum cholesterol. Clin Chem 20: 470–475Google Scholar
  24. 24.
    Bucolo G, David H (1973) Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem 19: 476–482Google Scholar
  25. 25.
    Albers JJ, Warnick GR, Wiebe D, King P, Steiner P, Smith L, Breckenridge C, Chow A, Kuba W, Weidman S, Arentt H, Wood P, Schlagenhaft A (1978) Multi-laboratory comparison of three Heparin-Mn 2+ precipitation procedures for estimating cholesterol in high-density lipoproteins. Clin Chem 24: 853–856Google Scholar
  26. 26.
    Herbert V, Lau KS, Gottlieb CW (1965) Coated charcoal immunoassay of insulin. J Clin Endocrinol 25: 1375–1384Google Scholar
  27. 27.
    Koenig RJ, Peterson CM, Jones RL, Saudek C, Lehrman M, Cerami A (1976) Correlation of glucose regulation of hemoglobin A1c in diabetes mellitus. N Engl J Med 295: 417–420Google Scholar
  28. 28.
    Daneman D, Wolfson DH, Becker DJ, Drash AL (1981) Factors affecting glycosylaited hemoglobin values in children with insulin-dependent diabetes. J Pediatr 99: 847–853Google Scholar
  29. 29.
    Paffenbarger RS Jr, Wing AL, Hyde RT (1978) Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 108: 161–175Google Scholar
  30. 30.
    Epstein LH, Wing RR, Koeske R, Valoski A (1985) A comparison of lifestyle exercise, aerobic exercise, and calisthenics on weight loss in obese children. Behav Ther 16: 345–356Google Scholar
  31. 31.
    Montoye HJ, Block WD, Metzner H, Keller JB (1977) Habitual physical activity and glucose tolerance. Diabetes 26: 172–176Google Scholar
  32. 32.
    Taylor R, Ram P, Zimmet P, Raper LR, Ringrose H (1984) Physical activity and prevalence of diabetes in Melanesian and Indian men in Fiji. Diabetologia 27: 578–582Google Scholar
  33. 33.
    Wing RR, Epstein LH, Nowalk MP, Scott N, Koeske R, Hagg S (1986) Does self-monitoring of blood glucose improve dietary compliance for obese patients with Type 2 diabetes? Am J Med 81: 830–836Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • R. R. Wing
    • 1
  • L. H. Epstein
    • 1
  • M. Paternostro-Bayles
    • 1
  • A. Kriska
    • 1
  • M. P. Nowalk
    • 1
  • W. Gooding
    • 1
  1. 1.University of Pittsburgh School of MedicinePittsburghUSA

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