Internal and Emergency Medicine

, Volume 12, Issue 1, pp 45–52 | Cite as

Supervised vs. self-selected physical activity for individuals with diabetes and obesity: the Lifestyle Gym program

  • Paolo Mazzuca
  • Luca Montesi
  • Gianni Mazzoni
  • Giovanni Grazzi
  • Maria Maddalena Micheli
  • Silvia Piergiovanni
  • Valeria Pazzini
  • Giulia Forlani
  • Pasqualino Maietta Latessa
  • Giulio MarchesiniEmail author


The effectiveness of different programs of physical activity outside randomized studies is difficult to determine. We carried out an audit in two different units where either a supervised physical activity (PA) program or a self-selected PA program was in use in individuals with type 2 diabetes or obesity. The supervised PA cohort (n = 101) received progressive gym training (120 min, twice a week for 13 weeks) by a dedicated team, with nutritional counseling during resting periods. The self-selected PA cohort (n = 69) was enrolled in a 13-week cognitive-behavioral program (120 min/week, in groups of 12–15 individuals), chaired by an expert team. Body weight and physical fitness (6-min walk test) were measured at baseline and after 6 and 12 months. Outcome measures were attrition, weight loss ≥10 % initial body weight, 10 % increase in 6-min walk test; their association with a PA program was tested by logistic regression analysis. Attrition rate was lower in the supervised PA group (28 vs. 45 % than in the self-selected cohort, P = 0.023). After adjustment for confounders, the supervised PA program was associated with a lower risk of attrition at 1 year (odds ratio 0.45; 95 % confidence interval, 0.21–0.98) at logistic regression analysis. Body weight similarly decreased in both groups (more rapidly in the supervised PA cohort); also physical fitness improved in a similar way, and no differences in achieved targets of body weight (supervised, 31 %; self-selected, 18 %; P = 0.118) or fitness (supervised, 62 %; self-selected, 49 %; P = 0.312) were demonstrated. Different PA programs produce very similar health benefits, but an initially supervised program has lower attrition rates, which might translate into better outcomes in the long term.


Body weight Diabetes Obesity Physical activity Physical fitness 



Body mass index


Confidence interval


Odds ratio


Physical activity


Compliance with ethical standards

Conflict of interest

None in relation to the material presented in this report.

Statement of human and animal rights

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study (clinical audit) formal consent is not required.


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Copyright information

© SIMI 2016

Authors and Affiliations

  • Paolo Mazzuca
    • 1
  • Luca Montesi
    • 2
  • Gianni Mazzoni
    • 3
  • Giovanni Grazzi
    • 3
  • Maria Maddalena Micheli
    • 3
  • Silvia Piergiovanni
    • 4
  • Valeria Pazzini
    • 4
  • Giulia Forlani
    • 2
  • Pasqualino Maietta Latessa
    • 5
  • Giulio Marchesini
    • 2
    • 6
    Email author
  1. 1.Unit of Internal Medicine, Diabetes and Metabolic Disease Center, Romagna Health DistrictRiminiItaly
  2. 2.Department of Medical and Surgical Sciences“Alma Mater Studiorum” UniversityBolognaItaly
  3. 3.Public Health Department and University Center for Sport-Applied Biomedical StudiesFerraraItaly
  4. 4.Lifestyle Gym GroupRiminiItaly
  5. 5.Department for Life Quality Studies“Alma Mater Studiorum” UniversityBolognaItaly
  6. 6.Unit of Metabolic Diseases“Alma Mater Studiorum” University, S. Orsola-Malpighi HospitalBolognaItaly

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