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Recommendations Summary

PDM: Physical Activity and Prevention of Type 2 Diabetes 2014

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    PDM: Physical Activity and Prevention of Type 2 Diabetes

    • The registered dietitian nutritionist (RDN) should educate individuals who are at high risk for type 2 diabetes that physical activity alone, without weight loss and dietary change, has limited impact on the prevention of type 2 diabetes
    • However, in adults with metabolic syndrome, research regarding moderate intensity physical activity, at a level of 135 to 180 minutes per week, independent of weight loss and dietary change, reported significant improvements:
      • Decreased triglycerides by 33mg per dL (0.37mmol per L)
      • Decreased waist circumference by 3cm
      • Decreased systolic blood pressure by 6mm Hg
      • Decreased diastolic blood pressure by 3mm Hg.

    Rating: Weak
    Imperative

    • Risks/Harms of Implementing This Recommendation

      Intense physical activity in some overweight and obese individuals may contribute to disability or death; thus, consultation with a physician prior to beginning an exercise program should be recommended.

       

    • Conditions of Application

    • Potential Costs Associated with Application

      The costs of medical nutrition therapy (MNT).

    • Recommendation Narrative

      A total of 12 studies (13 publications) were included in the evidence analysis for this recommendation:

      • Five positive-quality randomized controlled trials (RCT) (Cohen et al, 2008; Pescatello et al, 2008; Yates et al, 2009; Camhi et al, 2010; Desch et al, 2010; Yates et al, 2011)
      • One neutral-quality randomized controlled trials (RCT) (Sixt et al, 2008)
      • Five neutral-quality randomized crossover trials (RCT) (Zhang et al, 2006; Mestek et al, 2008; Melton et al, 2009; Black et al, 2010; van Dijk et al, 2012)
      • One neutral-quality case-control study (Casella-Filho et al, 2011).

      In Adults with Metabolic Syndrome

      • Glycemic-related outcomes (FBG, random BG, two-hour post-prandial BG, A1C):
        • While limited research reports that low intensity physical activity, independent of weight loss and dietary change, has no significant impact on fasting glucose levels in adults with metabolic syndrome, limited research on moderate-intensity physical activity reports mixed results on fasting glucose levels
        • In addition, while one feeding study reports that physical activity significantly decreases post-prandial glucose levels, both intervention and feeding studies report no significant impact of intensity on post-prandial glucose levels
        • Additional longer-term intervention studies are needed to ascertain an effect of physical activity on glycemic-related outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for impaired glucose tolerance and impaired fasting glucose
        • Evidence is based on the following: Zhang et al, 2006; Cohen et al, 2008; Mestek et al, 2008; Pescatello et al, 2008.
      • Lipid outcomes (TG, HDL):
        • While limited research reports that low intensity or short duration physical activity, independent of weight loss and dietary change, has no significant impact on triglyceride levels in adults with metabolic syndrome, limited research reports that moderate-intensity physical activity, at a level of 135 minutes per week, significantly reduces plasma triglycerides by 33mg per dL (0.37mmol per L)
        • The majority of research reported no significant impact of physical activity on HDL cholesterol levels, regardless of duration or intensity
        • Additional longer-term intervention studies are needed to ascertain an effect of physical activity on lipid outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for lipid levels
        • Evidence is based on the following: Zhang et al, 2006; Cohen et al, 2008; Mestek et al, 2008; Camhi et al, 2010; Casella-Filho et al, 2011.
      • Anthropometric outcomes (WC, WHR):
        • While limited research reports that low intensity physical activity, independent of weight loss and dietary change, has no significant impact on waist circumference in adults with metabolic syndrome, limited research on moderate-intensity physical activity, at a level of 135 to 180 minutes per week, significantly reduces waist circumference by 3cm
        • Additional longer-term intervention studies are needed to ascertain an effect of physical activity on anthropometric outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for anthropometric measures
        • Evidence is based on the following: Cohen et al, 2008; Camhi et al, 2010; Casella-Filho et al, 2011.
      • Blood pressure outcomes:
        • While limited research reports that low intensity or short duration physical activity, independent of weight loss and dietary change, has no significant impact on blood pressure in adults with metabolic syndrome, limited research on moderate intensity physical activity, at a level of 135 minutes per week, significantly reduces systolic blood pressure by 6mm Hg and diastolic blood pressure by 3mm Hg
        • Additional longer-term intervention studies are needed to ascertain an effect of physical activity on blood pressure in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for blood pressure
        • Evidence is based on the following: Cohen et al, 2008; Pescatello et al, 2008; Casella-Filho et al, 2011.
      • Renal outcomes:
        • There were no studies identified to evaluate the impact of physical activity, independent of weight loss and dietary change, on renal outcomes in adults with metabolic syndrome
        • Intervention studies are needed to ascertain an effect of physical activity on renal outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for renal measures.

      In Individuals with Prediabetes

      • Glycemic-related outcomes (FBG, random BG, two-hour post-prandial BG, A1C):
        • Most studies report that moderate intensity physical activity, independent of weight loss and dietary change, has no significant impact on fasting blood glucose levels in individuals with prediabetes
        • In addition, limited research reports mixed results regarding the impact of moderate-intensity physical activity on two-hour post-prandial blood glucose
        • Of two intervention studies reporting A1C values, both reported no significant effect of moderate intensity physical activity
        • Additional longer-term intervention studies are needed to ascertain an effect of physical activity on glycemic-related outcomes in individuals with prediabetes
        • Evidence is based on the following: Sixt et al, 2008; Melton et al, 2009; Yates et al, 2009; Black et al, 2010; Desch et al, 2010; Yates et al, 2011; van Dijk et al, 2012.
      • Lipid outcomes (TG, HDL):
        • Limited research reports mixed results regarding the impact of moderate-intensity physical activity, independent of weight loss and dietary change, on triglyceride levels in individuals with prediabetes
        • Intervention studies reported no significant impact of moderate intensity physical activity on HDL cholesterol levels
        • Additional longer-term intervention studies are needed to ascertain an effect of physical activity on lipid outcomes in individuals with prediabetes
        • Evidence is based on the following: Sixt et al, 2008; Melton et al, 2009; Yates et al, 2009; Desch et al, 2010.
      • Anthropometric outcomes (WC, WHR):
        • Limited research reports that moderate-intensity physical activity, independent of weight loss and dietary change, has no significant impact on waist circumference in individuals with prediabetes
        • Additional longer-term intervention studies are needed to ascertain an effect of physical activity on anthropometric outcomes in individuals with prediabetes
        • Evidence is based on the following: Yates et al, 2009; Yates et al, 2011.
      • Blood pressure outcomes:
        • Limited research reports that moderate-intensity physical activity, independent of weight loss and dietary change, has no significant impact on systolic or diastolic blood pressure in individuals with prediabetes
        • Additional longer-term intervention studies are needed to ascertain an effect of physical activity on blood pressure in individuals with prediabetes
        • Evidence is based on the following: Yates et al, 2009; Desch et al, 2010.

    • Recommendation Strength Rationale

      For Adults with Metabolic Syndrome

      • Grade III evidence is available for the conclusion statements regarding the impact of physical activity, independent of weight loss and diet change, on the following outcomes:
        • Glycemic-related outcomes (such as fasting blood glucose, random blood glucose, two-hour post-prandial blood glucose, A1C)
        • Lipid (TG, HDL)
        • Anthropometric measures (WC, WHR)
        • Blood pressure.
      • Grade V evidence is available for the conclusion statement regarding the impact of physical activity, independent of weight loss and diet change, on the following outcomes: Renal outcomes.

      For Individuals with Prediabetes

      • Grade II evidence is available for the conclusion statements regarding the impact of physical activity, independent of weight loss and dietary change, on the following outcomes:
        • Glycemic-related outcomes (such as fasting blood glucose, random blood glucose, two-hour post-prandial blood glucose, A1C)
        • Lipid (TG, HDL).
      • Grade III evidence is available for the conclusion statements regarding the impact of physical activity, independent of weight loss and dietary change, on the following outcomes:
        • Anthropometric measures (WC, WHR)
        • Blood pressure.

    • Minority Opinions

      Consensus reached.