DIABETES AND SEDENTARY BEHAVIOR

By Mary Gynn - Diabetes Educator

Modern lifestyles involve sitting for long periods of time, and recent research has shown the hazards of prolonged sitting. Sitting for eight hours per day is associated with increased risk of early death, Type 2 diabetes, heart disease, certain types of cancer, and depression. Short-term studies indicate that adding short bouts of physical activity into a sedentary lifestyle may help reduce blood glucose. The research is ongoing. For adults with Type 2 diabetes, interrupting sitting time with short bouts of walking or standing time improved 24-hour glucose control and insulin resistance vs. a standard exercise regimen, according to findings from a randomized crossover study conducted by Bernard Duvivier, MD, at Maastricht University Medical Centre in the Netherlands. The researchers noted that the duration of non-sitting activities may be more important than the intensity level.
Muscle activation is important for regulation and clearance of blood glucose, and sitting causes the large muscles in the legs to remain idle. Frequent bouts of light activity, such as walking throughout the day and standing, can yield substantial improvements in blood glucose levels and less time in a hyperglycemic state, according to David Dunstan, MD at the Baker Heart and Diabetes Institute in Melbourne, Australia. Experimental short-term studies show that glucose levels are 40 percent lower with 2-minute bouts of activity every 30 minutes than with uninterrupted sitting over a 7-hour period. Standing meetings in which participants are encouraged to move around may help normalize and encourage periodic standing.
A study published in Diabetes Care instructed patients with Type 2 diabetes to get up every 30 minutes and either walk at an easy pace or perform light calisthenics, such as half squats and knee lifts, that use large muscles groups, for three minutes. The intermittent activity led to an approximately 40 percent reduction in blood glucose over a 7-hour period and continuous glucose monitors showed that the decrease in glucose levels persisted during the sleeping hours. Because all studies so far have been short term (less than five days), no evidence has been found, or it's unclear, if activity breaks can result in weight loss. However, the research on the benefits of taking activity breaks can help health professionals to deliver the message to move more and sit less.
Frequent activity breaks help older individuals maintain their ability to rise from sitting to standing. In small areas, like a small office, when walking around is impractical, individuals can perform calisthenics.
Studies have shown that although uptake of programs into a primary practice is good, maintenance of programs is difficult. Effective implementation requires work and practices need in-house support from experts to clarify individual responsibilities. Making contact with Diabetes Educators who incorporate individual "movement" exercises into their practice is essential and can offer incentive programs. Medicare and Medicaid Services and other insurance payers have initiated programs into some DESM (Diabetes Education Self Management) practices.
The Diabetes Educator's practice includes appraisal and evaluation of health risks, including consideration of diet, physical activity, medications taken, alcohol and drug use, age, other co-morbidities, depression, lifestyle, and implementing the appropriate exercise intervention. The Diabetes Educator has the skill and confidence to interact with a broad range of patients around behavioral change issues while understanding the issues of timing, active listening, and speaking.

Mary Gynn, RN, MSN, MPH, is a Diabetes Educator who conducts diabetes classes. Contact her to start a workshop in your area at mmgynn@aol.com. Workshops at Lincourt Pharmacy, 501 S. Lincoln in Clearwater, Fla. (727) 447-4248. Contact: mtmgynn@ gmail.com

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