Page 18 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)
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VOLUME 9 NUMBER 4 • NOVEMBER 2012
CHANGING BEHAVIOUR
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Table 2.
Different types of physical activity
Light intensity
•
Walking – strolling, 2 mph
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Cleaning and dusting
Moderate intensity
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Brisk walking – 3 mph
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Hoovering
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Golf – walking, pulling clubs
•
Badminton – social
•
Cycling – 10–12 mph
•
Swimming – breast stroke
Vigorous intensity
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Cycling – 12–14 mph
•
Swimming – slow crawl,
50
yards per minute
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Running – 6 mph (10 minutes/
mile and faster)
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Aerobic exercise classes
•
Using cardiovascular gym
equipment
Muscle strengthening
•
Weight training
•
Carrying heavy loads
•
Heavy gardening
•
Push-ups and sit-ups
Start Active, Stay Active: A report on physical activity for health from
•
the four home countries’ Chief Medical Officers, 2011. Available at:
-
sPolicyAndGuidance/DH_128209
Thompson PD, Buchner D, Pina IL
•
et al
.
Exercise and physical activity in
the prevention and treatment of atherosclerotic cardiovascular disease.
AHA
Scientific Statement. Circulation
2003;
107
:3109–16.
Sigal RJ, Kenny GP, Wasserman DH
•
et al
.
Physical activity/exercise and
type 2 diabetes. A consensus statement from the American Diabetes
Association.
Diabetes Care
2006;
29
:1433–8.
Mclean C. How to use brief motivational interviewing.
•
Br J Prim Care
Nurs
2009;
6
:86–8.
Resources
NHS Choices. Physical activity guidelines for adults – information on the
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guidelines, a fitness self-assessment tool and exercise plans.
.
uk/Livewell/fitness/Pages/physical-activity-guidelines-foradults.aspx
Health Walks
•
MORE INFORMATION
Recommendations for people aged 65 and over are similar, and the
guidelines suggests they aim to be active daily. In diabetes, a consensus
statement from the American Diabetes Association (ADA) recommends
at least 150 minutes a week of moderate to vigorous exercise, with no
more than two consecutive days without aerobic exercise to maintain the
benefits of increased insulin sensitivity provided by exercise – which lasts
about 72 hours.
What’s the risk of hypoglycaemia? This isn’t a problem in most people,
but the ADA suggests that patients on insulin or secretagogues should
check capillary blood glucose before, after and several hours after an
exercise session until they know their usual glycaemic response. People
who show a tendency to hypoglycaemia during or after exercise should
adjust their insulin dose or consume extra carbohydrate before or during
exercise.
Having diabetes shouldn’t mean people stop being physically active.
After being diagnosed with diabetes in 1997, Sir Steve Redgrave went
on to win his fifth gold medal at the Sydney Olympics. He recommends
the website Runsweet.com for information on sports and diabetes (www.
runsweet.com).
PUTTING THE GUIDELINES INTO PRACTICE
Cath Robertson suggests the first step is to explore how active a patient
is at the moment, how they feel about becoming more active and what
they would like to change. She recommends motivational interviewing
–
a client-centred counselling style that helps the person explore their
understanding of a situation and their motivation to change before devel-
oping a solution that suits them.
For some very inactive patients, this may mean just deciding to walk
down the garden each day. “Asking someone who is completely inac-
tive to do 150 minutes of physical activity a week can seem completely
overwhelming. Getting a person to aim for just five minutes a day is more
realistic,” Ms Robertson says, adding that once people start to become
more physically active their fitness and confidence improves so they are
motivated to build on this. “Change is difficult and it’s often a slow proc-
ess, so just getting someone to think about being more active is a good
start.” A review of different ways of getting people to increase physical
activity has shown that brief, focused counselling in primary care can
work well.
The key, according to Dr Bird, is to make it simple for people to be
physically active. “If in doubt, just get the patient walking. It’s that easy.
Walking covers all the basic benefits of physical activity.” Inspired by the
idea of helping patients to become more active, he started up Health
Walks from his surgery nearly 20 years ago. There are now nearly 3 500
health walks every week and he says that every practice will soon have a
walk nearby (find the nearest walk in your area at
.
Some health professionals are concerned about potential risks of en-
couraging inactive people to exercise. But Dr Bird argues that remaining
inactive is more dangerous. “The number needed to treat (NNT) for physi-
cal activity to prevent one cardiac death over five years is 25. But the
numbers needed to harm are 1 208 for men and 146 000 for women,”
he says. “If people are really unfit, just get them to build up slowly.”
Referring patients who have had a heart attack or stroke to rehabili-
tation programmes can boost their confidence about being physically
active, as well as provide social support to help them come to terms
with having had a heart attack or stroke.
“
As a major risk factor and effective treatment for many long-term
conditions, it’s time that physical activity came of age and for its
effective promotion to be seen simply as good medicine,” concludes
Dr Bird.
