Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: LIFESTYLE| 5-49

should collaboratively set specific activity goals, anticipate possible barriers and develop strategies to overcome these barriers (211). Information on where and when to exercise should be provided. Recording daily physical activity has been shown to increase activity levels and improve self-efficacy (212). It is not surprising that self-efficacy is a strong cognitive predictor of both aerobic and resistance exercise participation in people with diabetes (183). There is an inverse relationship between higher self-reported walking with cardiovascular events and all-cause mortality (213). Wearing a pedometer may prompt activity, and it provides feedback for self-monitoring. Ask them to record values, review at visits, set step count targets and formalize recommendations with a written prescription (214). Structured physical activity counselling can lead to increased activity levels, improvements in glycemic control (215), reduction in the need for oral antihyperglycemic agents and insulin (216) and modest reductions in weight (217). But supervised programs may produce better results (179). Supervised programs involving aerobic or resistance exercise may improve glycemic control in adults with type 2 diabetes (194), with or without dietary co-intervention (166). Diabetes Canada has developed a manual for diabetes care providers (physicians, nurses, dieticians, social workers, pharmacists and physiotherapists) working with individuals with diabetes (218). Building Competency in Diabetes Education: Physical Activity and Exercise resource manual includes informative, practiced-based tools to assist diabetes care providers in providing physical activity and exercise counselling in a simple intervention as an essential component of overall quality diabetes care (218).

Table 1. Aerobic exercise

Definition and recommendation frequency

Intensity

Examples

Rhythmic, repeated and continuous movements of the same large muscle groups for at least 10 minutes at a time.

Moderate: 64%–76% of person's maximum heart rate

Biking

•

Brisk walking

•

Continuous swimming

•

Dancing

•

Raking leaves

•

Water aerobics

•