Physical inactivity and a sedentary lifestyle are two deleterious behaviors, but very common among people suffering from type 2 diabetes, a metabolic disease that develops especially in adulthood due to the inability of the body's cells to produce and use insulin. When we talk about physical inactivity we refer to an insufficient amount of movement, while with a sedentary lifestyle we mean the condition of someone who spends too much time, often uninterrupted, in a sitting or reclining position.

A randomized controlled trial, coordinated by Giuseppe Pugliese of the Department of Clinical and Molecular Medicine of Sapienza University and head of the Endocrine-Metabolic Unit of Sant'Andrea Hospital in Rome, compared a behavioral intervention strategy, aimed both at increasing physical activity and reducing sedentary time, with standard care in 300 physically inactive and sedentary patients with type 2 diabetes, of both sexes and an average age of about 62 years, recruited in three diabetes centers in Rome.

The results of this no-profit trial have been published in the Journal of the American Medical Association (JAMA).

The participants in the behavioral intervention group took part in a theoretical counseling session conducted by a diabetologist and 8 bi-weekly theoretical and practical counseling sessions with a personal trainer in the gym, once a year for 3 years. The participants in the standard care group received only generic recommendations to increase physical activity and reduce sedentary time.

The results showed a significant increase in the volume of physical activity, both of moderate-to-vigorous intensity and particularly of light intensity and a reciprocal reduction in sedentary time, as measured with an accelerometer, in the behavioral intervention group compared to the standard care group.
This behavioral change was accompanied by important clinical benefits, although the increase in physical activity was predominantly of light intensity. In particular, there was a sustained increase in cardiorespiratory and muscular fitness over time (that is the ability to perform aerobic and strength activities, respectively), both of which are known to be associated with increased survival, independent of one another.

"The take-home message of the study," said Giuseppe Pugliese, "is in the possibility of obtaining a long-term modification in the lifestyle of physically inactive and sedentary patients, as usually are those suffering from type 2 diabetes, provided that behavioral interventions are implemented; however, this requires a specifically trained staff. Furthermore," concluded Pugliese, "even modest behavioral changes can turn into significant clinical advantages." 

References:

Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes The Italian Diabetes and Exercise Study 2: A Randomized Controlled Trial. - Balducci S., D’Errico V., Haxhi J., Sacchetti M., Orlando G., Cardelli P., Vitale M., Bollanti L., Conti F., Zanuso S., Lucisano G., Nicolucci A., Pugliese G. - Journal of the American Medical Association 2019.  DOI: 10.1001/jama.2019.0922

Further Information

Giuseppe Pugliese
Department of Clinical and Molecular Medicine, Sapienza University of Rome 
giuseppe.pugliese@uniroma1.it