Type 1 diabetes and exercise: supporting patients in meeting the guidelines for health
Researchers from Tallaght University Hospital studied how well Irish patients with type 1 diabetes comply with physical activity guidelines, and what the barriers to compliance were. We spoke to lead study author, Senior Dietitian Mary Finn, about their recent publication in the Irish Journal of Medical Science, funded by the Meath Foundation of Tallaght University Hospital.
Physical activity is known to reduce cardiovascular disease risk among those with type 1 diabetes. Guidelines recommend that adults with type 1 diabetes should engage in at least 150 minutes of moderate-to-vigorous-intensity physical activity per week. Accurate information on activity levels is limited, and most studies employ self-reported activity data such as questionnaires which could be inaccurate, rather than objective data from devices such as accelerometers. Mary undertook a Master’s on this topic in the School of Medicine, Trinity College Dublin (TCD) in an interdisciplinary collaboration with Endocrinologists Dr Kevin Moore (TUH) and Dr Mark Sherlock (Beaumont Hospital), Dr Emer Guinan (Assistant Professor, TCD School of Medicine), Ms Sinead Feehan (Nutrition & Dietetics Manager, TUH) and Tony Moulton (Laboratory Medicine IT Manager, TUH). The researchers assessed adherence to physical activity guidelines using both objective and subjective measures. Mary Finn described the work:
“Physical activity was measured objectively over seven days in 72 participants using an Actigraph accelerometer, and subjectively using the International Physical Activity Questionnaire (IPAQ). Perceived barriers to activity were assessed using the Barriers to Physical Activity in Diabetes scale. We also determined the influence of physical activity on HbA1c (a common measure of diabetes control) as well as risk factors for cardiovascular disease.”
Mary summarised the key study findings:
“Almost all (97%) of participants reported taking sufficient exercise when they completed the IPAQ questionnaire. However, only a third of participants actually met the activity guidelines when we measured their activity using an accelerometer. Those who met the recommendations had better diabetes control and were slimmer (with a lower body mass index, lower body fat, and a smaller waist). However, those that met the exercise recommendations also had more episodes of hypoglycaemia (low blood sugar). The fear of developing hypoglycaemia was the main barrier to exercise.
Therefore, it would appear that individuals with type 1 diabetes overestimate their activity levels using self-reported measures. Healthcare professionals must offer more support and education to help these individuals increase their exercise levels without increasing the risk of exercise-induced hypoglycaemia.”
Physical activity is a crucial cornerstone of health for those with type 1 diabetes, and this study highlighted that most patients are not meeting the recommended exercise goals. Safely correcting this deficit will require a concerted effort. One educational strategy is the development of targeted online resources and factsheets. Patients could also be directed to the growing number of platforms for accurate information and advice (some examples: www.EXTOD.org; www.Runsweet.org; and www.JDRF.org.uk). Technology is also likely to offer a solution and individuals should be encouraged to use wearable fitness tracking devices to monitor and validate their level of activity. Medical devices including Continuous Glucose Monitors and closed-loop systems should also be encouraged to increase ‘time in range’, i.e. the percentage of time that individuals are within normal blood sugar range. These appliances are also valuable in preventing potentially dangerous exercise-induced hypoglycaemia and can therefore increase patient safety whilst providing considerable reassurance while exercising. Mary described some future planned work:
“As part of my Master’s study we developed a type 1 diabetes app to provide support and education regarding exercising with type 1 diabetes, and we plan to launch this app in due course.”
The study paper is open access and can be freely downloaded here: