The Effect of Physical Exercise Program in Patients with Type 2 Diabetes Mellitus in Ratchaburi Province, Thailand

1. INTRODUCTION

Diabetes is a disease caused by a disruption of the production function of insulin which increases blood sugar levels in the bloodstream. This disorder will later damage the most vital organs of the body [1]. Globally, this disease has been the cause of death of around 1.3 million; the main cause of death is kidney failure. Economically, diabetes has resulted in more than 15% of health-realted costs [2]. The incidence of diabetes occurs in almost 21-25% due to lack of physical activity [3]. In addition, the lack of exercise is a cause of death of 6% in the world [4].

Physical activity plays an important role in energy balance and management by keeping our body healthy [5]. It has been known that physical activity affects directly the metabolic system [5]. In accordance, diabetes can be controlled and prevented by exercise, weight management, healthy food consumption, as well as the cessation of smoking [1]. All these prevention strategies cannot be fully achieved but at least, we can encourage patients to follow these recommendations. These recommendations include exercise, a healthy lifestyle, and regular diabetic medication compliance.

It was reported that 37-60% of diabetic patients did not follow exercise recommendation [6]. Research has noted that around 80% diabetes cases were caused by the lack of awareness, and knowledge of healthy lifestyle and physical activities [7]. The intervention to promote physical activity and exercise should be encouraged due to some reasons, namely socio-demographic, and psychological factors. This study was designed to investigate the impact of psychological and demographic factors on physical activity in type 2 diabetic patients.

2. METHODS

3. RESULTS

Table 1 shows the characteristics of 1,890 respondents who successfully gave the data. The average age of respondents was 57.6 years (SD = 1.76) and the number of male respondents was more than females. Most respondents (36.2%) had a bachelor's degree. Most of the respondants (28.4%) were employees being diabetic of age 11-20 years. In terms of body mass index, 29.7% had a body mass index of 25.0-29.9 (which is overweight).

Table 2 presents the association between socio-demographic factors and physical activity level. The statistical analysis results showed there was a significant association between physical activity level, education and occupation, which were significant at alpha 0.05. However, there was no association between physical activity and sex, duration of diabetes, and body mass index (p>0.05).

4. DISCUSSION

In an effort to make effective physical activity interventions for diabetics, this study seeks to find out factors that are related to the motivation of diabetic patients in physical activity. Many studies have confirmed that the physical activity of a person with diabetes is lower than those who do not have diabetes. For example, a research in Nepal by Vaidya A. Krettek found that 43.3% of diabetics had low physical activity [10]. Other studies found differences in physical activity between male and female diabetics, their activities were 36.6% and 28.6%, respectively. Likewise, other activities show that women with diabetes are more passive than men [11]. Other studies also support the results of this study that most women with diabetes are less active than men [12]. Although there are methodological differences in the various studies discussed above, it can be concluded that gender is an important factor in various degenerative diseases, for example cardiovascular, cancer and diabetes-related diseases. This is related to the behavior of physical activity related to gender, while on the other hand, physical activity is an inhibiting factor for the occurrence of this degenerative disease. Physical activity has a great influence on several diseases and also on psychological aspects. People who have a positive attitude are more encouraged to do enough physical activity. Besides, active people have high self-efficacy which ultimately makes them think more positively [13].

Likewise, the results of this study indicated a meaningful relationship between sex, education level and also the type of work with a level of physical activity. Other studies showed that the level of education is a strong predictor to determine the level of one's physical activity [14]. However, there is also a research that contradicts with this finding, that one's level of education does not affect the level of physical activity [15]. This is because of other factors, for example, whether or not people are too busy at work, or taking care of their families, and also psychological barriers which prevent people from doing physical activities better.

Several studies confirmed that there is a significant relationship between working status and physical activity. A study in Canada showed that those who are not employed have lower health status compared with those who have a job. Similarly, a European study found that unemployment status is related to poor physical activity. The type of job is a significantly strong predictor for physical activity either for men or women. While the employment status is associated significantly with the daily physical activity for men [16]. Furthermore, regarding the recent economic trends, the sedentary jobs increased significantly, in consequence, it could result in less physical activity. Thus, it needs special programs that promote a higher activity level.

In conclusion, exercise is one of the most powerful tools that can help in controlling weight and blood sugar. Muscles use glucose without insulin when one performs an exercise. Exercise can also help people with type 2 diabetes avoid complications in the long term, particularly heart problems [17]. Diabetics are sensitive to the development of arteries. (arteriosclerosis) which can lead to a heart attack. The benefits of exercise are it reduces cholesterol, LDL cholesterol, and triglycerides. Exercise can help control the blood and the body's sensitivity to insulin, both are critical for diabetics [18].

Many studies indicate that exercise greatly helps in the treatment of diabetes. Aerobic exercise improves blood sugar control in type 2 diabetes, especially when performing an exercise at least 150 minutes / week. Resistance exercise increases strength in adults with type 2 diabetes, approximately 50% [19]. According to a meta-analysis, adults with type 2 diabetes reported a greater reduction in A1C following aerobics compared with resistance training [20].

CONCLUSION

The results of this study indicated a real relationship between physical activity and demographic characteristics. This relationship shows that demographic characteristics (such as education and work) are important in intervening and promoting physical activity. Governments should arrange appropriate exercise programs for patients with diabetes. Patients should start exercise with a warm-up session (i.e., stretching within the neck, triceps chest upper back torso and low back). Importantly, exercise should be initiated slowly and gradually (from light to heavy). It should start with normal walking for 10 minutes to running for 15 minutes.

LIMITATION

The limitation of this study is self-reporting of physical activity. The data collection methods could encourage biasness in information, because people may have provided incorrect information .

REFERENCE