Physical activity in adults with and without diabetes: from the "high-risk" approach to the "population-based" approach of prevention

Who took part?

Adults in Lebanon 25 years old and over who took part in the "Nutrition and Non-Communicable Disease Risk Factor" Study.

What has been measured?

Physical activity

Physical activity was measured using the IPAQ questionnaire, divided into 3 groups, inactive, moderately active, highly active.

To be classed as moderately active, respondents must report at least 30 minutes of moderate-intensity activity 5 days per week, or 20 minutes of vigorous-intensity activity 3 days per week. Those who reported less physical activity than this were classed as inactive.

To be classed as highly active (HEPA), respondents must report either 3000 MET minutes of moderate-intensity or vigorous-intensity physical activity per week, which equates to 10 hours of walking, 2 hours of running and 1 hour of cycling in a week, or 1500 MET minutes of vigorous-intensity activity per week, such as 3.5 hours of running.

Diabetes and risk factors

"Having diabetes" - self-report of a diagnosis of diabetes by a health professional, not including gestational diabetes.

At risk factor for developing diabetes: being over 45 years old, overweight (BMI of 25 or over), hypertension (mean of three blood pressure readings, over or equal to 140/90 mmHg, OR diagnosis of hypertension), self report of hyperlipidemia (elevated lipids in the blood), cardiovascular disease and having an immediate family member with diabetes

Other covariates:

Sex, location (Beirut or outside), education (low - less than 12 years schooling, middle - at least 12 years schooling, high - holding a university bachelor's degree or higher), "having received health professional advice to exercise more" within 6 months prior to the survey.

What did they find?

The mean BMI was 27.8kg/m2, and 29% were obese (BMI 30 or over). Just under half were inactive, 31% were moderately active, and 22% were highly active. Physical activity was higher in women, those living outside Beirut and without university degrees.

Diabetes patients who received advice from a health professional to alter their lifestyle and exercise were found to be significantly more likely to engage in physical activity than patients without diabetes receiving the same advice.

The proportion of respondents reporting high and moderate levels of physical activity was lower in diabetes patients and highest in those with no risk factors for diabetes. The level of activity decreased as the number of risk factors increased.

What does the paper suggest?

More patients could benefit from receiving more advice about physical activity, even if they do not yet have diabetes. Focus on physical activity as a prevention of diabetes rather than a treatment for it.

The paper can be read here.

Sibai AM, Costanian C, Tohme R, Assaad S, Hwalla N
"Physical activity in adults with and without diabetes: from the ‘high-risk’ approach to the ‘population-based’ approach of prevention" BMC Public Health October 2013, 13:1002