Patients with Type 2 Diabetes experiences of making multiple lifestyle changes: a qualitative study. Outcomes of a multifaceted physical activity regimen as part of a diabetes self-management intervention Movement as Medicine for Type 2 Diabetes: protocol for an open pilot study and external pilot clustered randomised controlled trial to assess acceptability, feasibility and fidelity of a multifaceted behavioural intervention targeting physical activity in primary care Effects of a tailored lifestyle self-management intervention in patients with type 2 diabetes. Lifestyle Counseling for Type 2 Diabetes Risk Reduction in Dutch Primary Care Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial Prescription of physical activity is not sufficient to change sedentary behavior and improve glycemic control in type 2 diabetes patients. Validation of a counseling strategy to promote the adoption and the maintenance of physical activity by type 2 diabetic subjects. Effectiveness of a computer-tailored print-based physical activity intervention among French Canadians with type 2 diabetes in a real-life setting. Dietary and physical activity strategies to prevent type 2 diabetes in South Asian adults: protocol for a systematic review PRomotion Of Physical activity through structured Education with differing Levels of ongoing Support for people at high risk of type 2 diabetes (PROPELS): study protocol for a randomized controlled trial A tailored print-based physical activity intervention for patients with type 2 diabetes. Living Well with Diabetes: a randomized controlled trial of a telephone-delivered intervention for maintenance of weight loss, physical activity and glycaemic control in adults with type 2 diabetes A lifestyle intervention to reduce Type 2 diabetes risk in Dutch primary care: 2.5-year results of a randomized controlled trial. Physical Activity/Exercise and Type 2 Diabetes
OBJECTIVES To explore patients newly diagnosed with Type 2 Diabetes Mellitus ( T2DM ) experiences of making single ( diet ) or multiple ( diet and physical activity ) changes in order to ( 1 ) assess whether patients experienced increases in physical activity as supporting or hindering dietary changes and vice versa , and ( 2 ) whether patients found making multiple lifestyle changes counterproductive or beneficial . METHODS In-depth interviews with 30 individuals taking part in a r and omised controlled trial that aim ed to determine the effect of diet and physical activity on T2DM . Interviewees had been r and omised to receive usual care , intensive dietary advice , or intensive dietary advice plus information on physical activity . Respondents were interviewed 6 and 9 months post-r and omisation . They were asked about their experiences of making lifestyle changes . Data were analysed thematically . RESULTS Findings suggest providing diet and physical activity information together encourages patients to use physical activity in strategic ways to aid disease management and that most patients find undertaking multiple lifestyle changes helpful . CONCLUSION Increasing physical activity can act as a gateway behaviour , i.e. behaviour that produces positive effects in other behaviours . PRACTICE IMPLICATION S Practitioners should provide diet and physical activity information together to encourage patients to use physical activity strategically to maintain dietary changes Background :  Physical activity ( PA )  is important for management of diabetes , yet practical interventions that achieve sustained behavior change are rare . Purpose : The goals of this research were to evaluate the effectiveness of a multifaceted PA intervention for people with type 2 diabetes that emphasized participant choice in activity selection . Baseline activity patterns were examined to determine whether they predicted changes in PA at 2 months . Methods : Three hundred thirty-five participants were recruited from 42 primary care physicians and then r and omized to either a computer-assisted , tailored self-management intervention ( N = 174 ) or health risk appraisal with feedback control ( N = 161 ) . Primary outcome measures included the Community Healthy Activities Model Program for Seniors Question naire , diet , and psychosocial assessment s at baseline and 2 months . Results : For 301 participants who completed the 2-month follow-up , the intervention significantly improved all PA ( p < .01 ) and moderate PA ( metabolic equivalents > 3.0 , p < .01 ) relative to controls . Baseline cluster analyses grouped participant activity patterns into three categories . At 2 months , cluster assignment differentially predicted change in calories expended in moderate , rote , sport , and lifestyle PA . Conclusions : A computer-assisted , multifaceted approach to PA demonstrated improvement after 2 months . The results suggest that individuals are capable of adjusting their activity patterns to maximize their PA Background Physical activity ( PA ) and nutrition are the cornerstones of diabetes management . Several review s and meta-analyses report that PA independently produces clinical ly important improvements in glucose control in people with Type 2 diabetes . However , it remains unclear what the optimal strategies are to increase PA behaviour in people with Type 2 diabetes in routine primary care . Methods This study will determine whether an evidence -informed multifaceted behaviour change intervention ( Movement as Medicine for Type 2 Diabetes ) targeting both consultation behaviour of primary healthcare professionals and PA behaviour in adults with Type 2 diabetes is both acceptable and feasible in the primary care setting . An open pilot study conducted in two primary care practice s ( phase one ) will assess acceptability , feasibility and fidelity . Ongoing feedback from participating primary healthcare professionals and patients will provide opportunities for systematic adaptation and refinement of the intervention and study procedures . A two-arm parallel group clustered pilot r and omised controlled trial with patients from participating primary care practice s in North East Engl and will assess acceptability , feasibility , and fidelity of the intervention ( versus usual clinical care ) and trial processes over a 12-month period . Consultation behaviour involving fidelity of intervention delivery , diabetes and PA related knowledge , attitudes/beliefs , intentions and self-efficacy for delivering a behaviour change intervention targeting PA behaviour will be assessed in primary healthcare professionals . We will rehearse the collection of outcome data ( with the focus on data yield and quality ) for a future definitive trial , through outcome assessment at baseline , one , six and twelve months . An embedded qualitative process evaluation and treatment fidelity assessment will explore issues around intervention implementation and assess whether intervention components can be reliably and faithfully delivered in routine primary care . Discussion Movement as Medicine for Type 2 Diabetes will address an important gap in the evidence -base , that is , the need for interventions to increase free-living PA behaviour in adults with Type 2 diabetes . The multifaceted intervention incorporates an online accredited training programme for primary healthcare professionals and represents , to the best of our knowledge , the first of its kind in the United Kingdom . This study will establish whether the multifaceted behavioural intervention is acceptable and feasible in routine primary care . Trial registration Movement as Medicine for Type 2 Diabetes ( MaMT2D ) was registered with Current Controlled Trials on the 14th January 2012 : IS RCT N67997502 . The first primary care practice was r and omised on the 5th October 2012 OBJECTIVES The aim of the present study was to develop , implement and evaluate a brief intervention to improve adherence to the recommended lifestyle changes for patients with Type 2 diabetes , in particular to help patients to reduce the total amount of fat consumed and to increase lifestyle physical activity levels . DESIGN AND METHOD A brief , tailored lifestyle self-management intervention for patients with Type 2 diabetes was evaluated in a r and omized controlled trial . One hundred participants ( aged 40 - 70 yrs ) completed assessment s at three time points- baseline , three months and one year . Participants were allocated to either an intervention group who received the brief tailored intervention including follow-up telephone calls , or a usual care control group . RESULTS Results indicate that the intervention was successful in helping patients to reduce fat intake and , to a lesser extent , increase lifestyle physical activity levels . These self-reported changes in behaviour were reflected in the objective data with weight maintenance in the intervention group compared to the control group , together with a significant reduction ( 2 cm ) in waist circumference . CONCLUSIONS These results provide further evidence of the effectiveness of tailored interventions for lifestyle change OBJECTIVE To study the overall effect of the Active Prevention in High-Risk Individuals of Diabetes Type 2 in and Around Eindhoven ( APHRODITE ) lifestyle intervention on type 2 diabetes risk reduction in Dutch primary care after 0.5 and 1.5 years and to evaluate the variability between general practice s. RESEARCH DESIGN AND METHODS Individuals at high risk for type 2 diabetes ( Finnish Diabetes Risk Score ≥13 ) were r and omly assigned into an intervention group ( n = 479 ) or a usual-care group ( n = 446 ) . Comparisons were made between study groups and between general practice s regarding changes in clinical and lifestyle measures over 1.5 years . Participant , general practitioner , and nurse practitioner characteristics were compared between individuals who lost weight or maintained a stable weight and individuals who gained weight . RESULTS Both groups showed modest changes in glucose values , weight measures , physical activity , energy intake , and fiber intake . Differences between groups were significant only for total physical activity , saturated fat intake , and fiber intake . Differences between general practice s were significant for BMI and 2-h glucose but not for energy intake and physical activity . In the intervention group , the nurse practitioners ’ mean years of work experience was significantly longer in individuals who were successful at losing weight or maintaining a stable weight compared with unsuccessful individuals . Furthermore , successful individuals more often had a partner . CONCLUSIONS Risk factors for type 2 diabetes could be significantly reduced by lifestyle counseling in Dutch primary care . The small differences in changes over time between the two study groups suggest that additional intervention effects are modest . In particular , the level of experience of the nurse practitioner and the availability of partner support seem to facilitate intervention success BACKGROUND Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits . METHODS We conducted a r and omized controlled trial of a 12-month intervention at 2 large community health centers , enrolling 310 patients with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 25 or greater . In the intervention group , self-management goals for nutrition and physical activity were set using a tailored computer program . Goals were then review ed at each clinic visit by physicians . The control group received only printed health education material s. The main outcome measures included change in physical activity and body weight . RESULTS In the intervention group , recommended levels of physical activity increased from 26 % at baseline to 53 % at 12 months ( P < .001 ) compared with controls ( 30 % to 37 % ; P= .27 ) , and 32 % of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9 % of controls ( odds ratio , 2.2 ; P= .006 ) . CONCLUSION A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss OBJECTIVE To describe the 1 ) lifestyle intervention used in the Finnish Diabetes Prevention Study , 2 ) short- and long-term changes in diet and exercise behavior , and 3 ) effect of the intervention on glucose and lipid metabolism . RESEARCH DESIGN AND METHODS There were 522 middle-aged , overweight subjects with impaired glucose tolerance who were r and omized to either a usual care control group or an intensive lifestyle intervention group .  The control group received general dietary and exercise advice at baseline and had an annual physician 's examination . The subjects in the intervention group received additional individualized dietary counseling from a nutritionist . They were also offered circuit-type resistance training sessions and advised to increase overall physical activity .  The intervention was the most intensive during the first year , followed by a maintenance period . The intervention goals were to reduce body weight , reduce dietary and saturated fat , and increase physical activity and dietary fiber . RESULTS The intervention group showed significantly greater improvement in each intervention goal . After 1 and 3 years , weight reductions were 4.5 and 3.5 kg in the intervention group and 1.0 and 0.9 kg in the control group , respectively . Measures of glycemia and lipemia improved more in the intervention group . CONCLUSIONS The intensive lifestyle intervention produced long-term beneficial changes in diet , physical activity , and clinical and biochemical parameters and reduced diabetes risk . This type of intervention is a feasible option to prevent type 2 diabetes and should be implemented in the primary health care system Background Lifestyle change is probably the most important single action to prevent type 2 diabetes mellitus . The purpose of this study was to assess the effects of a low-intensity individual lifestyle intervention by a physician and compare this to the same physician intervention combined with an interdisciplinary , group-based approach in a real-life setting . Methods The " Finnish Diabetes Risk score " ( FINDRISC ) was used by GPs to identify individuals at high risk . A r and omised , controlled design and an 18 month follow-up was used to assess the effect of individual lifestyle counselling by a physician ( individual physician group , ( IG ) ) every six months , with emphasis on diet and exercise , and compare this to the same individual lifestyle counselling combined with a group-based interdisciplinary program ( individual and interdisciplinary group , ( IIG ) ) provided over 16 weeks . Primary outcomes were changes in lifestyle indicated by weight reduction ≥ 5 % , improvement in exercise capacity as assessed by VO2 max and diet improvements according to the Smart Diet Score ( SDS ) . Results 213 participants ( 104 in the IG and 109 in the IIG group , 50 % women ) , with a mean age of 46 and mean body mass index 37 , were included ( inclusion rate > 91 % ) of whom 182 returned at follow-up ( drop-out rate 15 % ) . There were no significant differences in changes in lifestyle behaviours between the two groups . At baseline 57 % ( IG ) and 53 % ( IIG ) of participants had poor aerobic capacity and after intervention 35 % and 33 % , respectively , improved their aerobic capacity at least one metabolic equivalent . Unhealthy diets according to SDS were common in both groups at baseline , 61 % ( IG ) and 60 % ( IIG ) , but uncommon at follow-up , 17 % and 10 % , respectively . At least 5 % weight loss was achieved by 35 % ( IG ) and 28 % ( IIG ) . In the combined IG and IIG group , at least one primary outcome was achieved by 93 % while all primary outcomes were achieved by 6 % . Most successful was the 78 % reduction in the proportion of participants with unhealthy diet ( almost 50 % absolute reduction ) . Conclusion It is possible to achieve important lifestyle changes in persons at risk for type 2 diabetes with modest clinical efforts . Group intervention yields no additional effects . The design of the study , with high inclusion and low dropout rates , should make the results applicable to ordinary clinical setting s . Trial registration Clinical Trials.gov : OBJECTIVE To assess the impact of personalized exercise prescription on habitual physical activity and glycemic control in sedentary , insulin treated type 2 diabetes patients during a 2-y intervention period . RESEARCH DESIGN AND METHODS 74 patients were r and omized to the intervention ( n=38 ) or control ( n=36 ) group . The intervention group was stimulated to increase daily physical activity through regular , structured , and personalized exercise prescription by a physical therapist over the 2-y intervention period . RESULTS Physical activity levels at work or in leisure time were not modulated by the exercise prescription intervention . In accordance , no changes in body composition , glycemic control , medication use or risk factors for cardiovascular disease were observed . CONCLUSIONS Long-term behavioral intervention programs , providing individualized exercise prescription , are not sufficient to change sedentary behavior and /or improve glycemic control in insulin treated , type 2 diabetes patients OBJECTIVE There is enough evidence that physical activity is an effective therapeutic tool in the management of type 2 diabetes .  The present study was design ed to vali date a counseling strategy that could be used by physicians in their daily outpatient practice to promote the adoption and maintenance of physical activity by type 2 diabetic subjects . RESEARCH DESIGN AND METHODS The long-term ( 2-year ) efficacy of the  behavioral approach ( n = 182 ) was compared with usual care treatment  ( n = 158 ) in two matched , r and omized groups of patients with type 2 diabetes who had been referred to our Outpatient Diabetes Center . The outcome of the intervention was consistent patient achievement of an energy expenditure of > 10 metabolic equivalents (METs)-h/week through voluntary physical activity . RESULTS After 2 years , 69 % of the patients in the intervention group ( 27.1 + /- 2.0 METs x h/week ) and 18 % of the control group ( 4.1 + /- 0.8 METs x h/week ) achieved the target ( P < 0.001 ) with significant ( P < 0.001 ) improvements in BMI ( intervention group 28.9 + /- 0.2 versus control group 30.4 + /- 0.3 kg/m(2 ) ) and HbA(1c ) ( intervention group 7.0 + /- 0.1 versus control group 7.6 + /- 0.1 % ) . CONCLUSIONS This r and omized , controlled study shows that physicians can motivate most patients with type 2 diabetes to exercise long-term and emphasizes the value of individual behavioral approaches in daily practice The promotion of regular physical activity for people with type 2 diabetes poses a challenge for public health authorities . The purpose of this study was to evaluate the efficiency of a  computer-tailoring print-based intervention to promote the adoption of regular physical activity among people with type 2 diabetes . An experimental design was used ; 325 participants between the age of 35 and 55 years old were r and omized in one of two experimental conditions : the computer-tailoring intervention and the generic intervention . The two dependant variables were the frequency of participation and the intention to participate in leisure-time physical activities . Among the research hypotheses , only one was confirmed : the first computer-tailoring print on the practice of physical activity  was more efficient than the first generic intervention at 1-month follow-up . Other similar studies will be necessary to determine the real potential of this type of approach for people with type 2 diabetes in a real-life setting Introduction Type 2 diabetes ( T2D ) is a major health concern among population s of South Asian ethnicity . Although dietary and physical activity interventions may reduce the risk of T2D , the effectiveness has been moderate among South Asians . This might ( in part ) be because this subgroup follows strategies that were originally developed for interventions among other population s. Therefore , this review aims to assess the evidence for the current dietary and physical activity strategies recommended in T2D prevention intervention studies and guidelines for South Asians . Methods and analysis Included will be all studies and guidelines on dietary and /or physical activity strategies to prevent T2D in adult South Asians . Two review ers will search online data bases from their start until the present date for published and unpublished experimental/quasiexperimental studies , with at least an abstract in English . References of identified articles and key review s will be screened for additional studies . Guidelines will be identified by search es in online data bases and websites of public organisations . Finally , expert consultations will be held to supplement any missing information . Trial quality will be assessed with the Quality Assessment Tool for Quantitative Studies Data , and guidelines with the Appraisal of Guidelines for Research & Evaluation II . Data on the strategies recommended , targeting and evidence on effectiveness will be extracted by two review ers and presented in tabular and narrative forms . Recommendations will be compared with the National Institute for Health and Care Excellence guidelines [ PH35 ] . Overall findings on  dietary and physical activity recommendations , as well as findings for specific subgroups ( eg , by sex ) , will be discussed . Ethics and dissemination Ethics assessment is not required . Start date : 1 January 2016 , finishing and reporting date 31 July 2016 . Results will be published in a peer- review ed scientific journal , the project report of EuroDHYAN ( www.eurodhyan.eu ) and in a PhD dissertation . Trial registration number The protocol is registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) registration number CRD42015027067 Background The prevention of type 2 diabetes is recognised as a health care priority . Lifestyle change has proven effective at reducing the risk of type 2 diabetes , but limitations in the current evidence have been identified in : the promotion of physical activity ; availability of interventions that are suitable for commissioning and implementation ; availability of evidence -based interventions using new technologies ; and physical activity promotion among ethnic minorities . We aim to investigate whether a structured education programme with differing levels of ongoing support , including text-messaging , can increase physical activity over a 4 year period in a multi-ethnic population at high risk of diabetes . Methods / Design A multi-centre r and omised controlled trial , with follow-up at 12 and 48 months . The primary outcome is change in ambulatory activity at 48 months . Secondary outcomes include changes to markers of metabolic , cardiovascular , anthropometric and psychological health along with cost-effectiveness .  Participants aged 40–74 years for White European , or 25–74 years for South Asians , with an HbA1c value of between 6.0 and < 6.4 % ( 42 and 47 mmol/mol ) or with a previously recorded plasma glucose level or HbA1c value within the high risk ( prediabetes ) range within the last five years , are invited to take part in the trial . Participants are identified through primary care , using an automated diabetes risk score within their practice data base , or from a data base of previous research participants . Participants are r and omly assigned to either : 1 ) the control group who receive a detailed advice leaflet ; 2 ) the Walking Away group , who receive the same leaflet and attend a 3 hour structured education programme with annual maintenance sessions delivered in groups ; or 3 ) the Walking Away Plus group , who receive the leaflet , attend the structured education programme with annual maintenance sessions , plus receive follow-on support through highly-tailored text-messaging and telephone calls to help to aid pedometer use and behaviour change . Discussion This study will provide new evidence for the long-term effectiveness of a structured education programme focused on physical activity , conducted within routine care in a multi-ethnic population in the UK . It will also investigate the impact of different levels of ongoing support and the cost-effectiveness of each intervention . Trial registration IS RCT N83465245 Trial registration date : OBJECTIVE To examine the effects of a tailored , print-based intervention for promoting physical activity among patients with type 2 diabetes . METHOD This r and omized controlled trial was conducted 2006 - 2007 in Tallahassee , FL . Patients diagnosed with type 2 diabetes ( N=85 ; mean age=57.1 years ; 74.1 % Caucasian ) were recruited from a community diabetes clinic . The four-week intervention was tailored to participants ' current activity levels , motivational readiness , self-efficacy , and other relevant psychosocial constructs . Primary outcomes included self-reported physical activity and physical activity stage of change . RESULTS Compared with usual care , participants receiving the intervention were more likely to progress in their physical activity stage of change between baseline and month one ( OR=3.2 , 95 % CI 1.0 - 10.3 ) and were more likely to be in the Action or Maintenance stages at month one ( OR=5.6 , 95 % CI 1.7 - 18.3 ) . The change in weekly activity among intervention participants was 22 min greater than those receiving usual care , although this represented a non-significant difference , p=0.22 . CONCLUSION While this print-based intervention has the potential to reach a large audience and produced improvements in relevant psychosocial constructs , more intensive programs may be needed to achieve greater behavioral improvements Background By 2025 , it is estimated that approximately 1.8 million Australian adults ( approximately 8.4 % of the adult population ) will have diabetes , with the majority having type 2 diabetes . Weight management via improved physical activity and diet is the cornerstone of type 2 diabetes management . However , the majority of weight loss trials in diabetes have evaluated short-term , intensive clinic-based interventions that , while producing short-term outcomes , have failed to address issues of maintenance and broad population reach . Telephone-delivered interventions have the potential to address these gaps . Methods / Design Using a two-arm r and omised controlled design , this study will evaluate an 18-month , telephone-delivered , behavioural weight loss intervention focussing on physical activity , diet and behavioural therapy , versus usual care , with follow-up at 24 months . Three-hundred adult participants , aged 20 - 75 years , with type 2 diabetes , will be recruited from 10 general practice s via electronic medical records search . The Social-Cognitive Theory driven intervention involves a six-month intensive phase ( 4 weekly calls and 11 fortnightly calls ) and a 12-month maintenance phase ( one call per month ) . Primary outcomes , assessed at 6 , 18 and 24 months , are : weight loss , physical activity , and glycaemic control ( HbA1c ) , with weight loss and physical activity also measured at 12 months . Incremental cost-effectiveness will also be examined . Study recruitment began in February 2009 , with final data collection expected by February 2013 . Discussion This is the first study to evaluate the telephone as the primary method of delivering a behavioural weight loss intervention in type 2 diabetes . The evaluation of maintenance outcomes ( 6 months following the end of intervention ) , the use of accelerometers to objective ly measure physical activity , and the inclusion of a cost-effectiveness analysis will advance the science of broad reach approaches to weight control and health behaviour change , and will build the evidence base needed to advocate for the translation of this work into population health practice .Trial Registration AIMS To determine the effectiveness of a 2.5-year lifestyle intervention for Type 2 diabetes prevention in Dutch general practice compared with usual care . METHODS A r and omized controlled trial of 925 individuals at high risk for Type 2 diabetes ( FINDRISC-score ≥ 13 ) in 14 general practice s in the Netherl and s. Intervention consisted of lifestyle counselling from the nurse practitioner and the general practitioner . Usual care consisted of oral and written information at the start of the study . Study groups were compared over 2.5 years regarding changes in clinical and lifestyle measures . RESULTS Both groups showed modest changes in body weight , glucose concentrations , physical activity and dietary intake [ weight : intervention group , -0.8 ( 5.1 ) kg , usual care group , -0.4 ( 4.7 ) kg , ( P=0.69 ) ; fasting plasma glucose : intervention group , -0.17 ( 0.4 ) mmol/l , usual care group , -0.10 ( 0.5 ) mmol/l , ( P=0.10 ) ] . Differences between groups were significant only for total physical activity and fibre intake . In the intervention group , self-efficacy was significantly higher in individuals successful at losing weight compared with unsuccessful individuals . No significant differences in participant weight loss were found between general practitioners and nurse practitioners with different levels of motivation or self-efficacy . CONCLUSIONS Diabetes risk factors could significantly be reduced by lifestyle counselling in Dutch primary care . However , intervention effects above the effects attributable to usual care were modest . Higher participant self-efficacy seemed to facilitate weight loss . Lack of motivation or self-efficacy of professionals did not negatively influence participant guidance For decades , exercise has been considered a cornerstone of diabetes management , along with diet and medication . However , high- quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years . The present document summarizes the most clinical ly relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these . Our recently published technical review on physical activity/exercise and type 2 diabetes ( 1 ) includes greater detail on individual studies , on prevention of diabetes , and on the physiology of exercise . The present statement focuses on type 2 diabetes . Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement . The levels of evidence used are defined by the ADA in ref . 2 . Two r and omized trials each found that lifestyle interventions including ∼150 min/week of physical activity and  diet-induced weight loss of 5–7 % reduced the risk of progression from impaired glucose tolerance ( IGT ) to type 2 diabetes by 58 % ( 3,4 ) . A cluster-r and omized trial found that diet alone , exercise alone , and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes ( 5 ) . Therefore , there is firm and consistent evidence that programs of increased physical activity  and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT . Boule et al. ( 6 ) undertook a systematic review and meta- analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c ( A1C ) and body mass in people with type 2 diabetes . Postintervention A1C was significantly lower in exercise than control groups ( 7.65 vs. 8.31 % , weighted mean difference −0.66 % ; P < 0.001 ) . In contrast , postintervention body weight did not differ between the exercise and control groups . Meta-regression confirmed that the beneficial effect of exercise on A1C
Small effect sizes and potentially transient effect were reported in some studies , and some review ers noted that durability of intervention impact was potentially sensitive to duration of intervention and adherence to behaviour change .
Behaviour change , vascular disease and mortality outcome data were infrequently reported , and evidence of the impact of intervention on these outcomes was minimal .
Relatively long- duration lifestyle interventions can limit or delay progression to diabetes under trial conditions .
However , outcomes from more time-limited interventions , and those applied in routine clinical setting s , appear more variable , in keeping with the findings of recent pragmatic trials .
There is little evidence of intervention impact on vascular outcomes or mortality end points in any context . '
Real-world ' implementation of lifestyle interventions for diabetes prevention may be expected to lead to modest outcomes
OBJECTIVES To review the clinical outcomes of combined diet and physical activity interventions for population s at high risk of type 2 diabetes .