Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES).
Arch Intern Med 2010;170:1794-803
Balducci S, Zanuso S, Nicolucci A, De Feo P, Cavallo S, Cardelli P, Fallucca S, Alessi E, Fallucca F, Pugliese G, Italian Diabetes Exercise Study (IDES) Investigators
The aim of this study was to evaluate the efficacy of an intensive exercise intervention strategy (aerobic and resistance) in promoting physical activity and improving hemoglobin A1c (HbA1c) level and other cardiovascular risk factors in sedentary subjects with type 2 diabetes. This multicentre, randomized controlled trial included 606 sedentary patients with type 2 diabetes from 22 outpatient clinics across Italy. Patients were randomized to either twice-a-week supervised aerobic and resistance training plus structured exercise counselling (exercise group: n=303) or counselling alone (control group: n=303) for 12 months. Results showed that the combination of structured exercise counselling and a prescribed and supervised training program generated a higher volume of physical activity as well as more important reduction of HbA1c levels and other modifiable cardiovascular risk factors compared to the group with counselling alone. More specifically, the group receiving facility-based training had significantly better results in aerobic fitness, strength, blood pressure, lipid levels, waist circumference, markers of systemic inflammation, and estimated 10-year cardiovascular risk. Even though counselling alone had a significant effect in helping achieve the currently recommended amount of activity, the intervention strategy was necessary to improve significantly modifiable cardiovascular risk factors. In their editorial comment, Sigal RJ et al. recognized the importance of this trial because of its large cohort, the duration of the study and the fact that it was multicentre increasing its generalizability and the ability of maintaining compliance. This study demonstrates the effectiveness, feasibility, and sustainability of an exercise program for a large number of individuals with type 2 diabetes. They also emphasized the importance of incorporating supervised exercise training in the treatment of diabetes in the same way as nutritional therapy and medications.