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Physical activity recommendations for patients with type 2 diabetes: a cross-sectional survey

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Abstract

Aims

We aim to systematically review the existing guidelines on physical activity for T2DM and assess the consistency of their recommendations, methodological quality, and reporting quality.

Methods

We performed a literature search on PubMed, China Biology Medicine disc, and four main guideline databases in order to identify existing T2DM guidelines. We then evaluated the methodological and reporting qualities of the guidelines using the AGREE II instrument and the RIGHT checklist. Fifteen guidelines were included in total, with eight of these (53.33%) assessed being “recommended” and five graded as having good reporting quality.

Result

A total of 30 physical activity recommendations were extracted. Fifteen recommendations reported the levels of evidence, and of these, five were found to be based on a high quality of evidence. Aerobic exercise at least 3 days per week was recommended by most guidelines (10/15, 66.67%). Eight guidelines (53.33%) recommended resistance exercise, while combined aerobic and resistance exercise was recommended in three of the guidelines (20.0%). Only two guidelines recommended supervised exercise, and one recommended flexibility exercise. Four of the guidelines (26.67%) solely recommended physical activity or exercise, but with no added details.

Conclusions

The quality of the guidelines concerning physical activity for T2DM was found to be moderate to low and varied substantially. Recommendations regarding physical activity for T2DM are not very specific or clear and remain incompletely consistent, while the level of evidence and the strength of the recommendations were seldom reported. Our findings suggest a need for guidelines for diabetes based on high levels of evidence.

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Abbreviations

ADA:

American Diabetes Association

SFD:

Francophone Diabetes Society

BPTA:

Belgian Physical Therapy Association

ESSA:

Exercise and Sport Science Australia

DC:

Diabetes Canada

AHA:

American Heart Association

IDF:

International Diabetes Federation

ISPAD:

International Society for Pediatric and Adolescent Diabetes

MOH:

Ministry of Health

AAP:

American Academy of Pediatrics

ICSI:

Institute for Clinical Systems Improvement

NICE:

National Institute for Health and Care Excellence

SIGN:

Scottish Intercollegiate Guidelines Network

CDS:

Chinese Diabetes Society

GRADE:

Grading of Recommendations Assessment, Development and Evaluation

OCEBM:

Oxford Center for Evidence-based Medicine

T2DM:

Type 2 diabetes

Both:

Both adults and youth

RCT:

Randomized controlled trials

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Acknowledgements

We thank all authors whose data are included in this international review. We thank all members of our study team for their whole-hearted cooperation.

Funding

This study was supported by the Fundamental Research Funds for the Central Universities (2019jbkyjc002, 18LZUJBWZX006): Evidence Based Social Science Research, China Medical Board Open Project Funding (CMB #17-279): Tracking and Evaluating Quality (TEQ) of Rural Health Services in NW China: Tool kits for rural clinic quality management and capacity building and Special Fund for Soft Science in Gansu Province (18CX1ZA043): Study on the Measures to Improve the Quality of Rural Health Services in Gansu Province.

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Author notes

  1. Liangying Hou and Long Ge are co-first author.

Authors and Affiliations

  1. Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China

    Liangying Hou, Long Ge, Yanfei Li, Yajing Chen, Huijuan Li, Juanjuan He, Changhao Cao, Rui Li, Xingrong Liu & Kehu Yang

  2. Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China

    Liangying Hou, Long Ge, Yanfei Li, Yajing Chen, Huijuan Li & Rui Li

  3. Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China

    Jinhui Tian, Yaolong Chen & Kehu Yang

  4. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China

    Liangying Hou, Long Ge, Yanfei Li, Huijuan Li, Rui Li, Jinhui Tian, Yaolong Chen & Kehu Yang

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  1. Liangying Hou
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Contributions

LG, XRL and KHY planed and designed the current study. LYH, YFL, YJC, HJL, YTW, QXY and RL extracted data. LYH and LG performed the data analysis and initial interpretation. LYH and LG wrote the article and revised it. All authors revised critically for important intellectual content and approved the final version to be submitted.

Corresponding authors

Correspondence to Xingrong Liu or Kehu Yang.

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Hou, L., Ge, L., Li, Y. et al. Physical activity recommendations for patients with type 2 diabetes: a cross-sectional survey. Acta Diabetol 57, 765–777 (2020). https://doi.org/10.1007/s00592-020-01480-1

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