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Association Between Physical Activity and Physical Function in a Marshallese Population with Type 2 Diabetes

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Abstract

Physical activity can delay functional decline in people with type 2 diabetes (T2D), but these associations have not been studied within a sample of Native Hawaiian or Pacific Islander adults with T2D. Using data from a randomized control trial in which 218 Marshallese adults with T2D participated in a 10-week diabetes self-management education intervention, this study tested our hypothesis that physical activity would predict physical function when controlling for time and other variables. Levels of physical activity were positively associated with levels of physical function, even after controlling for time and other covariates. These findings provide a more robust understanding of the relationship between physical activity and physical function in a sample of minority adults with T2D. Future studies should further explore levels of physical activity needed to maintain and improve physical function so that culturally appropriate physical activity interventions can be developed.

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Data Availability

The deidentified data underlying the results presented in this study may be made available upon request from the corresponding author, Dr. Christopher S. Walter, at cwalter@uams.edu. The data are not publicly available in accordance with funding requirements and participant privacy.

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References

  1. Centers for Disease Control and Prevention. “National Diabetes Statistics Report, 2020," U.S. Department of Health and Human Services, Atlanta, GA, 2020. Available: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.

  2. Spanakis EK, Golden SH. “Race/ethnic difference in diabetes and diabetic complications,“ Curr Diab Rep, vol. 13, no. 6, pp. 814–23, 2013, https://doi.org/10.1007/s11892-013-0421-9.

  3. United States Census Bureau. “QuickFacts: United States.” Available: https://www.census.gov/quickfacts/fact/table/US/PST045222.

  4. Heslin A. Climate Migration and Cultural Preservation: the case of the Marshallese Diaspora. In: Mechler R, Bouwer L, Schinko T, Surminski S, editors. Loss and damage from climate change. Springer; 2019. pp. 383–91.

  5. van der Geest K, Burkett M, Fitzpatrick J, Stege M, Wheeler B. Climate change, ecosystem services and migration in the Marshall Islands: are they related? Clim Change, vol. 161, no. 1, pp. 109–27, 2020, https://doi.org/10.1007/s10584-019-02648-7.

  6. Yamada S, Dodd A, Soe T, Chen T, Bauman K. Diabetes mellitus prevalence in out-patient marshallese adults on Ebeye Island, Republic of the Marshall Islands, Hawaii Med J, vol. 63, no. 2, pp. 45–51, 2004.

  7. Aitaoto N, Ichiho H. Assessing the health care system of services for non-communicable diseases in the US-affiliated Pacific Islands: a Pacific regional perspective, Hawaii J Med Public Health, vol. 72, no. 5 Suppl 1, pp. 106–14, 2013.

  8. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012, Vital Health Stat 10. vol. 260, pp. 1–161, 2014.

  9. International Diabetes Federation. “IDF Diabetes Atlas 2021, 10th Edition,” 2021. Available: https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf.

  10. Burgess J et al. Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres, Diagnostics (Basel, Switzerland), vol. 11, no. 2, p. 165, 2021, https://doi.org/10.3390/diagnostics11020165.

  11. Singh R, Kishore L, Kaur N. Diabetic peripheral neuropathy: current perspective and future directions, Pharmacol Res, vol. 80, pp. 21–35, 2014, https://doi.org/10.1016/j.phrs.2013.12.005.

  12. Tesfaye S et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments, Diabetes Care, vol. 33, no. 10, pp. 2285–2293, 2010, https://doi.org/10.2337/dc10-1303.

  13. Andersen H. Motor dysfunction in diabetes, Diab/Metab Res Rev, vol. 28 Suppl 1, pp. 89–92, 2012, https://doi.org/10.1002/dmrr.2257.

  14. Roman de Mettelinge T, Cambier D, Calders P, Van Den Noortgate N, Delbaere K. Understanding the relationship between type 2 diabetes mellitus and falls in older adults: a prospective cohort study, PLoS ONE. vol. 8, no. 6, p. e67055, 2013. https://doi.org/10.1371/journal.pone.0067055. 

    Article  CAS  PubMed  PubMed Central  ADS  Google Scholar 

  15. Sayer A, Dennison E, Syddall H, Gilbody H, Phillips D, Cooper C. Type 2 diabetes, muscle strength, and impaired physical function: the tip of the iceberg?, Diabetes Care, vol. 28, no. 10, pp. 2541–2542, 2005, https://doi.org/10.2337/diacare.28.10.2541.

  16. Leenders M et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging, J Am Med Dir Assoc, vol. 14, no. 8, pp. 585–92, 2013, https://doi.org/10.1016/j.jamda.2013.02.006.

  17. Bruce D, Hunter M, Peters K, Davis T, Davis W. Fear of falling is common in patients with type 2 diabetes and is associated with increased risk of falls, Age Ageing, vol. 44, no. 4, pp. 687–90, 2015, https://doi.org/10.1093/ageing/afv024.

  18. Kalyani R, Tra Y, Yeh H, Egan J, Ferrucci L, Brancati F. Quadriceps strength, quadriceps power, and gait speed in older U.S. adults with diabetes mellitus: results from the National Health and Nutrition Examination Survey, 1999–2002, J Am Geriatr Soc, vol. 61, no. 5, pp. 769–75, 2013, https://doi.org/10.1111/jgs.12204.

  19. Schoene D, Heller C, Aung Y, Sieber C, Kemmler W, Freiberger E. A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls? Clin Interv Aging. vol. 14, pp. 701–19, 2019, https://doi.org/10.2147/CIA.S197857.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Walter CS, Narcisse M-R, Vincenzo JL, McElfish PA, Felix HC. Description of Variation in Age of Onset of Functional Limitations of Native Hawaiian and Pacific Islanders Compared to Other Racial and Ethnic Groups, Int J Environ Res Public Health, vol. 18, no. 5, p. 2445, 2021, https://doi.org/10.3390/ijerph18052445.

  21. Sluik D et al. Physical activity and mortality in individuals with diabetes Mellitus: a prospective study and Meta-analysis, Arch Intern Med, vol. 172, no. 17, pp. 1285–95, 2012, https://doi.org/10.1001/archinternmed.2012.3130.

  22. Yavari A, Hajiyev A, Naghizadeh F. The effect of aerobic exercise on glycosylated hemoglobin values in type 2 diabetes patients, J Sports Med Phys Fit, vol. 50, no. 4, pp. 501–5, 2010.

  23. Armstrong M, Boulé N, Sigal R. Exercise interventions and glycemic control in patients with diabetes, JAMA, vol. 306, no. 6, p. 607, 2011, https://doi.org/10.1001/jama.2011.1103.

  24. Bird S, Hawley J. Update on the effects of physical activity on insulin sensitivity in humans, BMJ Open Sport Exerc Med, vol. 2, no. 1, p. e000143, 2017, https://doi.org/10.1136/bmjsem-2016-000143.

  25. Donnelly J, Blair S, Jakicic J, Manore M, Rankin J, Smith B. American College of Sports Medicine position stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults, Med Sci Sports Exerc, vol. 41, no. 2, pp. 459–71, 2009, https://doi.org/10.1249/MSS.0b013e3181949333.

  26. Zoppini G et al. Effects of moderate-intensity exercise training on plasma biomarkers of inflammation and endothelial dysfunction in older patients with type 2 diabetes, Nutr Metab Cardiovasc Dis, vol. 16, no. 8, pp. 543–549, 2006, https://doi.org/10.1016/j.numecd.2005.09.004.

  27. Espeland M et al. Effects of Physical Activity Intervention on Physical and Cognitive Function in Sedentary Adults With and Without Diabetes, J Gerontol A Biol Sci Med Sci, vol. 72, no. 6, pp. 861–866, 2017, https://doi.org/10.1093/gerona/glw179.

  28. Colberg S et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the american Diabetes Association: joint position statement, Diabetes Care, vol. 33, no. 12, pp. e147–167, 2010, https://doi.org/10.2337/dc10-9990.

  29. Pfeifer L et al. Association between Physical Exercise Interventions participation and functional capacity in individuals with type 2 diabetes: a systematic review and Meta-analysis of controlled trials, Sports Med - Open, vol. 8, no. 1, p. 34, 2022, https://doi.org/10.1186/s40798-022-00422-1.

  30. Rejeski W et al. The MAT-sf: identifying risk for major mobility disability, J Gerontol A Biol Sci Med Sci, vol. 70, no. 5, pp. 641–646, 2015, https://doi.org/10.1093/gerona/glv003.

  31. Janssen S, Connelly D. The effects of exercise interventions on physical function tests and glycemic control in adults with type 2 diabetes: a systematic review, J Bodyw Mov Ther, vol. 28, pp. 283–93, 2021, https://doi.org/10.1016/j.jbmt.2021.07.022.

  32. Powers MA et al. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics, Diabetes Care, vol. 38, no. 7, pp. 1372–1382, 2015, https://doi.org/10.1177/0145721716689694.

  33. Yeary KHK, Long CR, Bursac Z, McElfish PA. Design of a randomized, controlled, comparative-effectiveness trial testing a family model of diabetes self-management education (DSME) vs. Standard DSME for Marshallese in the United States, Contemp Clin Trials Commun, vol. 6, pp. 97–104, 2017, https://doi.org/10.1016/j.conctc.2017.03.007.

    Article  Google Scholar 

  34. McElfish PA et al. Engagement practices that join scientific methods with community wisdom: designing a patient-centered, randomized control trial with a Pacific Islander community, Nurs Inq, vol. 24, no. 2, pp. 1–11, 2017, https://doi.org/10.1111/nin.12141.

  35. McElfish PA et al. Comparative Effectiveness and Maintenance of Diabetes Self-Management Education Interventions for Marshallese Patients With Type 2 Diabetes: A Randomized Controlled Trial, Diabetes Care, vol. 42, no. 5, pp. 849–858, 2019, https://doi.org/10.2337/dc18-1985.

  36. Tseng L et al. The association of menopause status with physical function: the Study of Women’s Health Across the Nation, Menopause, vol. 19, no. 11, pp. 1186–92, 2012, https://doi.org/10.1097/gme.0b013e3182565740.

  37. Raudenbush S, Bryk A. Hierarchical Linear Models: applications and data analysis methods. Second ed. Thousand Oaks, CA: Sage Publications, Inc.; 2001.

    Google Scholar 

  38. STATACorp. Stata Statistical Software: release 16. College Station, TX: StataCorp LLC; 2019.

    Google Scholar 

  39. Schwarz G. Estimating the Dimension of a Model, Annals of Statistics, vol. 6, no. 2, pp. 461–464, 1978, https://doi.org/10.1214/aos/1176344136.

  40. Piercy K et al. The Physical Activity Guidelines for Americans, JAMA, vol. 320, no. 19, pp. 2020–2028, 2018, https://doi.org/10.1001/jama.2018.14854.

  41. Mickute M et al. Device-measured physical activity and its association with physical function in adults with type 2 diabetes mellitus, Diabet Med, vol. 38, no. 6, p. e14393, 2021, https://doi.org/10.1111/dme.14393.

  42. Roehr B. Asians and Pacific Islanders in US need greater prominence in research, BMJ, vol. 340, p. c2495, 2010, https://doi.org/10.1136/bmj.c2495.

  43. Ro MJ, Yee AK. Out of the shadows: Asian Americans, native Hawaiians, and Pacific Islanders, Am J Public Health, vol. 100, no. 5, pp. 776–8, 2010, https://doi.org/10.2105/AJPH.2010.192229.

  44. McEwan D, Rhodes R, Beauchamp M. What Happens When the Party is Over? Sustaining Physical Activity Behaviors after Intervention Cessation, Behavioral Med, vol. 48, no. 1, pp. 1–9, 2022, https://doi.org/10.1080/08964289.2020.1750335.

  45. Marcus B et al. Physical activity behavior change: issues in adoption and maintenance, Health Psychol, vol. 19, no. 1S, pp. 32–41, 2000, https://doi.org/10.1037/0278-6133.19.suppl1.32.

  46. Rhodes R, Sui W. Physical Activity Maintenance: A Critical Narrative Review and Directions for Future Research, Front Psychol, vol. 12, p. 725671, 2021, https://doi.org/10.3389/fpsyg.2021.725671.

  47. Walter C, Narcisse M, Vincenzo J, Felix H, McElfish P. Associations between physical activity and functional limitations in native hawaiian and Pacific Islander middle-aged and older adults in the United States, Ethn Health, vol. 27, no. 7, pp. 1616–1629. https://doi.org/10.1080/13557858.2021.1921120

    Article  Google Scholar 

  48. Loprinzi P, Sng E. The effects of objectively measured sedentary behavior on all-cause mortality in a national sample of adults with diabetes, Prev Med, vol. 86, pp. 55–7, 2016, https://doi.org/10.1016/j.ypmed.2016.01.023.

  49. Maher C, Olds T, Mire E, Katzmarzyk P. Reconsidering the sedentary behaviour paradigm, PloS One, vol. 9, no. 1, p. e86403, 2014, https://doi.org/10.1371/journal.pone.0086403.

  50. Dempsey P et al. Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities, Diabetes Care, vol. 39, no. 6, pp. 964–72, 2016, https://doi.org/10.2337/dc15-2336.

  51. Hamasaki H. Daily physical activity and type 2 diabetes: A review, World J diabetes, vol. 7, no. 12, pp. 243–51, 2016, https://doi.org/10.4239/wjd.v7.i12.243.

  52. Lee J, Kim J, Chow A, Piatt J. Different Levels of Physical Activity, Physical Health, Happiness, and Depression among Older Adults with Diabetes, Gerontol Geriatr Med, vol. 7, p. 2333721421995623, 2021, https://doi.org/10.1177/2333721421995623.

  53. Althubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods, J Multidiscip Healthc, vol. 9, pp. 211-217, 2016. https://doi.org/10.2147/jmdh.s104807.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Arredondo E, Mendelson T, Holub C, Espinoza N, Marshall S. Cultural adaptation of physical activity self-report instruments, J Phys Act Health, vol. 9 Suppl 1, no. Suppl 1, pp. 37–43, 2012, https://doi.org/10.1123/jpah.9.s1.s37.

  55. Adams S et al. The effect of social desirability and social approval on self-reports of physical activity, Am J Epidemiol, vol. 161, no. 4, pp. 389–98, 2005, https://doi.org/10.1093/aje/kwi054.

  56. Brenner PS, DeLamater JD. Social Desirability Bias in Self-reports of Physical Activity: Is an Exercise Identity the Culprit?, Social Indicators Research, vol. 117, no. 2, pp. 489–504, 2013, https://doi.org/10.1007/s11205-013-0359-y.

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Funding

Financial support for the study was provided by the Patient-Centered Outcomes Research Institute (no. AD-1310-07159). Initial funding for a pilot project of the study was provided by a University of Arkansas for Medical Sciences College of Medicine Intramural Sturgis Grant for Diabetes Research from the Sturgis Foundation. Additional support for the community-based participatory research team was provided by University of Arkansas for Medical Sciences Translational Research Institute funding awarded through the National Center for Advancing Translational Sciences of the National Institutes of Health (no. U54 TR001629). A portion of the authors’ time was supported by University of Arkansas for Medical Sciences Translational Research Institute funding awarded through the National Center for Advancing Translational Sciences of the National Institutes of Health (no. UL1 TR003107). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations.

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Authors and Affiliations

  1. Department of Physical Therapy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA

    Christopher S. Walter

  2. College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA

    Marie-Rachelle Narcisse & Pearl A. McElfish

  3. Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Holly C. Felix

  4. Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA

    Brett Rowland

  5. Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA

    James P. Selig

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  1. Christopher S. Walter
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  2. Marie-Rachelle Narcisse
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  3. Holly C. Felix
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  6. Pearl A. McElfish
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Contributions

All authors contributed to the study conception and design. Data analyses were performed by Marie-Rachelle Narcisse. The first draft of the manuscript was written by Christopher S. Walter and Marie-Rachelle Narcisse, and all authors revised previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Christopher S. Walter.

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None declared.

Ethics Approval

This study was approved by the University of Arkansas for Medical Sciences Institutional Review Board (#203482). We certify that the study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Walter, C.S., Narcisse, MR., Felix, H.C. et al. Association Between Physical Activity and Physical Function in a Marshallese Population with Type 2 Diabetes. J Immigrant Minority Health 26, 361–370 (2024). https://doi.org/10.1007/s10903-023-01551-9

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