title: Brisk walking compared with an individualised medical fitness programme for patients with type 2 diabetes: a randomised controlled trial.
abstract: OBJECTIVE
  Structured exercise is considered a cornerstone in type 2 diabetes treatment. However, adherence to combined resistance and endurance type exercise or medical fitness intervention programmes is generally poor. Group-based brisk walking may represent an attractive alternative, but its long-term efficacy as compared with an individualised approach such as medical fitness intervention programmes is unknown. We compared the clinical benefits of a 12-month exercise intervention programme consisting of either brisk walking or a medical fitness programme in type 2 diabetes patients.
  
  
  METHODS
  We randomised 92 type 2 diabetes patients (60 +/- 9 years old) to either three times a week of 60 min brisk walking (n = 49) or medical fitness programme (n = 43). Primary outcome was the difference in changes in HbA1c values at 12 months. Secondary outcomes were differences in changes in blood pressure, plasma lipid concentrations, insulin sensitivity, body composition, physical fitness, programme adherence rate and health-related quality of life.
  
  
  RESULTS
  After 12 months, 18 brisk walking and 19 medical fitness participants were still actively participating. In both programmes, 50 and 25% of the dropout was attributed to overuse injuries and lack of motivation, respectively. Intention-to-treat analyses showed no important differences between brisk walking and medical fitness programme in primary or secondary outcome variables.
  
  
  CONCLUSIONS
  The prescription of group-based brisk walking represents an equally effective intervention to modulate glycaemic control and cardiovascular risk profile in type 2 diabetes patients when compared with more individualised medical fitness programmes. Future exercise intervention programmes should anticipate the high attrition rate due to overuse injuries and motivation problems.
authors.affiliation: Department of Human Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, the Netherlands. Stephan.Praet@BW.unimaas.nl
authors.forename: S F E
authors.initials: SF
authors.lastname: Praet
authors.forename: E S J
authors.initials: ES
authors.lastname: van Rooij
authors.forename: A
authors.initials: A
authors.lastname: Wijtvliet
authors.forename: L J M
authors.initials: LJ
authors.lastname: Boonman-de Winter
authors.forename: Th
authors.initials: T
authors.lastname: Enneking
authors.forename: H
authors.initials: H
authors.lastname: Kuipers
authors.forename: C D A
authors.initials: CD
authors.lastname: Stehouwer
authors.forename: L J C
authors.initials: LJ
authors.lastname: van Loon
mesh_terms: D000368:Aged; D001416:Back Pain / Q000209:etiology; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000534:rehabilitation*; D015444:Exercise; D005260:Female; D006339:Heart Rate; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010809:Physical Fitness; D012146:Rest / Q000502:physiology; D016896:Treatment Outcome; D016138:Walking
chemical_list: D001786:Blood Glucose