title: Changes in physical activity among adults with diabetes: a longitudinal cohort study of inactive patients with Type 2 diabetes who become physically active.
abstract: OBJECTIVE
  To identify the predictors and clinical effects among inactive patients with diabetes who become physically active, in the setting of a large integrated health system.
  
  
  METHODS
  We studied adults with Type 2 diabetes with at least two clinic visits between December 2011 and November 2012 who reported being inactive at their first visit. The mean (±sd) interval between their first and last visit was 6.2 (±2.3) months. We analysed self-reported moderate-to-vigorous physical activity data collected using a structured intake form during routine clinical care.
  
  
  RESULTS
  The study cohort (N = 6853) had a mean age of 60.2 years; 51.4% were women and 53.6% were non-white. Nearly two-thirds (62.5%, n = 4280) reported remaining physically inactive, while 16.0% reported achieving the recommended moderate-to-vigorous physical activity levels (≥ 150 min/week) by the last visit of the study period. Female gender (odds ratio 0.77, 95% CI 0.67, 0.88), obesity (BMI 30-34.9 kg/m(2) : odds ratio 0.76, 95% CI 0.60, 0.97; BMI ≥ 35 kg/m(2) : odds ratio 0.55, 95% CI 0.42, 0.70), chronic kidney disease (odds ratio 0.78, 95% CI 0.65, 0.94) and depression (odds ratio 0.77, 95% CI 0.62, 0.96) were each independently associated with not achieving the recommended moderate-to-vigorous physical activity level, while physician referral to lifestyle education was a positive predictor (odds ratio 1.40, 95% CI 1.09, 1.85). Controlling for baseline differences, patients achieving the recommended moderate-to-vigorous physical activity target lost 1.0 kg more weight compared with patients remaining inactive (P < 0.001).
  
  
  CONCLUSIONS
  Patients with diabetes in a real-world clinical setting lost weight after becoming physically active; however, nearly two-thirds of patients remained inactive. Novel interventions to address physical inactivity in primary care should address barriers faced by older patients with medically complex disease.
authors.affiliation: Department of Medicine, Kaiser Permanente Northern California, San Francisco, NC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Palakodeti
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, NC, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Uratsu
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, NC, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Schmittdiel
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, NC, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Grant
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D057185:Sedentary Behavior; D057566:Self Report; D012737:Sex Factors
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human