Social Connections and Strategies: Active Diabetes Programs

Most people know that exercise is important to maintain and improve health.   Just the same, too many of our population cling to a sedentary lifestyle. The result: We are facing conditions and diseases that are diminishing quality of life for too many of us.  Is the answer to this costly trend an increase in information about why the least active or those with chronic conditions should add physical activity?  The research says – No!

In a new study, University of Missouri researchers found that healthy adults who received interventions focused on behavior-changing strategies significantly increased their physical activity levels. Conversely, interventions based on cognitive approaches, which try to change knowledge and attitudes, did not improve physical activity.

“The focus needs to shift from increasing knowledge about the benefits of exercise to discussing strategies to change behaviors and increase activity levels,” said Vicki Conn, associate dean for research and Potter-Brinton professor in the MU Sinclair School of Nursing. “The common approach is to try and change people‟s attitudes or beliefs about exercise and why it‟s important, but that information isn‟t motivating. We can’t “think‟ ourselves into being more active.”

Behavior strategies that have been suggested include feedback, goal setting, self-monitoring, exercise prescription and stimulus or cues. Self-monitoring, any method where participants record and track their activity over time, appears to significantly increase awareness and provide motivation for improvement, Conn said.

“The thought of exercise may be overwhelming, but slowly increasing activity by just 10 minutes a day adds up weekly and is enough to provide health benefits,” Conn said. “Even small increases in physical activity will enhance protection against chronic illnesses, including heart disease and diabetes. Preventing or delaying chronic disease will reduce complications, health care costs and overall burden.”

For the least active or someone with a chronic condition, it is also overwhelming to attempt to determine which activity program is effective, safe or something they can manage.  HCD is working with many program providers and the ACSM to create a menu of physical activity program options for such interested populations.  When healthcare providers can prescribe a program with confidence, the winners will be the patients eager for a better quality of life.

At HCD we also realize the importance of a solid social structure of encouragement, engagement, validation and feedback.  Motivation over the long-term is a challenge for almost anyone.  For the least active among us, social network support is even more meaningful and powerful.

Previously, Conn completed a meta-analysis of interventions for chronically ill patients and found similar results. Conn found that interventions were similarly effective regardless of gender, age, ethnicity and socioeconomic status. The study, “Interventions to increase physical activity among healthy adults: Meta-analysis of outcomes,” is featured in this month‟s issue of the American Journal of Public Health. Conn‟s research is funded by a more than $1 million grant from the National Institutes of Health.

So the research supporting physical activity participation as the first step toward prevention increases regularly.  Our hope is that more physicians can identify activity programs for at-risk populations – and we are working hard toward that end. Why do we work so hard on that?

Pamela Peeke, M.D. is a spokesperson for Exercise is Medicine, a global initiative that encourages doctors to prescribe exercise in the same way they prescribe medication. Peeke describes new research (AARP May/June 2011) that suggests that when physicians prescribe physical activity adherence and participation increase. In one study, New Zealand researchers prescribed exercise to 544 inactive women 40 through 74. After two years, 39 percent were still at it.   That’s almost double average rates of regular physical activity participation among all populations and dramatically more than among the least active groups.

Perhaps exercise – specifically designed for specific population needs – could be the “pill” we’re looking for. No less important for every stakeholder in the “wellness participation” game is a solid understanding of what the least active choose to do in their leisure time. What’s fun and entertaining for them?  Who do they enjoy their leisure pursuits with?  Is there a way to gamify the wellness experience and connect it to the “social hubs” our target population emulate? Can we create a “gamiconnection” to choices, health habits and physical activity?