Exercise Assessment and Prescription in Patients With Type 2 Diabetes in the Private and Home Care Setting: Clinical Recommendations From AXXON (Belgian Physical Therapy Association)

Type 2 diabetes mellitus (T2DM) is a disease associated with many complications: the likelihood for the development of heart disease or stroke is elevated twofold to fourfold, and the prevalence of hypertension, retinopathy, and neuropathy in patients with T2DM is approximately 70%, 28%, and 60% to 70%, respectively. Moreover, T2DM is the most important cause of kidney failure and need for nontraumatic lower-limb amputation.1 Eventually, life expectancy is reduced by about 8.2 and 7.5 years in men and women, respectively, when T2DM is diagnosed at the age of 50 years.2 In addition to the hazardous effects of T2DM on health, economic and financial consequences of this disease have been described: health care–related costs are approximately twofold to threefold higher in patients with T2DM, as opposed to their healthy counterparts, not taking into account the economic costs related to absenteeism and lowered economic productivity.3 Recent statistical models indicate that the prevalence of T2DM will increase exponentially in the next few decades.4 The total number of patients with diabetes is projected to rise from 171 million in the year 2000 to 366 million in the year 2030.4 As a result, it is important to prevent T2DM and optimize medical treatment of T2DM to prevent the development of diabetes-associated complications and health care–related and economic costs. In the care of people with T2DM, exercise intervention—besides pharmacologic treatment and caloric intake restriction—is considered a cornerstone. According to clinical guidelines, people with T2DM should permanently (lifelong) exercise 3 to 5 days a week, at a low to moderate intensity (40%–70% of maximum oxygen uptake [Vo2max] or 50%–70% of maximal heart rate), achieving a minimal exercise duration of 150 minutes a week, and endurance exercises should be combined with resistance exercises (5–10 exercises per session, 3 series per …

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