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Cardio Diabetes Medicine 2017 621

The Indian Consensus guideline states that regular, physical activity and is not a structured exercise train-
excessive intake of alcohol is harmful to the individ- ing) interventions were associated with lower HbA1c
ual. Until more data are available for Indian subjects, levels only when they were combined with dietary
those who do not consume alcohol should not take management.
alcohol. However, those individuals who are already The best way to motivate and promote physical activ-
taking a small quantity of alcohol need not be dis- ity is not well known. However, RCTs have shown that
couraged.
reinforcement of the activity by healthcare workers
Physical activity and exercise: would be beneficial.

Physical activity plays a significant role in preventing/ Cessation of smoking:
delaying the development of diabetes in those with
IGT. It is also important in achieving and maintaining Active smoking is associated with an increased risk

glycaemic control in IGT and DM. Aerobic exercise of T2DM. Smoking increases the risk of premature
and resistance exercise improve insulin sensitivity, deaths. The leading causes of death due to smok-
plasma glucose levels, blood pressure and plasma ing were CVD, chronic obstructive pulmonary disease

lipid levels and decrease the CV risk. and lung cancer. Further, the cessation of smoking

decreases CVD risk. Therefore, smoking should be
According to the ADA, all children including those avoided. Smokers should be encouraged to quit
with diabetes or prediabetes, should engage in at smoking and should be offered a structured pro-
least 60 minutes of physical activity every day. Chil- gramme including pharmacological therapy. The ADA
dren should be encouraged to engage in 60 min- states that non-smokers should be advised not to
utes or more of moderate-to-vigorous aerobic activity use e-cigarettes, as research data on their short- and
each day, with muscle-and-bone strengthening ac- long-term effects is still not sufficient.
tivities at least 3 days per week. Adults (> 18 years)
should engage in 150 minutes per week of moderate Clinical trials and their inferences:
intensity aerobic physical activity or 75 minutes per
week of vigorous intensity aerobic physical activity or Landmark clinical trials and studies have given us
an equivalent combination of these. Muscle strength- useful information to understand the importance
ening activities should be performed 2 or more days/ of lifestyle modification in the prevention of T2DM.
week. Further, extended sedentary periods should be Some of these are discussed below.
avoided as much as possible. Sedentary periods (> The American DPP randomly assigned participants
30 minutes) may be broken by briefly standing, walk- with prediabetes, to receive either metformin (850
ing and doing some light physical activity. Avoided mg twice a day) or lifestyle intervention or placebo
extended sedentary periods may help prevent T2DM and measured the incidence of T2DM after an aver-
for those at risk and aid in achieving better glycaemic age follow-up period of 2.8 years. The lifestyle inter-
control for those with diabetes. vention targeted a weight loss of at least 7% of body
The RSSDI recommends moderate physical activity weight and physical activity of at least 150 minutes /
such as walking for at least 150 minutes/ week. The week. Lifestyle intervention reduced the incidence of
RSSDI also recommends 6-8 hours of sleep daily. diabetes by about 58% and metformin reduced the
incidence by about 31%, when compared to placebo.
In a systematic review and meta-analysis by Ump- The lifestyle intervention in DPP was a ‘goal-based
ierre and co-researchers, structured exercise training intervention’, that is, all participants were given the
reduced HbA1c by about 0.67% in those with diabetes same goals in weight reduction and physical activity.
when compared to controls.Structured aerobic exer- But individualization of the methods to achieve these

cises, resistance training and both combined reduced goals was permitted for each participant. An individu-
HbA1c by 0.73%, 0.57% and 0.51% respectively. Struc- alized approach rather than a group-based approach
tured exercise durations of > 150 minutes per week was used in the DPP.
were associated with HbA1c reduction of 0.89% while
those of ≤ 150 minutes per week were associated with The Finnish DPS studied participants with IGT and
reductions by 0.36%. As decrease in HbA1c level is divided them into two groups- the intervention group

associated with long-term reduction in microvascu- and the control group. The subjects in the interven-
lar complications and CV events, long-term exercise tion group received individualized counseling on diet,
regimens that help to improve glycaemic control are physical activity and weight reduction. The mean du-
likely to bring down the vascular complications. Phys- ration of follow-up was 3.2 years. The risk of T2DM

ical activity advice (i.e., advice to patients to increase was found be reduced by 58% in the intervention

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