title: Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income Latinos Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults. Impact of Using a Pedometer on Time Spent Walking in Older Adults With Type 2 Diabetes A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity. Testing mediator variables in a resistance training intervention for obese adults with type 2 diabetes Randomized controlled community-based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. Effects of long-term resistive training on mobility and strength in older adults with diabetes. Community based yoga classes for type 2 diabetes: an exploratory randomised controlled trial The effects of a supplemental, theory-based physical activity counseling intervention for adults with type 2 diabetes. Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes Multicomponent, home-based resistance training for obese adults with type 2 diabetes: a randomized controlled trial Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial Sitting time and all-cause mortality risk in 222 497 Australian adults. Fall and Balance Outcomes After an Intervention to Promote Leg Strength, Balance, and Walking in People With Diabetic Peripheral Neuropathy: “Feet First” Randomized Controlled Trial A preliminary report on an assessment of a community-based intervention for diabetes control in adults with type 2 diabetes. Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES). Impact of Physical Therapist–Directed Exercise Counseling Combined With Fitness Center–Based Exercise Training on Muscular Strength and Exercise Capacity in People With Type 2 Diabetes: A Randomized Clinical Trial The Alberta Diabetes and Physical Activity Trial (ADAPT):A Randomized Trial Evaluating Theory-Based Interventions to Increase Physical Activity in Adults with Type 2 Diabetes
abstract: OBJECTIVE To test whether a theory-based , literacy , and culturally tailored self-management intervention , Latinos en Control  , improves glycemic control among low-income Latinos with type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 252 patients recruited from community health centers were r and omized to the  Latinos en Control intervention or to usual care . The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge , attitudes , and self-management behaviors . The primary outcome was HbA1c . Secondary outcomes included diet , physical activity , blood glucose self-monitoring , diabetes knowledge and self-efficacy , and other physiological factors ( e.g. , lipids , blood pressure , and weight ) . Measures were collected at baseline and at 4- and 12-month follow-up . Change in outcomes over time between the groups and the association between HbA1c and possible mediators were estimated using mixed-effects models and an intention-to-treat approach . RESULTS A significant difference in HbA1c change between the groups was observed at 4 months ( intervention −0.88 [ −1.15 to −0.60 ] versus control −0.35 [ −0.62 to 0.07 ] , P < 0.01 ) , although this difference decreased and lost statistical significance at 12 months ( intervention −0.46 [ −0.77 to −0.13 ] versus control −0.20 [ −0.53 to 0.13 ] , P = 0.293 ) . The intervention result ed in significant change differences in diabetes knowledge at 12 months ( P = 0.001 ) , self-efficacy ( P = 0.001 ) , blood glucose self-monitoring ( P = 0.02 ) , and diet , including dietary quality ( P = 0.01 ) , kilocalories consumed ( P < 0.001 ) , percentage of fat ( P = 0.003 ) , and percentage of saturated fat ( P = 0.04 ) . These changes were in turn significantly associated with HbA1c change at 12 months . CONCLUSIONS Literacy-sensitive , culturally tailored interventions can improve diabetes control among low-income Latinos ; however , strategies to sustain improvements are needed OBJECTIVES We sought to determine the effects of a community-based , culturally tailored diabetes lifestyle intervention on risk factors for diabetes complications among African Americans and Latinos with type 2 diabetes . METHODS One hundred fifty-one African American and Latino adults with diabetes were recruited from 3 health care systems in Detroit , Michigan , to participate in the Racial and Ethnic Approaches to Community Health ( REACH ) Detroit Partnership  diabetes lifestyle intervention . The curriculum , delivered by trained community residents , was aim ed at improving dietary , physical activity , and diabetes self-care behaviors . Baseline and postintervention levels of diabetes-specific quality -of-life , diet , physical activity , self-care knowledge and behaviors , and hemoglobin A1C were assessed . RESULTS There were statistically significant improvements in postintervention dietary knowledge and behaviors and physical activity knowledge . A statistically significant improvement in A1C level was achieved among REACH Detroit program participants ( P<.0001 ) compared with a group of patients with diabetes in the same health care system in which no significant changes were observed ( P=.160 ) . CONCLUSIONS A culturally tailored diabetes lifestyle intervention delivered by trained community residents produced significant improvement in dietary and diabetes self-care related knowledge and behaviors as well as important metabolic improvements Purpose : The purpose of this study was to investigate the impact of using a pedometer on time spent walking , in sedentary and overweight adults with type 2 diabetes participating in a coaching intervention . It was hypothesized that participants using a pedometer would spend more time walking than would nonpedometer participants . Method : A sample of 57 men and women with a mean age of 62 years participated in a r and omized controlled trial in a community setting . Participants were allocated to either a pedometer and coaching ( intervention ) group or a coaching-only ( control ) group . Coaching for both groups involved education , goal setting , and supportive/motivational strategies to increase  time spent walking .  The duration of the study was 6 months , with blood pressure , glycosylated hemoglobin , anthropometric , and fitness measurements assessed at baseline and at 3-month intervals . Results : A repeated- measures analysis of variance indicated that the coaching-only group spent significantly more time walking than did the pedometer group . However , when an analysis of covariance with all the other variables as covariates was performed , group membership had no influence on time spent walking . Significant reductions in waist circumference and weight were achieved for both groups from baseline to 6 months . Cardiovascular fitness also increased significantly for both groups . Conclusion : The study demonstrated that previously sedentary older adults with type 2 diabetes , supported with a coaching intervention , were able to achieve the physical activity targets known to be beneficial to health . However , using a pedometer added no further benefit . Further research on the impact of specific coaching strategies in diabetes management is warranted OBJECTIVE To determine whether a culturally appropriate clinic- and community-based intervention for African-American women with type 2 diabetes will increase  moderate-intensity physical activity ( PA ) . RESEARCH DESIGN AND METHODS In this r and omized controlled trial conducted at seven practice s in central North Carolina , 200 African-American women , > or = 40 years of age with type 2 diabetes , were r and omized to one of three treatment conditions : clinic and community ( group A ) , clinic only ( group B ) , or minimal intervention ( group C ) . The clinic-based intervention ( groups A and B ) consisted of four monthly visits with a nutritionist who provided counseling to enhance PA and dietary intake that was tailored to baseline practice s and attitudes ; the community-based intervention ( group A ) consisted of three group sessions and 12 monthly phone calls from a peer counselor and was design ed to provide social support and reinforce behavior change goals ; and the minimal intervention ( group C ) consisted of educational pamphlets mailed to participants . The primary study outcome was the comparison of PA levels between groups assessed at 6 and 12 months by accelerometer , which was worn while awake for 7 days . RESULTS Totals of 175 ( 88 % ) and 167 ( 84 % ) participants completed PA assessment at 6 and 12 months , respectively . For comparison of PA , the P value for overall group effect was 0.014 . Comparing group A with C , the difference in the average adjusted mean for PA was 44.1 kcal/day ( 95 % CI 13.1 - 75.1 , P = 0.0055 ) . Comparing group B with C , the difference in the average adjusted mean was 33.1 kcal/day ( 95 % CI 3.3 - 62.8 , P = 0.029 ) . The intervention was acceptable to participants : 88 % were very satisfied with clinic-based counseling to enhance PA , and 86 % indicated that the peer counselor 's role in the program was important . CONCLUSIONS The intervention was associated with a modest enhancement of PA and was acceptable to participants A poor underst and ing of behaviour change mechanisms has hindered the development of effective physical activity interventions . The aim of this study was to identify potential mediators of change in a home-based resistance training ( RT ) program for obese individuals with type 2 diabetes . Obese individuals with type 2 diabetes ( N = 48 ) were r and omly allocated to either an RT intervention ( n = 27 ) or a control group ( n = 21 ) for the 16-week study period . The study sample included 16 men and 32 women and the mean age of participants was 54.4 ( ±11.7 ) years . Participants in the RT group received a multi-gym and dumbbells and home supervision from a certified personal trainer . RT behaviour was measured using a modified Godin Leisure Time Question naire . Social-cognitive constructs were measured and tested in a mediating variable framework using a product-of-coefficients test . The intervention had a significant effect on RT behaviour ( p < 0.001 ) and muscular strength ( p < 0.001 ) . The intervention had a significant effect on RT planning strategies ( p < 0.01 ) , which mediated the effect of the intervention on RT behaviour . The home-based RT program successfully targeted participants ’ RT planning strategies which contributed to their exercise adherence OBJECTIVE The prevalence of type 2 diabetes , especially in developing countries , has grown over the past decades . We performed a controlled clinical study to determine whether a community-based , group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica . RESEARCH DESIGN AND METHODS A total of 75 adults with type 2 diabetes , mean age 59 years , were r and omly assigned to the intervention group or the control group . All participants received basic diabetes education . The subjects in the intervention group participated in 11 weekly nutrition classes ( 90 min each session ) . Subjects for whom exercise was deemed safe also participated in triweekly walking groups ( 60 min each session ) . Glycosylated hemoglobin , fasting plasma glucose , total cholesterol , triglycerides , HDL and LDL cholesterol , height , weight , BMI , and blood pressure were measured at baseline and the end of the study ( after 12 weeks ) . RESULTS The intervention group lost 1.0 + /- 2.2 kg compared with a weight gain in the control group of 0.4 + /- 2.3 kg ( P = 0.028 ) . Fasting plasma glucose decreased 19 + /- 55 mg/dl in the intervention group and increased 16 + /- 78 mg/dl in the control group ( P = 0.048 ) . Glycosylated hemoglobin decreased 1.8 + /- 2.3 % in the intervention group and 0.4 + /- 2.3 % in the control group ( P = 0.028 ) . CONCLUSIONS Glycemic control of type 2 diabetic patients can be improved through community-based , group-centered public health interventions addressing nutrition and exercise . This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes BACKGROUND Strength training has been shown to be beneficial in older adults . However , very little data exist on the effects of strength training in older diabetics . METHODS 31 community-dwelling older adults with diabetes ( mean age = 66.1 years ) were r and omly assigned to either an exercise ( EX ) or control ( CO ) group . The EX group trained the plantar flexors , knee extensors , knee flexors , hip extensors , and hip flexors muscle groups at 50 % , 60 % , and 70 % of 1-repetition maximum , 2.6 days a week , for 24 months . Mobility tests included the timed up and go , 50-foot walk , and walking up and down 8 stairs . Strength and mobility for both groups were evaluated at 6-month intervals . RESULTS There was a group and time effect as the EX group increased 31.4 % ( p < .001 ) in strength for all muscle groups after the first 6 months of training , and the strength gains were retained for the duration of the training intervention . There was also a group and time effect for mobility as performance increased 8.6 % and 9.8 % ( p = .032 and p = 0.031 ) for the first 6 and 12 months , respectively , but decreased to 4.6 % above baseline at the end of the intervention . There were essentially no changes from baseline strength or mobility values for the CO group . CONCLUSION In conclusion , these data suggest that a moderate-intensity resistive-training program can improve mobility and strength for the duration of a 24-month intervention in older adults with diabetes , thus potentially reducing the rate of mobility loss during aging Background Yoga is a popular therapy for diabetes but its efficacy is contested . The aim of this study was to explore the feasibility of research ing community based yoga classes in Type 2 diabetes with a view to informing the design of a definitive , multi-centre trial Methods The study design was an exploratory r and omised controlled trial with in-depth process evaluation . The setting was two multi-ethnic boroughs in London , UK ; one with average and one with low mean socio-economic deprivation score . Classes were held at a sports centre or GP surgery . Participants were 59 people with Type 2 diabetes not taking insulin , recruited from general practice lists or opportunistically by general practice staff . The intervention group were offered 12 weeks of a twice-weekly 90-minute yoga class ; the control group was a waiting list for the yoga classes . Both groups received advice and leaflets on healthy lifestyle and were encouraged to exercise . Primary outcome measure was HbA1c . Secondary outcome measures included attendance , weight , waist circumference , lipid levels , blood pressure , UKPDS cardiovascular risk score , diabetes-related quality of life ( ADDQoL ) , and self-efficacy . Process measures were attendance at yoga sessions , self-reported frequency of practice between taught sessions , and qualitative data ( interviews with patients and therapists , ethnographic observation of the yoga classes , and analysis of documents including minutes of meetings , correspondence , and exercise plans ) . Results Despite broad inclusion criteria , around two-thirds of the patients on GP diabetic registers proved ineligible , and 90 % of the remainder declined to participate . Mean age of participants was 60 + /- 10 years .  Attendance at yoga classes was around 50 % . Nobody did the exercises regularly at home . Yoga teachers felt that most participants were unsuitable for ' st and ard ' yoga exercises because of limited flexibility , lack of basic fitness , co-morbidity , and lack of confidence . There was a small fall in HbA1c in the yoga group which was not statistically significant and which was not sustained six months later , and no significant change in other outcome measures . Conclusion The benefits of yoga in type 2 diabetes suggested in some previous studies were not confirmed . Possible explanations ( apart from lack of efficacy ) include recruitment challenges ; practical and motivational barriers to class attendance ; physical and motivational barriers to engaging in the exercises ; inadequate intensity and /or duration of yoga intervention ; and insufficient personalisation of exercises to individual needs . All these factors should be considered when design ing future trials . Trial registration National Research Register ( 1410 ) and Current Controlled Trials ( IS RCT N63637211 ) BACKGROUND Physical activity ( PA ) is a cornerstone in the management of type 2 diabetes ( T2DM ) . This pilot investigation explores the effects of a st and ard diabetes education program compared with a supplemental PA intervention on diabetes-related health outcomes . METHODS Using a prospect i ve 2-armed design , 96 adults with T2DM were r and omly assigned to either st and ard care ( diabetes education program ; n = 49 ) or st and ard care supplemented with an 8-week , individualized-counseling and community-based PA component ( n = 47 ) . Measurements were taken at baseline , 3 , 6 , and 12 months . Primary outcomes were changes in PA ( self-report ) and HbA1c . Between group changes were compared using analysis of covariance ( ANCOVA ) and changes over time using repeated- measures ANOVA . RESULTS In comparison with st and ard care , the supplemental group demonstrated an increase in PA ( Ps < 0.01 ) and cardiorespiratory fitness ( Ps < 0.05 ) from baseline to all follow-up time-points . HbA1c levels declined ( P < .05 ) from baseline to all time points in the st and ard care group . Reduction in cholesterol-ratio ( P < .01 ) , increase in HDL ( P < .05 ) , and reductions in blood pressure , resting heart rate and BMI ( approaching statistical significance Ps < 0.10 ) were also reported for both groups . CONCLUSIONS PA counseling in addition to st and ard care is effective for promoting PA behavior change and positive health-related outcomes among individuals with T2DM Hispanics are at increased risk of morbidity and mortality due to their high prevalence of diabetes and poor glycemic control . Strength training is the most effective lifestyle intervention to increase muscle mass but limited data is available in older adults with diabetes . We determined the influence of strength training on muscle quality ( strength per unit of muscle mass ) , skeletal muscle fiber hypertrophy , and metabolic control including insulin resistance ( Homeostasis Model Assessment –HOMA-IR ) , C-Reactive Protein ( CRP ) , adiponectin and Free Fatty Acid ( FFA ) levels in Hispanic older adults . Sixty-two community-dwelling Hispanics ( > 55 y ) with type 2 diabetes were r and omized to 16 weeks of strength training plus st and ard care ( ST group ) or st and ard care alone ( CON group ) . Skeletal muscle biopsies and biochemical measures were taken at baseline and 16 weeks . The ST group show improved muscle quality ( mean±SE : 28±3 ) vs CON ( -4±2 , p<0.001 ) and increased type I ( 860±252µm2 ) and type II fiber cross-sectional area ( 720±285µm2 ) compared to CON ( type I : -164±290µm2 , p=0.04 ; and type II : -130±336µm2 , p=0.04 ) . This was accompanied by reduced insulin resistance [ ST : median ( interquartile range ) -0.7(3.6 ) vs CON : 0.8(3.8 ) , p=0.05 ] ; FFA ( ST : -84±30µmol/L vs CON : 149±48µmol/L , p=0.02 ) ; and CRP [ ST : -1.3(2.9)mg/L vs CON : 0.4(2.3)mg/L , p=0.05 ] . Serum adiponectin increased with ST [ 1.0(1.8)µg/mL ] compared to CON [ -1.2(2.2)µg/mL , p<0.001  ] . Strength training improved muscle quality and whole-body insulin sensitivity . Decreased inflammation and increased adiponectin levels were related with improved metabolic control . Further studies are needed to underst and the mechanisms associated with these findings . However , these data show that strength training is an exercise modality to consider as an adjunct of st and ard of care in high risk population s with type 2 diabetes Purpose : To investigate whether a home-based resistance training ( RT ) program that supplied high- quality equipment and qualified exercise specialists could provide benefits to obese patients with type 2 diabetes . Methods : A total of 48 obese individuals with type 2 diabetes were r and omly assigned to either an RT ( n=27 ) or a control group ( n=21 ) . Those in the RT group received a multigym and dumbbells and performed RT 3 days per week for 16 weeks at home . A qualified exercise specialist supervised training , with supervision being gradually decreased throughout the study . Primary outcome measures included strength and hemoglobin-A1C , whereas secondary outcome measures included other cardiovascular risk markers , key social-cognitive constructs and health-related quality of life . Results : Intention-to-treat analyses indicated a significant increase in upper and lower body strength for the RT group compared with controls ( 20–37 % mean increases in the RT group ) . No significant reduction in A1C levels was observed . The RT group had unchanged high-density lipoprotein cholesterol levels in comparison to declines in the control group . Significant reductions in fasting insulin , and increases in RT-related self-efficacy and intentions , were also observed in the RT group . Conclusions : Supervised home-based RT with high- quality equipment was effective for improving strength , along with other secondary outcomes in obese patients with type 2 diabetes Objective To evaluate the effectiveness of a structured group education programme on biomedical , psychosocial , and lifestyle measures in people with newly diagnosed type 2 diabetes . Design Multicentre cluster r and omised controlled trial in primary care with r and omisation at practice level . Setting 207 general practice s in 13 primary care sites in the United Kingdom . Participants 824 adults ( 55 % men , mean age 59.5 years ) . Intervention A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care . Main outcome measures Haemoglobin A1c levels , blood pressure , weight , blood lipid levels , smoking status , physical activity , quality of life , beliefs about illness , depression , and emotional impact of diabetes at baseline and up to 12 months . Main results Haemoglobin A1c levels at 12 months had decreased by 1.49 % in the intervention group compared with 1.21 % in the control group . After adjusting for baseline and cluster , the difference was not significant : 0.05 % ( 95 % confidence interval −0.10 % to 0.20 % ) . The intervention group showed a greater weight loss : −2.98 kg ( 95 % confidence interval −3.54 to −2.41 ) compared with 1.86 kg ( −2.44 to −1.28 ) , P=0.027 at 12 months . The odds of not smoking were 3.56 ( 95 % confidence interval 1.11 to 11.45 ) , P=0.033 higher in the intervention group at 12 months . The intervention group showed significantly greater changes in illness belief scores ( P=0.001 ) ; directions of change were positive indicating greater underst and ing of diabetes . The intervention group had a lower depression score at 12 months : mean difference was −0.50 ( 95 % confidence interval −0.96 to −0.04 ) ; P=0.032 . A positive association was found between change in perceived personal responsibility and weight loss at 12 months ( β=0.12 ; P=0.008 ) . Conclusion A structured group education programme for patients with newly diagnosed type 2 diabetes result ed in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A1c levels up to 12 months after diagnosis . Trial registration Current Controlled Trials IS RCT N17844016 BACKGROUND Prolonged sitting is considered detrimental to health , but evidence regarding the independent relationship of total sitting time with all-cause mortality is limited . This study aim ed to determine the independent relationship of sitting time with all-cause mortality . METHODS We linked prospect i ve question naire data from 222 497 individuals 45 years or older from the 45 and Up Study to mortality data from the New South Wales Registry of Births , Deaths , and Marriages ( Australia ) from February 1 , 2006 , through December 31 , 2010 . Cox proportional hazards models examined all-cause mortality in relation to sitting time , adjusting for potential confounders that included sex , age , education , urban/rural residence , physical activity , body mass index , smoking status , self-rated health , and disability . RESULTS During 621 695 person-years of follow-up ( mean follow-up , 2.8 years ) , 5405 deaths were registered . All-cause mortality hazard ratios were 1.02 ( 95 % CI , 0.95 - 1.09 ) , 1.15 ( 1.06 - 1.25 ) , and 1.40 ( 1.27 - 1.55 ) for 4 to less than 8 , 8 to less than 11 , and 11 or more h/d of sitting , respectively , compared with less than 4 h/d , adjusting for physical activity and other confounders . The population -attributable fraction for sitting was 6.9 % . The association between sitting and all-cause mortality appeared consistent across the sexes , age groups , body mass index categories , and physical activity levels and across healthy participants compared with participants with preexisting cardiovascular disease or diabetes mellitus . CONCLUSIONS Prolonged sitting is a risk factor for all-cause mortality , independent of physical activity . Public health programs should focus on reducing sitting time in addition to increasing physical activity levels Background Weight-bearing exercise has been discouraged for people with diabetes mellitus and peripheral neuropathy ( DM+PN ) . However , people with diabetes mellitus and insensate feet have an increased risk of falling .  Lower-extremity exercise and balance training reduce fall risk in some older adults . It is unknown whether those with neuropathy experience similar benefits . Objective As part of a study of the effects of weight-bearing exercise on foot ulceration in people with DM+PN , the effects of a lower-extremity exercise and walking intervention on balance , lower-extremity strength ( force-generating capacity ) , and fall incidence were determined . Design The study was an observer-masked , 12-month r and omized controlled trial . Setting Part 1 of the intervention took place in physical therapy offices , and part 2 took place in the community . Patients The participants were 79 people who were mostly sedentary , who had DM+PN , and who were r and omly assigned to either a  control group  ( n=38 ) or an intervention group ( n=41 ) . Intervention Part 1 included leg strengthening and balance exercises and a graduated , self-monitored walking program ; part 2 included motivational telephone calls . Both groups received regular foot care , foot care education , and 8 sessions with a physical therapist . Measurements The measurements collected were strength , balance , and participant-reported falls for the year after enrollment . Results There were no statistically significant differences between the groups for falls during follow-up . At 12 months , there was a small increase in the amount of time that participants in the intervention group could st and on 1 leg with their eyes closed . No other strength or balance measurements differed between the groups . Limitations The study was design ed to detect differences in physical activity , not falls . The intensity of the intervention was insufficient to improve strength and balance in this population . Conclusions The training program had a minimal effect on  participants  ' balance and lower-extremity strength . Increasing weight-bearing activity did not alter the rate of falling for participants in the intervention group relative to that for participants in the control group . People who are sedentary and who have DM+PN appear to be able to increase activity without increasing their rate of falling OBJECTIVE The aim of this study was to evaluate the effectiveness of lay diabetes facilitators ( LDFs ) to increase knowledge and improve control among persons with diabetes . Methodology . A prospect i ve cohort study was conducted among persons with diabetes in 16 health care centres in Jamaica to evaluate the effect of LDFs on glycaemia [ haemoglobin A1c ( HbA1c ) ] and body mass index ( BMI ) .  One hundred and fifty-nine persons with diabetes were recruited for the intervention from eight clinical setting s in which LDFs had been recruited and trained . A matched group of 159 were recruited as a comparison sample from eight clinical setting s without LDFs .  HbA1c and BMI were measured at baseline and 6 months . RESULTS Mean HbA1c at baseline for the intervention and comparison groups were 7.9 % and 8 % , respectively . After 6 months , the intervention group showed a mean decrease of 0.6 % while the comparison group showed an increase of 0.6 % , significant after control for potential confounders ( P < 0.05 ) . There was no statistically significant change in BMI between groups . CONCLUSION Patients educated by LDFs showed improved metabolic control over the first 6 months of observation BACKGROUND This study aim ed to assess the efficacy of an intensive exercise intervention strategy in promoting physical activity ( PA ) and improving hemoglobin A(1c)(HbA(1c ) ) level and other modifiable cardiovascular risk factors in patients with type 2 diabetes mellitus ( T2DM ) . METHODS Of 691 eligible sedentary patients with T2DM and the metabolic syndrome , 606 were enrolled in 22 outpatient diabetes clinics across Italy and r and omized by center , age , and diabetes treatment to twice-a-week supervised aerobic and resistance training plus structured exercise counseling ( exercise group ) vs counseling alone ( control group )  for 12 months . End points included HbA(1c ) level ( primary ) and other cardiovascular risk factors and coronary heart disease risk scores ( secondary ) . RESULTS The mean ( SD ) volume of PA ( metabolic equivalent hours per week ) was significantly higher ( P < .001 ) in the exercise ( total PA [ nonsupervised conditioning PA + supervised PA ] , 20.0 [ 0.9 ] , and nonsupervised , 12.4 [ 7.4 ] ) vs control ( 10.0 [ 8.7 ] ) group . Compared with the control group , supervised exercise produced significant improvements ( mean difference [ 95 % confidence interval ] ) in physical fitness ; HbA(1c ) level ( -0.30 % [ -0.49 % to -0.10 % ] ; P < .001 ) ; systolic ( -4.2 mm Hg [ -6.9 to -1.6 mm Hg ] ; P = .002 ) and diastolic ( -1.7 mm Hg [ -3.3 to -1.1 mm Hg ] ; P = .03 ) blood pressure ; high-density lipoprotein ( 3.7 mg/dL [ 2.2 to 5.3 mg/dL ] ; P < .001 ) and low-density lipoprotein ( -9.6 mg/dL [ -15.9 to -3.3 mg/dL ] ; P = .003 ) cholesterol level ; waist circumference ( -3.6 cm [ -4.4 to -2.9 cm ] ; P < .001 ) ; body mass index ; insulin resistance ; inflammation ; and risk scores . These parameters improved only marginally in controls . CONCLUSIONS This exercise intervention strategy was effective in promoting PA and improving HbA(1c ) and cardiovascular risk profile . Conversely , counseling alone , though successful in achieving the currently recommended amount of activity , was of limited efficacy on cardiovascular risk factors , suggesting the need for a larger volume of PA in these high-risk subjects . Trial Registration is rct n.org Identifier : IS RCT N04252749 Background : Assessing muscular strength ( force-generating capacity ) and exercise capacity in response to an intervention for people with type 2 diabetes is clinical ly important in the prevention of type 2 diabetes-related complications . Objective : The purpose of this study was to investigate the impact of physical therapist – directed exercise counseling combined with fitness center – based exercise training on muscular strength and exercise capacity in people with type 2 diabetes . Design : This study was a r and omized clinical trial . Setting : The study was conducted on a university campus , with patient recruitment from the local community . Patients : Twenty-four people with type 2 diabetes were r and omly allocated to either a group that received physical therapist – directed exercise counseling plus fitness center – based exercise training ( experimental group ) or a group that received laboratory-based , supervised exercise ( comparison group ) . Intervention : The experimental group received physical therapist – directed exercise counseling on an exercise program and was provided access to a fitness center . The comparison group received the same exercise program as the experimental group while under supervision . Measurements : For all participants , chest press , row , and leg press muscular strength ( 1-repetition maximum [ in kilograms ] ) and exercise capacity ( grade d exercise test duration [ in minutes ] ) testing were conducted at baseline and 2 months later . Results : No significant differences in improvements in muscular strength were found for the chest press ( adjusted mean difference=1.2 ; 95 % confidence interval [CI]=−5.5 to 7.8 ) , row ( adjusted mean difference=0.1 ; 95 % CI=−9.0 to 9.1 ) , or leg press ( adjusted mean difference=2.7 ; 95 % CI=−9.1 to 14.6 ) between the groups . No significant difference in improvement in exercise capacity ( adjusted mean difference=0.2 ; 95 % CI=−0.9 to 1.2 ) was found between the groups . Limitations : Lack of group allocation blinding and the small sample size were limitations of this study . Conclusions : The results suggest that physical therapist – directed exercise counseling combined with fitness center – based exercise training can improve muscular strength and exercise capacity in people with type 2 diabetes , with outcomes comparable to those of supervised exercise Background Physical activity ( PA ) is associated with reduced morbidity and mortality in individuals with type 2 diabetes mellitus ( T2DM ) ; however , most T2DM adults are insufficiently active . Purpose To explore the effectiveness of two innovative/theoretically based behavioral-change strategies to increase PA and reduce hemoglobin A1c ( A1c ) in T2DM adults . Methods Participants ( n = 287 ) were r and omly assigned to a control group or an intervention group ( i.e. , print-based material s/pedometer group or print-based material s/pedometer plus telephone-counseling group ) . Changes in PA and A1c and other clinical measures were examined by Linear Mixed Model analyses over 18 months , along with moderating effects for gender and age . Results PA and A1c levels did not significantly change in intervention groups . Step counts significantly increased in the print-based material s and pedometer plus telephone counseling group , for women . Conclusions No significant effects were found for PA or A1c levels for T2DM adults . The multi-component strategy including telephone counseling may have potential for women . The trial was registered on Clinical Trials.gov identifier : NCT00221234
target: The findings demonstrate community-based PA interventions can be effective in producing increases in PA .
  Our findings can guide future PA community-based interventions  in adult population s diagnosed with TD2
background: Evidence suggests engaging in regular physical activity ( PA ) can have beneficial outcomes for adults with type 2 diabetes ( TD2 ) , including weight loss , reduction of medication usage and improvements in hemoglobin A1c (HbA1c)/fasting glucose .
  While a number of clinical -based PA interventions exist , community-based approaches are limited .