Methods to Quantify EE and Physical Fitness in Type 2 Diabetes Mellitus

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Levels of voluntary physical activity can be assessed using questionnaires. A series of validated questionnaires has been reviewed by Kirska and Caspersen [39]. The Diabetes Prevention Program [9] and our study [12] used the Modifiable Activity Questionnaire [39]. Energy expenditure was calculated as the product of the duration (hours x week) of the different activities weighted by an estimate of metabolic equivalent (MET) of each activity. The major limitations of calculating EE through questionnaires are: (1) it is not possible to rule out that some patients might over report their amount of physical activity; (2) not all patients are willing to compile a diary; (3) to convert the questionnaires filled by patients into METs is time consuming. The recent availability of wearable body monitoring devices might overcome these drawbacks and offers a direct measurement of "free-living" activity more feasible and accurate than previous methods. One such device, the SenseWear ArmBand (BodyMedia, Inc.), has been validated in normal subjects in the resting state [40] and during exercise [41], and in a small group of type 2 diabetes mellitus subjects [42] as a measure of daily physical activity. The Sense Wear Armband is a multisensor piece of equipment, worn on the triceps of the right arm for up to 2 weeks continuously, that uses physiological body signals from five sensors (skin temperature, near body temperature/heat flux, galvanic skin resistance, two accelerom-eters) in combination with free-living activity recognition patterns to calculate energy consumption based on specific algorithms.

The results of SenseWear ArmBand were compared to the doubly labeled water (DLW) technique over a period of 10 days in six diabetic patients treated with diet only and/or oral hypoglycemic agents [42]. The results of this preliminary study are promising because it demonstrated that the correlation between the armband and DLW reached r= 0.9696 (P=0.0014) and the authors hypothesized a narrow limit of agreement (±100-300kcal/day) between the two methods. From a practical point the Sense Wear ArmBand might be used in subjects affected by the metabolic syndrome to gain information about: (1) the basal metabolic rate of patients (average EE during resting hours); (2) EE consumed through spontaneous, moderate, or high intensity physical activity (setting different ranges of METs); (3) the status of physical fitness by recording the peak of METs achieved during high intensity physical activity; (4) the hours and the quality of sleep (constant or intermittent); (5) the accuracy of a physical activity diary report. Furthermore, the report of ArmBand can be used to discuss with the patient whether the targets of physical activity were achieved and to plan together the next steps to reach, in order to increase long-term compliance to regular activity. Accurate recording of EE is useful for a rationale individualization of long-term weight-loss programs. Knowledge of caloric consumption allows small but reliable reductions in the amount of daily caloric intake as a deficit of only 200-300 Kcal. On a long-term basis, such caloric shortage is better accepted by patients and combined with physical activity would result in a progressive and selective loss of fat mass, sparing lean body mass, and basal metabolic rate.

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