Physical Activity and HRQL in Diabetes

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The levels of physical activity of patients with various chronic diseases, including diabetes, hypertension, congestive heart failure, recent myocardial infarction, depressive symptoms, or current depressive disorder, are associated with subsequent functioning and well-being [37]. Greater levels of exercise were also associated with better functioning for patients with chronic conditions over a 2-year period. Physical activity has become an essential component of prevention and treatment of type 2 diabetes, and very recent recommendations of the American Diabetes Association classified as level of evidence "A" the benefits achieved by 30 min physical activity per day in subjects with impaired glucose tolerance or diabetes [38].

In both type 1 and type 2 diabetes mellitus, HRQL is remarkably impaired when tested with generic and disease-specific questionnaires [39], with type

1 diabetes having the greater negative effect [40]. In a large US sample of adults with diabetes, the respondents reported a moderate-to-low quality of life, and the factors associated with lower HRQL included lower levels of physical activity [41]. Multiple regression analyses revealed that the intensity of self-reported exercise was the only significant self-management behavior associated with HRQL, after controlling for demographic and medical variables. Also in subjects with diabetes complications, physical inactivity remains an independent predictor of poor HRQL [42].

Notably, diabetes patients undergoing intensive diabetes treatment do not face deterioration of their HRQL and psychopathology, assessed by generic and disease-related HRQL questionnaire. A questionnaire of general psychiatric distress (Symptom Checklist-90R [43]) in the Diabetes Control and Complications Trial [44] and intensive treatment for type I diabetes, coupled with education, are reported to improve HRQL [45]. The quality of life and the psychological well-being in patients with type 1 diabetes participating in an empowerment program improves significantly when compared with the scores measured in patients who refuse participation [45]. In particular, the Vitality and Social Functioning scales of SF-36 are no longer different from population norm after intensive education. Similarly, the Symptoms, Discomfort and Impact scales of the Well-Being Enquiry for Diabetics [46], reflecting physical functioning, diabetes-related worries and familiar relationships, role functioning and social network, improve significantly in treated patients. In this experience, the education program remarkably addressed the problems related to physical activity, favoring exercise without the risk of hypoglycemia.

When diet is coupled with exercise in a behavioral approach of a non-diabetic population at risk of type 2 diabetes, positive changes in lifestyle, blood lipids, and fasting insulin can be achieved and maintained after

2 years, and the results are better than diet alone [47].

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