Resistance and aerobic exercise among adults with diabetes in the U.S.

Diabetes affects muscle and bone health and is characterized by osteoporosis and reduced bone quality (1). Resistance training improves insulin sensitivity, HbA1c, lipid profile, blood pressure, bone development, physical performance, and quality of life (2,3), and serves as a promising intervention for diabetes management. Indeed, the American Diabetes Association (ADA) has published specific guidelines on resistance exercise for adultswith diabetes that exceed those for the general public (4). To ascertain adherence to guidelines for resistance training and aerobic exercise, we examined the proportionof diabetic Americans who meet these guidelines. We used the 2011 administration of the Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC). In this large, anonymous telephone survey, respondents reported, during the past month, 1) the frequency and duration of the two leisure-time aerobic activities on which they spent the most time and 2) the frequency of physical activities or exercises to strengthen their muscles (excluding aerobic activities but including yoga, sit-ups, push-ups, and exercises using weights or elastic bands). The CDC classifies aerobic activities as moderate or vigorous based upon their estimated metabolic equivalents and respondents’ aerobic capacity (5). We considered respondents who reported $150 min of moderate intensity or $90 min of vigorous intensity aerobic physical activity per week as meeting ADA aerobic guidelines and those who reported resistance training$3 times/week asmeeting ADA resistance guidelines (4). In 40 U.S. states and the District of Columbia (DC) (excluding Colorado, Idaho, Illinois, Maryland, Mississippi, New York, South Dakota, Vermont, Virginia, and Washington), the BRFSS also incorporated an additional series of questions for respondents with self-reported diabetes, including age at diagnosis, insulin use, home blood glucose testing, physician visits, complications, and other diabetesrelated behaviors. Throughout, we incorporated poststratification weights to appropriately represent the U.S. population, which we analyzed with logistic regression. Among 497,967 respondents nationwide, 55,234 reported a diagnosis of diabetes, corresponding to a weighted prevalence of 9.8% (95% CI 9.6–9.9). Among those with diabetes, 41.1% (40.2–41.9) met ADA aerobic exercise guidelines, compared with 51.5% (51.2–51.8) in the general U.S. adult population (odds ratio [OR] 0.63; 95% CI 0.60–0.65; P , 0.001). However, only 12.4% (11.9–13.0)met ADA resistance exercise guidelines, compared with 21.0% (20.8–21.3) in the general population (OR 0.51; 95% CI 0.48–0.53; P , 0.001). Table 1 reportsweighted proportions and ORs of diabetic Americans meeting aerobic and resistance exercise guidelines by selected characteristics that were significant predictors of adjusted prevalence, including sex (P, 0.001 for both), age (P5 0.05 for aerobic; P5 0.003 for resistance), race/ethnicity (P5 0.006 for both), education level (P , 0.001 for both), BMI (P , 0.001 for both), and U.S. census region (P , 0.001 for aerobic; P 5 0.01 for resistance). Among 36,622 respondents with diabetes in 40 states and DC, significant predictors of meeting resistance exercise guidelines included previous education in diabetes management (adjusted OR 1.33; 95% CI 1.13–1.57; P 5 0.001), insulin use (adjusted OR for noninsulin users 1.30; 95% CI 1.05– 1.59; P 5 0.01), and frequency of home blood glucose testing (e.g., adjustedOR for $3 times a day vs. never 1.62; 95% CI 1.18–2.23;P50.003). Yearswithdiabetes, retinopathy, and frequency of clinical examinations and HbA1c testing were not related to resistance exercise. In summary, only 12% of U.S. adults with diabetes meet ADA resistance exercise guidelines, lower than the 21% in the general public and the 41% who meet aerobic exercise guidelines. In addition, adherence to resistance exercise guidelines is low across a broad range of different demographic subgroups. This represents an enormous opportunity