Exercise Prescription Principles among Physicians and Physical Therapists for Patients with Impaired Glucose Control: A Cross-Sectional Study

Abstract

Exercise confers a multitude of benefits with limited adverse side effects, making it a powerful "medication" for a plethora of diseases. In people living with uncontrolled glucose levels, exercise can be an effective "medication" to assist in the management of hyperglycemia. We sought to survey healthcare providers (physicians and physical therapists) to determine the current state of exercise recommendation for people with glucose control issues. Healthcare providers were surveyed from six academic medical centers in the Midwest to determine the recommended exercise parameters (type, frequency, duration, intensity, and timing) for patients with glucose control issues. Data from 209 practitioners who completed the survey were used for analysis. Chi-square tests were used to determine differences in exercise recommendations between physical therapists (PTs) and physicians (MD/DOs). PTs and MD/DOs recommended similar exercise parameters. Of all respondents, 78.9% recommended exercise to patients with glucose control issues. Respondents who considered themselves to be active exercisers were more likely to recommend exercise than those who were not exercisers. Only 6.1% of all respondents recommended post-meal exercise. Healthcare providers overwhelmingly recommended exercise for people with glucose control issues, but the "timing" is not congruent with best practice recommendations.

Keywords: clinical practice; diabetes; exercise; glucose; recommendation.

Figure 1

Exercise Advice and Exercise Status. The percentage of surveyed healthcare practitioners who offer exercise-related advice (A) and those who consider themselves to be active exercisers (B). The percentage of healthcare providers grouped by their exercise advice and personal exercise status (C). Exerciser and prescriber: those who recommend exercise for people with glucose control issues and who consider themselves to be active exercisers. Exerciser and non-prescriber: those who do not recommend exercise for people with glucose control issues and who consider themselves to be active exercisers. Non-exerciser and prescriber: those who recommend exercise for people with glucose control issues and who do not consider themselves to be active exercisers. Non-exerciser and non-prescriber: those who do not recommend exercise for people with glucose control issues and who do not consider themselves to be active exercisers. The percentage of healthcare providers who offer exercise-related advice for people with glucose control issues based on their personal exercise status (D). Physicians (MD/DO); physical therapists (PT); combination of the two (Total). * Indicates a significant (p < 0.05) difference between healthcare providers who consider themselves to be active exercisers and those who do not consider themselves to be active exercisers.

Figure 2

Exercise Type, Frequency, Duration, and Intensity. The type (A), frequency (B), duration (C), and intensity (D) of exercise recommended by healthcare providers for patients with glucose control issues. Physicians (MD/DO), physical therapists (PT), and combination of the two (Total). * Indicates a significant (p < 0.05) difference between MD/DO and PT.

Figure 3

Exercise Timing. The time of day to exercise (A) and the timing of exercise relative to meals (B) recommended by healthcare providers who offer exercise-related advice for patients with glucose control issues. Physicians (MD/DO), physical therapists (PT), and combination of the two (Total).

Figure 4

Exercise Referrals. Healthcare providers’ referral practices (A) and exercise specialists to whom they refer patients with glucose control issues (B). Physicians (MD/DO), physical therapists (PT), and the combination of the two (Total). * Indicates a significant (p < 0.05) difference between MD/DO and PT.