Supervised vs. self-selected physical activity for individuals with diabetes and obesity: the Lifestyle Gym program.

Abstract

The effectiveness of different programs of physical activity outside randomized studies is difficult to determine. We carried out an audit in two different units where either a supervised physical activity (PA) program or a self-selected PA program was in use in individuals with type 2 diabetes or obesity. The supervised PA cohort (n=101) received progressive gym training (120min, twice a week for 13weeks) by a dedicated team, with nutritional counseling during resting periods. The self-selected PA cohort (n=69) was enrolled in a 13-week cognitive-behavioral program (120min/week, in groups of 12-15 individuals), chaired by an expert team. Body weight and physical fitness (6-min walk test) were measured at baseline and after 6 and 12months. Outcome measures were attrition, weight loss≥10% initial body weight, 10% increase in 6-min walk test; their association with a PA program was tested by logistic regression analysis. Attrition rate was lower in the supervised PA group (28 vs. 45% than in the self-selected cohort, P=0.023). After adjustment for confounders, the supervised PA program was associated with a lower risk of attrition at 1year (odds ratio 0.45; 95% confidence interval, 0.21-0.98) at logistic regression analysis. Body weight similarly decreased in both groups (more rapidly in the supervised PA cohort); also physical fitness improved in a similar way, and no differences in achieved targets of body weight (supervised, 31%; self-selected, 18%; P=0.118) or fitness (supervised, 62%; self-selected, 49%; P=0.312) were demonstrated. Different PA programs produce very similar health benefits, but an initially supervised program has lower attrition rates, which might translate into better outcomes in the long term.