Dr Trenell talks about the roles of physical activity and exercise in the prevention of Type 2 diabetes. The talk addresses some of the practical aspects of helping people to move more and sit less and how this could be used effectively in clinical care.

1. 1
Physical Activity and Exercise in
Type 2 Diabetes prevention;
why and how to use it in your clinic?
Mike Trenell
NIHR Senior Research Fellow & Director, MoveLab
MRC Centre for Brain Ageing & Vitality
NIHR Biomedical Research Centre for Ageing & Age Related Disease
Newcastle University.
E: michael.trenell@ncl.ac.uk W: www.MoveLab.org

2. Slide 1 of 13
2
What
Why
How

3. Slide 2 of 13
Mike Trenell MoveLab.org

4. Slide 3 of 13
The challenge
Physical Activity
CVD
Accelerated
NAFLD Ageing
Metabolic Type 2
Muscular
Deregulation dystrophy
Diabetes
Reduced Oxidative
Capacity?
Adapted from: Barabási AL.
N Engl J Med. 2007 26;357(4):404-7. Mike Trenell MoveLab.org

5. Slide 4 of 13
<10%
Mike Trenell MoveLab.org

6. US Diabetes Prevention Slide 5 of 13
Programme
8 Lifestyle
MET-hours/week
6
4
Metformin
2 Placebo
0
0 1 2 3 4
Years from Randomisation
Mike Trenell MoveLab.org

7. Slide 6 of 13
Diabetes Incidence
Placebo (n=1082)
Metformin (n=1073, p<0.001 vs. Placebo)
Cumulative Incidence (%)
Lifestyle (n=1079, p<0.001 vs. Met. P<0.001 vs. Plac)
40
30
Risk reduction
31% by Metformin
20
58% by Lifestyle
10
0
0 1 2 3 4
Years from Randomisation
Mike Trenell MoveLab.org

8. Slide 7 of 13
8
?
Mike Trenell MoveLab.org

9. Slide 8 of 13
9
Sleep Inactivity Activity Exercise
Mike Trenell MoveLab.org

10. Slide 9 of 13
10
? Walking (general PA)
Aerobic (Cycling / Running)
Resistance (Weights)
High Intensity Intermittent
Type?
Mike Trenell MoveLab.org

11. Slide 10 of 13
11
? Walking (general PA)
30 – 40min/day
Aerobic (Cycling / Running)
30mins 3/4 x week
Resistance (Weights)
45mins 3/4 x week
High Intensity Intermittent
How much? ?
Mike Trenell MoveLab.org

12. Slide 11 of 13
DIET
2
1.5
Control
Triglyceride Content (%)
12 1 Exercise
Change in Hepa c
0.5
0
-0.5
-1
-1.5
-2
-2.5
-3
Mike Trenell MoveLab.org

13. Slide 12 of 13
Diet
Physical Activity
0
13
-2
% Change in Body Weight
-4
-6
-8
0 3 6
Time (Months) Mike Trenell MoveLab.org

14. Slide 13 of 13
Change Behaviour…….
14
?
Theory Delivery
- Theory of planned behaviour - Frequency / of contacts
- Health Belief Model - 1:1 vs. group
- Risk Reduction Model - Web vs. paper
- Real person vs. Automated
Techniques
- Goal setting
- Follow-up prompts
- Time management
- Plan social support
Mike Trenell MoveLab.org

15. Summary
15
Mike Trenell, Newcastle University; www.MoveLab.org

16. References
Slid Topic Reference
e
3 Diseasome Barabási AL. N Engl J Med. 2007 26;357(4):404-7.
4 Genetic Risks Zeggini, Nat Genet. 2008 May; 40(5): 638–645.
6 US DPP The DPP Research Group, NEJM 346:393-403, 2002
9 Types of exercise (review) Hansen et al. Sports Med 2010; 40 (11): 921-940.
10 Walking Yates et al. Diabet Med. 2011 Oct;28(10):1268-71.
Aerobic Church et al. JAMA. 2010 Nov 24;304(20):2253-62.
Resistance Hallsworth Et al. Gut. 2011 Sep;60(9):1278-83.
High Intensity Intermittent Wisloff et al. Circulation 2007;115;3086-3094.
11 Resistance Hallsworth Et al. Gut. 2011 Sep;60(9):1278-83.
Weight loss Lim et al Diabetologia March 2011
Review Thoma et al. J Hepatol. 2012 Jan;56(1):255-66.
12 Exercise does not help you Miller W, Koceja D, Hamilton E. Int J Obes. 1997;21:941-947.
loose weight Redman LM, Huffman KM, Landerman LR, et al. J Clin Endocrinol Metab.
2010:jc.2010-1971.
Goodpaster BH, DeLany JP, Otto AD, et al. JAMA. 2010;304(16):1795-
1802.
Blair SN. Annal Intern Med. 1993;119(2):702-706.
Fogelholm M, Kukkonen-Harjula K. Obesity Rev. 2000;1(2):95-111.
13 Behaviour Change; CVD Dombrowski et al. Health Psychology Review 2010, 1-26.
Behaviour change; Type 2 Avery et al. Glasgow APC 2012 / Diabetes Care Under Revision, 2012