According to WHO, in 2014 the number of people suffering from diabetes worldwide reached 422 million, among which 8.5% are adults above the age of 18 years, and there is an estimate that diabetes will be the seventh leading cause of death in 2030.
Diabetes affects majority of adults in developed countries and is rising rapidly in developing countries because of urban growth with better means of transport and hence diminished physical activity (PA) beside eating unhealthy fast food with increased risk of obesity; which is the case also in Kuwait.
Diabetes, being a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation, represents a serious burden on organization and even countries by being one of the leading cause of deaths worldwide. In most cases of T2D, it can be controlled by adopting simple lifestyle changes, healthy nutrition and regular PA. The ministry of health, Kuwait has been concerned and have setup a specialized institute that provides the role necessary to confront the challenge of treating type 2 diabetes. This institute is a specialized patient centered health care setup to the level of being a facility concerned about the provision of researches and within which this study will be carried out.
In the past decades specifically in the Arab population the increase in obesity has played a role in the spectacular increase in the incidence of T2D. Obesity has been linked to the significant growth of income, urban growth and improved living conditions and is considered health crisis that needs to be addressed. PAPA is Critical in T2D prevention and management and relying on the emerging concept that active muscle doesn’t need insulin for glucose uptake, hence improves blood glucose level that can prevent T2D or delay it’s onset or complications. This can even reverse T2D in early stages. PA would also positively influence other factors that can decrease the risk for developing cardiovascular diseases, blood cholesterol and blood pressure. By knowing this, yet T2D patients tend to abstain from doing any PA and according to a study, participants reported that they only favored light activity like walking.
Many researches, have been conducted to reveal the role of PA in treating major diseases of chronic nature like diabetes, having presented abundant information about cons and pros of exercise on patients. Such information has been differentiating between different sorts of exercise while concentrating on resistance exercise or aerobic activities. Findings from such studies have been included within the recommendations of organizations that are concerned about developing guidelines to help their management, (like WHO, American diabetes association) and have included exercise (taking into account its duration, different types and frequency) within their treatment guidelines for diabetes.
Barriers and influences
To reveal the barriers against doing any PA, an assessment is essential to establish subsequent strategies to improve T2D patients‘ adherence to PA regularly. According to the currently available literature, acquiring support from family members, peers and health care personnel would help patients to initiate and maintain regular exercise. PA should not be confused with exercise, as such terms might be used interchangeably giving a broader meaning for exercise. PA is any movement we do involving skeletal muscles contraction that necessitates energy utilization while exercise is planned, structured, repetitive and purposeful so as to enhance physical fitness.
Most of studies were done concentrating on moderate to high intensity exercise, while defining the least cardioprotective PA to be as stated by WHO, leaving the light to moderate PA unassessed just by. A recent study claimed that even light to moderate exercise is beneficial than being physically inactive. While there is valid evidence about the advantage of PA for T2D there are also risks that one should speculate taking into account injuries (esp. foot care) and abnormal heart response. Such limitations may be linked to a medical condition.
Major illnesses with chronic nature are associated with number of major and minor risk factors, among them there are modifiable risk factors like tobacco smoking, unhealthy eating, sedentary lifestyle, stress and alcohol use. These modifiable risk factors considerably decrease the risk of heart diseases, stroke and as well as T2D would be established.
Some studies have revealed the impact of these factors on diabetes and amongst them some were done to assess the effect of exercise on insulin sensitivity and glucose tolerance. A study was conducted on T2D patients mainly women who received insulin as treatment, and there were significant difference in insulin resistance and fasting glucose after doing aerobic exercise 3 times per week for 8 weeks.
Other studies have also demonstrated similar conclusion about different sorts of exercise for other age groups and gender.
A study was done in Muscat, Oman demonstrated that 16% pt had satisfactory knowledge and good Practice except adherence to regular PA. In other articles some researches done worldwide showed that increasing knowledge about a health problem would reflect positively on attitude and practice of patients toward diabetes and would result in better outcomes. A research carried out in Napal showed that less than 16% of the involved participants had good knowledge towards diabetes with association of their level of education. Of them nearly 40%wereilliterate and nearly 25% were from rural areas. Less than 12 % had good attitude and practice but with no regular PA. In this study those who had satisfactory knowledge had poor practice that the author attributed this to the lack of motive to put their knowledge into action and over confidence with conservative thoughts. (16)Some studies showed poor level of Knowledge, Attitude and Practice while others showed satisfactory levels of Knowledge with good levels of Attitude and Practice but all of these studies cannot be representative for the whole population because of small sample size.
Regardless of the poor level of K, A and P, patients feel that they should be in charge of their self-care which shows their willingness to have lifestyle modification if educated appropriately. It is of crucial significance that patients should be aware of their own condition and to be well knowledgeable about diabetes in order to have a good control, to handle their condition properly and to get preferable outcomes. Studies do back up such claims that it would be more efficient to establish better diabetes management via proper patient education and such education aided patients to lead a healthy lifestyle and self-care.
Studies have demonstrated that educating patients about disease and its consequences has better outcomes with respect to their adherence to treatment and decreasing the risk of complications. (20)Even though there is a study supposing that there is no significant interrelation between patient education and pursuing a positive behavior; but vast majority of studies has emphasized the role of involving the patient in the decision making about their case management being essential for better course of treatment and after all it is their own health.