A pilot exercise referral scheme offering patients individual and proactive support could help diabetes sufferers lose weight and reduce their risk of cardiovascular disease (CVD) and other diabetic complications.
Although increasing physical activity levels in type-2 diabetic patients improves their overall well-being and health, educating and encouraging these patients to exercise is rarely prioritised.
It is estimated that 60–80 per cent of type-2 diabetic patients do not meet the guidelines of doing a minimum of 30 minutes moderate physical activity five days a week.
The pilot project, known as DOROTHEA (an acronym of Diabetes On Referral Option To Healthy Exercise for Adults), was developed by Guy’s and St Thomas’ NHS Foundation Trust and is being evaluated by London South Bank University (LSBU).
GPs in Lambeth and Southwark, south London, were invited to select patients who might benefit — based on their willingness to participate — and to refer them to the scheme with a view to improving their insulin resistance, blood sugar and body fat levels.
Lambeth and Southwark have large populations of type-2 diabetics and the scheme received funding from Guy’s and St Thomas’ charity, which provides funds to support health services in Lambeth and Southwark and to benefit the wider NHS.
Of the 225 patients that took part in the pilot, 74 per cent completed the scheme and participants will be followed up for a further 12 months.
Patients who accepted a referral were invited to attend an initial consultation with the DOROTHEA team, where their participation was explained in detail.
They then received an exercise consultation with a specialist who could give tailored advice, exercises and support to build activity into their lifestyle.
Because very overweight people typically find exercise regimes intimidating, the scheme focused on integrating increased physical activity into patient’s daily routine and offered proactive support at times when they were finding it tough.
The team built on patients’ existing activities, such as gardening and walking and invited them to take part in group walks and community exercise classes. The emphasis was on activities being both accessible and enjoyable.
The patients attended three consultations during the year. Follow-up calls were made a month after the first two consultations, and three months before the last consultation, to offer support and consider any relapse prevention needed.
By reaching out to people individually, team members were able to talk through some of the factors that make physical activity difficult and this proved highly motivational.
Interim results show a mean increase in the amount of physical activity participants were doing at the three-month measurement point of between 302Kcal and 870Kcal per week. Participants also showed a positive change in their behaviour and motivations towards taking part in physical activity.
The Melbourne Grove Medical Practice in East Dulwich, south London, referred 45 patients to the scheme. Referrals were made by practice nurse Rosemary Rose, who either invited patients to attend at normal follow-up appointments or sent them written invitations.
She took baseline measurements of height, weight, waist circumference, BP, cholesterol, HDL/LDL, triglycerides and HbA1c. Ms Rose also attended meetings with the project team and was kept updated on progress.
‘I got plenty of feedback from the project team but I could see the changes for myself,’ she says. ‘There was a big difference in diet and lifestyle for these patients, although some made greater progress than others did, of course.
However, they all moved on over the year and were able to do more. For some, that meant being able to do more in their gardens; for others, it meant that they could go to work.’
After a year Ms Rose reported the measurements for all the participating patients and was able to see good progress, with most of the results showing improvement. Not only was the practice pleased but the patients were pleased with their own progress too.
A GP at the practice Dr Stephen Johnson says: ‘The project themes meshed well with our practice ethos of patients taking care of their own health and exercise.
‘The project was excellent: well-run and well-organised. Patients enjoyed taking part and made good progress. Even the patients who might have come under the heading of no-hopers were invigorated to help themselves and it was great to see.’
Dr Johnson believes that the reason this project achieved results where other similar projects have had limited impact is because of its hands-on approach, organisation and enthusiasm.
Patients were not put off meeting with staff about their condition because the meetings were not about the medical aspects but rather about empowering them to act for themselves and improving their general health status.
While the pilot project has now finished, it has been deemed a success. Guy’s and St Thomas’ Charity says that what has been learned from the pilot is being used to develop generic exercise programmes.
Dorothea's keys to success
The project was well organised and remained involved with the patients.
The exercise programme was built around patients’ existing activities such as gardening and walking.
Activities were designed to be accessible and fun.
Patients felt empowered to improve their health.
The patients were supported enthusiastically.
Guy’s and St Thomas’ Charity