Continuing Education Bits for PTs & PTAs

Archive for August, 2012

What’s the Right Exercise Dose for Patients with Type II Diabetes?

By guest blogger David Taylor, PT, Ph.D., CSCS, with an introduction by Marilyn Pink, PT, Ph.D., CEO of EDUCATA


Well, it’s proven, you guys like our guest bloggers!! And I love them too, because each of you have your own expertise. So, I learn from those of you whose expertise is different from mine, and I can apply your evidence-based knowledge to my patients!

You know, my definition of Ph.D.  –‘Pin Head Degree’– is someone who knows their pin head better than anyone else. And a really smart Ph.D. acknowledges that they need loads of people with different Pin Head Degrees to really understand the patient. 

Enough said! I now bring you a topic –and a guest blogger– whose Pin Head Degree is very different from mine; a person I admire and a person from whom I can learn much. So, with that, I give you… (drum roll please) Dr. DAVID TAYLOR!

Clinical practice guidelines recommend exercise training, along with medications and medical nutrition therapy, for treating patients with type 2 diabetes. So, how do we as PTs prescribe the appropriate “dose” of therapeutic exercise in an objective manner?

Randomized clinical trials that have investigated the effect of various drugs in treating individuals with the condition describe the use of the drugs in terms of a specific dosage (for example, milligrams per day). However, where exercise is concerned it has either:

  1. Not been objectively measured in most previous studies, or,
  2. Where it has been, the amount is conflicting, in terms of how the dose was quantified.

Research studies that have described the total quantity of exercise training for improving outcomes in patients with type 2 diabetes have expressed the total dose in terms such as:

  • Metabolic equivalents (METs) or
  • Workload (work or power).

As well as in more general terms, for example, number of sets and repetitions during each session of resistance training.

In a type 2 diabetes randomized clinical trial we conducted (results published in 2009), we compared a group that received exercise counseling to a group that received supervised exercise training. The group that received counseling had access to a fitness center and was guided by a PT, but otherwise completed the training without supervision. The other group received supervised exercise training on a one-on-one basis. At the end of the trial it was found that there was no statistically significant differences in outcomes. One rational explanation for these findings is that both groups were equalized in terms of dose of exercise training, meaning both groups completed the same amount.

So, why is quantifying the dose important to the practice of physical therapy, and more importantly, to patients? Consider how physicians make choices as to the dose of medication to prescribe for a patient: they do it based on the findings of clinical trials. Like physicians prescribe medications, we sould be able to prescribe the dose of exercise training that would result in optimal outcomes for our patients.

But, how do we go about it? I would enjoy and appreciate your feedback to these questions:

  1.  Do you think having an objective measure for exercise prescription would be beneficial in treating patients with type 2 diabetes (and other patient populations) and
  2. How can we quantify the total amount of exercise training?

I look forward to reading your thoughts and comments!

Dr. Taylor has earned both Master’s and doctorate degrees in physical therapy and is also a Certified Strengthening and Conditioning Specialist (CSCS). He is considered an expert in the field of exercise training for patients with diabetes, as well as the validity and reliability of exercise testing. Dr. Taylor has frequently presented his research and served as an invited speaker at state and national conferences and has an established record of publications, including peer-reviewed research studies, textbook contributions and abstracts. More… 


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