Diabetes Forecast

A Good Test Run

Motivating Older Adults to Exercise

By Andrew Curry , , ,

Researcher: Kimberlee Gretebeck, PhD, RN
Occupation: Assistant Professor, University of Michigan School of Nursing, Ann Arbor, Mich.
Focus: Lifestyle Intervention
Research Funding: Junior Faculty Award

There's no doubt exercising is healthy for people with diabetes. Regular exercise can help improve circulation, aid in glucose control, relieve the pain of nerve damage, and keep people mobile into old age. The Centers for Disease Control and Prevention recommends that older Americans get at least 2a hours a week of moderate exercise—walking, for example, or climbing stairs.

Yet 2 out of 3 Americans over the age of 60 exercise less than 30 minutes a week. University of Michigan School of Nursing assistant professor Kimberlee Gretebeck, PhD, RN, says the numbers are even lower for people with diabetes. "Older adults tend to be pretty sedentary," says Gretebeck, "and if they have chronic illnesses, they're even more so."

Yet most efforts to get people to exercise more are frustratingly unsuccessful. Call it the New Year's Resolution Syndrome: Studies have shown that half of people in the general public will stop exercising within six months of completing an organized workout program. For the rising number of people with type 2 diabetes in America, it's an important issue. "Type 2 diabetes is linked to sedentary behavior as well as overweight," Gretebeck says. "I wanted to focus on where the greatest needs seem to be."

With a grant from the American Diabetes Association, Gretebeck, 48, looked for a way to help older adults with diabetes stay motivated. One of Gretebeck's specialties is studying how to motivate people: She has done research on everything from how to get low-income African American kids to brush their teeth to convincing blue-collar workers to get more exercise. When it came to motivating older people with diabetes, Gretebeck thought that combining organized workouts with motivational classes and regular phone calls would help turn resolutions into results.

To test her hypothesis, Gretebeck set up an experiment. First, she recruited more than 100 people with type 2 from over 60 Ann Arbor, Mich.—area churches, senior centers, and clinics. (She also reached out to clinics in heavily African American Detroit to make sure the study was racially diverse.) Participants had to be in good enough health to take part in exercise classes, and they had to be getting less than 30 minutes of exercise per week. After all, "if they were already exercising, there wouldn't be any room for improvement," Gretebeck says.

Next, she randomly divided the volunteers into two groups. Half were placed in the control group and given a very mild workout three times a week. The other half, called the intervention group, would test her hypothesis that more intense exercise, combined with motivational classes and regular follow-up calls, would keep seniors with diabetes exercising longer on their own and improve their fitness and health. The intervention group had a more ambitious program: Three hours a week, they were guided through a circuit of exercises by a physical trainer. The workout included things like climbing up and down a single step, wall push-ups, and swinging a 5-pound medicine ball from side to side while walking down a hallway, each for one minute at a time.

The intervention group's lessons included setting exercise goals, overcoming barriers and finding ways to keep exercising once the program was over. A major focus was encouraging participants to be physically active outside of class as well, taking on a low-impact activity like walking two extra days a week for a total of five days of exercise. The group with the easier exercises got a class focused on general health, with no specific attention paid to physical fitness.

Both groups were coached on how to carefully monitor their glucose while exercising. Since physical activity lowers the amount of glucose in the bloodstream, "we were really concerned that their glucose would decline and they would get hypoglycemia," says Gretebeck. "Most of them didn't know how to manage their medication while exercising."
After 10 weeks of supervised workouts and classes, participants were assessed with a set of standard exercises, like how many feet they could walk in six minutes. Surprisingly, both groups showed substantial improvements. (It turned out that the people in the control group were getting caught up in the spirit of the experiment and exercising outside of class, helping them stay even with the intervention group.)

The real test, though, came after the 10 weeks ended. For the next 2 1/2 months, Gretebeck's team called the intervention group weekly, discussing their exercise goals and keeping them motivated. The control group got calls about general health issues with no particular attention to exercise.

At 20 weeks, Gretebeck had both groups tested again. The control group showed no improvement over their 10-week marks, while the intervention group had consistently better performance on tests like the six-minute walk. "It shows the intervention group was improving their lower-extremity functionality," Gretebeck says. Most important, the intervention group was staying active thanks to the attention to motivation and exercise.

Gretebeck says there's lots more work to be done. The exercise experiment was just a test run, so to speak. Her next plan is to design and conduct a larger study looking at ways to translate the motivational attention her intervention group got to a more everyday setting. "The goal is eventually to move this into a clinic, so doctors can prescribe these exercises," she says—because when it comes to keeping fit, a little help goes a long way.

To sponsor an ADA research project at the Research Foundation's Pinnacle Society level of $50,000 or more, call Elly Brtva, MPH, managing director of Individual Giving, at (703) 253-4377, or e-mail her at ebrtva@diabetes.org.



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