Michael See MS, ACSM-CEP, NBCHWC, CDES joins the Huddle to share his expertise and experiences in bringing physical activity to people with type 2 diabetes who also have physical limitations. He covers topics like how to assess physical limitations, their prevalence in people with type 2 diabetes, and how to use a motivational interviewing approach in conversations with your clients. This episode was made possible with support from Lilly, A Medicine Company.
Michael See MS, ACSM-CEP, NBCHWC, CDES joins the Huddle to share his expertise and experiences in bringing physical activity to people with type 2 diabetes who also have physical limitations. He covers topics like how to assess physical limitations, their prevalence in people with type 2 diabetes, and how to use a motivational interviewing approach in conversations with your clients. This episode was made possible with support from Lilly, A Medicine Company.
Learn more about this topic in our latest patient/client handout (support for the development of this handout was provided by Lilly, A Medicine Company): adces_tipsheet_physical_activity2.pdf
References
American Diabetes Association Professional Practice Committee; 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S77–S110.
Ahmad E, Sargeant JA, Yates T, Webb DR, Davies MJ. Type 2 Diabetes and Impaired Physical Function: A Growing Problem. Diabetology. 2022; 3(1):30-45. https://doi.org/10.3390/diabetology3010003
Angulo, J., Assar, M. E., Álvarez-Bustos, A., & Rodríguez-Mañas, L. (2020). Physical activity and exercise: Strategies to manage frailty. Redox Biology, 35. https://doi.org/10.1016/j.redox.2020.101513
Colberg SR, Sigal RJ, Yardley JE, et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079. doi:10.2337/dc16-1728
O'Neill D, Forman DE. The importance of physical function as a clinical outcome: Assessment and enhancement. Clin Cardiol. 2020;43(2):108-117. doi:10.1002/clc.23311
Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25 Suppl 3:1-72. doi:10.1111/sms.12581
36-Item Short form survey instrument (SF-36). Available at: https://www.rand.org/content/dam/rand/www/external/health/surveys_tools/mos/mos_core_36item_survey.pdf (Accessed: 21 October 2024).
Physical activity vital sign. Available at: https://www.exerciseismedicine.org/wp-content/uploads/2021/04/EIM-Physical-Activity-Vital-Sign.pdf (Accessed: 21 October 2024).
Jodi Lavin-Tompkins (00;00;00 - 00;01;04)
Hello and welcome to ADCES’s podcast “The Huddle: Conversations with the Diabetes Care Team.” In each episode, we speak with guests from across the diabetes care space to bring you perspectives, issues, and updates that elevate your role, inform your practice, and ignite your passion.
I’m Jodi Lavin-Tompkins, Director of Accreditation and Content Development at the Association of Diabetes Care and Education Specialists.
My guest today is Michael See. He is a board-certified exercise physiologist and health and wellness coach, as well as a certified diabetes care and education specialist practicing in Massachusetts.
In this episode, we’ll dive into physical limitations, how to assess them, their prevalence in people with type 2 diabetes, and using a motivational interviewing approach in conversations with your clients.
Michael, welcome to the Huddle.
Michael See (00;01;04 - 00;01;08)
Thanks, Jodi. I'm excited to have this conversation with you.
Jodi (00;01;08 - 00;01;17)
Great. Well, before we get into today's discussion, could you tell our audience a bit more about yourself and your work as it relates to today's topic?
Michael (00;01;18 - 00;01;34)
Yeah, certainly. I'm a as you mentioned, I'm a clinical exercise physiologist, diabetes care and education specialist, and board-certified health coach, and I've worked in various health and wellness settings for over the past 20 years. So, I'm excited about this conversation.
Jodi (00;01;35- 00;01;43)
Well, Michael, I was wondering if you could give us some context about what physical function is and how it relates to diabetes.
Michael (00;01;43 - 00;02;39)
Yeah. Good question Jodi. Physical functions associated with the quality of life, especially in older persons. In fact, reduced physical function is not just coupled with older age. For people with type 2 diabetes, we see physical problems more commonly seen in older persons. Type 2 diabetes when it co-exists with multiple co-morbidities, and people under the age of 40 is associated with reduced physical fitness and functional muscle mass.
You know, in fact, a recent study found that more adults with diabetes had some physical limitations compared to those without. This really highlights the need to address physical functioning in people with diabetes. Impaired physical functioning is among a major category of complications of diabetes. In addition to micro and macro vascular conditions.
Jodi (00;02;40 - 00;03;00)
So, it sounds like it's pretty common in people with type two diabetes. So, it's important for our audience to understand where people with type two diabetes are with their physical limitations. So, Michael, can you share with us some practical ways to assess physical function in clinical practice?
Michael (00;03;01 - 00;04;04)
It starts with assessment. One simple way is to administer a physical activity vital sign questionnaire. We've even included a link to this in the show notes. This can take 30 seconds to administer and can help you tailor your conversation to the individual's activity, habits, abilities, and interests. Age and prior physical activity levels should be considered when putting together an exercise plan. And those with complications may need more thorough evaluation. This is where a referral to a physical therapy, a certified exercise professional, or a medical fitness program is appropriate.
Assessing your client's level of physical function can be done using a validated tool, that can be done using a subjective self-report questionnaire, like the Short Form 36 or SF 36. Alternatively, you can use an objective measure like a 6-minute walk test that assesses physical function and functional capacity.
Jodi (00;04;04 - 00;04;13)
Well, once we've assessed their level of physical limitations, Michael. What is a good way to start a conversation with your client regarding physical activity?
Michael (00;04;14 - 00;06;13)
Yeah, that's a good point. You know, there are five conversational techniques recommended by the American Diabetes Association for behavioral change. These are really similar to what I do using motivational interviewing techniques with my clients. You can start with a prompt that focuses on past successes. This can be brought up by asking questions like, tell me about your best experiences around physical activity and exercise.
How did it make you feel? What was the best part of it? Or what have you been able to do in the past? Or what do you feel you're able to do now? Then we can ask this question to identify barriers and get to the problem solving. Such questions as, if you decide to start a physical activity or exercise program tomorrow, what would it look like? What needs to happen for that to occur? Or assessing any discomfort such as physical pain, shortness of breath, balance or other issues limit your physical activity on a regular basis. Keeping in mind that if there are potential cardiovascular related complications that do come up, a more thorough evaluation might need to be performed.
As we're discussing these things, it's important for us to understand how this fits into the person's daily life. With follow up prompts like, how did exercise influence other areas of your life, such as your mood, sleep quality, overall well-being? Social network? How does it fit into your life? While we're talking about how physical activity fits into their daily lives, it's also helpful to provide information on where or when to perform the activity as long as they're open to receiving this information. And finally, promptly review physical activity goals to find out what's working and what's not.
Jodi (00;06;13 - 00;06;29)
This is very helpful, Michael, but if we want to reaffirm the importance of physical activity for people living with type two diabetes, then in addition to potential weight loss, what other benefits are there? Can you review those for us?
Michael (00;06;29 - 00;08;06)
There's so much more to physical activity beyond thinking about its impact on weight, especially for people with type two diabetes who might have mobility considerations. I first like to get a foundational understanding about their values around physical activity and how it fits in their lives by asking questions like, what do you know about physical activity or exercise and its impact on your cardiovascular health? Such as blood pressure, blood sugar, and stamina. Or have you ever heard of the concept, exercise is medicine. What does that mean to you? And after that, if it's okay with the client, I'll share some information about the role of exercise in cardiovascular health. For example, emphasizing that physical activity can help avoid or improve some cardiovascular risk factors like keeping your blood vessels healthy, managing blood pressure, or physical activity helps lower blood fats such as triglycerides.
And finally, it helps lower blood sugar. You know, current guidelines recommend 150 minutes per week of moderate intensity activity, such as 30 minutes five times a week or ten minutes three times a day, with resistance training at least twice per week. But really, it's great to emphasize the need to meet your clients where they are and encouraging mobility to improve their cardiovascular health.
Jodi (00;08;06 - 00;08;23)
Yeah, so now that we've discussed identifying physical limitations, how to have a conversation about increasing physical activity and the importance of it beyond weight loss, let's get to the options that might work for people with physical limitations.
Michael (00;08;23 - 00;09;07)
Certainly, the goal is for people living with type two diabetes to be active in a way that makes sense to them. It might mean being active, might include creative ideas like chair exercise, yoga or stretching, using water bottles or resistance bands for strength and resistance training. Reducing sitting time with light activity. Non weight bearing exercises such as water exercise. Structured and group classes for people with limitations. And if you need ideas or conversation topics, check out the show notes for the helpful tip sheet to share with your clients.
Jodi (00;09;07 - 00;09;19)
Well, that's good that there's a resource our audience can access. Thank you for that. And you know, once people express an interest in being more active, what advice should we give to them to keep them safe?
Michael (00;09;20 - 00;10;09)
Yeah, safety is first. Keep it consistent with the usual diabetes routine is always helpful. But if you have someone who might be new to exercise plans, they may need reminders about carrying a phone with them, staying well hydrated, or carrying a rapid acting carbohydrate source in case of hypoglycemia. It may also be best to monitor their blood glucose before, during, and after exercise, at least initially. For those with complications such as neuropathy, make sure that they have well-fitting shoes and moisture wicking socks, and inspect their feet after activity for any redness, blisters or open sores is a good safety measure.
Jodi (00;10;09- 00;10;39)
Well, Michael, it sounds like individuals with diabetes are likely to have greater functional limitations and disabilities, and they can be either visible or hidden. So, we know there are ways to assess physical function with simple questions formal questionnaires or functional assessment tests. And there are ways to have engaging conversations about physical activity to help them get moving. So, in addition to that tip sheet you mentioned, do you have any other closing thoughts?
Michael (00;10;40 - 00;11;14)
Yeah, I think the take home message is you don't have to be an exercise physiologist to discuss exercise with your clients, who may have physical limitations. All members of the diabetes care team can have an effective conversation about physical activity and exercise. Take the time and be intentional about assessing your client's physical activity habits and limitations. Have a curious conversation about their interests and opportunities that may be available and address any safety considerations.
Jodi (00;11;14 - 00;11;34)
Well, Michael, thank you so much for taking the time to join us for this episode of The Huddle and for sharing your expertise as an exercise physiologist. You've provided us with some practical and helpful tips to remind our clients that having a physical limitation doesn't have to prevent them from being physically active.
Michael (00;11;34 - 00;11;37)
Jodi it’s wonderful to have a conversation with you. Thank you.
Jodi (00;11;37 - 00;12;53)
Thank you for listening to this week’s episode of The Huddle. I also want to thank Lilly for partnering on this episode. You can find the tipsheet that goes with this podcast in the show notes. It is a low literacy teaching tool you can use to discuss physical activity and a take home handout for the person with diabetes to refer to.
Make sure to download the resources discussed in today’s episode. You can find them linked in the show notes at adces.org/Podcast.
And remember, ADCES membership gets you free access to resources, education, and networking that improve your practice and optimize outcomes for your clients. Learn more about what ADCES can do for you at adces.org/Join.
The information in this podcast is for informational purposes only and may not be appropriate or applicable to your individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a healthcare professional. Please consult your healthcare professional for any medical questions.
Michael (00;12;54 - 00;12;59)
And I want to thank ADCES and Lilly for this opportunity. Thank you.