Area of Research
- “Exercise is Medicine”
- Overcoming barriers to physical activity in patients with Type 2 Diabetes
What got you into the research that you are doing?
There is a lot of information and public messaging about implementing healthy lifestyles to prevent diabetes (such as ‘my plate’ portion control, eat healthy, exercise). However, there are not many programs in place to help the growing number of people who already have diabetes. We can’t just focus on prevention – we have to know how to treat the disease once it happens. I have a family member and many patients with Type 2 Diabetes, and I have seen firsthand to the benefits of implementing healthy diet and exercise lifestyles proactively early after diagnosis, and not waiting until the disease has really taken hold.
Diabetes is becoming more and more common, and it causes many dangerous complications that we would like to prevent. Cardiovascular complications are particularly concerning for people with diabetes. The risk of heart attack is similar in people with diabetes as compared to people who have already had a heart attack. Doing more physical activity, like brisk walking, has been shown to reduce the risk of heart attack in people with and without diabetes, but people with diabetes are actually less physically active than people with diabetes. Part of why people with diabetes are less active than people without diabetes may relate to diabetes-specific barriers to exercise. For example, we recently found that people with diabetes report a greater fear of injury during physical activity than people without diabetes. Also, it appears that people with diabetes perceive low intensity exercise to feel more difficult than people without diabetes, and this may also be a barrier to physical activity. My goal is to identify and overcome barriers to physical activity for people with diabetes.
A specific challenge for my research is to develop practical exercise prescriptions for people with diabetes that fit their personal preferences. We already know how to set exercise goals for people, but to make it more likely for people to meet those goals it is ideal to determine what types of activity they like to do, and to address any barriers to those activities. For example, if someone enjoys walking but the sidewalks are uneven by their house and they are worried about falling as a result, we may need to help them problem-solve alternate solutions.
What are your hopes and dreams for your research?
Currently, I am working to understand the barriers to exercise and effective ways to overcome those barriers. After we have developed an effective program to identify and overcome barriers for individuals, the next step will be to find ways to broaden the reach of such a program so that it can impact more people. A challenge in this will be to develop a cost-efficient way to get that effective program to work across a larger community.
My dream to address these challenges is to develop and test a validated exercise/activity ‘tool’ that physicians and patients can access via the internet. I envision this tool as a key community resource that is used by physicians to give ‘prescriptions’ for activity specific to the patient, and that provides a wide variety of information and ideas. For example, the online tool could be used to monitor and track activity levels, and could function as an electronic coach by sending prompts to optimize current activity levels coach.
The goal is to develop an effective electronic/online system with the capacity to be tied into local community resources, and that would be personalized and high touch. In order to reach this goal we need to do more high touch programs locally, and keep working iteratively to see how they work. Frequency of contact will be important to keep people on track and also understanding to what extent that contact can translate electronically – this may be more feasible with up and coming generations because of their skill with technology.
We also see the opportunity for this to have an economic ‘engine’. For example, the online tool could become a “prescription” like medicine (through your health care provider) that is underwritten by insurance. It could also be an executive program that could be ‘bought’ through a qualified gym or personal trainer.
There is a model for this which we are looking at. It is the Diabetes Prevention Program which has been picked up by Blue Cross/Blue Shield as a pilot in YMCAs across the country. If that worked, the question I have is could we do this programming for people WITH diabetes, especially with the exercise piece?
Other possibilities for the economic impact of this type of online program would be working within an HMO plan where there is incentive to improve the health of the entire group, and demonstrating that this type of online exercise programming treats Type 2 Diabetes effectively enough that it not only costs less than medicine or surgery or hospitalization, it also reduces longer term cost of care in terms of less incidences of heart attacks, strokes, disabling impairments. It could also be huge for seniors to stay out of nursing homes and remain independent.
What can we do to report on your work in a way that can be understood and valued by the general public?
Find more ways to report on the importance of exercise as a way to control and treat diabetes, and also what the barriers to exercise are.
My dream is the development of a validated exercise/activity ‘tool’ that physicians and patients can access via the internet. I envision this tool as a key community resource that is used by physicians to give ‘prescriptions’ for activity specific to the patient, and that provides a wide variety of information and ideas. For example, the online tool could give prompts,
Ultimately I would like to see insurance plans such as HMOs embrace the concept of “Exercise is Medicine” as a primary incentive to improve the health of the entire insured group, and in doing so demonstrating that this type of online exercise programming treats Type 2 Diabetes effectively enough that it not only costs less than medicine or surgery or hospitalization, it also reduces longer term cost of care in terms of less incidences of heart attacks, strokes, disabling impairments.