All Parties Parliamentary Group for Diabetes Type 2 Diabetes: The role of Physical Activity/Exercise Dr. Silvano Zanuso, Ph.D University of Padua Technogym Medical Scientific Dept. London, 9 of March, 2010

Brief literature analysis background Exercise Intervention and Economic Analysis From research to practical application Conclusions Presentation Outlines

From 2.3 million in 2000 to 5 million in 2030 (+117%) (ISTAT, 2006) The incidence of non insulin dependent Diabetes is increasing worldwide From 171 million in 2000 to 366 million in 2030 (+114%) (Wild et al., 2004) The Problem

The cost of diabetes to the National Health Service stands at approximately £1 million per hour, and is increasing rapidly, a new report indicates. As many as 2.75 million people in the UK now have diabetes, the latest figures show. The Problem

Physical Activity is highly beneficial in the prevention of type 2 diabetes What we know

Exercise is a good tool in the improvement of various clinical and physiological parameters in type 2 diabetic patients Aerobic Exercise alone is effective Resistance Exercise alone is effective Combined Aerobic and Resistance training offer additional benefits to either aerobic and reistance exercise alone

23 outpatients clinics plus 23 ‘metabolic fitness centres’ in Italy, covering the peninsula from north to south The IDES study was a prospective multicentre Randomised Control Trial A succesful RCT

To execute the IDES Exercise intervention An educational program was conducted across the country aimed to: a)Increase the exercise literacy of the diabetologists b)Increase the diabetes literacy of the exercise professionals Effectiveness and Feasibility Results: a)Adherence was over 80%(of all prescribed exercise sessions) b) Drop out over a full year was 7%

Cost Savings (€) IDES Exercise Group Per capita yearly medical costs saving Italian Diabetes and Exercise Study. Unpublished data

Cost Savings P De Feo et al. Make Your Diabetic Patients Walk Long-term impact of different amounts of physical activity on type 2 diabetes. DIABETES CARE, VOLUME 28, NUMBER 6, JUNE 2005

DARE study: economic analysis Under all sensitivity analyses, the incremental cost effectiveness ratio for exercise training as delivered in DARE, compared to no training, was well under $20,000 (~13,000 Euros) per quality adjusted life year (QALY). Data presented in Madrid, June 2008 (now in press). Courtesy of Prof. Ron Sigal

Structured exercise programs (aerobic + resistance) are better in terms of clinical parameters than voluntary physical activity alone. Physically active type2 diabetic patients take less medications, both those specific for their pathology and those general, with significant costs saving. The feasibility of exercise intervention needs to be proven with large national trials that start with the education of both clinician and exercise professionals. High quality and certified exercise professionals and fitness facilitites in the UK could be viewed as a fundamental asset in offering to patients (and their doctor) an effective aid in preventing and treating type 2 diabetes. To Conclude