• Week 1-6: Body-weight and hand-held weights
• Week 7-12: increased Rating of Perceived Exertion (RPE) to 4/10
• Week 13-18: Added Thera-Band Resistance Bands and exercise ball; progressed resistance when RPE was below 5

All patients received information on diabetes self-management as well.  Both groups exercised for 18 weeks with progressive increases in intensity, followed by a 34-week maintenance program. After the intervention, both groups significantly reduced their risk factors for developing diabetes.  Both exercise programs also helped patients lose weight, averaging a 4 kg loss. There was no significant difference in outcome between the gym-based group and the group using Thera-Band Resistance Bands, other than a higher drop in systolic blood pressure in the gym-based group.  The findings of this study complement another study (Colado and Triplett 2008), which found similar improvements in middle-aged women performing either weight machine training or Thera-Band exercises. Both studies confirm that elastic resistance is as effective as more expensive and space-consuming weight machines.  In addition, Thera-Band exercises may be a more cost-effective intervention to reduce the risk of developing diabetes.

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Dr. Fowles was contacted by the Diabetes Care Program of Nova Scotia (who manages all of the 38 diabetes Centres in the province) to prepare a practical informational and instructional guide to help diabetes educators recommend physical activity and exercise to their patients. The focus of the toolkit is practical exercise strategies including resistance training using Thera-Band exercise bands to for different patient groups. There are tailored guidelines for individuals with diabetes who are inactive, just beginning to be active, or who are already active.

The exercise advice is tailored to the patients’ physical activity level, their health level, and their motivation level, and is geared toward a ‘facilitated’ exercise model where the patient is ‘helped’ along to get going with exercise but it is not directly supervised for exercise sessions. “We felt that his model would be the most effective to help get more individuals with type 2 diabetes more active, considering physical inactivity itself is a major problem in this population,” said Dr. Fowles.

Supervised exercise done in a clinical exercise rehabilitation clinic atmosphere is a little different; this would be more what exercise physiologists would directly supervise. “Our program was developed by exercise physiologists and experts in psychological aspects of exercise participation, to help get individuals with diabetes more active on their own,” said Fowles, “because that is where the life-long changes occur: what they can do regularly for the rest of their lives.”

The curriculum involved attending two, 3 hour workshops and gave specific instructions on using the Toolkit in clinical practice. There was specific instruction on basic resistance training techniques to help the diabetes educators prescribe resistance training to their patients.  There are 5 brochures, or ‘tools’ that are given to clients relative to their level to help them along with their physical activity and exercise plans, complete with resistance band training and an intermediate resistance free weight training program. Typically, clients are seen at diabetes centres every 6 months, and their programs are adjusted by diabetic educators to progress the individuals along. Dr. Fowles pointed out, “The toolkit was developed for Diabetes Educators; however, it is useful to anybody ‘on the front line’ who is trying to get more individuals with type 2 diabetes more active.”

The research completed to this point has been an evaluation of the Diabetes Educators and the impact of the Toolkit on physical activity and exercise (PAE) counselling. Dr. Fowles concluded, “We have found a great increase in confidence toward PAE counselling, a reduction in barriers, and high ratings of usefulness of the Toolkit as a resource.”