Sustainability and Replicability of a Medical Fitness Model in Obese Patients with Diabetes Mellitus Type II (T2DM)

Abstract

PURPOSE: The purpose of this project was to create an evidence-based implementation model of the MyFitScript, LLC exercise prescription that is replicable across outpatient healthcare clinics and creates the infrastructure for replicability and sustainability of the program while improving health outcomes and behaviors in obese patients with T2DM. METHODS: The MyFitScript, LLC Weight Management Exercise Prescription Program was provided to a primary care practice for implementation in obese patients with T2DM. This prescription exercise program included: 1) Weight Management Exercise Readiness Assessment Tool, 2) Weight Management Exercise Prescription, 3) Weight Management Patient Tool Kit which includes multiple resources for patient engagement and accountability while completing the exercise prescription, and 4) Provider training and resources for implementation of the prescription exercise with patients. Obese patients with T2DM within the practice were screened and invited to voluntarily participate in the program. Baseline data were collected from the participating patients which included patient demographics, current weight, BMI, blood pressure, HgbA1C, patient exercise frequency, and readiness to move stage. The prescription exercise program was then implemented in participating patients. Patient follow-up occurred at 30, 60, and 90 days with the same data collection as baseline. RESULTS: Biometrics: The average pounds lost among the 4 participants after 90 days of prescription exercise implementation was 9.5 pounds with an average of 1.8 kg/m2 reduction in BMI. HgbA1C was lowered by an average of 1.1% among the 4 patients and average systolic/diastolic blood pressure increased by 8/6 mmHg after 90 days of prescription exercise. Prescription Exercise: Patients C and D went from not participating in aerobic exercise at baseline to routinely exercising 60 minutes weekly. Patient C remained consistent in weekly strength training at 45 minutes from baseline to 90 days, while patient D went from no strength training to 60 minutes weekly. Patient A remained consistent in aerobic exercise from baseline to 90 days at 150 - 200 minutes weekly. Patient A also remained consistent with 0 minutes of strength training throughout the 90-day program implementation. Patient E decreased their weekly aerobic exercise and strength training from 120 minutes at baseline to 0 minutes after 90 days. Transtheoretical model: Patients C and D transitioned from the preparation stage to the action stage, and patient A transitioned from the action stage to the maintenance stage. Patient E regressed from the maintenance stage to the preparing to move stage. IMPLICATIONS FOR PRACTICE: The MyFitScript, LLC Weight Management Prescription Exercise Program can guide patients through structured exercise, leading to better glycemic control with reduced HgbA1c and effective weight loss. Sustained exercise that leads to a reduction in HbA1c levels can potentially decrease the need for medications like insulin or metformin, thus lowering healthcare costs and reducing the risk of medication-related side effects. Prescription exercise can be used by primary care physicians, endocrinologists, physical therapists, and dietitians to create a comprehensive diabetes care plan that facilitates a team-based approach to weight loss and long-term health management.