Jonathon Fowles, PhD, CEP, CSCS, an Associate Professor at Acadia University in Canada, developed a Physical Activity and Exercise Tool-kit for Diabetes Educators. According to Dr. Fowles, "Diabetes Educators in Nova Scotia are primarily nurses and dieticians with very little or no training in exercise prescription; however, according to the Canadian Diabetes Association clinical practice guidelines, diet and exercise are two of the primary means with which to manage type 2 diabetes, so they feel unprepared to actually deliver the guidelines on the front line."
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 TheraBand exercise bands 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."
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