Harnessing Technology for Better Outcomes

Guest Post by Dr Tejal Lathia

Video-based fitness assessment in diabetes for customized exercise prescription

Lifestyle changes have a profound impact on the successful management of diabetes. However, Type 2 diabetes can negatively impact musculoskeletal health, which limits exercise. 

Often when people with diabetes initiate unsupervised and vigorous exercise routines, they suffer from injuries. This derails their attempts to exercise consistently, especially if they are overweight or obese.

I get asked a lot of questions about exercise but am often unable to answer them for 3 major reasons: 

1)      Time

2)      Knowledge

3)      Personalisation

Time:

With limited time available to me in the clinic, exercise though extremely important tends to get sidelined. There is so much that I need to convey to the person about their diabetes in those 20 minutes – ranging from diagnosis to treatment to complications…I confess discussion about exercise gets barely a minute.

Knowledge:

My knowledge on the subject of exercise is limited to the general American Diabetes Association ( ADA) guidelines of 150 minutes of exercise at least 5 days a week. Some endocrinologists, who are fitness conscious themselves, may have more in-depth knowledge about exercise, but these are few and far between. Also, the field of exercise medicine is exploding, and it is impossible for us to be fully informed at all times.

Personalization:

Some of the questions I am frequently asked are - 

“How often should we exercise? How vigorous or gentle do the exercises need to be? How long does each session need to be?” 

My answers are not as comprehensive as I would like them to be, as I have limited information on the person’s exercise capacity, flexibility, and any musculoskeletal injuries/pain they already struggle with. 

My answers end up being quite generic and not personalized enough for the person sitting in front of me.

Then what is the solution?

What people living with diabetes deserve is an expert in exercise science. Someone who can assess their fitness levels, understand their pain and injuries, and design a customized exercise prescription for them.

This expert is a physiotherapist.

A person living with diabetes is already struggling with time, and recommending a visit with yet another expert, is challenging and likely to be missed. This is where Digital therapeutics can fill the gap.

Digital therapeutics (DTx) delivers medical interventions directly to patients using evidence-based, clinically evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders.

For the first time in India, I am part of an initiative where the fitness assessment of a person with diabetes is being done virtually by a trained and experienced physiotherapist. 

This is path-breaking because: 

• It allows our patients to receive a fully customized exercise prescription suited to their unique needs. 
• The virtual assessment takes into account pre-existing pain and injuries. 
• The exercise prescription is designed to resolve and improve these issues. 

Our experience has recently been published as a scientific paper in the prestigious, peer-reviewed journal – JAPI (Journal of the Association of Physicians in India). 

In this study, 100 participants underwent a video call-based fitness assessment at the start of the DIABEFLY program – a DTx program that coaches people with diabetes through intensive lifestyle modifications to better manage their condition. 

We observed that: 

• 50% of the participants had BMI > 25 kg/m2
• 80% had a larger waist circumference than normal 
• Average HbA1c (glycosylated hemoglobin) was 8.22% (poor glycemic control)

The program assessed: 

• Aerobic capacity
• Core, upper and lower body strength
• Flexibility

The overall fitness scores of most people were poor to very poor (close to 90%)

The importance of this finding is that embarking on an exercise regimen without understanding baseline fitness heightens the risk of injuries. Understanding baseline fitness greatly aids in customizing the exercise prescription and guides the tempo of intensification of exercise as well.

Conclusion:

This is the first time in India that baseline fitness levels have been assessed in a structured and scientific manner on a video call by experienced physiotherapists.

It adds a new tool to the armamentarium of healthcare providers who are helping people with diabetes live fitter lives. 

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