Physical inactivity as a risk factor of chronic disease burden in Australia

More than half of Australian adults do not engage in adequate physical activity as per the recommended guidelines and physical inactivity is linked to high percentage of disease burden for diabetes (Australian Institute of Health and Welfare, 2017). The main research question to explore the effect of exercise on diabetes and obesity prevalence in Australia is as follows: Do regular exercise (I) reduce the incidence of diabetes and obesity (O) compared to no exercise (C) in young children and adolescent in Australia (P)?

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Research question:
This report is focused on the prevalence of diabetes and obesity in Australia. Physical
inactivity is regarded as one of the risk factor of chronic disease burden in Australia. More than
half of Australian adults do not engage in adequate physical activity as per the recommended
guidelines and physical inactivity is linked to high percentage of disease burden for diabetes
(Australian Institute of Health and Welfare, 2017). Due to such link, exploring the impact of
exercise on reducing diabetes and obesity in Australia is considered important. The main
research question to explore the effect of exercise on diabetes and obesity prevalence in Australia
is as follows:
Do regular exercise (I) reduce the incidence of diabetes and obesity (O) compared to no
exercise (C) in young children and adolescent in Australia (P)?
Research topic:
The research is concerned with the prevalence of diabetes and obesity in young children
and adolescent in Australia. Diabetes is turning out to be an epidemic in Australia and it is
presenting biggest challenge to the health system of the country. The rate at which the incidence
of diabetes occurs in Australia is understood from the fact that about 1.2 million people aged 2
years and above have been diagnosed with diabetes in Australia (The Department of Health,
2017). Another challenge for the Australian health care system is the prevalence of diabetes in
children and young people. Around 4000 new cases of type 2 diabetes was observed among 10-
24 year old in 2011-2012 (The Department of Health, 2014). Obesity, poor diet and inadequate
physical activity is regarded as the main risk factor of diabetes in Australia. This can be said by

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the review of obesity statistics in Australia. More than half of the Australian population has
abnormal body weight. 285 of Australian adults were obese in 2014-2015 and one in every four
Australian children (2-17 years old) were obese or overweight (Australian Institute of Health and
Welfare, 2015).
The main aim of the research is to investigate about the impact of exercise in reducing
the prevalence of diabetes and obesity in children and young people in Australia. This is
considered important because sedentary behavior increases risk of diabetes and exercise has the
potential to reduce the risk in vulnerable population (Rockette-Wagner et al., 2015). The topic of
diabetes and obesity prevalence in children and adolescent is linked to the National Strategic
framework for chronic diseases because the framework focuses on prevention and management
of chronic disease condition to provide healthy life to all Australians. Diabetes is listed as one of
the chronic disease in the national framework and evaluating the effectiveness of exercise as an
intervention for diabetes and obesity may help to promote health and reduce risk in children and
adolescent population of Australia (health.gov.au., 2017). Physical exercise is part of life-style
intervention and it may help to reduce the burden of diabetes in Australia.
Literature review:
The review of research literature gave clear insight regarding the effectiveness of exercise
to reduce risk of diabetes and obesity in children and adolescent. Davis et al. (2012) investigated
about the effect of aerobic exercise dose on insulin resistance and fatness in overweight children.
The population group and the research objective is congruent t the research question. By
employing randomized controlled trial as a study design, the research participants were randomly
assigned to low dose or high d11ose aerobic training group (intervention group) and control

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condition (usual physical activity). The aerobic exercise intervention was offered for 10 to 15
weeks and children in the high dose group received 40 minutes exercise per day compared to
low dose group who received 20 minute exercise/day. The evaluation of primary and secondary
outcome revealed that effect of high or low dose was similar and aerobic training improved
fitness and had positive impact on insulin resistance, adiposity and overweight. Hence, safe dose
of vigorous physical activity can reduce risk of diabetes and obesity in children.
Another research that is relevant to address the research question is the study by Stoner et
al. (2016) which aimed to evaluate whether exercise intervention can improve body weight and
reduce risk of obesity in adolescents or not. The Meta-analysis of randomized controlled trials
included those studies which had structured exercise intervention and a control group that
received no exercise or received behavioral intervention. The review of all included studies
showed variability in exercise intervention, however robust evidence for reduction in BMI was
found following exercise intervention. Although the meta-analysis identified very few RCT
trials, however the study gave evidence to prove that exercise intervention lead to moderate
decrease in BMI, waist circumference and body fat. Hence, from this perspective, exercise can
be considered as an intervention to reduce the risk factor of diabetes.
A separate randomized controlled trial also evaluated supervised exercise on prevention
of diabetes in overweight children. Moderate reduction in obesity among adolescents was
observed, however the limitation was that it did not analyzed effect of exercise separately (Hollis
et al., 2016). Another randomized controlled trial compared effect of low-intensity exercise and
no exercise on abdominal obesity and glucose tolerance in obese individuals. Hence, credibility
and reliability of such evidence is high. It was a single center parallel group trial and 300 obese
individuals as research participant. The primary outcome for the study was waist circumference

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and 2-hour glucose level. The intervention group performed walk/jog exercise on treadmill
times per week for 24 weeks and the control group received no exercise intervention. However,
the factor that was similar for both the group was that both group received diet composition
advice. Primary outcome variable was waist circumference and 2-hour glucose level and
secondary measurement was cardio-respiratory fitness. The outcome of the research proved that
exercise intervention consistent to current guideline are effective in reducing abdominal obesity
irrespective of the intensity of exercise (Ross et al., 2015). However, the research showed that to
achieve glucose tolerance level, high intensity exercise was needed to achieve desired outcome.
The review of additional evidence to validate the result that high intensity was needed to achieve
desired outcome showed that there is lack of robust evidence to prove the effect of high-intensity
exercise on blood glucose level (Adams, 2013). Hence, large scale randomized trial may confirm
the result in future.
From the review of research literature related to research question, the evidence
by Ross et al. (2015) is the best evidence to address the research question because it had similar
intervention and comparator like the research question. Secondly, it is high quality evidence
because it used randomized control study design and such research design comes under top level
in the hierarchy of evidence. Another rational for regarding it as the best evidence to address the
research question is that by the use of abdominal obesity and glucose tolerance as a primary
outcome variable, it clearly gave evidence regarding the impact of exercise on both diabetes and
obesity in high risk individual. This evidence has been regarded as a high quality research
evidence also because of methodological rigor. The research had adequate sample size and
requirement for randomization and blinding was fulfilled. Ethical consideration related to
informed consent approach for research was also done. All lost to follow-up and number of

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participants in follow-up was also analyzed. Another strength of the study is strong adherence to
excellent exercise regimen. Hence, nurse practitioner can use the evidence as a guide to support
children and adolescent in Australia to engage in low intensity exercise and maintain healthy
weight.
The nurse working in primary care and Australian health department can prioritize
exercise as an intervention to reduce incidence of diabetes and obesity and improve health
outcome of the target population. By the use of outcome from the study by Ross et al. (2015),
nurse working in diabetes prevention program in Australia can collaborate with other health staff
to implement low-intensity exercise for children and adolescent at risk of obesity and diabetes.
They can also utilized method used in the study to improve adherence to the exercise program
and promote heath of Australian population as per the goal of the National Strategic framework
for chronic disease (Whittemore et al., 2013).
Recommendation:
Based on the review of research evidence, it was found that strong evidence was found
for impact of exercise on weight loss and reducing obesity. However, one finding that could not
be effectively analyzed was the impact of high intensity exercise on glucose tolerance level.
Several studies investigated effect of low and high density exercise. However, enough evidence
could not be found regarding the claim that high intensity exercise regimen reduces 2 hours
glucose level. The finding was not reliable because many participants in the high-intensity group
lost to follow-up and adherence level was low in those groups. Hence, it is recommended that
future randomized controlled trial should study the effect of high-intensity exercise on
heterogeneous population group such as those at risk of diabetes and those without risk. In

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addition, adequate sample size should be taken so that research finding can be generalized. Strict
measures for adherence to the program should also be done so that high intensity exercise can be
implemented by nurses to prevent diabetes.

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Reference:
Adams, O. P. (2013). The impact of brief high-intensity exercise on blood glucose
levels. Diabetes, metabolic syndrome and obesity: targets and therapy, 6, 113.
Australian Institute of Health and Welfare (2015). Overweight & obesity. Retrieved from:
https://www.aihw.gov.au/reports-statistics/behaviours-risk-factors/overweight-obesity/
overview
Australian Institute of Health and Welfare (2017). Impact of physical inactivity as a risk factor
for chronic conditions: Australian Burden of Disease. Retrieved from:
https://www.aihw.gov.au/reports/burden-of-disease/impact-of-physical-inactivity-
chronic-conditions/contents/summary
Davis, C. L., Pollock, N. K., Waller, J. L., Allison, J. D., Dennis, B. A., Bassali, R., ... & Gower,
B. A. (2012). Exercise dose and diabetes risk in overweight and obese children: a
randomized controlled trial. Jama, 308(11), 1103-1112.
health.gov.au. (2017). National Strategic Framework for Chronic Conditions. Retrieved from:
http://www.health.gov.au/internet/main/publishing.nsf/content/nsfcc
Hollis, J. L., Sutherland, R., Campbell, L., Morgan, P. J., Lubans, D. R., Nathan, N., ... & Cohen,
K. E. (2016). Effects of a ‘school-based’physical activity intervention on adiposity in
adolescents from economically disadvantaged communities: secondary outcomes of the
‘Physical Activity 4 Everyone’RCT. International Journal of Obesity, 40(10), 1486.

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Rockette-Wagner, B., Edelstein, S., Venditti, E. M., Reddy, D., Bray, G. A., Carrion-Petersen,
M. L., ... & Montez, M. G. (2015). The impact of lifestyle intervention on sedentary time
in individuals at high risk of diabetes. Diabetologia, 58(6), 1198-1202.
Ross, R., Hudson, R., Stotz, P. J., & Lam, M. (2015). Effects of exercise amount and intensity on
abdominal obesity and glucose tolerance in obese adults: a randomized trial. Annals of
internal medicine, 162(5), 325-334.
Stoner, L., Rowlands, D., Morrison, A., Credeur, D., Hamlin, M., Gaffney, K., ... & Matheson,
A. (2016). Efficacy of exercise intervention for weight loss in overweight and obese
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The Department of Health. (2014). Type 2 diabetes in Australia's children and young people: a
working paper. Retrieved from: https://www.aihw.gov.au/reports/diabetes/type-2-
diabetes-in-australia-s-children-and-young/contents/table-of-contents
The Department of Health. (2017). Diabetes. Retrieved from:
http://www.health.gov.au/internet/main/publishing.nsf/content/chronic-diabetes
Whittemore PhD, R., Rosenberg, M. P. H., & Jeon PhD, S. (2013). A diabetes prevention
program provided by home care nurses to residents of public housing
communities. Journal of Health Disparities Research and Practice, 6(1), 2.