Literature Review: Exercise Therapy as a Key Intervention for Diabetes

This literature review examines the effectiveness of exercise therapy as a non-pharmacological intervention for managing diabetes in adults aged 18 to 60 in the United Kingdom. It addresses the growing prevalence of diabetes and the limitations of pharmacological interventions, highlighting the potential of exercise to improve blood glucose levels and overall quality of life. The review synthesizes findings from eight articles, assessing their methodologies and limitations using tools like CASP, and identifies themes related to the impact of exercise on diabetes, weight reduction, and metabolism. The study acknowledges the challenges of patient adherence and cultural homogeneity in research, aiming to inform strategies for promoting exercise as a key component of diabetes management. Desklib offers a range of study tools and solved assignments for students.

Running head: EXERCISE AS INTERVENTION OF DIABETES
Exercise as intervention of diabetes
Name of the student:
Name of the university
Author note:

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EXERCISE AS INTERVENTION OF DIABETES
Introduction:
With the growing prevalence of chronic disease, diabetes type II has become a public health concern that contributed to the
global burden of the disease and premature death. A study by Roze et al. (2016 ), suggested that in united kingdom approximately 24
millions of individuals are suffering from this chronic disease which affected their quality of life . A significant number of individuals
have above normal blood glucose level. Therefore, populations who are at higher risk of developing diabetes type II can also develop
other chronic diseases such as kidney and liver disease and cardiovascular. The issue is prevalent in the Asia Pacific region due to the
specific race and ethnicity but United Kingdom also identified one of the countries for higher prevalence (Patel et al. 2017). Ntuk et
al . (2014), suggested that a considerate number of individuals were refuse to seek clinical help due to high expenditure of the
pharmacological interventions. A study Scheen (2015), suggested that the implementation of physical activity as a component of
lifestyle interventions is useful for reducing the global burden of the disease. However, the lack of clinical applications of this
intervention and low patient adherence are huge barriers for improving patient outcome (Campbell et al. 2014). This paper will
illustrate a literature review of diabetes in the first part and critical appraisal of a paper in second part in the following paragraphs.
Background of the study:
According to Punthakee et al. (2017), approximately 24 million of the individuals in the United Kingdom are affected by this
chronic disease which increased their risk of premature death. A study by Shah et al. (2015), suggested that diabetes mellitus causes
production of insulin impaired. As discussed by Green et al. (2015), that because of this health condition, type II diabetes patient
experience physically weakness and therefore, physical activity is crucial for improving the blood glucose level in individuals.

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EXERCISE AS INTERVENTION OF DIABETES
Molecular biologist suggested that intensive physical activity is effective in enhancing the metabolism such as mitochondrial
biogenesis and beta-oxidation and molecular biogenesis. Li et al. (2017), argued that physical exercise proved to reduce 58% risk of
developing diabetes mellitus in pre-diabetic individuals and improved the quality of life in the patient with diabetes mellitus. Low et
al. (2014) suggested that only 40 % of the population engage in exercise as lifestyle interventions and 28.4% of them are able to
achieve a positive outcome. Accumulated evidence suggested that poor knowledge of individuals about lifestyle modification through
exercise and rare clinical practice of it are identified as a huge barrier for the management of the disease (Guest et al., 2015).
Therefore, literature reviews need to conduct for reducing the gap.
Research question:
In the United Kingdom can exercise therapy as non-pharmacological interventions be effective in the management of diabetes in a
population of 18 to 60 years old?
The rationale behind this question is that diabetes is public health concern that not only affected health but also affected the
psychological wellbeing. Therefore, the purpose of the research question is to identify whether exercise is effective for the
management of diabetes.
Strategy:
For constructing research question, the SPICE model was beneficial for identifying the type of search concept in the (appendix
A), it help in obtaining qualitative research articles. To find the research question, a specific research tool SPICE model which
evaluated the specific outcome and thus formulated research question was used for this literature review.

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EXERCISE AS INTERVENTION OF DIABETES
Aim and objectives:
The purpose of the literature review is to evaluate the effectiveness of exercise therapy as non-pharmacological interventions in the
management of diabetes in a population of 18 to 60 years old through collecting evidence.
Objective:
• To explore the effectiveness of to exercise therapy in population between 18 to 60 years.
• To explore the reason behind lack of adherence
• To recommend strategies to adhere to the non-pharmacological interventions.
Design and Methodology
Because of the type the research question most appropriate nature of the study is the qualitative methodology as it provided a
relevant and possible result which further assists researchers in gaining details of the effectiveness of exercise therapy for management
of diabetes mellitus (Berger et al. 2015). The research was conducted using library where various articles were searched in order to
assess the effectiveness of physical activity for diabetic patient and adherence of it in the study. It is important to gather all of the
important information and critically analyses those articles in the realistic time frame for addressing the research question.

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EXERCISE AS INTERVENTION OF DIABETES
Search for article and data extracting:
:
Once the research question had been formulated using specific research tool, it was possible to gather information and analyze articles
which were obtained after filtering range of evidence (Lewis 2015). There are specific inclusions and exclusion criteria for the articles
which was an roadmap for evaluation of the effect of exercise that further helped in obtaining the relevant article for research. The
research term that was used for the study including “type II diabetes mellitus”,” lifestyle intervention” “exercise’, “exercise-induced
metabolic changes”, “glucose metabolism”. To access articles, electronic databases were used such as CINAHL, Social Science
Citation index, Medline, in order to identify the accurate result of research question which would improve patient outcome.
The inclusion and exclusion criteria for the literature review are the following:
The inclusion and exclusion criteria for the literature review are following:
Inclusion criteria Exclusion criteria
 All relevant journals included
were published within last 5
 All relevant journal than 5
years were excluded
 All non reviewed articles were

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EXERCISE AS INTERVENTION OF DIABETES
years
 All relevant paper that were
included in the study were peer
review journal
 All relevant articles that were
included in the study were
published in English language.
 All relevant paper that were
included in the study worked on
human subject.
 All relevant paper which
discussed about the theories,
specific concepts was included.
 all relevant paper that fit into
the check list of CASP tool
were included in the study
 All relevant paper that
excluded
 All articles published in other
than English article were
excluded.
 All articles that published the
data work on other than human
subject will be eliminated.
 All paper which discussed
other then theories, specific
concepts were excluded
 all relevant paper that does not
fit into the check list of CASP
tool were included in the study
 . All relevant paper that was
undertaken studies other than

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EXERCISE AS INTERVENTION OF DIABETES
undertaken primary studies
were included.
primary studies were excluded.
Once all the articles had been filtered, 5423 articles which were further filtered for eliminating duplicates. After elimination of all
irreverent articles, 8 articles were selected from 63 articles corresponding with the inclusion criteria. In order to gain theme with the
help of prisma flowchart, different range of the study was evaluated and ultimately 8 journals were selected for best comprehensive
study (Moher et al. 2015). After obtaining these eight articles, these articles assisted researchers to categorize as well as analyze
different themes of the research.
Results Synthesis and Quality Appraisal of 8:
In order to identify the strength and limitation of each article, it is crucial to analyze and appraise each article which relate to
the research question for addressing the current issue (Lockwood et al. 2014). All of the articles were analyzed by using different
parameters such as methodology. Articles were assessed for different theme generation such as the effect of exercise on diabetes, the
effect of exercise on weight reduction and effect of exercise on metabolism.
Using data extraction table found in appendix C, the researcher was able to assess what is important for the study. The aim of
this is to provide clarity regarding extracted paper without re-examining the original articles. The extracted articles were assessed in

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EXERCISE AS INTERVENTION OF DIABETES
order to identify it was fit for the purpose or not (Alvesson and Sköldberg 2017). Once all of the articles were methodically read
through for generating logical themes, the literature synthesis was done.
Miller et al. (2018) suggested that in order obtain accurate literature review, it is crucial to identify the studies which are
appropriate for the synthesis of the result. The articles were that was mostly randomized trail control and using meta-synthesis
approach, each articles were assessed thoroughly. Few cohort studies are also included for gaining appropriate result in order to
address the research question. Qualitative meta-synthesis is defined as a coherent and international approach of literature for analyzing
the data of qualitative studies (Herber et al. 2015). This process is useful in assisting researchers in identifying a research question and
select, appraise and summarize the combination of different qualitative studies for addressing the research question (Brundisini et al.
2015). Therefore, Meta-synthesis is extremely crucial for the successful accomplishment of the study. However, the limitation of
these eight articles also identified after assessing these paper thoroughly. The limitations of these eight articles are that these articles
although researchers were tried to address the issue and use exercise as a lifestyle interventions for managing diabetes, These studies
failed to answer each part of the question. Moreover, the majority of the studies were conducted in the United Kingdom and thereby,
level of cultural homogeneity is a potential bias of these studies which might not be applicable for the patients who are living in other
countries.
These articles were filtered again using a specific tool for the diagnosis tool ( critical appraisal skill program ) produced by
Kitchenham (2007), which was intended to appraise specific papers by subjecting each paper in specific scales of questions such as

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EXERCISE AS INTERVENTION OF DIABETES
whether the aims are clear or not , whether study able to achieve the aim and data was adequate to conduct literature or not. These
articles were ranked on the basis of the variable answer such as ‘Yes’, ‘No’ and ‘Inconclusive’(see Appendix D).
The ranking of these eight articles was based on the highest level of evidence observed i (appendix c). and grading was done
by Cardwell’’s appraisal tool before selecting the highest level of the articles which were critically appraised (Pitt et al. 2015). it was
observed during the study that only one out of 63 articles were able to give conscious information of the study which was included in
the appendix B. Details calculation were used for gaining the sample size and no missing inclusion criteria were not observed that was
observed in other articles and immediately excluded from the research. Ultimately, these articles were selected for conducting an
appropriate study which met all of the inclusion criteria that is present in the methodology section. Moreover, these articles were
successful in avoiding any potential bias that would otherwise impact the evidence of the research.
Reviewing each of the eight articles, each article considered diabetes type two is a public health problem that is not only
affecting the quality of life but also enhancing the premature rate. Each of the eight articles highlighted that due to high expenditure of
the health care, majority of the individuals do not seek clinical help. One of the articles such as Bhopal et al. (2014) Implementation
of nonpharmacological intervention such as physical activity is effective in reducing the prevalence in reducing the high risk of
diabetes and obesity. Dixit et al. (2014) and Cassidy et al. (2016), also highlighted the positive effect of exercise on individuals with
diabetic and it is able to enhance the metabolic activity of the individuals. Cassidy et al. (2016) showed that intense aerobic exercise
is effective in shaping cardiac muscles and reduce the fat in the patient who is suffering from type II diabetes. Ngandu et al. (2015),

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EXERCISE AS INTERVENTION OF DIABETES
highlighted that exercise with other psychological therapies are crucial for reducing the premature death amongst elderly patient who
is at higher risk of developing a disease like a type II diabetes. On a different note, Vlaar et al. (2017), highlighted that the culturally
targeted lifestyle interventions such as physical activity are not always effective because the high rate of unemployment, high drop out
and other psychological disorders also affected the adherence to the physical activity.
Other articles such as Palakodeti et al. (2015), Otten et al. (2015) and Karjalainen et al. ( 2015) are successfully conducted
research and highlighted that proper diet such as Palaeolithic diet as well as intensive physical activity is crucial for reducing the fat
mass and increasing insulin sensitivity. Karjalainen et al. ( 2015) also highlighted that physical activity not only help in insulin
sensitivity also assist in controlling glucose production. Therefore, this research evidence are highly useful for identifying the
effectiveness of the non-pharmacological interventions such as exercise and implementing it in the clinical practice for reducing
premature death in the vulnerable population. This research evidence are accurate compared to other 63 journals in terms of research
method which help in theoretical understanding the diabetes type ii in patients and who are at higher risk of at it. This evidence also
effective in identifying the effects of physical activity in reducing the risk factor of diabetes, cardiovascular disease and managing
other chronic diseases. These eight articles addressed the potential ethical issues such as confidentiality data after data collection and
patient’s information. Patient’s safety is crucial ethical that usually arise in the research field while conducting any primary studies. In
the last stage of appraising articles for obtaining best evidence of research, each 8 articles were ranked on the basis of hierarchical
study and individually graded based on the scientific publication published by Kitchenhams (2007) and one out of eight articles were
selected for the critical appraisal which would be conducted in the second part of the study. Each of the eight studies that were

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EXERCISE AS INTERVENTION OF DIABETES
included in addressing the research question provided excellent evidence of the exercise therapy as a lifestyle intervention which is
effective in reducing diabetes.
Summary and synthesis of the paper:
Assessment of Quality of Evidence and Overview of Themes:
After assessment of study using critical appraisal skill program for qualitative study, each article was thoroughly scrutinized
for ensuring that each of them addresses the issue written in the research question, as well as each study, is compatible with the current
study for sound contribution in the findings of the study. Therefore, the understanding the cost-effectiveness of the exercise in a
patient with type II diabetes and individuals with pre-diabetes assisted the researcher to select common themes that are prevalent in
these eight journals. Through identifications of the themes, researchers were able to assess the common research process and the
methodology and sample tool used for the study.
The theme was generated on the basis of three crucial components such as:
Abstracts:
Abstract was clearly produced in each of the eight articles and therefore, it provided a concise idea of the study indicating
prime aim of the study. It also assisted researchers to generate effective and logical theme for the research topic with the help of
databases which is useful for the study.

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EXERCISE AS INTERVENTION OF DIABETES
Methodology:
Eight articles that are included in the study were chosen qualitative methodology; that further helped in scrutinizing on
participants in details on the prospective study (Baumann, Schröder and Fink 2015). Majority of the study conducted a randomized
control trial for the research. Only in Palakodeti et al. (2015) and Karjalainen et al. (2015), the researcher conducted a cohort study for
obtaining accurate evidence. However, the assessment questions limit the further exploration of the study. All eight evidence was used
for assessing the effectiveness of exercise including the effect of it in metabolic activity, fat reduction, weight reduction which would
further useful for implementing it in the clinical practice; Therefore, few of the studies also highlighted the reason behind lack of
adherence through gaining feedback from the participants. Qualitative methodology is also an effective procedure since it helps
researchers to gain personal narrative in each study (Zulfiqar et al. 2017). However, potential biases also exist in the qualitative
research method during the data collection since it is highly subjective. The study also depends on the point of view of others which is
also a potential bias for the study.
Sample tool:
Sample tool for the majority of the article systematic for assessing the qualitative of evidence found in the research article. The
prime reason behind choosing this study is that it enables researchers to collect data efficiently and give an opportunity to gain an idea
of the individuals suffering. However, the potential bias is that cultural homogeneity in the study. Few studies also highlighted the
broader sampling and data collection need to be done.
Broader themes form the study: