Introduction 1 2 5 6 7 3 5 7 9 10 17 11 18 20 6 21 22 3 23 n 1c 3 23 1c Methods Participants 24 25 26 n n 1 1 Fig. 1 Study flow diagram  Table 1 Participants’ baseline characteristics Characteristic n n n Age (years) 60 ± 9 61 ± 9 59 ± 9 n 47/45 27/22 20/23 Duration of diabetes (years) 5 ± 5 5 ± 4 5 ± 5 BW (kg) 94.3 ± 18.4 94.1 ± 18.1 94.5 ± 19.0 2 32.3 ± 5.5 32.1 ± 5.2 32.5 ± 6.0 W max 156 ± 47 155 ± 49 157 ± 45 \documentclass[12pt]{minimal}
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\begin{document}$$\mathop {V{\text{O}}}\limits^ \cdot _{{\text{2peak}}} $$\end{document} 82 ± 11 82 ± 10 83 ± 11 Participants treated with: n 11 5 6 n   Total 81 44 37   Metformin 43 24 19   Sulfonylurea 25 13 12   Thiazolidinedione 10 4 6   Insulin 13 6 7 n   Total 59 32 27   ACEI/ARB 39 20 19   Beta-blocker 17 7 10   Diuretic 19 10 9   Calcium-channel blocker 9 5 4   Other 3 1 2 n   Total 54 30 24   Statin 53 29 24   Fibrate 1 1 0   Other 0 0 0 n \documentclass[12pt]{minimal}
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\begin{document}$$\mathop {V{\text{O}}}\limits^ \cdot _{{\text{2peak}}} $$\end{document} 31 ACEI, ACE inhibitor; ARB, angiotensin receptor blocker; BW, body weight Exercise intervention Overview 27 Brisk walking programme 1 Medical fitness programme 1 Energy expenditure and monitoring blood glucose 28 29 −1 −1 Financial cost of the intervention programmes Outcome variables Resting heart rate and blood pressure Physical fitness \documentclass[12pt]{minimal}
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\begin{document}$$\mathop {V{\text{O}}}\limits^ \cdot _{2{\text{peak}}} $$\end{document} 31 Blood analyses 1c g 32 33 1c Quality-of-life assessment 34 35 Statistical analyses 1c α 36 t χ 2 U Results Characteristics of the study population 1 Programme adherence, follow-up and adverse events p 2 p 2 1 2 p Table 2 Adverse medical events Events n n Adverse events related to exercise intervention 15 12  Shoulder pain/chronic tendinopathy of rotator cuff 0 1  (Aggravation of) low back pain 2 2  Aggravation of pre-existing osteoarthritis in hip or knee joint 6 4  Shin splints/lower leg pain 1 0  Chronic tendinopathy of Achilles tendon/plantar fascia 3 1  Other/generalised musculoskeletal discomfort 3 3 Adverse events not related to exercise intervention 4 6 a 3 3 b 1 3 Participants with adverse event resulting in withdrawal 19 17 Data are number of participating diabetes patients that experienced an adverse event throughout the 12 months follow-up period a n n n n n n b n n n n Glycaemic control 1c p 3 n n 1c p 1c p 3 Table 3 Changes in diabetes outcome (ITT analysis) Variable Change from baseline to 12 months Mean ± SD n Mean ± SD n Difference 95% CI p 1c  Total 7.13 ± 1.36 92 6.99 ± 1.26 71       Brisk walking group 7.18 ± 1.42 49 7.08 ± 1.37 38        Medical fitness group 7.08 ± 1.29 43 6.89 ± 1.13 33        Intragroup comparisons                 Intragroup comparison total         −0.14 −0.39, 0.03 0.153   Intragroup comparison brisk walking         −0.11 −0.51, 0.15 0.464   Intragroup comparison medical fitness         −0.18 −0.45, 0.09 0.176  Brisk walking vs medical fitness         0.00 −0.42, 0.43 0.985 2  Total 32.3 ± 5.5 92 31.8 ± 5.4 89        Brisk walking group 32.1 ± 5.2 49 31.9 ± 5.0 48        Medical fitness group 32.5 ± 6.0 43 31.7 ± 5.9 41        Intragroup comparisons                 Intragroup comparison total         −0.5 −1.1, 0.1 0.108   Intragroup comparison brisk walking         −0.2 −0.6, 0.3 0.471   Intragroup comparison medical fitness         −0.8 −2.0, 0.3 0.152  Brisk walking vs medical fitness         0.7 −0.5, 1.9 0.237 Fasting plasma glucose (mmol/l)  Total 8.44 ± 2.81 92 8.21 ± 2.37 71        Brisk walking group 8.64 ± 2.83 49 8.33 ± 2.64 38        Medical fitness group 8.21 ± 2.80 43 8.06 ± 2.05 33        Intragroup comparisons                 Intragroup comparison total         −0.23 −0.72, 0.25 0.345   Intragroup comparison brisk walking         −0.31 −0.96, 0.34 0.344   Intragroup comparison medical fitness         −0.15 −0.91, 0.61 0.699  Brisk walking vs. medical fitness         −0.16 −1.14, 0.82 0.744 a  Total 5.55 ± 3.68 68 5.60 ± 3.38 54        Brisk walking group 5.86 ± 3.56 37 5.75 ± 3.20 30        Medical fitness group 5.19 ± 3.58 31 5.43 ± 3.64 24        Intragroup comparisons                 Intragroup comparison total         0.05 −0.50, 0.62 0.833   Intragroup comparison brisk walking         −0.12 −1.11, 0.85 0.794   Intragroup comparison medical fitness         0.24 −0.19, 0.74 0.241  Brisk walking vs medical fitness         −0.40 −1.52, 0.72 0.479 Resting heart rate (bpm)  Total 73.4 ± 11.8 91 69.6 ± 13.9 77        Brisk walking group 72.6 ± 11.8 48 68.3 ± 15.0 41        Medical fitness group 74.4 ± 11.8 43 71.0 ± 12.4 36        Intragroup comparisons                 Intragroup comparison total         −3.9 −5.9, −1.8 0.000   Intragroup comparison brisk walking         −4.3 −7.4, −1.1 0.009   Intragroup comparison medical fitness         −3.4 −5.9, −0.9 0.010  Brisk walking vs medical fitness         −0.9 −4.9, 3.2 0.678 Systolic blood pressure (mmHg)  Total 148.5 ± 18.1 91 137.5 ± 15.5 77        Brisk walking group 150.3 ± 18.9 48 138.9 ± 16.3 41        Medical fitness group 146.3 ± 17.1 43 135.9 ± 14.6 36        Intragroup comparisons                 Intragroup comparison total         −10.9 −14.0, −7.8 0.000   Intragroup comparison brisk walking         −11.4 −15.9, −6.8 0.000   Intragroup comparison medical fitness         −10.4 −14.7, 6.2 0.000  Brisk walking vs medical fitness         −0.9 −7.1, 5.3) 0.768 Diastolic blood pressure (mmHg)  Total 81.9 ± 10.6 91 76.6 ± 8.3 77        Brisk walking group 81.3 ± 10.8 48 75.9 ± 8.8 41        Medical fitness group 82.6 ± 10.4 43 77.4 ± 7.7 36        Intragroup comparisons                 Intragroup comparison total         −5.3 −7.1, −3.6 0.000   Intragroup comparison brisk walking         −5.4 −7.8, 2.9 0.000   Intragroup comparison medical fitness         −5.2 −7.8, −2.7 0.000  Brisk walking vs medical fitness         −0.1 −3.6, 3.4 0.949 Total cholesterol level (mmol/l)  Total 4.70 ± 0.86 88 4.53 ± 0.94 65        Brisk walking group 4.83 ± 0.89 47 4.61 ± 0.92 35        Medical fitness group 4.54 ± 0.12 41 4.44 ± 0.96 30        Intragroup comparisons                 Intragroup comparison total         −0.16 −0.32, −0.01 0.035   Intragroup comparison brisk walking         −0.22 −0.45, 0.01 0.064   Intragroup comparison medical fitness         −0.10 −0.30, 0.10 0.307  Brisk walking vs medical fitness         −0.12 −0.42, 0.19 0.453 LDL-cholesterol level (mmol/l)  Total 2.83 ± 0.76 88 2.70 ± 0.79 64        Brisk walking group 2.90 ± 0.82 47 2.72 ± 0.85 35        Medical fitness group 2.74 ± 0.69 41 2.68 ± 0.72 29        Intragroup comparisons                 Intragroup comparison total         −0.12 −0.26, 0.01 0.070   Intragroup comparison brisk walking         −0.18 −0.38, 0.02 0.080   Intragroup comparison medical fitness         −0.06 –0.25, 0.12 0.493  Brisk walking vs medical fitness         −0.11 −0.38, 0.16 0.401 HDL-cholesterol level (mmol/l)  Total 1.09 ± 0.28 88 1.10 ± 0.29 65        Brisk walking group 1.10 ± 0.23 47 1.09 ± 0.26 35        Medical fitness group 1.07 ± 0.33 41 1.11 ± 0.32 30        Intragroup comparisons                 Intragroup comparison total         −0.01 –0.02, 0.04 0.570   Intragroup comparison brisk walking         −0.01 −0.06, 0.04 0.629   Intragroup comparison medical fitness         0.03 −0.01, 0.08 0.129  Brisk walking vs medical fitness         −0.05 −0.12, 0.02 0.172 Triacylglycerol level (mmol/l)  Total 1.88 ± 0.99 88 1.79 ± 0.91 64        Brisk walking group 2.00 ± 1.08 47 1.94 ± 0.98 35        Medical fitness group 1.74 ± 0.88 41 1.61 ± 0.79 29        Intragroup comparisons                 Intragroup comparison total         −0.09 −0.25, 0.06 0.239   Intragroup comparison brisk walking         −0.06 −0.33, 0.17 0.646   Intragroup comparison medical fitness         −0.13 −0.27, 0.06 0.120  Brisk walking vs medical fitness         −0.02 −0.29, 0.33 0.892 RAND-36 (score 0–100 scale)  Total 71 ± 15 89 70 ± 15 58        Brisk walking group 69 ± 15 46 68 ± 15 31        Medical fitness group 73 ± 15 43 71 ± 14 27        Intragroup comparisons                 Intragroup comparison total         −0.6 −2.4, 1.2 0.503   Intragroup comparison brisk walking         0.1 –2.7, 2.8 0.969   Intragroup comparison medical fitness         −1.4 −3.8, 1.1 0.261  Brisk walking vs medical fitness         1.4 −2.2, 5.0 0.438 n a n Resting heart rate and blood pressure p 3 n n p p 3 Blood lipid profile 3 n n p Body composition and workload capacity 3 p p p p W max p 1c W max R p n R p n Quality of life assessment p 3 Discussion 37 15 19 3 38 39 23 40 42 43 44 45 21 46 1c 3 7 27 47 49 3 In conclusion, the prescription of group-based brisk walking represents an equally effective interventional strategy to modulate glycaemic control and cardiovascular risk profile in type 2 diabetes patients compared with a more individualised medical fitness programme. General deconditioning, musculoskeletal overuse injuries and lack of motivation limit the benefits of long-term exercise intervention as an add-on to a comprehensive diabetes care programme. Future diabetes exercise intervention programmes in primary healthcare settings should consider diabetes-related co-morbidities and patient motivation as important factors, which determine both long-term programme adherence and the associated clinical benefits. Electronic supplementary material Below is the link to the electronic supplementary material.
 Table 1 Exercise programme (PDF 60.7 KB) Table 2 1c Table 3 Changes in diabetes outcome in long-term active participants (PDF 160 KB)