To evaluate the effect of lifestyle modification by adopting a DASH diet, with and without physical activity guidance, on blood pressure, glycemic control, lipid profile, weight, and body composition in older patients with type 2 diabetes mellitus (T2DM) and hypertension.
Methods and Results
For this randomized clinical trial, we recruited patients aged 60 years or older with T2DM and uncontrolled hypertension. One group (DASH) received only DASH dietary guidance, while the other group (DASHPED) received dietary guidance and encouragement to walk with a pedometer. Outcomes of interest were (1) blood pressure, (2) physical activity, (3) weight, body mass index (BMI), and body composition, and (4) biochemical variables. Measurements were taken at baseline and 16 weeks after the intervention. We included 35 patients in the analysis. At the end of the study, the DASHPED group had an mean increase in physical activity of 1721 steps/day. Both groups displayed significantly reduced weight, BMI, and waking diastolic pressures on ambulatory blood pressure monitoring after the intervention. A trend of reduced sleeping diastolic pressure was found in the DASHPED group. Changes in weight, BMI, muscle mass, body fat, waist-hip ratio, glycemic control, lipid profile, and insulin sensitivity did not differ between the groups.
Conclusion
There was no difference in outcomes between the group that only dieted and the group that also performed increased physical activity, despite a significant increase in exercise. This reinforces the importance of dietary changes in immediate blood pressure control.
Adamsson ErydSGudbjörnsdottirSManhemK, et al. (2016) Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: National population based cohort study. BMJ (Online) 354: –8.
3.
American Association of Diabetes (2021) ADA standards of diabetes care 2021. Diabetes Care.
4.
AndrewsRCooperARMontgomeryAA, et al. (2011) Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: The early ACTID randomised controlled trial. The Lancet378(9786)Elsevier Ltd: 129–139.
5.
AppelLJMooreTJObarzanekE, et al. (1997) A clinical trial of the effects of dietary patterns on blood pressure. The New England Journal Of Medicine336: 1117–1124.
6.
BakrisGAliWParatiG (2019) ACC/AHA versus ESC/ESH on hypertension guidelines: JACC guideline comparison. Journal of the American College of Cardiology73(23): 3018–3026.
7.
BarrosoWKSRodriguesCISBortolottoLA, et al. (2021) Diretrizes brasileiras de hipertensão arterial-2020 barroso et al. Arq bras cardiol. Arquivos Brasileiros de Cardilologia116(3): 516–658. Available at:
8.
BaskervilleRRicci-CabelloIRobertsN, et al. (2017) Impact of accelerometer and pedometer use on physical activity and glycaemic control in people with type 2 diabetes: A systematic review and meta-analysis. Diabetic Medicine34(5): 612–620.
9.
Tudor-LockeCBellRCMyersAM, et al. (2004) Controlled outcome evaluation of the first step program: A daily physical activity intervention for individuals with type II diabetes. International Journal of Obesity28(1)C. Tudor-Locke, Department Exercise and Wellness, Arizona State University East, Mesa, AZ 85212, United States, England: 113–119.
10.
ColbergSRSigalRJYardleyJE, et al. (2016) Physical activity/exercise and diabetes: A position statement of the American diabetes association. Diabetes Care39(11): 2065–2079.
11.
De BoerIHBangaloreSBenetosA, et al. (2017) Diabetes and hypertension: A position statement by the American diabetes association. Diabetes Care40(9): 1273–1284.
12.
De MoraisPKSalesMMAlmeidaJA, et al. (2015) Effects of aerobic exercise intensity on 24-h ambulatory blood pressure in individuals with type 2 diabetes and prehypertension. Journal of Physical Therapy Science27(1): 51–56.
13.
De PaulaTPSteemburgoTDe AlmeidaJC, et al. (2012) The role of dietary approaches to stop hypertension (DASH) diet food groups in blood pressure in type 2 diabetes. British Journal of Nutrition108(1): 155–162.
14.
DeguchiKEnishiTSatoN, et al. (2016) Acute effect of fast walking on postprandial blood glucose control in type 2 diabetes. Diabetology International7(2): 119–123.
15.
FigueiraFRUmpierreDCureau FV., et al. (2014) Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: A systematic review and meta-analysis. Sports Medicine44(11): 1557–1572.
16.
FlackJMAdekolaB (2020) Blood pressure and the new ACC/AHA hypertension guidelines. Trends in Cardiovascular Medicine30(3)Elsevier Inc.: 160–164.
17.
FranciscoPMSBSegriNJBorimFSA, et al. (2018) Prevalence of concomitant hypertension and diabetes in Brazilian older adults: Individual and contextual inequalities. Ciencia e Saude Coletiva23(11): 3829–3840.
18.
FriedewaldWLevyRFredricksonD (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical Chemistry18(6): 499–502.
19.
GreggEWCaspersenCJ (2005) Physical disability and the cumulative impact of diabetes in older adults. British Journal of Diabetes and Vascular Disease5(1): 13–17.
20.
GreggEWBecklesGLAWilliamsonDF, et al. (2000) Diabetes and physical disability among older U.S. Adults. Diabetes Care23(9): 1272–1277.
21.
GrossJLDe AzevedoMJSilveiroSP, et al. (2005) Diabetic nephropathy: Diagnosis, prevention, and treatment. Diabetes Care28(1): 164–176.
22.
KalacheAGattiA (2002) Active ageing: A policy framework. World Health Organization (WHO) 11: 7–18.
23.
LewingtonSClarkRQizilbashN, et al. (2002) Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet (London, England)360(9349): 1903–1913.
24.
LiubaoerjijinYTeradaTFletcherK, et al. (2016) Effect of aerobic exercise intensity on glycemic control in type 2 diabetes: A meta-analysis of head-to-head randomized trials. Acta Diabetologica53(5): 769–781.
25.
MarshallSJLevySSTudor-LockeCE, et al. (2009) Translating physical activity recommendations into a pedometer-based step goal. 3000 steps in 30 min. American Journal of Preventive Medicine36(5): 410–415.
26.
MatthewsDRHoskerJPRudenskiAS, et al. (1985) Homeostasis model assessment: Insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia28(7): 412–419.
MiyauchiMToyodaMKaneyamaN, et al. (2016) Exercise therapy for management of type 2 diabetes mellitus: Superior efficacy of activity monitors over pedometers. Journal of Diabetes Research2016England: 5043964.
29.
PahraDSharmaNGhaiS, et al. (2017) Impact of post-meal and one-time daily exercise in patient with type 2 diabetes mellitus: A randomized crossover study. Diabetology and Metabolic Syndrome9(1): 1–7. DOI: 10.1186/s13098-017-0263-8.
30.
PatersonDHWarburtonDER (2010) Physical activity and functional limitations in older adults: A systematic review related to Canada’s physical activity guidelines. International Journal of Behavioral Nutrition and Physical Activity7: 1–22. DOI: 10.1186/1479-5868-7-38.
31.
PintoLCRicardoEDLeitãoCB, et al. (2010) Controle inadequado da pressão arterial em pacientes com diabete melito tipo 2. Arquivos Brasileiros de Cardiologia94(5): 651–655.
32.
QiuSCaiXChenX, et al. (2014) Step counter use in type 2 diabetes: A meta-analysis of randomized controlled trials. BMC Medicine12(1): 1–9.. DOI: 10.1186/1741-7015-12-36.
33.
SacksFMSvetkeyLPVollmerWM, et al. (2001) Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet: Editor’s comments. Current Hypertension Reports344: 3–10.
34.
Saint-MauricePFTroianoRPBassettDR, et al. (2020) Association of daily step count and step intensity with mortality among US adults. JAMA323(12): 1151–1160.
35.
SimsOTOhHNohH, et al. (2018) Prevalence and predictors of co-occurring diabetes and hypertension in community-dwelling older adults. Geriatrics and Gerontology International18(9): 1356–1360.
36.
SteemburgoTDall’AlbaVAlmeidaJC, et al. (2009) Intake of soluble fibers has a protective role for the presence of metabolic syndrome in patients with type 2 diabetes. European Journal of Clinical Nutrition63(1): 127–133.
37.
StrattonIMAdlerAINeilHAW, et al. (2000) Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): Prospective observational study. British Medical Journal321(7258): 405–412.
38.
The task force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) (2018) 2018 ESC/ESH guidelines for the management of arterial hypertension. European Heart Journal39: 3021–3104.
39.
Tudor-LockeCCraigCLAoyagiY, et al. (2011) How many steps/day are enough? For older adults and special populations. International Journal of Behavioral Nutrition and Physical Activity8(1)BioMed Central Ltd: 80.
40.
UK Prospective Diabetes Study Group (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. British Medical Journal317(7160): 703–713.
41.
UmpierreDKramerCKLeitaCB, et al. (2016) Physical activity advice only or structured with HbA1c levels in type 2 diabetes. A systematic review and meta-analysis. JAMA305(17): 1790–1799.
42.
UngerTBorghiCCharcharF, et al. (2020) 2020 International society of hypertension global hypertension practice guidelines. Hypertension75(6): 1334–1357.
43.
WheltonPKCareyRMAronowWS, et al. (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. DOI: 10.1161/HYP.0000000000000065.
44.
ZhouBCarrillo-LarcoRMDanaeiG, et al. (2021) Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet6736(21): 957–980. DOI: 10.1016/s0140-6736(21)01330-1.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
