CONFERENCE PAPER

Published Online: January 30, 2024

https://doi.org/10.31893/multirev.2023ss014

Advancing Healthcare Innovation: Multidisciplinary Collaboration and Translational Research

A critical analysis of physical activity's promising

function in the management of Type 2 Diabetes
Mellitus
K. Benson Johna | Feba Abrahama | Shraddha Gandhib | W. Vinuc |
S. Punitha Josephined | Pranavjith Arukandye
aDepartment of Nursing, Desh Bhagat University (DBU), Mandi Gobindgarh, Punjab, India.
bDepartment of Emergency Medicine, ESIC hospital, Andheri, Maharashtra, India.
cDepartment of Physical Education and Sports, Pondicherry university, Tamil nadu, India.
dDepartment of Nursing, Kasturba Gandhi Nursing College, Sri Balaji Vidyapeeth (Deemed to be university) Puducherry, India.
eDepartment of Medicine, PSG Institute of Medical Science and Research, Coimbatore, Tamil Nadu, India.

Abstract Physical activity (PA) has been demonstrated to have negative correlations with type 2 diabetes mellitus.
Considering provided the establishment of the dose‒response interactions still additionally undiscovered. For investigating
the association involving extra cases of type 2-diabetes and PA, the study utilizes model nonlinearity. Implementing together
study findings from multidemographic long-term studies. A metric that exclusively considers energy employed above resting
metabolic rate was used to translate PA exposures through reduced metabolic equivalent of task (MET) and the
physiological equivalent of task hours per the previous week. The association involving radiation and illness was modeled
utilizing restricted quadratic splices. The results point to a general nonlinear association; utilizing the rectangular spline
model, we discovered a probability decrease for type 2 diabetes of twenty-six percent among people who attained eleven
twenty-five MET hours per month. A risk decrease of 36% was shown when this quantity of PA was doubled, and more
significant reductions were seen at higher dosages. For moderate-intensity PA the power source marginal MET week dose‒
response curve's findings revealed comparable. However, the advantages of higher-intensity PA were more significant, and
those of lower-intensity activity substantially decreased. Among the overall population, higher levels of has been connected
to a significantly decreased risk of type 2 diabetes. The relationships between type’s two diabetics with LTPA were curved.
At quantities far higher than those recommended by the health department standards, however, further benefits may be
possible. The most significant insufficient quantities of exercise result in relative improvements.
Keywords: physical activity, diabetes, critical analysis, leisure-time

1. Introduction
Physical inactivity (PA) is considered one of the most controllable risk factors affecting various conditions and has been
recognized as the fourth-highest risk factor for overall mortality. PA and exercise have been proven to improve quality of life
and lower the risk of multiple conditions (Dasso, 2019). Sleep deprivation has been shown to significantly increase the
probability of serious medical issues, including cancer and cardiovascular diseases, and it also exacerbates the occurrence of
depression (Garbe et al., 2020). Improving the quality of sleep plays an essential role in promoting health. The expression "sleep
quality" has often been employed in sleep medicine, although it has not yet been established (Mulyani et al., 2020). Type 2
diabetes mellitus (T2DM) is becoming increasingly common. Instead of the growing insulin response in previously temperate
regions, the current procedures for treating T2DM simply reduce the disease's indications. Several studies in the last decade
have connected insulin resistance and the development of T2DM to a specific chaperone family called heat shock protein 70
(HSP70). HSP70 is a molecular chaperone involved in protein folding and degradation and has cytoprotective effects
(Höchsmann et al., 2019). Increasing daily PA in bored, stagnant people has received substantial amounts of research attention.
Exercises performed on a controller have been shown to motivate sedentary people with type 2 diabetes to increase their PA
levels on their own, improving glucose control and, as a result, overall health. Furthermore, PA-promoting mobile games such
as Pokemon GO have made use of enhanced rewards. (Niantic Labs, San Francisco, CA) with the same goal of maintaining PA
behaviors (Ramadhan et al., 2019; Jin et al., 2020).
Understanding the primary variables that are associated with an increased commitment to physical activity in diabetes
patients is crucial for providing physicians providing primary care in Saudi Arabia because these data will serve as a scientific
Multidiscip. Rev. (2023) 6:e2023ss014 Supplementary Issue: Medical (AlliedCon 2023)
John et al. (2023) 2

foundation for creating suitable strategies that can increase physical exercise levels in that population, with the ultimate aim
of enhancing physical activity and bloodstream sugar management for patients (Świątoniowska et al., 2019). To a considerable
extent, investigations have demonstrated that diabetic education improves patients' quality of life, contentment with
treatment, compliance, self-care, and general well-being (McDowell et al., 2019). The research contribution analyzes model
deviations to examine the interaction between type 2 diabetes and PA in more cases. This article integrates an analysis of
demographically distinct ongoing studies.
Schram et al., 2021, described certain vital deficiencies in the current proof base, such as problems with exposure and
effect measures, inconsistent evaluation and modification of putative confounding variables, accurate representation of
instances, and decreased discrimination; moreover, there is some confirmation that PA could safeguard against indicators of
anxiety and conditions. This resource emphasizes the promising protective effects and the primary research gaps in this
discipline. Ijaz et al. (2018) analyzed the context of the decision; outcomes across previous investigations provide opportunities
for additional investigations into the role of social network initiatives in the detection of diabetes, prevention of complications,
and self-management of type 2 diabetes. One's beliefs, actions, and conformity to accepted norms in the field of health
behavior are strongly affected by one's social network. Lahtinen et al. (2018) reported that increased LTPA is related to a
significantly decreased risk of type 2 diabetes. Although the most significant relative advantages are attained at modest levels
of activity, additional benefits could be realized at intensities substantially more critical than those indicated by health
departments, indicating a quadratic connection between type 2 diabetes and LTPA (Avery et al., 2012). Iwase et al. (2018)
evaluated individuals with type 2 diabetes and suggested that baseline HbA1c levels decrease significantly after individuals
participate in behavioral treatments that emphasize increased PA and exercise. Clinically substantial reductions in HbA1c are
possibly more likely to occur with specific behavior alteration methods (Letizia et al., 2021). It is possible that a greater emphasis
on altering behavioral strategies could prove desirable. Intervention efficacy may also depend on other aspects, for instance,
the theories used and how long they are implemented. Prevention of type 2 diabetes, an endocrine condition, requires
adjusting a person's eating habits, exercising regularly, and maintaining weight (Jeffcoate et al., 2018).
The most crucial factor in combating the current pandemic is, unfortunately, still public education. Despite advances in our
understanding of the disease's biology and the development of potential alternative therapies, no resolution is currently
available. The management plans of individuals with type 2 DM should be created in this condition. Nuzum et al. (2020), to
conduct an interim analysis of this investigation to indicate that the DSMQ is a proper and accurate tool for evaluating self-care
behaviors related to glycemic control (Schmitt et al., 2013). The use of questionnaires might benefit both type 1 and type 2
diabetic patients in research and treatment environments. Wake (2020), although considered in proximity, suggested that older
individuals who have been previously diagnosed or are at concern with MCI or dementia may benefit from more excellent
physical activity in various essential ways. Therefore, subsequent studies describing the influence of physical activity on those
fields simultaneously, in addition to the interactions between each of them, are bound to provide relevant insight into the best
methods for preventing older persons with MCI or dementia, as well as potential rehabilitation initiatives. George et al. (2020)
reported that the prevalence of type 2 diabetes continues to increase significantly worldwide. Consequently, multiple studies
advocate for frequent PA as a vital component of diabetes care. The positive benefits of PA on diabetic patients have been
recognized for some time (Sandström et al., 2005). The health of individuals and the responsibilities of medical professionals
both improve with consistent physical activity. According to our systematic review and meta-analysis, increased physical activity
is related to lower death rates in persons with T2D and breast cancer.
2. Materials and Methods
2.1. Search strategy
Medical subject heading (MeSH) and indexed keywords were used to search for associations between anemia and type
2 diabetes in prospective cohorts in Medline, and the findings were reduced by utilizing filters designed explicitly for empirical
studies. More studies were found by manually searching the referenced works of previous systematic reviews (Zhang et
al.,2018). There were no limits regarding when the findings could be released; therefore, results up to December of the same
year were considered.
2.2. Eliability criteria
Prospective studies included met the following criteria for the occurrence of type 2 diabetes: (1) they tracked an adult
population; (2) they did not include participants who already had the disease at baseline; (3) they measured baseline levels of
leisure-time or total PA; and (4) they provided relative risks (RRs), odds ratios (ORs), or hazard ratios (HRs). Studies that failed
to disclose enough information on PA evaluation to calculate PA quantity as MET hours per week were disqualified; simply,
those that used fitness measurements to determine exposure presented PA as a binary variable or had redundant information.
Descriptions and titles were evaluated by two researchers for eligibility under predetermined standards (Wang et al., 2020).
The whole text was collected when eligibility was in doubt. To ensure that no indication of redundant information had been
included, only the more complete publication was included when comparing cohort names, recruitment timeframes, or

https://www.malque.pub/ojs/index.php/mr
John et al. (2023) 3

techniques. The discovered products were evaluated by a third researcher, and any discrepancies were investigated until an
agreement was reached. The electronic supplementary material explains the scientific discovery (Jin et al., 2020).
2.3. Data extraction and exposure harmonization
The first criterion, the inclusion of this point, the setting, cohort size, age, sex characteristics, total number of people or
decades for each PA discipline, case count for each PA exposure PA evaluation category, procedures, and units, as well as
reported PA susceptibility quantities, odds ratios, relative risks, and 95% confidence intervals, were extracted. The various PA
groups, variables used in the studies, and type 2 diabetes were also extracted. The Newcastle Ottawa Scale was used to
calculate an overall research efficacy score indicating the reliability of the difference between observers. The authors
hypothesized that the hazard ratio indicated for type 2 diabetes in prospective studies was equivalent to the risk. The authors
averaged the risk estimates modified for and with body mass index (Canu et al., 2020). First, we converted all weekly exposure
estimates to the same metabolic equivalent of task h/week, making it possible to combine activities of varying intensity and
duration. MVPA and VPA were described as having average powers of 4.5 and 8 METs, respectively, for attributing particular
passion to categories of PA exposure. These studies included distinct observation studies that reported sex-specific or
multicohort data (Tyrell et al., 2019).
Risk estimates from studies that used the highest PA category as a reference have been revised using the lowest PA
category. When not provided, investigators multiplied the standard deviation and baseline frequency of the considered
subcategory by the assigned gross metabolic equivalent of task value to obtain the traditional PA volume—establishing because
investigators succeeded in transforming the unrestricted categories for the point estimations of the average LTPA length
because the median of the Almost 50% of the range of measures in the next category's measuring range separated the
unrestricted category and its bottom category boundary. The LTPA metabolic equivalent of task h/week was calculated to
produce the study that assessed PA for a given grade depending on each company's justification for optimal PA values. In the
main study, they assumed that every appointment of PA lasted forty-five minutes, whereas in the sensitivity analysis, they
evaluated an assumption that each session lasted thirty minutes. Additionally, we assumed that there was a 4.5 MET intensity
for PAs if only the average time was specified. To obtain the marginal PA volume (MMET h/week), we subtracted 1 MET from
the resting metabolic rate. The electronic supplementary material (ESM) provides an overview of the methodology used in dose
assignment estimates. The hours of indicated activity were rounded toward the most unrealistic hour, after which 1 MET h was
eliminated from the total (Halperin et al., 1990). When the necessary statistics considering the initial studies failed to provide
details regarding the length of PA or the percentage of individuals with type 2 diabetes with each exposure to the PA group,
we created participants representing the relevant cohorts to collect additional data. They obtained further follow-up
information and details regarding PA behavior via subsequent conversations.
2.4. Statistical analysis
To predict dose‒response curves for this investigation, we used generalized least-squares (GLS) regression. Although
the linear dose‒response characteristics were computed according to a personal-related GLS analysis, controls for the
correlation for each exposed category were included in each study for the PA exposure category. With a random-effects model,
the Simpson–Laird estimation was implemented. The dose‒response estimates from individual studies were combined. initially
established a linear relationship, after which they predicted and accumulated risk ratio estimates relevant to each 10-MET-
hour-per-week increment. Insufficient information was available from two cohorts for inclusion in the model. Both studies
estimated linear connections using variance-weighted least-squares regression analysis. Therefore, we could determine the
extent to which excluding them affected the final impact estimates by excluding investigations each individually from the
averaged probability estimate and limiting the evaluation to only the highest quality studies that were both employed in the
sensitivity analyses (Iacobellis et al., 2020). While evaluating the potential effect of length and intensity preconceptions, we
used reduced values. The data were divided according to sex, study site, cohort size, and duration of monitoring. The mediating
effects of physique composition indices on participants' corpulence and correction level were also examined. They applied risk
estimates that had been alternatively narrowly focused on levels of leisure-time or broadly focused on total PA to minimize
variability further. The significance of the sensitivity or subgroup, or the p value for variability, was used to determine the
significance of the analysis. Additionally, they investigated potential irregular connections through modeling PAs using a limited
quadratic interpolation that included strings at the 25th, fifty-fifth, and seventh percentiles. In this meta-analysis, we only had
papers that reported predictions of the probability of incident type 2 diabetes for patients with at least three levels of PA
exposure. The nonlinearity Wald test was also conducted to evaluate the degree of linear deviation in the final cubic
interpolation approach.
3. Results and Discussion
Overall, twenty-eight appropriate cohort studies were identified, and an overall of twenty-two distinct physical activity
assessments were shown to be associated with the incidence of type two diabetes. Most of the related research yielded type

https://www.malque.pub/ojs/index.php/mr
John et al. (2023) 4

2 diabetes and LTPA data; nevertheless, four separate cohorts were investigated and provided information on total PA. This
analysis included a total of 1,261,991 people and 84,134 new diabetes types.
3.1 Study characteristics
The study population included persons, and the yearly incidence of type 2 diabetes was, on average, between 1.6% and
27.5%. The follow-up period ranged from three to twenty-three years. one year. In the USA, twelve investigations have been
carried out—two in Australia, six in Asia, and eight in Europe. Except for a single analysis among Hawaiians, all cohorts relied
on self-reported PA obtained via surveys and conversations (Goveia et al., 2018). Table 1 provides a detailed description of the
cohort characteristics. These cohorts reported corrected outcomes for age, while the adjustments of the remaining variables
differed significantly. Obesity cannot be accounted for in these four mates (Sathish et al., 2021). Moderating effect of PA on
type 2 diabetes incidence Numerous of the analyzed categories revealed a typical adverse relationship between PA and the
development of diabetes of the second type.
Table 1 Based on the method weekly/hours of physical activity, the type 2 diabetes risk was estimated approximately by study
methodology and demographic factors.
10 MET hours Unbiased Type 2 diabetesoccurs
95% CI I! (%) P Het
per week RR Observations (n) sometimes.
Level of Adaptation
Total aggregate 0.83, 0.88
0.86 94.4 <.002 33 85,143
estimations
Unadjusted BMI 0.83 0.76, 0.83 95.9 <.002 20 71,252
BMI modified 0.88 0.85,0.91 93.5 <.002 28 81,506
Status
Male 0.88 0.85,0.94 96.2 <.002 12 11,281
Female 0.82 0.76,0.91 88.6 <.002 9 16,318
Male/Female 0.85 0.79,0.92 85.8 <.002 10 56,546
Take Action
< 10 years 0.93 0.91,0.96 87.2 <.002 15 69,848
> 10 years 0.83 0.81,0.90 89.7 <.001 17 15,294
Position
N America 0.86 .78,0.92 95.7 <.002 14 19,075
Europe 0.82 .78,0.88 81.5 <.002 10 57,441
Australia 0.80 .64,1.02 76.2 .03 3 1213
Asia 0.96 .94,0.99 64.3 .02 5 11,517
Study Excellence
High (≤ 7 stars) 0.91 0.89,0.94 81.1 <.002 16 18,130
Medium to low 0.82 0.74,0.87 95.3 <.002 14 68,014
BMI
< 30 kg/m2 0.76 0.64,0.94 62.0 .02 5 908
>30 kg/m2 0.89 0.81,0.95 1.01 <.002 2 1154
VPA only 0.43 .24,0.85 1.01 .02 3 119
Intensity of PA - - - - - -
domain physical activity
Total PA 0.94 0.92,0.97 86.5 <.002 6 1826a
LTPA 0.82 0.78,0.86 91.8 <.002 26 82,318

3.2 Linear relationship between type 2 diabetes occurrence and PFS

The ten MET h/week straight RRs were provided for each investigation, grouped by the PA domain and the year of
production. Despite the substantial heterogeneity, the average aggregated decrease in the probability of developing type 2
diabetes was thirteen percent per increase in ten MET hours/week of PA. The sequential exclusion of individual studies revealed
that none of the studies had a substantial influence on the overall heterogeneity of the model. Model heterogeneity was
unaffected significantly by the limitation of studies of high quality. Compared to the advantages predicted for total PA, lowering
type 2 diabetes risk became exceedingly important for LTPA. A ten-minute MET/week increase in LTPA decreased the
probability of acquiring type two diabetes by seventeen percent, as opposed to a comparable ten-minute MET/week increase
in total PA risk by five percent. Improvements in the use of VPA integrated with MET h/week over time were substantially more
significant, with a 50% lower probability of developing type 2 diabetes for every increase in the number of ten METs h/week.
Women had a greater impact than men did, resulting in a combined RR of 0.83 for women and 0.89 for men per week for each
of the ten methods (Berbudi et al., 2020). Compared to those in the USA or Europe, studies in Asia generally found that

https://www.malque.pub/ojs/index.php/mr
John et al. (2023) 5

considering the standard deviation, there is a lesser advantage, with ten distinct recurrences. The most significant benefit was
generally discovered by two Australian studies (Table 1).
The combined protective effect size appears to be reduced by approximately one-third from 0.81 after accounting for
BMI. The observed mean RRs were 0.75 and 0.88 for obese people, and stratification of participant BMI revealed that the
preventive impact of exercise was evident in those with a BMI of 30 kg/m2. The indication of publication bias or the influence
of tiny studies was determined using Egger's procedure for asymmetric or funnel plot analysis.
3.3 Analyses of nonlinear dose‒response relationships
The data from a total of twenty-three cohorts were analyzed with a two-stage univariate dose‒response model with
limited quadratic weighting, and the results are presented in Figure 1 and Table 2. The cubic spline model predicts the value of
the findings; those who log 11.25 MET hours per week have a 26% lower chance of acquiring type 2 diabetes than do entirely
passive people. There was no evidence of a significant threshold effect or a decline in the acquired advantage as PA levels rose.
With additional decreases at higher dosages in the cubic spline model, becoming athletic to the extent of twice the
recommended daily PA was connected to a 36% lower risk for type 2 diabetes. In the above difficulties, where this information
was not immediately accessible, sensitivity analyses were performed to evaluate the impact of the predictions on the length of
PA exposure according to the LTPA dose distribution technique; Figure 2-4 and Table 3-5 show that, considering these many
hypotheses, the dose‒response curves exhibited comparable structures (Ji et al., 2022). In the original experiments involving
these hypotheses, the benefits were more significant because the exposure timeframe and quantity were expected to decrease.
In addition, they constructed a quadratic polynomial model using the variance-weighted linear dose‒response gradients of two
identified studies, but their discoveries were insufficient for the primary equation. The conclusion was only slightly affected by
excluding these trials, which had a 24% risk decrease.

Figure 1 45 min/session in the various scenarios.

Table 2 45 minutes of each session for the various scenarios.
(a)
LTPA MET h/week RR 95% CI
2.25 0.93 (0.92,0.95)
4.50 0.87 (0.84,0.90)
10.00 0.76 (0.71,0.81)
11.25 0.74 (0.69,0.80)
22.50 0.64 (0.56,0.73)
30.00 0.60 (0.51,0.70)
60.0 0 0.47 (0.34,0.65)

Figure 2 30 min/session scenarios.

https://www.malque.pub/ojs/index.php/mr
John et al. (2023) 6

Table 3 30 min/session scenarios.

(b)
LTPA MET h/week RR 95% CI
2.25 0.92 (0.90,0.94)
4.50 0.85 (0.82,0.89)
10.00 0.73 (0.67,0.80)
11.25 0.72 (0.65,0.79)
22.50 0.61 (0.52,0.71)
30.00 0.58 (0.48,0.69)
60.0 0 0.45 (0.31,0.68)

Figure 3 45 min/session in the various scenarios.

Table 4 45 min/session scenarios.

(c)
LTPA MET h/week RR 95% CI
2.25 0.92 (0.90,0.94)
4.50 0.85 (0.82,0.89)
10.00 0.73 (0.67,0.79)
11.25 0.71 (0.65,0.77)
22.50 0.61 (0.52,0.70)
30.00 0.57 (0.47,0.68)

Figure 4 30 min/session scenarios.

Table 5 30 min/session scenarios.

(d)
LTPA MET h/week RR 95% CI
2.25 0.88 (0.85,0.92)
4.50 0.82 (0.77,0.87)
10.00 0.68 (0.60,0.76)
11.25 0.67 (0.58,0.75)
22.50 0.55 (0.45,0.67)
30.00 0.52 (0.41,0.65)
60.0 0 0.39 (0.26,0.60)

https://www.malque.pub/ojs/index.php/mr
John et al. (2023) 7

4. Discussion
Our findings, through an extensive examination of the scientific literature to find relevant long-term research,
demonstrated a negative correlation throughout the cohorts under investigation, and there was a constant link between PA
and type 2 diabetes. The limited cubic line model revealed that constructing an activity volume similar to the following was
possible. The prevalence of type 2 diabetes decreased by almost 26% throughout the community. The sedentary adults
followed the presently exposed policy guidelines of a maximum of 150 minutes of MVPA each week (Deodhar et al., 2019). The
results we achieved imply that greater exercise levels provide advantages beyond what is advised as the minimum. By doubling
the amount of exercise from 11.25 MET hours per week to 22.5 MET hours per week, we observed that the risk of type 2
diabetes would be reduced by an additional 10%, for a total risk reduction of 36%, compared to inactivity. Our outcomes with
an intensity of 4.5 MET were quite comparable when using the MMET analysis. However, more intense exercise would benefit
more from using MMETs, while less intensive activity would recover less from employing MMETs (Wu et al., 2019). The problem
of inconsistencies regarding how PA is measured in independent individuals exists in the coronary arteries of quantitative dose
dependence analysis to assess the health effects of PA. Self-reported PA generally has a 10% common variance and is strongly
but sporadically linked with scientific PA determination techniques.
The significant variation in the evaluation and reporting of PA behavior, primarily a consequence of instruments
establishing various domains, timeframes, and units of PA, is another key problem that may have had an impact on our results.
The outcome evaluation methods used varied because of the variances in the accuracy of diabetes detection; diagnostic bias
likely corrupted some of the studies' outcomes (Johns et al., 2020). Most investigations were primarily performed with
percentages of educated white people in developed nations, which must be considered when evaluating the outcomes.
Previous studies on type 2 diabetes have shown that Asian Indians may have distinct dose‒response curves and may need more
PA to prevent this disease because of their greater degree of insecurity (Bergmans et al., 2019). In addition, current studies
indicate that MMET h/week is an alternative for determining the total amount of PA exposure. is the potential strength. There
is actually little difference between these two measurements. A person who performs activities at three METs consumes twice
the quantity of activity-related energy above her recuperate compared to a person who performs an activity at 2 METs.
Improved statistical attributes of the exposure variable were considered by establishing the PA volume starting point at 0 MMET
h/week. This enables differing intensities of operation, both inside and across people and groups, to be more accurately
compared. Compared to traditional METs, this approach provides substantially more time spent engaging in more strenuous
exercise. Consequently, performing an activity at a higher intensity could end in a proportionally higher dosage in the MMET
approach than in the MET concept (Ghaly et al., 2019). Subsequently, most cohorts were not developed, especially for studying
PAs; our investigation should be affected by the absence of complete data on all PA behaviors. In contrast, it appears probable
that the greater accuracy of the MMET predictions was determined by the availability of personal-level unprocessed PA data.
The crowd utilized gathered contact evaluations across a range of operations for every investigation, which depended on
utilizing the fundamental study analysis and combined intervals based on their initial prescribed degrees of severity for each
exercise.
5. Final considerations
The quantity of improvement in population health resulting from various PA treatments in particular scenarios was
calculated using a curve relationship that established the foundation for subsequent health impact modeling investigations.
Subsequently, uncertainty regarding the long-term effects of participating in PA for disease prevention was significantly
influenced by inconsistencies in the dose‒response curve. Our findings suggest that the correlation for type 2 diabetes
prevention was significantly more linear than that previously demonstrated for all-cause mortality or ischemic heart disease,
even though it may have curved across a much greater exposure spectrum. The prevailing assumption indicating a graduated
interaction between PA and maintaining longevity is supported by our meta-analysis. It supports the adage "some is good,
more is better," whereby particular objectives are mainly employed for psychological impact. At exercise levels beyond current
guidelines, health protection increases, but these benefits are not always realized. Cultures and constructed environments that
encourage PAs at the population level may reduce significant economic burdens and human misery. Considering the current
pandemic of obesity and diabetes, the effectiveness of such a technique may go beyond that of any existing methods for
enhancing the public's health.

Ethical Considerations
Not Applicable.
Conflict of Interest
The authors declare no conflict of interest.

https://www.malque.pub/ojs/index.php/mr
John et al. (2023) 8

Funding
The current review did not receive any financial support.
References
Avery, L., Flynn, D., Van Wersch, A., Sniehotta, F. F., & Trenell, M. I. (2012). Changing physical activity behavior in type 2 diabetes: a systematic review and
meta-analysis of behavioral interventions. Diabetes care, 35(12), 2681-2689.10.2337/dc11-2452
Berbudi, A., Rahmadika, N., Tjahjadi, A. I., & Ruslami, R. (2020). Type 2 diabetes and its impact on the immune system. Current diabetes reviews, 16(5), 442-
449. 10.2174/1573399815666191024085838
Bergmans, R. S., Zivin, K., & Mezuk, B. (2019). Depression, food insecurity and diabetic morbidity: Evidence from the Health and Retirement Study. Journal of
psychosomatic research, 117, 22-29. 10.1016/j.jpsychores.2018.12.007
Canu, I. G., Batsungnoen, K., Maynard, A., & Hopf, N. B. (2020). State of knowledge on the occupational exposure to carbon nanotubes. International journal
of hygiene and environmental health, 225, 113472. 10.1016/j.ijheh.2020.113472
Dasso, N. A. (2019, January). How is exercise different from physical activity? A concept analysis. In Nursing forum (Vol. 54, No. 1, pp. 45-52).10.1111/nuf.12296
Deodhar, A., Mease, P. J., McInnes, I. B., Baraliakos, X., Reich, K., Blauvelt, A., ... & Fox, T. (2019). Long-term safety of secukinumab in patients with moderate-
to-severe plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis: integrated pooled clinical trial and post-marketing surveillance data. Arthritis research
& therapy, 21(1), 1-11.10.1186/s13075-019-1882-2
Garbe, C., Amaral, T., Peris, K., Hauschild, A., Arenberger, P., Bastholt, L., ... & European Association of Dermato-Oncology (EADO. (2020). European consensus-
based interdisciplinary guideline for melanoma. Part 2: Treatment–Update 2019. European Journal of Cancer, 126, 159-177, 10.1016/j.ejca.2019.11.015
George, M. D., Baker, J. F., Winthrop, K., Hsu, J. Y., Wu, Q., Chen, L., ... & Curtis, J. R. (2020). Risk for serious infection with low-dose glucocorticoids in patients
with rheumatoid arthritis: a cohort study. Annals of internal medicine, 173(11), 870-878. 10.1186/s12966-020-01007-5
Ghaly, S., Bliuc, D., Center, J. R., Clarke, M. W., Jones, A. P., Trend, S., ... & Hart, P. H. (2019). Vitamin D C3-epimer levels are proportionally higher with oral
vitamin D supplementation compared to ultraviolet irradiation of skin in mice but not humans. The Journal of steroid biochemistry and molecular biology, 186,
110-116.10.1016/j.jsbmb.2018.10.002
Halperin, Y., Surks, M. I., & Shapiro, L. E. (1990). L-Triiodothyronine (T3) regulates cellular growth rate, growth hormone production, and levels of nuclear T3
receptors via distinct dose-response ranges in cultured GC cells. Endocrinology, 126(5), 2321-2326.10.1210/endo-126-5-2321
Höchsmann, C., Infanger, D., Klenk, C., Königstein, K., Walz, S. P., & Schmidt-Trucksäss, A. (2019). Effectiveness of a behavior change technique–based
smartphone game to improve intrinsic motivation and physical activity adherence in patients with type 2 diabetes: randomized controlled trial. JMIR serious
games, 7(1), e11444.10.2196/11444
Iacobellis, G., Penaherrera, C.A., Bermudez, L.E. and Mizrachi, E.B., 2020. Admission hyperglycemia and radiological findings of SARS-CoV2 in patients with and
without diabetes. Diabetes research and clinical practice, 164, p.108185. 10.1016/j.diabres.2020.108185
Ijaz, M. F., Alfian, G., Syafrudin, M., & Rhee, J. (2018). Hybrid prediction model for type 2 diabetes and hypertension using DBSCAN-based outlier detection,
synthetic minority over sampling technique (SMOTE), and random forest. Applied sciences, 8(8), 1325.10.3390/app8081325
Iwase, M., Fujii, H., Nakamura, U., Ohkuma, T., Ide, H., Jodai-Kitamura, T., ... & Kitazono, T. (2018). Incidence of diabetic foot ulcer in Japanese patients with
type 2 diabetes mellitus: the Fukuoka diabetes registry. Diabetes research and clinical practice, 137, 183-189. 10.1016/j.diabres.2018.01.020
Jeffcoate, W. J., Vileikyte, L., Boyko, E. J., Armstrong, D. G., & Boulton, A. J. (2018). Current challenges and opportunities in the prevention and management of
diabetic foot ulcers. Diabetes care, 41(4), 645-652. 10.2337/dc17-1836
Ji, P., Zhu, J., Feng, J., Li, H., Yu, Q., Qin, H., ... & Zhang, J. (2022). Serum uric acid levels and diabetic kidney disease in patients with type 2 diabetes mellitus: A
dose-response meta-analysis. Primary care diabetes, 16(3), 457-465. 10.1016/j.pcd.2022.03.003
Jin, S., Sha, L., Dong, J., Yi, J., Liu, Y., Guo, Z., & Hu, B. (2020). Effects of nutritional strategies on glucose homeostasis in gestational diabetes mellitus: a systematic
review and network meta-analysis. Journal of Diabetes Research, 10.1155/2020/6062478
Johns, E. M., Lumpkin, R., Putman, N. F., Smith, R. H., Muller-Karger, F. E., Rueda-Roa, D. T., ... & Werner, F. E. (2020). The establishment of a pelagic Sargassum
population in the tropical Atlantic: Biological consequences of a basin-scale long distance dispersal event. Progress in Oceanography, 182, 102269.
10.1016/j.pocean.2020.102269
Lahtinen, M., Toukola, T., Junttila, M. J., Piira, O. P., Lepojärvi, S., Kääriäinen, M., ... & Kiviniemi, A. M. (2018). Effect of changes in physical activity on risk for
cardiac death in patients with coronary artery disease. The American Journal of Cardiology, 121(2), 143-148.10.1016/j.amjcard.2017.10.002
Letizia, A. G., Ge, Y., Vangeti, S., Goforth, C., Weir, D. L., Kuzmina, N. A., ... & Sealfon, S. C. (2021). SARS-CoV-2 seropositivity and subsequent infection risk in
healthy young adults: a prospective cohort study. The Lancet Respiratory Medicine, 9(7), 712-720.10.1016/S2213-2600(21)00158-2
McDowell, C. P., Dishman, R. K., Gordon, B. R., & Herring, M. P. (2019). Physical activity and anxiety: a systematic review and meta-analysis of prospective
cohort studies. American journal of preventive medicine, 57(4), 545-556.10.1016/j.amepre.2019.05.012
Mulyani, W. R. W., Sanjiwani, M. I. D., Sandra, Prabawa, I. P. Y., Lestari, A. A. W., Wihandani, D. M., ... & Manuaba, I. B. A. P. (2020). Chaperone-based therapeutic
target innovation: Heat shock protein 70 (HSP70) for Type 2 diabetes mellitus. Diabetes, Metabolic Syndrome and Obesity, 559-568.10.2147/DMSO.S232133
Nuzum, H., Stickel, A., Corona, M., Zeller, M., Melrose, R. J., & Wilkins, S. S. (2020). Potential benefits of physical activity in MCI and dementia. Behavioural
neurology, 2020.10.1155/2020/7807856
Olokoba, A. B., Obateru, O. A., & Olokoba, L. B. (2012). Type 2 diabetes mellitus: a review of current trends. Oman medical journal, 27(4),
269.10.5001%2Fomj.2012.68
Plotnikoff, R. C., Trinh, L., Courneya, K. S., Karunamuni, N., & Sigal, R. J. (2009). Predictors of aerobic physical activity and resistance training among Canadian
adults with type 2 diabetes: An application of the Protection Motivation Theory. Psychology of Sport and Exercise, 10(3), 320-328.
10.1016/j.psychsport.2008.10.002
Ramadhan, B. J. A., Alramadan, M. J., Alhassan, R. E., Almajed, H. A., Khamseen, M. A. B., & Billah, B. (2019). Adherence to the recommended physical activity
duration among Saudis with type 2 diabetes mellitus. Journal of Family Medicine and Primary Care, 8(11), 3668.10.4103%2Fjfmpc.jfmpc_662_19
Sandström, O., Larsson, Å., Andersson, J., Appelberg, M., Bignert, A., Ek, H., ... & Olsson, M. (2005). Three decades of Swedish experience demonstrates the
need for integrated long-term monitoring of fish in marine coastal areas. Water Quality Research Journal, 40(3), 233-250. 10.2166/wqrj.2005.030

https://www.malque.pub/ojs/index.php/mr
John et al. (2023) 9

Sathish, T., Kapoor, N., Cao, Y., Tapp, R. J., & Zimmet, P. (2021). Proportion of newly diagnosed diabetes in COVID‐19 patients: a systematic review and meta‐
analysis. Diabetes, obesity & metabolism, 23(3), 870. 10.1111%2Fdom.14269
Schmitt, A., Gahr, A., Hermanns, N., Kulzer, B., Huber, J., & Haak, T. (2013). The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation
of an instrument to assess diabetes self-care activities associated with glycaemic control. Health and quality of life outcomes, 11, 1-14.10.1186/1477-7525-11-
138
Schram, M. T., Assendelft, W. J., van Tilburg, T. G., & Dukers-Muijrers, N. H. (2021). Social networks and type 2 diabetes: a narrative review. Diabetologia, 64,
1905-1916.https://doi.org/10.1007/s00125-021-05496-2
Świątoniowska, N., Sarzyńska, K., Szymańska-Chabowska, A., & Jankowska-Polańska, B. (2019). The role of education in type 2 diabetes treatment. Diabetes
research and clinical practice, 151, 237-246.10.1016/j.diabres.2019.04.004
Tyrell, F. A., Yates, T. M., Widaman, K. F., Reynolds, C. A., & Fabricius, W. V. (2019). Data harmonization: Establishing measurement invariance across different
assessments of the same construct across adolescence. Journal of Clinical Child & Adolescent Psychology. 10.1080/15374416.2019.1622124
Wake, A. D. (2020). Antidiabetic effects of physical activity: how it helps to control type 2 diabetes. Diabetes, Metabolic Syndrome and Obesity, 2909-
2923.10.2147/DMSO.S262289
Wang, X., Wang, S., Sun, L., & Qin, G. (2020). Prevalence of diabetes mellitus in 2019 novel coronavirus: a meta-analysis. Diabetes research and clinical practice,
164, 1082000. 10.1016/j.diabres.2020.108200
Wu, N. N., Tian, H., Chen, P., Wang, D., Ren, J., & Zhang, Y. (2019). Physical exercise and selective autophagy: benefit and risk on cardiovascular health. Cells,
8(11), 1436. 10.3390/cells8111436
Zhao, M., Veeranki, S. P., Magnussen, C. G., & Xi, B. (2020). Recommended physical activity and all cause and cause specific mortality in US adults: prospective
cohort study. Bmj, 370. 10.1136/bmj.m2031

https://www.malque.pub/ojs/index.php/mr