Impact Of A Clinical Exercise Program On Trajectories Of Hba1c And Weight In Older Veterans

PURPOSE Gerofit is a clinical exercise program for Veterans ≥65 years, originally developed at the Durham VA Medical Center and offered at the Baltimore VA Medical Center (BVAMC) since 2013. Veterans receive individualized exercise programs and participation in the program is voluntary. We assessed hemoglobin A1C (A1C) and weight changes in Veterans with a diagnosis of diabetes who completed one year of exercise training in Gerofit. METHODS Older Veterans with primary care at the BVAMC were referred to Gerofit. Functional assessments included measures of weight and were used in conjunction with patients’ personally identified exercise goals to develop comprehensive exercise programs including cardiorespiratory, strength, and flexibility training. Clinical chart reviews were conducted to determine A1C and weight one year prior to starting Gerofit, time of enrollment, and one year into participation. Initial program enrollment eligibility did not exclude for elevated A1C, but was later modified to include pre-program A1C ≤10%. Veterans could attend Gerofit exercise sessions up to 3 days per week. RESULTS Forty-four Veterans with diabetes (43 male, 73.5 ± 5.6 years, 89% African American, BMI 32.9 ± 5.0 kg/m2) completed 1 year of Gerofit. On average, both weight and A1C increased in the year prior to initiating Gerofit (A1C 7.2 ± 1.2 to 7.4 ± 1.5%, weight +1.2 lbs.). Overall A1C declined to 7 ± 1.1% (p <0.05) and weight by -.04 ± 41.5 (p= 0.73) 1 year into the program. Half the group (22/44) experienced a decrease in A1C, 2/44 had no change, and 17/44 increased A1C. The group that decreased A1C at 1 year started with a significantly higher A1C at time of enrollment compared to those that increased A1C at 1 year (7.8 ± 1.6% vs. 6.8 ± 1.2%). CONCLUSION Diabetic Veterans who participated in one year of Gerofit overall demonstrated a reversed trajectory of rising A1C and weight. Overall, the decline in A1C approached the clinically significant reduction of 0.5%. Those Veterans with a higher A1C at time of enrollment demonstrated a statistically and clinically significant reduction; reducing potential diabetes complications. Results demonstrate the importance of advocating for participation in a low level, multi-component exercise program for weight and diabetes management.