Sitting less and moving more: A contemporary public health approach for the prevention and management of Type 2 diabetes

Professor David Dunstan

Australian Catholic University


The 2018 Physical Activity Guidelines Advisory Committee Scientific Report from the USA recently concluded that there is strong epidemiological evidence of a significant relationship between greater time spent in sedentary behavior and higher risk of type 2 diabetes.

Human experimental studies have begun to corroborate and extend the experimental evidence by showing that reducing and frequently breaking up prolonged sitting with light-intensity physical activities may be practical strategies for improving type 2 diabetes prevention and management. Studies have consistently showed clinically meaningful acute improvements in postprandial glucose metabolism following the initiation of frequent (every 20–30 min) short (2–3 min) interruptions during prolonged sitting involving either light-intensity or moderate-intensity ambulation, standing, or simple resistance activities. Some have also demonstrated improved responses in blood pressure, lipids, haemostatic markers and cognitive function. Thus far, the original published observational and experimental findings have provided strong indications that the potential benefits of reducing and breaking up sitting time are likely to be most pronounced in those with, or at risk of, dysglycemia.

Working from a behavior-change model positing that sitting time is highly contextually driven, we have begun to shape behavior change frameworks pertaining to reducing and breaking up sitting time through multicomponent interventions in real-world settings as part of an integrated research program underpinned by the laboratory evidence. These short- and medium-term multi-component interventions that incorporate environmental, organisational, policy and individual-level change elements in workplace and domestic settings in adults have consistently demonstrated that these approaches are feasible and can result in substantial reductions in prolonged sitting time.

In this presentation I will discuss current research efforts directed at gaining a better understanding of whether making sustained changes in a ubiquitous risk exposure in people’s daily lives – prolonged periods of time spent sitting – can influence or modify type 2 diabetes risk.


David is Head of the Physical Activity laboratory at the Baker Heart and Diabetes Institute in Melbourne and is an NHMRC Senior Research Fellow and Baker Fellow. He also holds the position of Professor within the Centre for Exercise and Nutrition at the Mary MacKillop Institute for Health Research, Australian Catholic University. His research focuses on the role of physical activity and sedentary behaviour in the prevention and management of chronic diseases. He has published over 200 peer reviewed papers, including publications in high impact journals such as Circulation, Diabetes Care and Diabetologia. Over the past 15 years David has extensive media interest in his research including interviews with ABC CatalystSBS Insight60 Minutes AustraliaNational Public Radio, Wall Street Journal, CNN, the New York Times and the LA Times.

A group lifestyle intervention program reduced emergency department presentations for people with metabolic syndrome: a retrospective case control study

Dr Casey L Peiris1,2, Professor Nicholas F Taylor1,3, Ms Susan Hull2, Ms Amanda Anderson2, Dr Regina Belski1, Dr Spiros Fourlanos2,4, Professor Nora Shields1,2

1La Trobe University, Melbourne, Australia, 2Northern Health, Epping, Australia, 3Eastern Health , Box Hill, Australia, 4Royal Melbourne Hospital, Melbourne, Australia


To evaluate the effect of an 8-week lifestyle intervention program for people with metabolic syndrome on emergency department presentations, hospital admissions and metabolic parameters.

A retrospective, case-control study of adults (n=58, mean age 60±7 years) with metabolic
Biography:syndrome referred to a group lifestyle self-management intervention program between 2013 and 2015. The intervention program consisted of 8 weekly sessions of group exercise and education delivered in a community health care setting. The intervention group (n=29) was compared to a group of people who declined to attend the program (n=29). Data were collected from the time a participant was referred to the program and all participants were followed for a minimum of 100 days.

Participants who attended the lifestyle intervention program had significantly fewer emergency department presentations [Risk Ratio (RR) 0.31, 95% Confidence Interval (CI) 0.11 to 0.83] and potentially avoidable emergency department presentations (RR 0.06, 95%CI .004 to .097) over the follow-up period. There were no differences between the groups in hospital admissions and there were insufficient data to determine changes in metabolic parameters. Lifestyle group participants increased their exercise capacity [6-minute walk test mean difference (MD) 41m, 95%CI 20 to 62] and had a mild decrease in weight (MD -0.8kg, 95%CI -1.5 to -0.2) and waist circumference (MD -1.3cm, 95%CI -2.1 to -0.6) after 8 weeks.

Significance of findings to allied health:
Implementation of a group lifestyle intervention program to improve activity and self-management skills may assist to decrease emergency department presentations.


Dr Casey Peiris is an academic lecturer and early career researcher who completed a PhD on the effects of additional weekend allied health rehabilitation for inpatients. She is passionate about physical activity, chronic disease and rehabilitation and has published 27 peer-review papers related to these areas which have been cited 303 times. Dr Peiris received her bachelor’s degree in physiotherapy from the University of Melbourne in 2006, her PhD from La Trobe University in 2013.

The effect of a Mediterranean and low fat diet on liver fat in patients with non alcoholic fatty liver disease: Preliminary findings from the MEDINA trial

Dr Elena George1,2, Ms Anjana Reddy2, Prof Stuart Roberts3, Dr Audrey Tierney2,4

1Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia, 2School of Allied Health, La Trobe University, Bundoora, Australia, 3Department of Gastroenterology, Alfred Health, Prahran, Australia, 4School of Allied Health, University of Limerick, Limerick, Ireland


The aim of this study was to explore the effect of a Mediterranean Diet (MD) compared to a Low Fat Diet (LFD) on liver fat.

Patients with proven NAFLD were randomised to a MD or LFD for a three month intervention.  Liver fat was quantified using Magnetic Resonance Spectroscopy, liver stiffness measurement with Transient Elastography and insulin resistance using homeostatic model assessment. Anthropometry, dietary and biochemistry were also measured.

Interim results included 25 patients, mean age 49.6±15.9 years, BMI of 32.7±7.1 kg/m2, 44% male and 48% with diabetes were randomised to a MD (n=12) or a LFD (n=13).The MD group demonstrated a clinically meaningful reduction in liver fat (-12%, NS) with no change in the LFD group (0.2%, NS). The LFD group reduced energy consumption (-800kJ) resulting in significant weight loss (-6.6kg, p=0.045), there was no weight change in the MD group (0.8kg, p=0.213). There was a small significant improvement in liver stiffness (-0.9kPa, p=0.022) in the LFD group but not in the MD group (0.1kPa, p=0.65). Insulin resistance improved equally across both groups (-0.6 mmol/L, NS).

Significance of the findings to allied health:
Diet is an effective management strategy for patients with NAFLD. The MD may possibly reduce liver fat ad libitum while LFD may be better at facilitating weight loss, larger studies are required to confirm these findings.


Dr Elena George is an Accredited Practising Dietitian and Lecturer in Nutrition and Dietetics at Deakin University. Elena is interested in translational research, in particular enhancing evidence based practice in dietetics through research. Her interests are in metabolic factors that contribute to chronic disease and dietary interventions for the prevention and management of including non-alcoholic fatty liver disease, metabolic syndrome, diabetes and cardiovascular disease.

Falls prevention in osteoarthritis care

A/Prof Ilana Ackerman1, Dr Sze-Ee Soh1, A/Prof Anna Barker1,2

1Monash University, Melbourne, Australia, 2Medibank Private Limited, Australia


To investigate physiotherapists’ knowledge, beliefs and current practice around falls prevention in osteoarthritis (OA) care.

Currently registered, practising Australian physiotherapists who care for people with hip or knee OA were invited to participate in this national cross-sectional study.  Data on falls prevention training, beliefs, and practices were collected via an online survey and analysed descriptively.

Complete responses were received from 370 eligible physiotherapists across all Australian states.  Participants worked in public hospital, private practice, private hospital, community health and aged care settings and most had practiced for ≥6 years (69%).  Only a small proportion had not received training or accessed resources relating to falls risk screening (18%) or prevention interventions (16%).  Although most participants (77%) perceived falls risk was higher among people with OA than for the general older population, physiotherapists reported only moderate confidence in assessing falls risk (median score 7, interquartile range (IQR) 6-8; scale 0 (not at all confident) – 10 (extremely confident)) and delivering falls prevention care (median 7, IQR 6-8). While most participants asked about falls history (88%), only 39% used falls risk screening tools and of these, relatively few used an appropriate tool.  Few physiotherapists used purposed-designed tests to assess standing balance (18%), which was commonly considered within overall functional assessments (75%) or not assessed at all (7%).

Significance of the findings to allied health:
These data reveal clear opportunities for improving physiotherapist confidence and skills to facilitate best-practice falls prevention within OA care.


Ilana Ackerman is an Associate Professor (Research) in the School of Public Health and Preventive Medicine at Monash University. She is a musculoskeletal epidemiologist and an experienced orthopaedic physiotherapist with 20 years of clinical practice. Her impressive continuum of clinical and population-based studies has systematically documented the substantial personal and societal impact of osteoarthritis among older and younger individuals.  Her qualifications include a Bachelor of Physiotherapy (Honours) and a Doctor of Philosophy, both from The University of Melbourne.  Ilana is a highly productive researcher, with 9 publications to date in 2018 and an average 17 publications per year (full-time equivalent) for 2016-2017.   She has 61 publications (29 as first author), including 9 co-authored Lancet papers, 3 invited papers, 2 editorials and a book chapter in the Oxford Textbook of Osteoarthritis.  Ilana has been awarded over $2.7 million in research funding from government, philanthropic organisations and industry, including an early career researcher fellowship for 2008-2015 and a mid-career researcher fellowship for 2018-2021.  She is also a weekend physiotherapist at a private rehabilitation hospital, where she predominantly provides care for people following joint replacement surgery.

Home-based or Centre Based Chronic Heart Failure Rehabilitation?

Miss Katie Palmer1,2, Mrs Carla Gordon1,2, Miss Zoey Hoi Man  Wu1, Miss Hiu Yan Hilary  Yu1, Miss Phoebe Kwok1

1Monash University, Frankston, Australia, 2Monash Health, Melbourne, Australia


Chronic Heart Failure (CHF) is a rising epidemic with a high global economic cost. In Australia the prevalence is currently 2% of the population, with over 600,000 new cases expected by 2025 (Chen, 2017). Rehabilitation has been shown to be effective in improving patient and economic outcomes, yet reported engagement rates have been low world-wide (Sagar, 2015). It has been suggested that home-based rehabilitation may remove some barriers to attendance including transportation and time flexibility, but there is limited evidence on the effectiveness of home-based programs (Palmer, 2018).

To investigate the effect of home-based rehabilitation for people living with CHF on quality of life, physical function, mortality and hospital re-admission rates. .

Six electronic health-related database were searched. Two reviewers completed the screening process, data extraction and quality assessment. Articles were included if they involved a home-based exercise program in the CHF population

Eleven articles were included of the 919 identified (n=633, mean age 63yrs, 79% male). Home-based rehabilitation was found to significantly improve physical function (SMD 0.42, 95%CI 0.12-0.73, p=0.007) and quality of life (SMD 0.49, 95% CI 0.02-0.96, p=0.000) over usual care. None of the included studies included outcome measures on mortality and hospital re-admission rates.

Home-based rehabilitation is effective in improving physical function and quality of life more than usual care in the CHF population. These findings support the provision of home-based programs as an evidence-based alternative for CHF patients and may help to improve engagement and adherence with CHF rehabilitation.


Katie Palmer is currently completing a PhD at Monash University in Melbourne, Victoria in the School of Primary and Allied Health Care. Her research is focused on improving engagement of people with Chronic Heart Failure with rehabilitation programs, by identifying and addressing the barriers this population faces.

Her passion for this research project stems from her current work as the physiotherapist for the Chronic Heart Failure rehabilitation program at Monash Health.

Factors associated with discharge destination from the acute general medical ward

Ms Aruska D’Souza1,2, Dr Catherine Granger1,2, Mr Cameron Patrick2, Ms Jacqueline Kay1, Associate Professor Catherine Said2,3

1Melbourne Health, Parkville, Australia, 2University of Melbourne, Parkville, Australia, 3Western Health, Sunshine, Australia


Factors associated with discharge destination from the acute general medical ward

To investigate the association between patient factors (including physical and cognitive function) on hospital admission with discharge destination.

This was a prospective, single-site observational study of general medical patients referred to physiotherapy. Patients from residential care were excluded.  Data collected included demographics (Blaylock Risk Assessment Screening Score, BRASS), co-morbidities (Charlson Comorbidity Index, CCI), pre-morbid physical function, current physical function (de Morton Mobility Index, DEMMI and Alpha Functional Independence Measure, AlphaFIM) and cognition (Rowland Universal Dementia Assessment Scale, RUDAS), all measured within 72 hours of initial Physiotherapy contact.

Between July 2016 and August 2017, 417 patients were recruited (53% female, median age 81 years [IQR 76 – 86]. 245 patients were discharged directly home; 172 were not discharged home, of whom 140 were discharged to subacute. Patients going directly home had higher median functional, mobility and cognitive scores. Fifty-four patient factors were associated with discharge destination. Data were partitioned into training, validation and test sets to provide unbiased estimates of sensitivity, specificity, receiver operative characteristic (ROC) curve and area under curves (AUC) with confidence intervals (CI). Models best associated with discharge destination were “DEMMI and toilet transfers” (AUC 83.8%, 95% CI 76.4 – 91.2) and “AlphaFIM and walking independence” (AUC 81.5, 95% 95% CI 73.2 – 89.7)

Significance of the findings to allied health:
These models provide the basis for developing tools which can be used to rapidly identify discharge destination in this complex patient group.


Ms D’Souza is a senior physiotherapist who graduated from La Trobe University in 2010 and has worked in the public health system for almost eight years. She currently works at the Royal Melbourne Hospital. Ms D’Souza was the successful recipient of the Mary Elizabeth Watson Early Career Fellowship in Allied Health and commence a PhD part time at the University of Melbourne. Her PhD topic aims to investigate discharge from acute general medical wards. She is the lead researcher in a systematic review, two observational studies and a qualitative study. Ms D’Souza was successful in a poster presentation at the 2017 national Australian Physiotherapy Association conference and a table top discussion at the 2018 Australian Association of Gerontology conference.

Changes in walking performance in the chronic phase of stroke recovery using botulinum toxin, physiotherapy and orthotic management: Three longitudinal case studies

Ms Janine Simondson1, Mr Robert Mehan1, Ms Diana  Poole2, Dr  Kim Brock1

1Physiotherapy Department St Vincent’s Hospital Melbourne, , Australia

2Prosthetics and Orthotic Department St Vincent’s Hospital Melbourne, , Australia


Aim: The aims will be to determine the long term change in walking performance and function over time with the combination of treatment for spasticity with Botulinum Toxin (BTX), physiotherapy and orthotic management in patients who are over 6 months post stroke.


Method: Stroke survivors were recruited via a BTX clinic. Participants who consented had 18 months of therapy documented, including physiotherapy, orthotic and pharmacological management. Objective gait measures were recorded at baseline, two, four, six, eight, twelve and eighteen months post initial management. Gait measures recorded were velocity, affected limb step length (ALSL) and single support (ALSS) walking in three walking conditions: barefoot, shod and shod with prescribed orthoses (“bracing”).


Results: Three participants have completed all assessments. Patient A’s velocity improved over the three walking conditions; however ALSL and ALSS were equivocal.  Patient B’s velocity, ALSL and ALSS improved walking in shoes and bracing but not barefoot. Patient C’s walking velocity, ALSL and ALSS improved between baseline and eight months walking in the bracing condition. There was deterioration in walking performance between eight and 18 months. Each participant received BTX and physiotherapy (treatment techniques/gait retraining) and orthotic management (serial casting/orthotic prescription and modification). Patient C fell at 10 months; resulting in pain and loss of confidence which may have caused their deterioration in walking.


Significance of findings to allied health: Walking performance can be improved with an individualised multidisciplinary approach. Chronic stroke survivors perform differently under different walking conditions. Deteriorations in walking performance may be attributable to adverse events.

Expansion, evaluation and sustainability of a new paediatric multidisciplinary weight management service

Dr Jacqueline Walker1, Dr Robyn Littlewood2,3,4, Ayala Rogany2, Professor Sandra Capra1

1School of Human Movement and Nutrition Sciences, The University Of Queensland, Brisbane, Australia, 2Dietetics and Food Services, Clinical Support Directorate, Lady Cilento Children’s Hospital, Children’s Health Queensland Hospital and Health Service, South Brisbane, Australia, 3Queensland Statewide Child and Youth Clinical Network, Office of Strategy Management, Queensland Health , Brisbane, Australia, 4Centre for Children’s Health Research, South Brisbane, Australia

Aim: To expand and evaluate a recently established paediatric multidisciplinary weight management service and investigate, develop and support proposals for ongoing sustainability. This service and associated clinics focus on the management of overweight and obesity in children and adolescents, and is being disseminated under real-world conditions by specialist clinicians from the Lady Cilento Children’s Hospital (LCCH), Brisbane.

Methods: Outcome measures for participants will be collected prior to commencing the four month intensive weight management clinic, upon completion, and again at 8, 12 and 24 months post clinic commencement. Details regarding anthropometric measures, body composition, dietary intake, physical activity and quality of life will be collected. Evaluations of the clinic as a whole will also occur, comparing the current two locations (LCCH and Ipswich). Finally, an evidence-based, consumer-informed model of care will be developed, that is realistic, cost-effective and achievable to implement.

Results: 25 participants have been recruited and attended their baseline appointments. It is anticipated that a total of 100 participants will have been recruited to the study and attended their baseline appointment by June 2017, with all data collection completed by June 2019.


Significance of the findings to allied health: This research will determine important and meaningful outcomes or measures of success in paediatric weight management. It will also provide a consumer-informed, evidence-based model of care for the management of overweight and obesity in children and adolescents, which can be embedded in future service delivery models, ensuring the continuity and quality of family-centred care within the public health system

Self care action packs for diabetic foot ulcers in the remote Kimberley region of Western Australia

Ms Amy Freeman1

1Boab Health Services, Broome, Australia

Aim: To investigate the change in self care behaviours in people with diabetic foot ulcers when provided with a Foot Care Action Pack containing basic foot health and wound care items and instructions.

Method: Every client who presented to Boab Health Podiatry with either 1. Active high risk foot ulcer or 2. Recent high risk foot ulcer healed within previous 6 months were offered the Foot Care Action Pack.  On provision of the pack each client was asked four “Pre-pack” questions regarding their own self care for their feet which were recorded on a sheet by the podiatrist. Five “Post- pack” questions were asked when the client presented for review a minimum of two weeks later to investigate the change in self care behaviours.

Results: Over a 5 week period 10 clients have been issued packs and completed the questionnaire. 9/10 clients were Indigenous. For the question “Do you feel like you have what you need to look to look after your feet at home” 10/10 clients responded No.

At this time two clients have presented for review. For the question “Do you feel like you have what you need to look to look after your feet at home” 2/2 clients responded Yes. For the question “Do you use your Foot Care Action pack?” 2/2 clients reponded “Two or more times” which is the most frequent choice.

*It is expected that by February 2017 there be 20-30 response to analyse and report at this conference.

Significance of the findings to allied health: Providing basic self care items and information to people with high risk foot ulcers living in remote areas may improve management and overall outcomes including presentation to remote clinics and hospitals.


The effectiveness of felt padding for offloading diabetes-related foot ulcers, at baseline and after one week of wear

Kate Waller1,  Anita Raspovic2, Wan Mun Wong2

1Northern Health, Melbourne, Australia

2Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne, Australia, 3086

Aim: Felt padding is used to offload diabetes-related foot ulceration although limited quality data exists to support its use. This study aimed to quantify pressure offloading from neuropathic plantar foot ulcers in a clinical setting, when felt padding is first applied and after wear.

Methods: This study used a within-subjects, repeated measures design. Data was collected in a high-risk foot service. Peak plantar pressures, contact area and contact time were measured in 15 diabetes subjects with 16 non-complicated plantar neuropathic foot ulcers, with: no felt padding, newly applied felt padding and felt padding after one week of wear.

Results: Statistically significant decreases in peak pressure of 49% and 32% were measured with newly applied felt padding (188.0kPa; p<0.001) and worn felt padding (248kPa; p=0.003) respectively, compared to no padding (367.2kPa). Worn felt offloaded 32% less pressure than new felt however this did not reach statistical significance (p=.069).

Conclusion: New felt padding offloaded on average ½ the pressure applied to sites of plantar neuropathic ulceration, which reduced to 1/3 after wear. Further studies are required to evaluate effectiveness of felt padding directly on ulcer healing.

Significance of the findings to allied health: Felt offloading for plantar neuropathic ulcers is a very important and integral part of wound management. With frequent patient reviews for replacement of this felt, this shows podiatrists, wound care specialist and patients that this reduces up to half the pressure directly on the wound to allow for wound healing.