Present situation of exercise therapy for patients with diabetes mellitus in Japan: a nationwide survey

Purpose This study was performed to investigate the actual situation and problems of exercise therapy in Japan. Methods A self-recording questionnaire was prepared and sent to 1,200 randomly selected diabetologists and non-specialist physicians of the Japan Medical Association. Responses were obtained from 403 physicians (34% response rate). Two subgroups of the physicians were extracted according to the rate of exercise guidance provided to patients at their initial visit to the clinic: more than 70% [high-rate of exercise guidance (HG) group, N = 212] and less than 50% [low-rate of exercise guidance (LG) group, N = 131]. Results The rate of exercise guidance was significantly lower (p < 0.001) than that of dietary guidance. About 65 and 53% of physicians in both groups responded that their "lack of time'' and the "absence of an additional consultation fee,'' respectively, were the main problems they faced for implementing exercise guidance to patients. Compared with the HG group, a higher number of physicians in the LG group responded that there were no specialized physical exercise educators in their clinics (p < 0.001). As to the reasons why patients do not perform exercise, 70% of physicians responded that patients "had no time to exercise'' and "were not eager to perform exercise.'' Conclusions The current survey revealed that, in Japan, the proportion of exercise guidance is low because physicians have no time, they receive no additional consultation fee, and specialized physical exercise educators are lacking. Although an improvement in these factors may lead to higher rates of exercise guidance, we consider that the preparation of specific exercise guidelines for type 2 diabetes patients is essential to effectively implement this therapy in clinical practice.