Physical therapist Edward Dullmeyer, PT, MBA, OCS, CSCS, has developed a recent collaboration with a nurse practitioner who specializes in diabetes, and together, they help people with type 2 diabetes get moving and start incorporating exercise into their lives. 

By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net

Possibly one of the least-explored or discussed aspects of diabetes self-management is exercise. While it is a vital part of self-management, most medical providers do not have the education or professional training to get involved in their patients’ exercise regimens. And in today’s treatment paradigm most are lacking the time too. Therefore, it limits their discussions about the importance of exercise.

Still, there is too much information in the medical literature to say it can be completely ignored either. So, what is a medical provider to do?

One nurse practitioner based in the Orlando, Fla., area decided to collaborate with a nearby trainer. Jackie Hudson ARNP-BC, CDE, was seeing a lot of patients in her primary care practice with type 2 diabetes. She was looking for a way to alleviate patients’ fears associated with the diagnosis, so she decided to adapt a holistic diabetes education program working with medical professionals in various specialties, including Edward Dullmeyer who has been helping her patients begin to reacquaint themselves with exercise.

Dullmeyer has an impressive professional background. He is a physical therapist who is also a board certified orthopedic clinical specialist and certified strength and conditioning specialist. He owns a local business, ProFormPT, a physical therapy company that also does specialized training for people.
 
As a former coach for the Team Diabetes marathon training program, and a speaker at an American Diabetes Association’s event on diabetes and exercise, Dullmeyer had been involved with diabetes-related projects, and agreed to help Hudson.

When Dullmeyer speaks to Hudson`s patients during her group meetings, he understands that people may be uncomfortable with exercise, either getting away from it as they have gotten older, or it being something they never enjoyed. Now faced with a type 2 diagnosis, they need to incorporate it into their lives and he wants to start them off slowly beginning with just getting them to do a little extra movement each day.

One of the ongoing issues Dullmeyer sees in working with medical providers is that they often expect their patients to begin to exercise without giving them the tools to be successful with an exercise regimen.

Providers need to acknowledge that if their patients are going to step out of their comfort zones when it comes to exercise, it may be best for providers to do so as well and find some helpful information for their patients to begin physical activity. As such, it may be good for medical providers to consider investigating what some of the local options are for their patients in terms of exercise. 

For providers that are able to find a trainer or an exercise physiologist who can help their patients, it can provide a few obvious benefits like better glucose control and weight management, but in developing a relationship with a trainer, it could also lead to the trainer or exercise physiologist reciprocating the medical provider’s services to his or her clients.

DiabetesCare.net sat down with Dullmeyer to talk about how sedentary people can begin exercising, how trainers can help bridge the exercise gap to people and help give them the tools to succeed, and considerations for how medical providers can find trainers locally. 

DiabetesCare.net: What is your philosophy in working with people with diabetes? Is it more of a training or physical therapy approach?

Dullmeyer: If you are looking at a continuum of care, it is broken up into three sections. You have got the far left side of the physical spectrum where someone is injured. The physical therapy role is to take that person back from injury to a state of “physical normal” so to speak. The midle section of the spectrum is the training model, which takes them from a normal, non-injured state and trains them to be better at certain activities. Lastly, we have the people who are in an above normal state. They might be marathon runners and so those people we are trying to take them to the next level of fitness. I have trained a group of people with diabetes to do a marathon.

Anytime I have worked with someone with diabetes who is not an athlete, they are physically unfit and not well, but I’m training them. They are mostly sedentary people. The goal is to take these people from not moving to doing some type of activity on a regular basis.

DiabetesCare.net: For the people who are sedentary, how do you approach them to begin this process of getting them to exercise? 

Dullmeyer: The first role I take is one of educator. I say to these people to start to think about movement. I tell them about the three types of exercise, including cardiovascular, strength, and flexibility. And for this group, I include a fourth type: movement. This is the number one step I want to talk with them about. I’m not trying to educate them on the other types of exercises right out of the gate. They need to start moving first, and I teach them to think about ways to move, like not taking the elevator every time, or finding other ways to move. These people may only walk from their cars to their offices, do the same at night going home, and then they are on the couch the rest of the night.

I explain to them the most important thing is getting started, like joining a gym or working out in a pool. I give them some simple things to do like walking down to the end of the driveway or down the street. Then I’ll give them simple exercises to do. For example, one of the exercises I might have them start off with is sitting in a chair then they have to stand up and then sit down 10 times. It may be elementary but for a group of people who are not doing any exercise, it is way to begin. We are starting them with the mindset that this is not so bad to do something. Ultimately, we want them to be much more active than that, but it is a good way to get them doing something.

Beyond that, we try to establish a routine of exercise on a daily basis. The biggest thing we try to do here is to incorporate accountability through a partner or loved one, someone they are held accountability to for what they are doing in terms of exercise.

DiabetesCare.net: You have been working with Jackie Hudson in helping people with diabetes. What is it that you as a trainer and her as a diabetes educator and nurse practitioner do together?

Dullmeyer: We complement each other. As I do not know the medical aspects of diabetes like understanding the blood glucose and medications, it is important to work with an expert like a diabetes educator to help each other out in your own area of expertise.

DiabetesCare.net: When working together with a medical provider, do you see greater results for patients?

Dullmeyer: Anytime you can put together a team of experts, you are going to get the best of both worlds. You are not just getting a physician or a nurse practitioner who is talking about exercise. Although those medical professionals may be familiar with it, exercise is not something they do everyday. You could say the same with a trainer who is working with someone who has diabetes and they don’t prescribe medication or understand all the medical elements to treating people with the disease.

DiabetesCare.net: For those medical providers who might be interested in working with a physical therapist or trainer, what is the best way to find someone like yourself?

Dullmeyer: Try to find trainers or people who do physical therapy and who are in tune with diabetes and addressing lifestyle changes. There is a stigma about trainers. We are not standing there screaming at people to work harder.

We do a lifestyle training approach. The training program we have here is one where we work with a lot of people who are prediabetic, they are in the 40 to 50 year old range and overweight. We are dealing with people who could potentially be at risk for type 2 diabetes. We are trying to deal with their whole lifestyle and making changes, which include things such as exercise but also sleep and stress habits.

If a medical provider is looking to partner with someone they should go to someone who is a trainer who is not just going to incorporate exercise. I would look up physical therapy clinics first and they might be able to point people in the right direction or look up trainers who do lifestyle changes. You certainly want to look for trainers who have certifications.

DiabetesCare.net: What are biggest lessons or the most important elements that might be overlooked when it comes to medical providers, exercise, and diabetes?

Dullmeyer: Often, medical providers will give someone a sheet of paper and say, ‘you need to start exercising.’ The doctor doesn’t show the patient how to do them. The patient who is not sure how to exercise ends up not doing it at all.

It has to be about taking it from a casual offering of lifestyle advice to a practical, next-step level. You have to give people more tools, guiding them by offering solutions about where there might be a swimming class or giving them a name of a trainer. With the trainer, the medical provider can begin to develop a referral relationship where the patients go for an inexpensive consultation. And that medical provider’s patients who have diabetes can begin to go there regularly.

I used to own a gym where people would pay a lot of money and never come in because they were just too intimidated to actually come in. They didn’t feel comfortable, they didn’t know what to do, and they didn’t reach out for help. Actively showing people how to do exercise and why they should do certain activities will take people with diabetes a lot further than just telling someone to go out and do it.

If you are interested in finding out more about Dullmeyer’s business, you can contact him at (407) 671-0433 or e-mail him at
ed@proformpt.com.