Author: Chantel Moore

Getting regular exercise can be a challenge, but there are many positive benefits, particularly for people with diabetes. Physical inactivity is associated with the development of 40 chronic diseases, including Type 2 Diabetes.¹ However, exercise can be difficult for people living in public housing because some public housing developments are in crime-ridden areas or areas that are not readily walkable.² In this blog post, we will discuss ways that diabetic patients living in public housing can exercise that are simple and convenient for them. To help these individuals gain the benefits of regular exercise, health centers can continue to promote the benefits of exercise and suggest practical ways for doing so. Listed below are some benefits of exercise for diabetic patients, in addition to ways that patients can get more active.

Why Promote Exercise for Patients Living in Public Housing?

1. Exercise improves mood and mental health³
Improved mental health can provide additional motivation to exercise. People with diabetes are 2 to 3 times more likely to have depression than people without diabetes.⁴ Over 70% of individuals receiving housing assistance or rental assistance reported that they had feelings of depression.⁵ Engaging in physical exercise releases endorphins and improves mood. Running for 15 minutes a day or walking for an hour has been found to lower the risk of major depression by over 26 percent.⁶ People with diabetes are also more likely to suffer from anxiety⁷ and people with diabetes are 20% more likely to have anxiety at some point in their life than those without diabetes.⁸

2. Balanced with a healthy diet, exercise can contribute to weight loss, which can lower one’s A1C levels
People with diabetes are recommended to have a low-fat, low-sugar diet. In addition to a healthy diet, losing weight is a critical point to help lower one’s A1C levels. Experts recommend losing at least 5-10% of body weight to reduce A1C levels.⁹

 

Tips on How to Encourage Patients to Be More Active

1. Implement it into their daily routine.
   Instead of taking the elevator, take the stairs. Another strategy is to park further away from stores in order to walk for a bit longer.
2. Do indoor at-home workouts.
   Indoor at-home workouts are a great way for diabetic public housing residents to exercise. They can be more affordable than going to a gym and can be more convenient because there is no travel time involved.
   Ways that diabetic public housing residents can exercise at home include:
   • Working out using small exercise weights or resistance bands
   • Accessing workout videos on TV or the internet
   • Accessing yoga and/or meditation videos
   • Get their family involved in exercising with them, meaning that there are accountability partners involved
3. Use A Common Area
   Residents can contact their property manager to see if they can use a common space or community room to exercise. They can recruit other residents in the public housing development to host an exercise event.
4. Promote Guidelines
   According to the Centers for Disease Control and Prevention, people should have at least 30 minutes of exercise per day, equating to 150 minutes per week.¹⁰
5. Create An Action Plan
   Health centers can help diabetic patients make a clear and concise action plan stating what they will do, where they will do it, when they will do it, and how they will do it to achieve their exercise goals and improve A1C.¹¹

Health Center Promising Practices:

1. Pennsylvania Association of Community Health Centers Lifestyle Coach Program¹²
   The Pennsylvania Association of Community Health Centers has implemented a lifestyle coaching program for diabetes. In this year-long program, participants work with lifestyle coaches to help them learn the skills that they would need to have a healthy diet and exercise routine.
2. Pounds Off With Empowerment (POWER)¹³
   Pounds Off With Empowerment is an initiative by Arnold School of Public Health, University of South Carolina, and South Carolina Primary Health Care Association designed to address diabetes and weight loss in rural areas. This program contains regionally and culturally appropriate suggestions for physical activity and changes in diet, as well as goals that are specifically tailored to the individual.
3. El Rio Community Health Center Diabetes Exercise Program¹⁴
   El Rio Community Health Center, located in Tucson, AZ, offers a 12-week diabetes exercise program. In each session, participants spend 30 minutes learning about nutrition, medication, etc., and the other 60 minutes focus strictly on cardio and strength exercise.
4. Community Health Centers of Wichita Falls, TX Diabetes Empowerment Education Program (DEEP) and Healthy Living Classes¹⁵
   Community Health Centers of Wichita Falls, Texas offers two diabetes education programs for people with diabetes, prediabetes, or at risk for prediabetes. The Diabetes Empowerment Education Program (DEEP) course lasts 6 weeks. In this course, participants learn about a wide range of diabetes management topics, including physical activity. The Healthy Living classes last for 12 weeks. In the Healthy Living classes, participants get to learn about diabetes, and they also exercise as a part of the course.

Conclusion
Health centers have been taking steps to promote exercise in diabetic patients, in addition to the benefits such as improved mood, weight loss, etc. However, due to certain barriers in public housing developments that can restrict diabetic patients’ ability to exercise (crime rates, etc.), they are encouraged to work within these constraints by doing specialized workouts, such as at-home workouts. Since health centers have been actively working with patients to promote exercise and its benefits, they have established several different promising practices that other health centers can also utilize to help diabetic patients living in public housing with their exercise habits.

Disclaimer
This blog post is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $668,800 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit hrsa.gov.

Resources:
¹Health Benefits of Exercise; Cold Spring Harbor Perspectives in Medicine

²Social Determinants of Health for Public Housing Residents: Community Violence; National Center for Health in Public Housing

³Health Benefits of Exercise; Cold Spring Harbor Perspectives in Medicine

⁴Diabetes and Mental Health; Centers for Disease Control and Prevention

⁵Social Determinants of Health for Public Housing Residents: Community Violence; National Center for Health in Public Housing

⁶The Mental Health Benefits of Exercise; HelpGuide.org

⁷Diabetes and Mental Health; Centers for Disease Control and Prevention

⁸Ibid.

⁹Diabetes; Johns Hopkins Medicine

10How Much Physical Activity Do Adults Need?; Centers for Disease Control and Prevention

¹¹Prevent Type 2 Diabetes Program Action Plan Journal; Centers for Disease Control and Prevention

¹²Lifestyle Coach; Pennsylvania Association of Community Health Centers

¹³Pounds Off With Empowerment (POWER); Arnold School of Public Health, University of South Carolina, and South Carolina Primary Health Care Association

¹⁴El Rio Community Health Center Diabetes Exercise Program; El Rio Community Health Center

¹⁵Community Health Centers of Wichita Falls, TX Diabetes Empowerment Education Program; Community Health Centers of Wichita Falls, TX

Nutrition is one of the key elements to living a healthy lifestyle and is particularly important for persons living with diabetes. It is one of the main factors that can affect a person’s quality of life. While a diabetic patient may be eating at least three meals every day, the nutritional value of the food is very important to consider. Another important factor to consider is where people live. There are certain areas where people live that makes them disadvantaged when it comes to having access to healthy food.

Food deserts are defined as “low-income communities with limited access to healthy food”.¹ Food deserts frequently include neighborhoods with public housing developments.² Even though living in a food desert can result in food insecurity³, food deserts are different from food insecurity, which is defined as “a disruption of eating patterns because of a lack of money or resources”.⁴ Low-income neighborhoods often lack full-service grocery stores and farmers’ markets where residents can buy a variety of high-quality fruits, vegetables, and low-fat foods.⁵ Some Health centers that are in or immediately accessible to public housing developments are located within food deserts.⁶

Approximately 60.5% of counties with Public Housing Primary Care (PHPC) Health Centers have diabetes rates that are higher than the national average.⁷ This is important to note because public housing residents are more likely⁸ to have diabetes than the general population based on a report from the U.S. Department of Housing and Urban Development (HUD).⁹ The report shows that individuals who receive HUD assistance are more likely to have chronic health conditions such as diabetes and cardiovascular disease and are higher utilizers of health care than the rest of the U.S. population, even more so than low-income renters.

Since there are some public housing developments that are in food desert areas, the ability to obtain healthy food to prevent or manage diabetes is more difficult for public housing residents when compared to the general population. As a result, living in a food desert area can have adverse effects on public housing residents living with diabetes.

Some adverse effects that food deserts have on public housing residents living with diabetes include:

Increased A1C

Nationally, about 18% of patients with diabetes have A1C levels greater than 9 compared to 32% of diabetic patients seen at PHPC Health Centers.¹⁰ Some contributions to the likelihood of someone having diabetes include lack of exercise, poor management of diet, and smoking. Food deserts can contribute to increased A1C since food deserts are in low-income communities like public housing developments. With that being said, public housing residents are more likely to purchase cheaper and readily available foods.¹¹

Increased reliability on carbohydrate rich foods, which can contribute to obesity

Carbohydrate rich foods, such as fast food and other cheaper and readily available foods, can make it harder to manage diabetes.¹² One example of this is the fact that the average fast food meal has 836 calories.¹³ Since fast food has plenty of calories and little to no nutritional value, this could potentially increase one’s blood sugar. This is important to note because in food deserts, there are few to no options available for affordable healthy food with high nutritional value. Public housing residents in food deserts do not have enough access to grocery stores. Groceries can also be too expensive for public housing residents living in food deserts. With that being said, affordability is very important when considering food deserts. More than 21% of public housing residents fall into HUD’s “Very Low Income” category, with an income of less than 50% of the national median. This can make public housing residents living in food deserts more likely to purchase cheaper and processed foods, therefore being overweight or obese and develop type 2 diabetes.

Higher risk of increased blood pressure and cardiovascular disease

Cardiovascular disease is the most common cause of death in diabetic patients¹⁴, therefore making public housing residents more likely to have cardiovascular disease due to the increased diabetes rate amongst public housing residents when compared to the nation. According to the American Diabetes Association, nearly 1 in 3 American adults have high blood pressure, and 2 out of 3 people with diabetes report having high blood pressure or take prescription medications to lower their blood pressure.¹⁵ Diabetic patients are twice as likely to have higher blood pressure and cardiovascular disease.¹⁶ One study indicated that residing in a food desert was associated with higher risk of incident heart attacks and deaths among patients with cardiovascular disease and this association was largely driven by area income instead of access to healthy foods.¹⁷

Listed below are some solutions that health centers can adapt or have adapted to help mitigate the issue of food deserts in public housing communities:

• Add more grocery stores
  As a means of addressing issues within food deserts, Lower Lights Christian Health Center, a Health Center in Columbus, Ohio, opened a non-profit grocery store named Jubilee Market and Café, in Franklinton, Ohio, where there had not been a grocery store in years.¹⁸
• Create community gardens
  Williamson Health and Wellness Center, a health center in Williamson, West Virginia, oversees various initiatives to address food deserts in the area. Ramella Park Community Garden of Eatin’ is a community garden located in Williamson directly across from a low-income housing development.¹⁹ Residents can rent a raised bed to grow their own produce. La Maestra Community Health Centers²⁰ located in San Diego,California, and TCA Health located in Chicago, Illinois²¹, have also established their own community gardens.
• Establish a mobile food market
  Brockton Neighborhood Health Center, a health center located in Brockton, Massachusetts, partners with Stonehill College. Stonehill College has a campus farm, and they give produce to the health center during the summer months to sell.²²This mobile market provides fresh produce at low cost to patients at the health center.²³

Since public housing residents are more susceptible to diabetes when compared to other groups, there are many different things to consider in the field of diabetes self-management, with location playing a primary role. With there being many negative effects of living in a food desert, there are not enough healthy food options. However, health centers have been making efforts to address the issue of food deserts by providing mobile services, community gardens, additional grocery stores, and more. Continued outreach services can have a very positive effect on public housing residents living with diabetes.

Disclaimer:

This publication is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $668,800 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit hrsa.gov.

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References:

¹ Living in Food Deserts and Adverse Cardiovascular Outcomes in Patients with Cardiovascular Disease; American Heart Association

² Social Determinants of Health for Public Housing Residents: Access to Healthy Food; National Center for Health in Public Housing

³ Advice for Living with Diabetes in a Food Desert; Healthline

⁴ Social Determinants of Health for Public Housing Residents: Access to Healthy Food; National Center for Health in Public Housing

⁵ Map the Meal Gap 2015; Feeding America

⁶ Social Determinants of Health for Public Housing Residents: Access to Healthy Food; National Center for Health in Public Housing

⁷ Social Determinants of Health for Public Housing Residents: Diabetes; National Center for Health in Public Housing

⁸ Ibid.

⁹ A Health Picture of HUD-Assisted Adults, 2006-2012; U.S. Department of Housing and Urban Development

¹⁰ Social Determinants of Health for Public Housing Residents: Diabetes; National Center for Health in Public Housing

¹¹ Food Insecurity and Diabetes; American Diabetes Association

¹² Ibid.

¹³ Healthy Fast Food; National Center for Health Research

¹⁴ Diabetes and High Blood Pressure; Johns Hopkins Medicine

¹⁵ Diabetes and High Blood Pressure; American Diabetes Association

¹⁶ Diabetes and High Blood Pressure; Johns Hopkins Medicine

¹⁷ Living in Food Deserts and Adverse Cardiovascular Outcomes in Patients with Cardiovascular Disease; American Heart Association

¹⁸ A Food Desert in Ohio Welcomes a New Grocery Store, Thanks to a Community Health Center; National Association of Community Health Centers

¹⁹ Local Foods, Local Places in Williamson; Rural Health Information Hub

²⁰ La Maestra’s Main Clinic Site; La Maestra Community Health Centers

²¹ Collaborating with Families: Preparing for Success: National Center for Health in Public Housing

²² Community Health Centers as Food Oasis Partners: Addressing Food Insecurity for Patients and Communities: National Association of Community Health Centers

²³Ibid.