Movement as Medicine for Type 2 Diabetes: protocol for an open pilot study and external pilot clustered randomised controlled trial to assess acceptability, feasibility and fidelity of a multifaceted behavioural intervention targeting physical activity in primary care Outcomes of a multifaceted physical activity regimen as part of a diabetes self-management intervention The effects of a supplemental, theory-based physical activity counseling intervention for adults with type 2 diabetes. Increasing Physical Activity in Belgian Type 2 Diabetes Patients: a Three-Arm Randomized Controlled Trial Physical activity levels six months after a randomised controlled physical activity intervention for Pakistani immigrant men living in Norway Continuous glucose monitoring counseling improves physical activity behaviors of individuals with type 2 diabetes: A randomized clinical trial. The Alberta Diabetes and Physical Activity Trial (ADAPT):A Randomized Trial Evaluating Theory-Based Interventions to Increase Physical Activity in Adults with Type 2 Diabetes The physical activity counselling (PAC) randomized controlled trial: rationale, methods, and interventions. Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease. Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes The diabetes network internet-based physical activity intervention: a randomized pilot study. Remote and web 2.0 interventions for promoting physical activity. Aerobic physical activity and resistance training: an application of the theory of planned behavior among adults with type 2 diabetes in a random, national sample of Canadians Prescription of physical activity is not sufficient to change sedentary behavior and improve glycemic control in type 2 diabetes patients. A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity. A cognitive-behavioural pedometer-based group intervention on physical activity and sedentary behaviour in individuals with type 2 diabetes Rationale and study protocol for the 'eCoFit' randomized controlled trial: Integrating smartphone technology, social support and the outdoor physical environment to improve health-related fitness among adults at risk of, or diagnosed with, Type 2 Diabetes.
Background Physical activity ( PA ) and nutrition are the cornerstones of diabetes management . Several review s and meta-analyses report that PA independently produces clinical ly important improvements in glucose control in people with Type 2 diabetes . However , it remains unclear what the optimal strategies are to increase PA behaviour in people with Type 2 diabetes in routine primary care . Methods This study will determine whether an evidence -informed multifaceted behaviour change intervention ( Movement as Medicine for Type 2 Diabetes ) targeting both consultation behaviour of primary healthcare professionals and PA behaviour in adults with Type 2 diabetes is both acceptable and feasible in the primary care setting . An open pilot study conducted in two primary care practice s ( phase one ) will assess acceptability , feasibility and fidelity . Ongoing feedback from participating primary healthcare professionals and patients will provide opportunities for systematic adaptation and refinement of the intervention and study procedures . A two-arm parallel group clustered pilot r and omised controlled trial with patients from participating primary care practice s in North East Engl and will assess acceptability , feasibility , and fidelity of the intervention ( versus usual clinical care ) and trial processes over a 12-month period . Consultation behaviour involving fidelity of intervention delivery , diabetes and PA related knowledge , attitudes/beliefs , intentions and self-efficacy for delivering a behaviour change intervention targeting PA behaviour will be assessed in primary healthcare professionals . We will rehearse the collection of outcome data ( with the focus on data yield and quality ) for a future definitive trial , through outcome assessment at baseline , one , six and twelve months . An embedded qualitative process evaluation and treatment fidelity assessment will explore issues around intervention implementation and assess whether intervention components can be reliably and faithfully delivered in routine primary care . Discussion Movement as Medicine for Type 2 Diabetes will address an important gap in the evidence -base , that is , the need for interventions to increase free-living PA behaviour in adults with Type 2 diabetes . The multifaceted intervention incorporates an online accredited training programme for primary healthcare professionals and represents , to the best of our knowledge , the first of its kind in the United Kingdom . This study will establish whether the multifaceted behavioural intervention is acceptable and feasible in routine primary care . Trial registration Movement as Medicine for Type 2 Diabetes ( MaMT2D ) was registered with Current Controlled Trials on the 14th January 2012 : IS RCT N67997502 . The first primary care practice was r and omised on the 5th October 2012 Background :  Physical activity ( PA )  is important for management of diabetes , yet practical interventions that achieve sustained behavior change are rare . Purpose : The goals of this research were to evaluate the effectiveness of a multifaceted PA intervention for people with type 2 diabetes that emphasized participant choice in activity selection . Baseline activity patterns were examined to determine whether they predicted changes in PA at 2 months . Methods : Three hundred thirty-five participants were recruited from 42 primary care physicians and then r and omized to either a computer-assisted , tailored self-management intervention ( N = 174 ) or health risk appraisal with feedback control ( N = 161 ) . Primary outcome measures included the Community Healthy Activities Model Program for Seniors Question naire , diet , and psychosocial assessment s at baseline and 2 months . Results : For 301 participants who completed the 2-month follow-up , the intervention significantly improved all PA ( p < .01 ) and moderate PA ( metabolic equivalents > 3.0 , p < .01 ) relative to controls . Baseline cluster analyses grouped participant activity patterns into three categories . At 2 months , cluster assignment differentially predicted change in calories expended in moderate , rote , sport , and lifestyle PA . Conclusions : A computer-assisted , multifaceted approach to PA demonstrated improvement after 2 months . The results suggest that individuals are capable of adjusting their activity patterns to maximize their PA BACKGROUND Physical activity ( PA ) is a cornerstone in the management of type 2 diabetes ( T2DM ) . This pilot investigation explores the effects of a st and ard diabetes education program compared with a supplemental PA intervention on diabetes-related health outcomes . METHODS Using a prospect i ve 2-armed design , 96 adults with T2DM were r and omly assigned to either st and ard care ( diabetes education program ; n = 49 ) or st and ard care supplemented with an 8-week , individualized-counseling and community-based PA component ( n = 47 ) . Measurements were taken at baseline , 3 , 6 , and 12 months . Primary outcomes were changes in PA ( self-report ) and HbA1c . Between group changes were compared using analysis of covariance ( ANCOVA ) and changes over time using repeated- measures ANOVA . RESULTS In comparison with st and ard care , the supplemental group demonstrated an increase in PA ( Ps < 0.01 ) and cardiorespiratory fitness ( Ps < 0.05 ) from baseline to all follow-up time-points . HbA1c levels declined ( P < .05 ) from baseline to all time points in the st and ard care group . Reduction in cholesterol-ratio ( P < .01 ) , increase in HDL ( P < .05 ) , and reductions in blood pressure , resting heart rate and BMI ( approaching statistical significance Ps < 0.10 ) were also reported for both groups . CONCLUSIONS PA counseling in addition to st and ard care is effective for promoting PA behavior change and positive health-related outcomes among individuals with T2DM Background Pedometer-based physical activity programs have been typically delivered in a group format by a behavioral expert . An alternative strategy that builds on existing interactions is delivery through individual consultation by a general practitioner ( GP ) . These two delivery strategies have not been directly compared . Purpose To compare effectiveness of a 12-week physical activity ( PA ) intervention for type 2 diabetes patients delivered by a trained GP via an individual consultation or as group delivery by a behavioral expert . MethodS ixty-seven primary care participants ( mean age = 67.4 years , 70 % male ) from three Belgian general practice s were r and omized into three different treatment arms : ( 1 ) individual consultation ( n = 22 ) with three PA contacts with the patient 's GP ; ( 2 ) group counseling ( n = 21 ) with three PA group sessions delivered by a behavioral expert ; and ( 3 ) a control arm ( n = 24 ) receiving no intervention .  Participant inclusion criteria were ≤80 years ; 25–35 kg/m² ; ≤12 % HbA1c and reporting no PA limitations . Outcome measures were pedometer-determined steps/day , self-reported PA , and health parameters ( weight , body mass index , waist circumference , total cholesterol , fasting glucose , and HbA1c ) . Results Group counseling participants increased 1,706 steps/day over baseline significantly ( p ≤ 0.05 ) more than other treatment arms . Moreover , they increased their self-reported PA ( + 82 min/day ) , while control arm participants showed a decrease in PA ( p ≤ 0.05 ) . Participants of the individual consultation had a decrease in waist circumference ( −1.4 cm ) and HbA1c ( −0.32 % ) and a lower increase in total cholesterol ( + 7.2 mg/dl ) compared to the other treatment arms ( all p ≤ 0.05 ) . Conclusion Group counseling in type 2 diabetes patients improved PA , whereas individual consultations had an impact on some health outcomes on the short-term Background To our knowledge , no studies have aim ed at improving the PA level in south Asian immigrant men residing in Western countries , and few studies have considered the relevance of SCT constructs to the PA behaviour of this group in the long term . The observed low  physical activity ( PA ) level among south Asian immigrants in Western countries may partly explain the high prevalence of cardiovascular diseases ( CVD ) and type 2 diabetes ( T2D ) in this group . We have shown previously in a r and omised controlled trial , the Physical Activity and Minority Health study ( PAMH ) that a social cognitive based intervention can beneficially influence PA level and subsequently reduce waist circumference and insulin resistance in the short-term . In an extended follow-up of the PAMH study : we aim ed 1 ) to determine if the intervention produced long-term positive effects on PA level six months after intervention ( follow-up 2 ( FU2 ) ) , and 2 ) to identify the social cognitive mediators of any intervention effects . Methods Physically inactive Pakistani immigrant men ( n = 150 ) who were free of CVD and T2D were r and omly assigned to a five months PA intervention or a control group . Six months after the intervention ended , we telephoned all those who attended FU1 and invited them for a second follow-up test ( FU2 ) ( n = 133 ) . PA was measured using ActiGraph accelerometers . Statistical differences between groups were determined by use of ANCOVA . Results Significant differences ( baseline to FU2 ) between the groups were found for all PA variables ( e.g. , total PA level , sedentary time , PA intensity ) . Support from family and outcome expectancies increased more in the intervention group compared with the control group . Self-efficacy did not differ significantly between groups . Conclusions Our results show that a multi component PA programme can increase PA over the short and long term in a group of immigrant Pakistani men . However , we could not identify the factors that mediated these changes in PA . Protocol ID07112001326 , NCT ID : AIMS Despite the known benefits , 60 % of individuals with diabetes do not engage in regular physical activity ( PA ) . This pilot study tested the effects of a counseling intervention using continuous glucose monitoring system ( CGMS ) feedback on PA self-efficacy , PA levels , and physiological variables . METHODS Adults ( N=52 ) with type 2 diabetes ( non-insulin requiring , inactive ) were r and omized to intervention ( n=27 ) or control ( n=25 ) groups . Both groups received 90min of diabetes education with a follow-up phone call 4 weeks later . The intervention group also received counseling derived from self-efficacy theory . This intervention included feedback on each participant 's CGMS graph and used role model CGMS graphs to clearly depict glucose reductions in response to PA . Outcomes were assessed at baseline and 8 weeks . RESULTS Participants receiving the intervention had higher self-efficacy scores than the control group for sticking to activity/resisting relapse at 8 weeks ( p<0.05 ) , indicating more confidence in maintaining a PA program . Intervention group participants light/sedentary activity minutes decreased significantly ( p<0.05 ) , moderate activity minutes increased significantly ( p<0.05 ) , and , HbA1c and BMI decreased significantly ( p<0.05 ) . CONCLUSIONS These data suggest that PA counseling interventions using CGMS feedback for individuals with type 2 diabetes may improve PA levels and reduce risk factors for diabetes-related complications Background Physical activity ( PA ) is associated with reduced morbidity and mortality in individuals with type 2 diabetes mellitus ( T2DM ) ; however , most T2DM adults are insufficiently active . Purpose To explore the effectiveness of two innovative/theoretically based behavioral-change strategies to increase PA and reduce hemoglobin A1c ( A1c ) in T2DM adults . Methods Participants ( n = 287 ) were r and omly assigned to a control group or an intervention group ( i.e. , print-based material s/pedometer group or print-based material s/pedometer plus telephone-counseling group ) . Changes in PA and A1c and other clinical measures were examined by Linear Mixed Model analyses over 18 months , along with moderating effects for gender and age . Results PA and A1c levels did not significantly change in intervention groups . Step counts significantly increased in the print-based material s and pedometer plus telephone counseling group , for women . Conclusions No significant effects were found for PA or A1c levels for T2DM adults . The multi-component strategy including telephone counseling may have potential for women . The trial was registered on Clinical Trials.gov identifier : NCT00221234 Primary care is a promising venue to build patient motivation and confidence to increase physical activity ( PA ) . Physician PA counselling has demonstrated some success ; however , maintenance of behaviour change appears to require more intensive interventions . In reality , most physicians do not have the necessary training nor the time for this type of counselling . The purpose of this paper is to outline the rationale , methods , and interventions for the ongoing physical activity counselling ( PAC ) r and omized controlled trial ( RCT ) , which aims to assess the impact of integrating a PA counsellor into a primary care practice . This RCT has 2 arms : ( i ) brief PA counselling ( 2 - 4 min ) from a health care provider and ( ii ) brief PA counselling+intensive PA counselling from a PA counsellor ( 3 months ) . The impact of this intervention is being evaluated using the comprehensive RE- AIM framework . One hundred twenty insufficiently active adult patients , aged 18 to 69 y and recruited during regular primary care visits have been r and omized . Dependent measures include psychological mediators , PA participation , quality of life , and physical and metabolic outcomes . The PAC project represents an innovative , theoretically-based approach to promoting PA in primary care , focusing on psychological mediators of change . We anticipate that key lessons from this study will be useful for shaping future public health interventions , theories , and research The aim of this study was to investigate the impact of a physical activity (PA)-focused behavioural intervention during and after  pulmonary rehabilitation ( PR ) on PA levels ( primary aim ) , health-related outcomes and self-efficacy ( secondary aims ) of patients with COPD . Thirty-two patients were r and omly assigned to an experimental group ( EG ) or control group ( CG ) . The EG received a PA-focused behavioural intervention during PR ( 3 months ) and follow-up support ( 3 months ) . The CG received PR ( 3 months ) . Daily PA was collected : number of steps ; time spent in moderate-to-vigorous PA ( MVPA ) , total PA and sedentary activities ( SA ) . Secondary outcomes comprised exercise capacity , muscle strength , health-related quality of life ( HRQOL ) and self-efficacy . Measures were collected at baseline , 3 and 6 months . Compared with the CG , the EG improved the number of steps ( p = 0.006 ) and time spent in MVPA ( p = 0.007 ) , total PA ( p = 0.014 ) and SA ( p = 0.018 ) at 3 months . Differences were maintained after follow-up support ( 0.025 ≤ p ≤ 0.040 ) , except for SA ( p = 0.781 ) . Exercise capacity , muscle strength and HRQOL were increased at 3 and 6 months ( p ≤ 0.002 ) with no between-group differences ( 0.148 ≤ p ≤ 0.987 ) . No changes were observed in self-efficacy ( p = 0.899 ) . A PA-focused behavioural intervention during and after PR may improve patients ' PA levels . Further research is warranted to assess the sustainability of the findings OBJECTIVE : To conduct a r and omised trial of a physical activity ( PA ) intervention , The First Step Program ( FSP ) for adults with type II diabetes . DESIGN : A 16-week intervention study and 24-week follow-up assessment . PARTICIPANTS : A total of 47 overweight/obese , sedentary individuals ( age=52.7±5.2 y ; BMI = 33.3±5.6 kg/m2 ) recruited through a diabetes education centre . MEASUREMENTS : Primary outcome :  daily PA assessed by pedometer ( steps/day ) . Secondary outcomes : anthropometric measures ( weight , BMI , waist girth , hip girth ) ; indicators of cardiovascular health ( resting heart rate and blood pressure ) ; glycemic control ( fasting glucose , insulin , HbA1c , glucose concentration 120 min postglucose load ) ; plasma lipid status ( total cholesterol , HDL cholesterol , LDL cholesterol , and triglycerides ) . RESULTS : Relative to the CONTROL group , FSP participants increased  their PA > 3000 steps/day ( approximately 30 min/day ) during the intervention ( P<0.0001 ) . Waist and hip girth decreased ( approximately 2–3 cm ) , but did not differ significantly between groups . Significant changes did not emerge for any of the other variables . CONCLUSIONS : The FSP is a practical intervention that elicits an immediate and profound change in walking behaviour . Such change is an important ‘ first step ’ towards increasing the volume and /or intensity of PA necessary to improve long-term health outcomes in this largely sedentary and overweight or obese population . Relapse by 24 weeks indicates that other strategies such as booster sessions are needed to maintain lifestyle change . Further research must determine realistic and responsive health outcomes for this population that are achievable through practical , real-world programming OBJECTIVE Because of other competing priorities ,  physical activity ( PA ) is seldom addressed in a consistent way in either primary care or diabetes education . This 8-week pilot study evaluated the short-term benefits of an Internet-based supplement to usual care that focused on providing support for sedentary patients with type 2 diabetes to increase their PA levels . RESEARCH DESIGN AND METHODS A total of 78 type 2 diabetic patients ( 53 % female , average age 52.3 years ) were r and omized to the Diabetes Network ( D-Net ) Active Lives PA Intervention or an Internet information-only condition .  The intervention condition received goal - setting and personalized feedback , identified and developed strategies to overcome barriers , received and could post messages to an on-line " personal coach , " and were invited to participate in peer group support areas . Key outcomes included minutes of PA per week and depressive symptomatology . RESULTS There was an overall moderate improvement in PA levels within both intervention and control conditions , but there was no significant improvement in regard to condition effects . There was substantial variability in both site use and outcomes within the intervention and control conditions . Internal analyses revealed that among intervention participants , those who used the site more regularly derived significantly greater benefits , whereas those in the control condition derived no similar benefits with increased program use . CONCLUSIONS Internet-based self-management interventions for  PA and other regimen areas have great potential to enhance the care of diabetes and other chronic conditions . We conclude that greater attention should be focused on methods to sustain involvement with Internet-based intervention health promotion programs over time BACKGROUND Remote and web 2.0 interventions for promoting physical activity ( PA ) are becoming increasingly popular but their ability to achieve long term changes are unknown . OBJECTIVES To compare the effectiveness of remote and web 2.0 interventions for PA promotion in community dwelling adults ( aged 16 years and above ) with a control group exposed to placebo or no or minimal intervention . SEARCH METHODS We search ed CENTRAL , MEDLINE , EMBASE , CINAHL , and some other data bases ( from earliest date s available to October 2012 ) . Reference lists of relevant articles were checked . No language restrictions were applied . SELECTION CRITERIA R and omised controlled trials ( RCTs ) that compared remote and web 2.0 PA interventions for community dwelling adults with a placebo or no or minimal intervention control group .  We included studies if the principal component of the intervention was delivered using remote or web 2.0 technologies ( for example the internet , smart phones ) or more traditional methods ( for example telephone , mail-outs ) , or both . To assess behavioural change over time , the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results . We excluded studies that had more than a 20 % loss to follow-up if they did not apply an intention-to-treat analysis . DATA COLLECTION AND ANALYSIS At least two authors independently assessed the quality of each study and extracted the data . Non-English language papers were review ed with the assistance of an interpreter who was an epidemiologist . Study authors were contacted for additional information where necessary . St and ardised mean differences ( SMDs ) and 95 % confidence intervals ( CIs ) were calculated for the continuous measures of self-reported PA and cardio-respiratory fitness . For studies with dichotomous outcomes , odds ratios and 95 % CIs were calculated . MAIN RESULTS A total of 11 studies recruiting 5862 apparently healthy adults met the inclusion criteria . All of the studies took place in high-income countries . The effect of the interventions on cardiovascular fitness at one year ( two studies ; 444 participants ) was positive and moderate with significant heterogeneity of the observed effects ( SMD 0.40 ; 95 % CI 0.04 to 0.76 ; high quality evidence ) . The effect of the interventions on self-reported PA at one year ( nine studies ; 4547 participants ) was positive and moderate ( SMD 0.20 ; 95 % CI 0.11 to 0.28 ; moderate quality evidence ) with heterogeneity ( I2 = 37 % ) in the observed effects . One study reported positive results at two years ( SMD 0.20 ; 95 % CI 0.08 to 0.32 ; moderate quality evidence ) . When studies were stratified by risk of bias , the studies at low risk of bias ( eight studies ; 3403 participants ) had an increased effect ( SMD 0.28 ; 95 % CI 0.16 to 0.40 ; moderate quality evidence ) . The most effective interventions applied a tailored approach to the type of PA and used telephone contact to provide feedback and to support changes in PA levels . There was no evidence of an increased risk of adverse events ( seven studies ; 2892 participants ) . Risk of bias was assessed as low ( eight studies ; 3060 participants ) or moderate ( three studies ; 2677 participants ) . There were no differences in effectiveness between studies using different types of professionals delivering the intervention ( for example health professional , exercise specialist ) . There was no difference in pooled estimates between studies that generated the prescribed PA using an automated computer programme versus a human , nor between studies that used pedometers as part of their intervention compared to studies that did not . AUTHORS ' CONCLUSIONS We found consistent evidence to support the effectiveness of remote and web 2.0 interventions for promoting PA . These interventions have positive , moderate sized effects on increasing self-reported PA and measured cardio-respiratory fitness , at least at 12 months . The effectiveness of these interventions was supported by moderate and high quality studies . However , there continues to be a paucity of cost effectiveness data and studies that include participants from varying socioeconomic or ethnic groups . To better underst and the independent effect of individual programme components , longer term studies , with at least one year follow-up , are required Background Aerobic physical activity ( PA ) and resistance training are paramount in the treatment and management of type 2 diabetes ( T2D ) , but few studies have examined the determinants of both types of exercise in the same sample . Objective The primary purpose was to investigate the utility of the Theory of Planned Behavior ( TPB ) in explaining aerobic PA and resistance training in a population sample of T2D adults . Methods A total of 244 individuals were recruited through a r and om national sample which was created by generating a r and om list of household phone numbers . The list was proportionate to the actual number of household telephone numbers for each Canadian province ( with the exception of Quebec ) . These individuals completed self-report TPB constructs of attitude , subjective norm , perceived behavioral control and intention , and a 3-month follow-up that assessed aerobic PA and resistance training . Results TPB explained 10 % and 8 % of the variance respectively for aerobic PA  and resistance training ;  and accounted for 39 % and 45 % of the variance respectively for aerobic PA and resistance training intentions . Conclusion These results may guide the development of appropriate PA interventions for aerobic PA and resistance training based on the TPB OBJECTIVE To assess the impact of personalized exercise prescription on habitual physical activity and glycemic control in sedentary , insulin treated type 2 diabetes patients during a 2-y intervention period . RESEARCH DESIGN AND METHODS 74 patients were r and omized to the intervention ( n=38 ) or control ( n=36 ) group . The intervention group was stimulated to increase daily physical activity through regular , structured , and personalized exercise prescription by a physical therapist over the 2-y intervention period . RESULTS Physical activity levels at work or in leisure time were not modulated by the exercise prescription intervention . In accordance , no changes in body composition , glycemic control , medication use or risk factors for cardiovascular disease were observed . CONCLUSIONS Long-term behavioral intervention programs , providing individualized exercise prescription , are not sufficient to change sedentary behavior and /or improve glycemic control in insulin treated , type 2 diabetes patients OBJECTIVE To determine whether a culturally appropriate clinic- and community-based intervention for African-American women with type 2 diabetes will increase  moderate-intensity physical activity ( PA ) . RESEARCH DESIGN AND METHODS In this r and omized controlled trial conducted at seven practice s in central North Carolina , 200 African-American women , > or = 40 years of age with type 2 diabetes , were r and omized to one of three treatment conditions : clinic and community ( group A ) , clinic only ( group B ) , or minimal intervention ( group C ) . The clinic-based intervention ( groups A and B ) consisted of four monthly visits with a nutritionist who provided counseling to enhance PA and dietary intake that was tailored to baseline practice s and attitudes ; the community-based intervention ( group A ) consisted of three group sessions and 12 monthly phone calls from a peer counselor and was design ed to provide social support and reinforce behavior change goals ; and the minimal intervention ( group C ) consisted of educational pamphlets mailed to participants . The primary study outcome was the comparison of PA levels between groups assessed at 6 and 12 months by accelerometer , which was worn while awake for 7 days . RESULTS Totals of 175 ( 88 % ) and 167 ( 84 % ) participants completed PA assessment at 6 and 12 months , respectively . For comparison of PA , the P value for overall group effect was 0.014 . Comparing group A with C , the difference in the average adjusted mean for PA was 44.1 kcal/day ( 95 % CI 13.1 - 75.1 , P = 0.0055 ) . Comparing group B with C , the difference in the average adjusted mean was 33.1 kcal/day ( 95 % CI 3.3 - 62.8 , P = 0.029 ) . The intervention was acceptable to participants : 88 % were very satisfied with clinic-based counseling to enhance PA , and 86 % indicated that the peer counselor 's role in the program was important . CONCLUSIONS The intervention was associated with a modest enhancement of PA and was acceptable to participants The purpose of this study was to investigate the benefits of a pedometer and a cognitive-behavioural group intervention for promoting physical activity ( PA ) in type 2 diabetes patients . We recruited 41 participants and r and omized them into an intervention group ( IG ) ( n = 20 ) and a control group ( CG ) ( n = 21 ) . The intervention consisted of five sessions within 12 weeks , a booster session after 22 weeks and a pedometer . Primary outcome was PA assessed by accelerometer ( minutes per day ) and pedometer ( steps per day ) . Secondary outcomes were weight , body mass index , blood pressure , haemoglobin A1c and total cholesterol . After 12 weeks , the IG increased with more than 2000 steps day−1 compared with the CG , whereas sedentary behaviour decreased more than 1 hour day−1 in the IG and showed no change in the CG . There was no intervention effect on the accelerometer-based PA nor on health measurements . After 1 year , the increase in steps per day remained significant in the IG , but sedentary activity increased again to baseline levels . This pilot study showed that the combination of a 12-week cognitive-behavioura intervention and a pedometer has a significant short-term impact on daily steps and sedentary behaviour but that the effects on total PA and long-term effects were limited INTRODUCTION The prevalence and risk of Type 2 Diabetes ( T2D ) has dramatically increased over the past decade . Physical activity ( PA ) has significant benefits for the treatment and prevention of T2D . The aim of this study is to develop , implement and evaluate a community-based PA intervention to improve aerobic and muscular fitness among adults at risk of , or diagnosed with T2D . RESEARCH DESIGN AND METHODS The eCoFit pilot intervention will be evaluated using a r and omized controlled trial ( RCT ) design . The 20-week ( Phases 1 and 2 ) multi-component intervention was guided by Social Cognitive Theory , Health Action Process Approach Model , and Cognitive Behavior Therapy strategies . Phase 1 ( Weeks 1 - 10 ) includes : i ) 5 group face-to-face sessions consisting of outdoor training and cognitive mentoring ; and ii ) the use of the eCoFit smartphone application with a description of where and how to use the outdoor environment to be more physically active . Phase 2 ( Weeks 11 - 20 ) includes the use of the eCoFit smartphone application only . Assessment s are to be conducted at baseline , 10-weeks ( primary end-point ) and 20-weeks ( secondary end-point ) post-baseline . Primary outcomes are cardio-respiratory fitness and muscular fitness ( lower body ) . Secondary outcomes include physical , behavioral , mental health and quality of life , and social-cognitive outcomes . DISCUSSION eCoFit is an innovative , multi-component intervention , which integrates smartphone technology , social support and the outdoor physical environment to promote aerobic and resistance training PA among adults at risk of , or diagnosed with T2D . The findings will be used to guide future interventions and to develop and implement effective community-based prevention programs . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry No : ACTRN12615000990527
A minority of published evidence -based PA interventions for adults with T2D were both effective and pragmatic for clinical implementation .
Although regular physical activity ( PA ) is a cornerstone of treatment for type 2 diabetes ( T2D ) , most adults with T2D are sedentary .
R and omized controlled trials ( RCTs ) have proven the effectiveness of PA behavioral interventions for adults with T2D but have rarely been conducted in healthcare setting s. We sought to identify PA interventions that are effective and practical to implement in clinical practice setting s. Our first aim was to use the valid Pragmatic-Explanatory Continuum Indicator Summary 2 ( PRECIS-2 ) tool to assess the potential for future implementation of PA interventions in clinical practice setting s. Our second aim was to identify interventions that effectively increased PA and glycemic control among the interventions in the top tertile of PRECIS-2 scores .