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L P de Oliveira V, de Freitas MM, P de Paula T, Gubert ML, Miller MEP, Schuchmann RA, Souza KLA, Viana LV. DASH diet vs. DASH diet plus physical activity in older patients with type 2 diabetes and high blood pressure: A randomized clinical trial. Nutr Health 2024; 30:389-398. [PMID: 36114615 DOI: 10.1177/02601060221124201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS To evaluate the effect of lifestyle modification by adopting a DASH diet, with and without physical activity guidance, on blood pressure, glycemic control, lipid profile, weight, and body composition in older patients with type 2 diabetes mellitus (T2DM) and hypertension. METHODS AND RESULTS For this randomized clinical trial, we recruited patients aged 60 years or older with T2DM and uncontrolled hypertension. One group (DASH) received only DASH dietary guidance, while the other group (DASHPED) received dietary guidance and encouragement to walk with a pedometer. Outcomes of interest were (1) blood pressure, (2) physical activity, (3) weight, body mass index (BMI), and body composition, and (4) biochemical variables. Measurements were taken at baseline and 16 weeks after the intervention. We included 35 patients in the analysis. At the end of the study, the DASHPED group had an mean increase in physical activity of 1721 steps/day. Both groups displayed significantly reduced weight, BMI, and waking diastolic pressures on ambulatory blood pressure monitoring after the intervention. A trend of reduced sleeping diastolic pressure was found in the DASHPED group. Changes in weight, BMI, muscle mass, body fat, waist-hip ratio, glycemic control, lipid profile, and insulin sensitivity did not differ between the groups. CONCLUSION There was no difference in outcomes between the group that only dieted and the group that also performed increased physical activity, despite a significant increase in exercise. This reinforces the importance of dietary changes in immediate blood pressure control.
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Affiliation(s)
- Vanessa L P de Oliveira
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mauren M de Freitas
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tatiana P de Paula
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mayara L Gubert
- Department of internal Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Maria E P Miller
- Department of internal Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Renata A Schuchmann
- Department of internal Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Karen L A Souza
- Department of internal Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Luciana V Viana
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of internal Medicine, Universidade Federal do Rio Grande do Sul, Brazil
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Brazil
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de Oliveira VLP, de Paula TP, Viana LV. Pedometer- and accelerometer- based physical activity interventions in Type 2 diabetes: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2024; 34:548-558. [PMID: 38220510 DOI: 10.1016/j.numecd.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024]
Abstract
AIMS Although accelerometer- and pedometer-based physical activity (PA) interventions can increase PA, there is no solid evidence for their benefits in patients with type 2 diabetes (T2DM). The aim of this systematic review and meta-analysis of randomized controlled clinical trials (RCTs) was to determine the effects of accelerometer- and pedometer-based PA interventions on hemoglobin A1c (HbA1c), fasting glucose, weight, BMI, blood pressure, lipids, and PA in adults with T2DM. DATA SYNTHESIS Records from MEDLINE/PubMed, EMBASE, LILACS, and Scopus were searched from inception through March 28th, 2022. RCTs of at least two weeks of duration evaluated the effectiveness of pedometers or accelerometers as motivating tools for increasing PA in T2DM patients. This study was registered with PROSPERO and followed the PRISMA reporting guide. Of the 7131 non-duplicated articles retrieved, 24 RCTs (1969 patients) were included. The mean baseline HbA1c of the experimental group of included studies varied from 6.3 ± 0.9 % to 9.0 ± 0.01 %. The accelerometer- and pedometer-based PA interventions resulted in a greater improvement in HbA1c (-0.22 %; 95%CI, -0.4 % to -0.05 %; I2 = 77 %) and triglycerides (-13.11 mg/dL; 95%CI, -25.21 to -1.02; I2 = 22 %) versus control participants. Pedometer ambulatory use as a motivating tool significantly increased PA by 2,131 steps/day (95 % CI, 1,348 to 2,914; I2 = 74 %) in T2DM patients. CONCLUSIONS Pedometers and accelerometers are associated with reductions in HbA1c and triglycerides when used as motivating tools. Larger and higher-quality studies are required to determine the full effects of PA as motivated by trackers in T2DM population.
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Affiliation(s)
- Vanessa L P de Oliveira
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2º andar, Porto Alegre, Brazil.
| | - Tatiana P de Paula
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2º andar, Porto Alegre, Brazil
| | - Luciana V Viana
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2º andar, Porto Alegre, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350 sala 401, Porto Alegre, Brazil
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Lefferts EC, Saavedra JM, Song BK, Brellenthin AG, Pescatello LS, Lee DC. Increasing Lifestyle Walking by 3000 Steps per Day Reduces Blood Pressure in Sedentary Older Adults with Hypertension: Results from an e-Health Pilot Study. J Cardiovasc Dev Dis 2023; 10:317. [PMID: 37623330 PMCID: PMC10455876 DOI: 10.3390/jcdd10080317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Increasing daily steps by an additional 3000 steps/day on 5 days/week equates to ~150 min/week of aerobic physical activity to meet the physical activity guidelines; however, its effectiveness for blood pressure control in older adults with hypertension is unknown. A 20-week, single-arm, pilot e-health lifestyle walking intervention was conducted in 21 sedentary older adults (73 ± 5 years old) with hypertension (13 female, 8 male) to investigate the effectiveness of increasing daily steps by an additional 3000 steps/day for blood pressure control. The intervention consisted of two phases, with behavior change assistance provided during the first active phase (weeks 1-10) to help reach step goals and minimal assistance provided during the second self-maintenance phase (weeks 11-20). Nineteen participants (91%) completed both the 10- and 20-week assessments. The participants wore the pedometer for ≥10 h on 97% of the days over 20 weeks. They significantly increased average steps/day from 3899 ± 2198 at baseline to 6512 ± 2633 at 10 weeks and 5567 ± 2587 at 20 weeks. After 20 weeks, both systolic (137 ± 10 to 130 ± 11 mm Hg, p < 0.001) and diastolic (81 ± 6 to 77 ± 6 mm Hg, p = 0.01) blood pressure improved. The response was consistent in participants with (n = 8) and without (n = 13) anti-hypertensive medication. The results of our lifestyle walking intervention are encouraging for reducing blood pressure in older adults with hypertension; however, larger randomized, controlled trials need to be performed to confirm these findings.
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Affiliation(s)
- Elizabeth C. Lefferts
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
| | - Joseph M. Saavedra
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
| | - Bong Kil Song
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
| | - Angelique G. Brellenthin
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
| | | | - Duck-chul Lee
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
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Amin M, Kerr D, Atiase Y, Aldwikat RK, Driscoll A. Effect of Physical Activity on Metabolic Syndrome Markers in Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Sports (Basel) 2023; 11:sports11050101. [PMID: 37234057 DOI: 10.3390/sports11050101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
People with Type 2 diabetes mellitus (T2DM) are reported to have a high prevalence of metabolic syndrome (MetS), which increases their risk of cardiovascular events. Our aim was to determine the effect of physical activity (PA) on metabolic syndrome markers in people with T2DM. The study design was a systematic review and meta-analysis of randomised controlled trials evaluating the effect of PA on MetS in adults with T2DM. Relevant databases including SPORTdiscus, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PsycINFO, EMBASE, SocINDEX were searched up to August 2022. Primary endpoints were changes in MetS markers (blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar, and waist circumference) after an exercise intervention. Using a random effect model with 95% confidence interval (CI), the mean difference between intervention groups and control groups were calculated. Twenty-six articles were included in the review. Overall, aerobic exercise had a significant effect on waist circumference (Mean Difference: -0.34 cm, 95% CI: -0.84, -0.05; effect size: 2.29, I2 = 10.78%). The effect sizes on blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar were not statistically significant. No significant differences were found between exercise and control group following resistance training. Our findings suggest that aerobic exercise can improve waist circumference in people with T2DM and MetS. However, both aerobic and resistance exercise produced no significant difference in the remaining MetS markers. Larger and higher-quality studies are required to determine the full effects of PA on MetS markers in this population.
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Affiliation(s)
- Mohammed Amin
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Yacoba Atiase
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana
| | - Rami Kamel Aldwikat
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- School of Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, VIC 3800, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
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Yang J, Xia Y, Sun Y, Guo Y, Shi Z, Cristina do Vale Moreira N, Zuo H, Hussain A. Effect of lifestyle intervention on HbA1c levels in overweight and obese adults with type 2 diabetes across ethnicities: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2023; 199:110662. [PMID: 37028602 DOI: 10.1016/j.diabres.2023.110662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023]
Abstract
AIMS Weight reduction is fundamental for the management and remission of diabetes. We aimed to assess ethnic differences in the effects of lifestyle weight-loss interventions on HbA1c levels in overweight or obese adults with type 2 diabetes mellitus (T2DM). METHODS We systematically searched PubMed/MEDLINE and Web of Science online databases up to 31 Dec 2022. Randomized controlled trials using lifestyle weight-loss interventions in overweight or obese adults with T2DM were selected. We performed subgroup analyses to explore the heterogeneity across different ethnicities (Asians, White/Caucasians, Black/Africans and Hispanics). A random effects model was applied to calculate weighted mean difference (WMD) with 95% confidence interval (CI). RESULTS Thirty studies including 7580 subjects from different ethnicities were identified according to the predefined inclusion and exclusion criteria. HbA1c levels were significantly reduced by lifestyle weight-loss intervention. Notably, a significantly beneficial effect on HbA1c was observed in White/Caucasians (WMD = -0.59, 95% CI: -0.90, -0.28, P < 0.001) and Asians (WMD = -0.48, 95% CI: -0.63, -0.33, P < 0.001), but not in the Black/African or Hispanic group (both P > 0.05). The findings remained essentially unchanged in the sensitivity analysis. CONCLUSIONS Lifestyle weight-loss interventions had distinct beneficial effects on HbA1c levels in different ethnic groups with T2DM, especially in Caucasians and Asians.
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Affiliation(s)
- Jie Yang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yujia Xia
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yanan Sun
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yufei Guo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Zumin Shi
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Qatar
| | | | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China.
| | - Akhtar Hussain
- Faculty of Health Sciences, NORD University, Bodø, Norway; Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; International Diabetes Federation. 166 Chaussee de La Hulpe B-1170, Brussels, Belgium.
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Peng P, Zhang N, Huang J, Jiao X, Shen Y. Effectiveness of Wearable Activity Monitors on Metabolic Outcomes in Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis. Endocr Pract 2023; 29:368-378. [PMID: 36804969 DOI: 10.1016/j.eprac.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Wearable activity monitors are promising tools for improving metabolic outcomes in patients with type 2 diabetes mellitus (T2DM); however, no uniform conclusive evidence is available. This study aimed to evaluate the effects of the intervention using wearable activity monitors on blood glucose, blood pressure, blood lipid, weight, waist circumference, and body mass index (BMI) in individuals with T2DM. METHODS Two independent reviewers searched 4 online databases (PubMed, Cochrane Library, Web of Science, and Embase) to identify relevant studies published from January 2000 to October 2022. The primary outcome indicator was hemoglobin A1c (HbA1c), and the secondary outcome indicators included physical activity (steps per day), fasting blood glucose, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, BMI, waist circumference, and weight. RESULTS A total of 25 studies were included. The HbA1c level (standardized mean difference [SMD], -0.14; 95% confidence interval [CI], -0.27 to -0.02; P = .02; I2 = 48%), BMI (SMD, -0.16; 95% CI, -0.26 to -0.05; P = .002; I2 = 0), waist circumference (SMD, -0.21; 95% CI, -0.34 to -0.09; P < .001; I2 = 0), and steps/day (SMD, 0.55; 95% CI, 0.36-0.94; P < .001; I2 = 77%) significantly improved. CONCLUSION Wearable activity monitor-based interventions could facilitate the improvement of the HbA1c level, BMI, and waist circumference and increase in physical activity in individuals with T2DM. Wearable technology appeared to be an effective tool for the self-management of T2DM; however, there is insufficient evidence about its long-term effect.
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Affiliation(s)
- Ping Peng
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Neng Zhang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Jingjing Huang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Xiaojuan Jiao
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Yunfeng Shen
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China.
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Shibuta T, Waki K, Miyake K, Igarashi A, Yamamoto-Mitani N, Sankoda A, Takeuchi Y, Sumitani M, Yamauchi T, Nangaku M, Ohe K. Preliminary Efficacy, Feasibility, and Perceived Usefulness of a Smartphone-Based Self-Management System with Personalized Goal Setting and Feedback to Increase Step Count among Workers with High Blood Pressure: Before-After Study (Preprint). JMIR Cardio 2022. [PMID: 37477976 PMCID: PMC10403795 DOI: 10.2196/43940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND High blood pressure (BP) and physical inactivity are the major risk factors for cardiovascular diseases. Mobile health is expected to support patients' self-management for improving cardiovascular health; the development of fully automated systems is necessary to minimize the workloads of health care providers. OBJECTIVE The objective of our study was to evaluate the preliminary efficacy, feasibility, and perceived usefulness of an intervention using a novel smartphone-based self-management system (DialBetes Step) in increasing steps per day among workers with high BP. METHODS On the basis of the Social Cognitive Theory, we developed personalized goal-setting and feedback functions and information delivery functions for increasing step count. Personalized goal setting and feedback consist of 4 components to support users' self-regulation and enhance their self-efficacy: goal setting for daily steps, positive feedback, action planning, and barrier identification and problem-solving. In the goal-setting component, users set their own step goals weekly in gradual increments based on the system's suggestion. We added these fully automated functions to an extant system with the function of self-monitoring daily step count, BP, body weight, blood glucose, exercise, and diet. We conducted a single-arm before-and-after study of workers with high BP who were willing to increase their physical activity. After an educational group session, participants used only the self-monitoring function for 2 weeks (baseline) and all functions of DialBetes Step for 24 weeks. We evaluated changes in steps per day, self-reported frequencies of self-regulation and self-management behavior, self-efficacy, and biomedical characteristics (home BP, BMI, visceral fat area, and glucose and lipid parameters) around week 6 (P1) of using the new functions and at the end of the intervention (P2). Participants rated the usefulness of the system using a paper-based questionnaire. RESULTS We analyzed 30 participants (n=19, 63% male; mean age 52.9, SD 5.3 years); 1 (3%) participant dropped out of the intervention. The median percentage of step measurement was 97%. Compared with baseline (median 10,084 steps per day), steps per day significantly increased at P1 (median +1493 steps per day; P<.001), but the increase attenuated at P2 (median +1056 steps per day; P=.04). Frequencies of self-regulation and self-management behavior increased at P1 and P2. Goal-related self-efficacy tended to increase at P2 (median +5%; P=.05). Home BP substantially decreased only at P2. Of the other biomedical characteristics, BMI decreased significantly at P1 (P<.001) and P2 (P=.001), and high-density lipoprotein cholesterol increased significantly only at P1 (P<.001). DialBetes Step was rated as useful or moderately useful by 97% (28/29) of the participants. CONCLUSIONS DialBetes Step intervention might be a feasible and useful way of increasing workers' step count for a short period and, consequently, improving their BP and BMI; self-efficacy-enhancing techniques of the system should be improved.
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Chen P, Shen Y, Li Z, Sun X, Feng XL, Fisher EB. What Factors Predict the Adoption of Type 2 Diabetes Patients to Wearable Activity Trackers-Application of Diffusion of Innovation Theory. Front Public Health 2022; 9:773293. [PMID: 35047473 PMCID: PMC8761937 DOI: 10.3389/fpubh.2021.773293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Globally, diabetes has brought an enormous burden to public health resources, and the situation of disease burden caused by diabetes in China is especially severe. China is currently facing the dual threat of aging and diabetes, and wearable activity trackers could promote elderly diabetic patients' physical activity levels and help them to manage blood glucose control. Therefore, examining the influencing factors of elderly patients' adoption intention is critical as wearing adoption determines actual wearing behaviors. Objective: This study aims to explore the predicting factors of Chinese elderly type 2 diabetic patients' adoption intention to wearable activity trackers and their actual wearing behavior, using diffusion of innovation theory as the theoretical framework. We hope to provide insights into future interventions using wearable activity trackers as tools to improve the outcome of patients. Methods: Wearable activity trackers were freely distributed to type 2 diabetic patients in Beijing, China. A questionnaire survey was conducted to examine predicting factors of adoption intention after a week's try-on. Actual wearing behavior for 3-month was obtained from the exclusive cloud. Data were analyzed with structural equation modeling. Results: A total of 725 patients completed the questionnaire. Patients had a mean age of 60.3 ± 7.6 years old and the educational level was generally lower. The results indicated that observability was the primary influencing factor of patients' adoption intention (β = 0.775, P < 0.001). Relative advantage (β = 0.182, P = 0.014) and perceived social image (β = 0.080, P = 0.039) also had a positive influence while perceived risk (β = -0.148, P < 0.001) exerted a negative influence. In addition, results showed that the more intention led to the better actual wearing behavior (β = 0.127, P = 0.003). Observability (β = 0.103, P = 0.005), perceived ease (β = 0.085, P = 0.004), and relative advantage (β = 0.041, P = 0.009) also indirectly influenced the wearing behavior. Conclusion: The intentions of Chinese elderly type 2 diabetic patients to wearable activity trackers directly influenced the actual wearing behavior. In addition, their adoption intention to wearable activity trackers was mainly influenced by observability, perceived ease to use, relative advantage, perceived risk, and social image.
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Affiliation(s)
- Ping Chen
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Ying Shen
- Global Health Office, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Zeming Li
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Edwin B Fisher
- Department of Health Behavior Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Social cognitive measures related to exercise behaviour: Validation in Indonesian middle-aged and older adults. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Larsen RT, Wagner V, Korfitsen CB, Keller C, Juhl CB, Langberg H, Christensen J. Effectiveness of physical activity monitors in adults: systematic review and meta-analysis. BMJ 2022; 376:e068047. [PMID: 35082116 PMCID: PMC8791066 DOI: 10.1136/bmj-2021-068047] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate the effectiveness of physical activity monitor (PAM) based interventions among adults and explore reasons for the heterogeneity. DESIGN Systematic review and meta-analysis. STUDY SELECTION The electronic databases MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on 4 June 2021. Eligible randomised controlled trials compared interventions in which adults received feedback from PAMs with control interventions in which no feedback was provided. No restrictions on type of outcome measurement, publication date, or language were applied. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were used to synthesise the results. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach. MAIN OUTCOME MEASURES The three primary outcomes of interest were physical activity, moderate to vigorous physical activity, and sedentary time. RESULTS 121 randomised controlled trials with 141 study comparisons, including 16 743 participants, were included. The PAM based interventions showed a moderate effect (standardised mean difference 0.42, 95% confidence interval 0.28 to 0.55) on physical activity, equivalent to 1235 daily steps; a small effect (0.23, 0.16 to 0.30) on moderate to vigorous physical activity, equivalent to 48.5 weekly minutes; and a small insignificant effect (-0.12, -0.25 to 0.01) on sedentary time, equal to 9.9 daily minutes. All outcomes favoured the PAM interventions. CONCLUSIONS The certainty of evidence was low for the effect of PAM based interventions on physical activity and moderate for moderate to vigorous physical activity and sedentary time. PAM based interventions are safe and effectively increase physical activity and moderate to vigorous physical activity. The effect on physical activity and moderate to vigorous physical activity is well established but might be overestimated owing to publication bias. STUDY REGISTRATION PROSPERO CRD42018102719.
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Affiliation(s)
- Rasmus Tolstrup Larsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
| | - Vibeke Wagner
- Department of Brain Injury Rehabilitation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christoffer Bruun Korfitsen
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Capital Region, Frederiksberg, Denmark
- Danish Health Authority, Copenhagen, Denmark
| | - Camilla Keller
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Carsten Bogh Juhl
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Henning Langberg
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
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Price JC, Santos HO, Bueno AA. The effectiveness of automated digital health solutions at successfully managing obesity and obesity-associated disorders: A PICO-structured investigation. Digit Health 2022; 8:20552076221091351. [PMID: 35401996 PMCID: PMC8990694 DOI: 10.1177/20552076221091351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Most adults in the UK and USA are classified as overweight or obese. Recent
studies suggest that the prevalence of obesity has further increased during the
SARS-CoV-2 pandemic and associated lockdowns. Digital technologies may be
effective at managing obesity and related comorbidities, a potential further
justified by social isolation and distancing circumstances. This review of published literature employed a
Patient-Intervention-Comparison-Outcome structured approach on the use of
digital solutions to determine the effectiveness of their use in the management
and treatment of obesity, hypertension, and type 2 diabetes and included
commercially available, automated devices and applications that did not require
intervention from a clinician. Our search covered studies published between
January 2004 and February 2019, and 18 papers were included in the final
analysis. The digital solutions reviewed were smartphone applications, wearable
activity trackers, and ‘digital medicine offerings’ (DMO), including ingestible
sensors and wearable patches. This study found that not all interventions were effective at encouraging the
lifestyle changes required for the management of obesity. Smartphone
applications requiring interaction from the patient appeared to be more
effective at encouraging engagement with treatment interventions than more
passive wearable activity trackers. Automated feedback from smartphone
applications was effective at managing type 2 diabetes, while DMO were effective
at reducing blood pressure. With the advancement of new technologies alongside a rapid increase in the
prevalence of obesity and associated disorders, further studies comparing the
various technologies available in larger sample populations for longer periods
would help determine the most cost-effective preventive and therapeutic
strategies.
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Affiliation(s)
| | - Heitor Oliveira Santos
- School of Medicine, Federal University of Uberlândia (UFU), Uberlandia, Minas Gerais, Brazil
| | - Allain Amador Bueno
- College of Health, Life and Environmental Sciences, University of Worcester, UK
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12
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Robinson TN, Carmichael H, Hosokawa P, Overbey DM, Goode CM, Barnett CC, Jones EL, Jones TS. Decreases in daily ambulation forecast post-surgical re-admission. Am J Surg 2021; 223:857-862. [PMID: 34392912 DOI: 10.1016/j.amjsurg.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Surgical readmissions are clinically and financially problematic. Our purpose is to determine if a decrease in postoperative ambulation (steps/day) is associated with hospital readmission. METHODS In this prospective cohort study, patients undergoing elective operations wore an accelerometer activity tracker to measure steps/day for 28 consecutive postoperative days. The primary outcome was hospital readmission. The change in steps/day over two consecutive days prior to the day of the readmission were examined. Predetermined thresholds for decreases of consecutive daily ambulation levels were used to calculate sensitivity and specificity for the outcome of hospital readmission. RESULTS 215 patients (aged 63 ± 12 years) were included. Readmission occurred in 10% (n = 21). For each of the first 28-postoperative days, the entire cohort had an average daily step increase of 136 ± 146 steps/day (Spearman correlation rho = 0.990; p < 0.001). A decrease in steps for two consecutive days of >50% from the prior day had a 79% sensitivity and 90% specificity for hospital readmission. CONCLUSIONS A decrease of >50% daily ambulation (steps/day) over two consecutive post-discharge days accurately forecasts hospital readmission. The implications of these findings are that monitoring daily ambulation could serve as a form of outpatient telemetry aiding to forecast post-surgical readmissions.
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Affiliation(s)
- Thomas N Robinson
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Heather Carmichael
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Patrick Hosokawa
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Douglas M Overbey
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christina M Goode
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carlton C Barnett
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Edward L Jones
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Teresa S Jones
- Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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13
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Cortés OL, Herrera-Galindo M, Becerra C, Rincón-Roncancio M, Povea-Combariza C, Esparza-Bohorquez M. Preoperative walking recommendation for non-cardiac surgery patients to reduce the length of hospital stay: a randomized control trial. BMC Sports Sci Med Rehabil 2021; 13:80. [PMID: 34321092 PMCID: PMC8320206 DOI: 10.1186/s13102-021-00317-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Even though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery. METHODS A two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan-Meier estimator (log-rank test). RESULTS There were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001). CONCLUSION Our study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation. TRIAL REGISTRATION PAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.
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Affiliation(s)
- Olga L Cortés
- Research Unit and Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Cl. 163a #13B-60, Bogotá D.C, Colombia.
| | - Mauricio Herrera-Galindo
- Faculty of Health Sciences, Universidad Autónoma de Bucaramanga, Avenida 42 No 48-11PBX, Bucaramanga, Colombia
| | - Claudia Becerra
- Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Cl. 163a #13B-60, Bogotá D.C, Colombia
| | - Mónica Rincón-Roncancio
- Cardiovascular Rehabilitation Department, Fundación Cardioinfantil-Instituto de Cardiología, Cl. 163a #13B-60, Bogotá D.C, Colombia
| | | | - Maribel Esparza-Bohorquez
- Nursing Department, Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lulle, FOSCAL, Calle 155A No23-60, Floridablanca, Colombia
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14
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Carraça EV, Encantado J, Battista F, Beaulieu K, Blundell JE, Busetto L, van Baak M, Dicker D, Ermolao A, Farpour-Lambert N, Pramono A, Woodward E, Bellicha A, Oppert JM. Effect of exercise training on psychological outcomes in adults with overweight or obesity: A systematic review and meta-analysis. Obes Rev 2021; 22 Suppl 4:e13261. [PMID: 33960106 PMCID: PMC8365728 DOI: 10.1111/obr.13261] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022]
Abstract
This study systematically identified the effects of exercise on multiple psychological outcomes among adults with overweight/obesity, also assessing whether these effects differed across exercise types, genders, age, and body mass index (BMI) categories. Pubmed, Web of Science, PsychInfo, and SportDiscus were searched up to October 2019 for peer-reviewed papers assessing exercise training effects on psychosocial outcomes in adults with overweight/obesity. Thirty-six articles, 32 randomized controlled trials (RCTs), were included in this review. Most interventions were supervised (65%), ranging between 6 and 76 weeks (median = 12). Sixteen psychological outcomes were studied. Exercise induced positive changes in quality of life but did not reduce depression. Large effect sizes were observed on quality of life's physical component, but exercise was also able to improve vitality and mental health. Most psychological outcomes (e.g., body image, anxiety, and perceived stress) are poorly studied, evidencing either conflicting or null exercise effects. Exercise self-efficacy and autonomous motivations were also consistently improved. Exercise types and gender seem to moderate exercise psychological effects. Exercise training programs might lead to positive changes in some psychological outcomes, especially in quality of life, in adults with overweight and obesity, but more studies, with greater systematization in program characteristics, and longer follow-ups are still required to allow more solid conclusions.
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Affiliation(s)
- Eliana V Carraça
- CIDEFES, Universidade Lusófona de Humanidades e Tecnologias, Faculdade de Educação Física e Desporto, Lisbon, Portugal
| | - Jorge Encantado
- APPsyCI-Applied Psychology Research Center Capabilities and Inclusion, ISPA-University Institute, Lisbon, Portugal
| | - Francesca Battista
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy
| | - Kristine Beaulieu
- Appetite Control and Energy Balance Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - John E Blundell
- Appetite Control and Energy Balance Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Luca Busetto
- Obesity Management Task Force (OMTF), European Association for the Study of obesity (EASO).,Department of Medicine, University of Padova, Padua, Italy
| | - Marleen van Baak
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Dror Dicker
- Obesity Management Task Force (OMTF), European Association for the Study of obesity (EASO).,Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy
| | - Nathalie Farpour-Lambert
- Obesity Management Task Force (OMTF), European Association for the Study of obesity (EASO).,Obesity Prevention and Care Program Contrepoids; Service of Endocrinology, Diabetology, Nutrition and Patient Education, Department of Internal Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Adryan Pramono
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Euan Woodward
- Obesity Management Task Force (OMTF), European Association for the Study of obesity (EASO)
| | - Alice Bellicha
- INSERM, Nutrition and obesities: systemic approaches, NutriOmics, Sorbonne University, Paris, France.,UFR SESS-STAPS, University Paris-Est Créteil, Créteil, France
| | - Jean-Michel Oppert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière hospital, Department of Nutrition, Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France
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15
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillian B, Bower P, Panagioti M. Interventions Using Wearable Physical Activity Trackers Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2116382. [PMID: 34283229 PMCID: PMC9387744 DOI: 10.1001/jamanetworkopen.2021.16382] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic conditions, such as diabetes, prediabetes, obesity, and cardiovascular disease, is unknown. OBJECTIVE To assess the association of interventions using wearable PA trackers (accelerometers, fitness trackers, and pedometers) with PA levels and other health outcomes in adults with cardiometabolic conditions. DATA SOURCES For this systematic review and meta-analysis, searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO were performed from January 1, 2000, until December 31, 2020, with no language restriction. A combination of Medical Subject Heading terms and text words of diabetes, obesity, cardiovascular disease, pedometers, accelerometers, and Fitbits were used. STUDY SELECTION Randomized clinical trials or cluster randomized clinical trials that evaluated the use of wearable PA trackers, such as pedometers, accelerometers, or fitness trackers, were included. Trials were excluded if they assessed the trackers only as measuring tools of PA before and after another intervention, they required participants to be hospitalized, assessors were not blinded to the trackers, or they used a tracker to measure the effect of a pharmacological treatment on PA among individuals. DATA EXTRACTION AND SYNTHESIS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A random-effects model was used for the meta-analysis. MAIN OUTCOMES AND MEASURES The primary outcome was mean difference in PA levels. When the scale was different across studies, standardized mean differences were calculated. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. RESULTS A total of 38 randomized clinical trials with 4203 participants were eligible in the systematic review; 29 trials evaluated pedometers, and 9 evaluated accelerometers or fitness trackers. Four studies did not provide amenable outcome data, leaving 34 trials (3793 participants) for the meta-analysis. Intervention vs comparator analysis showed a significant association of wearable tracker use with increased PA levels overall (standardized mean difference, 0.72; 95% CI, 0.46-0.97; I2 = 88%; 95% CI, 84.3%-90.8%; P < .001) in studies with short to medium follow-up for median of 15 (range, 12-52) weeks. Multivariable metaregression showed an association between increased PA levels and interventions that involved face-to-face consultations with facilitators (23 studies; β = -0.04; 95% CI, -0.11 to -0.01), included men (23 studies; β = 0.48; 95% CI, 0.01-0.96), and assessed pedometer-based interventions (26 studies; β = 0.20; 95% CI, 0.02-0.32). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, interventions that combined wearable activity trackers with health professional consultations were associated with significant improvements in PA levels among people with cardiometabolic conditions.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health,
Brighton and Sussex Medical School, University of Brighton, Brighton, United
Kingdom
| | - Brian McMillian
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
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16
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Mönninghoff A, Kramer JN, Hess AJ, Ismailova K, Teepe GW, Tudor Car L, Müller-Riemenschneider F, Kowatsch T. Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2021; 23:e26699. [PMID: 33811021 PMCID: PMC8122296 DOI: 10.2196/26699] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood. OBJECTIVE The primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators. METHODS We performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool. RESULTS Of the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P<.001; MVPA SMD 0.28, 95% CI 0.21-0.35; P<.001; TPA SMD 0.34, 95% CI 0.20-0.47; P<.001; energy expenditure SMD 0.44, 95% CI 0.13-0.75; P=.01). Only 33 studies reported short-term follow-up measurements, and 8 studies reported long-term follow-up measurements in addition to end-of-intervention results. In the short term, effects were sustained for walking (SMD 0.26, 95% CI 0.09-0.42; P=.002), MVPA (SMD 0.20, 95% CI 0.05-0.35; P=.008), and TPA (SMD 0.53, 95% CI 0.13-0.93; P=.009). In the long term, effects were also sustained for walking (SMD 0.25, 95% CI 0.10-0.39; P=.001) and MVPA (SMD 0.19, 95% CI 0.11-0.27; P<.001). We found the study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and nonscalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 80.3% (94/117) of the studies. Heterogeneity was significant, resulting in low to very low quality of evidence. CONCLUSIONS mHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects.
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Affiliation(s)
- Annette Mönninghoff
- Institute for Customer Insight, University of St. Gallen, St. Gallen, Switzerland
- Institute for Mobility, University of St. Gallen, St. Gallen, Switzerland
| | - Jan Niklas Kramer
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- CSS Insurance, Lucerne, Switzerland
| | - Alexander Jan Hess
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Kamila Ismailova
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Gisbert W Teepe
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Public Health, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | | | - Tobias Kowatsch
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore-ETH Centre, Singapore, Singapore
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17
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Zaharia OP, Kupriyanova Y, Karusheva Y, Markgraf DF, Kantartzis K, Birkenfeld AL, Trenell M, Sahasranaman A, Cheyette C, Kössler T, Bódis K, Burkart V, Hwang JH, Roden M, Szendroedi J, Pesta DH. Improving insulin sensitivity, liver steatosis and fibrosis in type 2 diabetes by a food-based digital education-assisted lifestyle intervention program: a feasibility study. Eur J Nutr 2021; 60:3811-3818. [PMID: 33839905 PMCID: PMC8437928 DOI: 10.1007/s00394-021-02521-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Recent trials demonstrated remission of type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) following formula diet-induced weight loss. To improve the outreach for populations in need, many mobile health apps targeting weight loss have been developed with limited scientific evaluation of these apps. The present feasibility study investigated the effects of a novel approach incorporating a regular 'whole food-based' low-calorie diet combined with app-based digital education and behavioral change program on glucose metabolism and disease management. METHODS Twenty-four individuals with type 2 diabetes followed this approach supported by weekly coaching calls for 12 weeks. Phenotyping included bioimpedance analysis, mixed-meal tolerance test, magnetic resonance spectroscopy and transient elastography for assessing liver fat content and liver stiffness. RESULTS Over 12 weeks, participants reduced their body weight by 9% (97 ± 13 to 88 ± 12 kg), body mass index (BMI; 33 ± 5 to 29 ± 4 kg/m2), total fat mass (31 ± 10 to 27 ± 10%) (all p < 0.01) and liver fat by 50% alongside with decreased liver stiffness. Target HbA1c (< 6.5%) was achieved by 38% and resolution of NAFLD (liver fat content < 5.6%) was observed in 30% of the participants. CONCLUSION This novel approach combining digital education with a low-calorie diet results in effective improvements of body weight, glycemic control and NAFLD and could complement existing care for patients with type 2 diabetes. TRIAL REGISTRATION NCT04509245.
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Affiliation(s)
- Oana P Zaharia
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Yuliya Kupriyanova
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Yanislava Karusheva
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Daniel F Markgraf
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Konstantinos Kantartzis
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Internal Medicine, Division of Diabetology, Endocrinology, and Nephrology and Institute of Diabetes Research and Metabolic Diseases (IDM), University Hospital Tübingen, Tübingen, Germany
| | - Andreas L Birkenfeld
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Internal Medicine, Division of Diabetology, Endocrinology, and Nephrology and Institute of Diabetes Research and Metabolic Diseases (IDM), University Hospital Tübingen, Tübingen, Germany
| | - Michael Trenell
- NIHR Innovation Observatory, Newcastle University, Newcastle Upon Tyne, UK.,Changing Health, Newcastle Upon Tyne, UK
| | | | | | - Theresa Kössler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, c/o Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Kálmán Bódis
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, c/o Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Jong-Hee Hwang
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, c/o Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany. .,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, c/o Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
| | - Dominik H Pesta
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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18
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Abstract
BACKGROUND Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings. OBJECTIVES To determine the effect of walking as a physical activity intervention on blood pressure and heart rate. SEARCH METHODS We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings. MAIN RESULTS A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.
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Affiliation(s)
- Ling-Ling Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien City, Hualien County, Taiwan
| | | | | | | | - Michael C Watson
- School of Health Sciences, The University of Nottingham, Nottingham, UK
| | - Hui-Hsin Lin
- Medical Affairs Division, Hualien Armed Forces General Hospital, Hualien, Taiwan
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19
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Dorling JL, Höchsmann C, Tudor-Locke C, Beyl R, Martin CK. Effect of an office-based intervention on visceral adipose tissue: the WorkACTIVE-P randomized controlled trial. Appl Physiol Nutr Metab 2021; 46:117-125. [PMID: 33451268 DOI: 10.1139/apnm-2020-0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Office-based activity reduces sedentariness, yet no randomized controlled trials (RCTs) have assessed how such activity influences visceral adipose tissue (VAT). This study examined the effect of an office-based, multicomponent activity intervention on VAT. The WorkACTIVE-P RCT enrolled sedentary office workers (body mass index: 31.4 (standard deviation (SD) 4.4) kg/m2) to an intervention (n = 20) or control (n = 20) group. For 3 months, the intervention group received an office-based pedal desk, further to an intervention promoting its use and increased walking. The control group maintained habitual activity. At baseline and follow-up, VAT, cardiometabolic disease risk markers, physical activity, and food intake were measured. Steps/day were not altered relative to control (P ≥ 0.51), but the pedal desk was utilized for 127 (SD 61) min/day. The intervention reduced VAT relative to control (-0.15 kg; 95% confidence interval (CI) = -0.29 to -0.01; P = 0.04). Moreover, the intervention decreased fasting glucose compared with control (-0.29 mmol/L; 95% CI = -0.51 to -0.06; P = 0.01), but no differences in other cardiometabolic disease markers or food intake were revealed (P ≥ 0.11). A multicomponent intervention decreased VAT in office workers who were overweight or obese. Though longer-term studies are needed, office-based, multicomponent activity regimens may lower cardiometabolic disease risk. Trial registered at ClinicalTrials.gov (NCT02561611). Novelty: In WorkACTIVE-P, a multicomponent activity intervention decreased visceral adipose tissue relative to control in office workers. The intervention also reduced glucose compared with control, though other metabolic risk markers and food intake were not altered. Such multicomponent interventions could help reduce cardiometabolic disease risk, but longer studies are needed.
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Affiliation(s)
- James L Dorling
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.,Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.,Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Catrine Tudor-Locke
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.,Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Robbie Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.,Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.,Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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20
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Pilmark NS, Petersen-Bønding C, Holm NFR, Johansen MY, Pedersen BK, Hansen KB, Karstoft K. The Effect of Metformin on Self-Selected Exercise Intensity in Healthy, Lean Males: A Randomized, Crossover, Counterbalanced Trial. Front Endocrinol (Lausanne) 2021; 12:599164. [PMID: 33716963 PMCID: PMC7947847 DOI: 10.3389/fendo.2021.599164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/19/2021] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION In general, patients with type 2 diabetes have lower cardiorespiratory fitness levels and perform exercise at lower intensities compared to healthy controls. Since metformin (MET) has been shown to increase the rate of perceived exertion (RPE) during exercise with a fixed intensity, MET per se may reduce self-selected exercise intensity. The aim of this study was to assess the effect of MET on self-selected exercise intensity. METHODS Healthy males were eligible for this crossover, counterbalanced study with two treatment periods: MET and placebo (PLA), each lasting 17 days. Treatment dose was gradually increased and reached 2 g/day on treatment day 9, and continued at that level for the rest of the treatment period. The two periods were performed in randomized order. Two experimental days (A+B) were conducted on Day 15 (A) and Day 17 (B) of each period, respectively. Day A consisted of an exercise bout with self-selected exercise intensity (equal to RPE = 14-15 on the Borg Scale). Day B consisted of an exercise bout with fixed intensity (70% of VO2peak). Oxygen consumption rate was assessed continuously during both exercise bouts. RESULTS Fifteen males (age 23.7 ± 0.6 years, BMI 22.3 ± 2.0, VO2peak 3.5 ± 0.6 L/min) were included in the study. On Day B, RPE was higher in MET compared to PLA (14.8 ± 0.4 vs. 14.0 ± 0.3, P = 0.045). On Day A, no difference in self-selected exercise intensity measured by oxygen consumption rate (PLA 2.33 ± 0.09 L O2/min, MET 2.42 ± 0.10 L O2/min, P = 0.09) was seen between treatment periods. CONCLUSIONS Self-selected exercise intensity was not reduced by MET in healthy males, despite the fact that MET increased RPE during an exercise bout with fixed intensity.
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Affiliation(s)
- Nanna Skytt Pilmark
- Centre for Physical Activity Research (CFAS), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Christina Petersen-Bønding
- Centre for Physical Activity Research (CFAS), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Nielse Frederich Rose Holm
- Centre for Physical Activity Research (CFAS), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Mette Yun Johansen
- Centre for Physical Activity Research (CFAS), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- Centre for Physical Activity Research (CFAS), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Kristian Karstoft
- Centre for Physical Activity Research (CFAS), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Kristian Karstoft, ; orcid.org/0000-0002-6596-4199
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21
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Freak-Poli RLA, Cumpston M, Albarqouni L, Clemes SA, Peeters A. Workplace pedometer interventions for increasing physical activity. Cochrane Database Syst Rev 2020; 7:CD009209. [PMID: 32700325 PMCID: PMC7389933 DOI: 10.1002/14651858.cd009209.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review. OBJECTIVES To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'. SELECTION CRITERIA We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity. MAIN RESULTS We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up after completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence). No studies compared biochemical measures or disease risk scores at follow-up after completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow-up after completion of the intervention were not compared to an alternative physical activity intervention. Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions. AUTHORS' CONCLUSIONS Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. Future studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.
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Affiliation(s)
- Rosanne LA Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Miranda Cumpston
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Stacy A Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, Australia
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22
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Masuki S, Morikawa M, Nose H. Internet of Things (IoT) System and Field Sensors for Exercise Intensity Measurements. Compr Physiol 2020; 10:1207-1240. [PMID: 32941686 DOI: 10.1002/cphy.c190010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Although exercise training according to individual peak aerobic capacity ( V ˙ o2peak ) has been recommended at all ages, sensors available in the field are limited. The most popular sensors in the field are pedometers, but they cannot be used to monitor exercise intensity. Instead, although heart rate (HR) monitors are broadly available in the field to estimate exercise intensity, HR responses to exercise vary by individual according to physical fitness and environmental conditions, which hinders the precise measurement of energy expenditure. These issues make it difficult for exercise physiologists to collaborate with geneticists, nutritionists, and clinicians using the internet of things (IoT). To conquer these problems, we have developed a device that is equipped with a triaxial accelerometer and a barometer to measure energy expenditure during interval walking training (IWT) in the field with inclines. IWT is a training regimen to repeat fast and slow walking for 3 min each, equivalent to greater than 70% and approximately 40% of individual V ˙ o2peak , respectively. Additionally, we developed an IoT system that enables users to receive instructions from trainers according to their walking records even if they live far away. Since the system is available at low cost with minimum personnel, we can investigate any factors affecting the adherence to and effects of IWT in a large population for a long period. This system was also used to verify any effects of nutritional supplements during IWT and to examine the value of applying IWT to clinical medicine. © 2020 American Physiological Society. Compr Physiol 10:1207-1240, 2020.
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Affiliation(s)
- Shizue Masuki
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan
| | - Mayuko Morikawa
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan.,Jukunen Taiikudaigaku Research Center, Matsumoto, Japan
| | - Hiroshi Nose
- Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Jukunen Taiikudaigaku Research Center, Matsumoto, Japan
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23
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Hall KS, Hyde ET, Bassett DR, Carlson SA, Carnethon MR, Ekelund U, Evenson KR, Galuska DA, Kraus WE, Lee IM, Matthews CE, Omura JD, Paluch AE, Thomas WI, Fulton JE. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int J Behav Nutr Phys Act 2020; 17:78. [PMID: 32563261 PMCID: PMC7305604 DOI: 10.1186/s12966-020-00978-9] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes. METHODS A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations. RESULTS Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4-10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6-36%) and CVD (5-21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics. CONCLUSIONS Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.
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Affiliation(s)
- Katherine S. Hall
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC USA
- Claude D. Pepper Older Americans Independence Center, Duke Aging Center, and the Department of Medicine, Duke University, Durham, NC USA
| | - Eric T. Hyde
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - David R. Bassett
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN USA
| | - Susan A. Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway and Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, NC USA
| | - Deborah A. Galuska
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - William E. Kraus
- Claude D. Pepper Older Americans Independence Center, Duke Aging Center, and the Department of Medicine, Duke University, Durham, NC USA
| | - I-Min Lee
- Brigham and Women’s Hospital, Harvard Medical School; Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Charles E. Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD USA
| | - John D. Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Amanda E. Paluch
- Department of Kinesiology, Institute for Applied Life Sciences, University of Massachusetts, Amherst, MA USA
| | - William I. Thomas
- Office of Library Science, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Janet E. Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
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Franssen WMA, Franssen GHLM, Spaas J, Solmi F, Eijnde BO. Can consumer wearable activity tracker-based interventions improve physical activity and cardiometabolic health in patients with chronic diseases? A systematic review and meta-analysis of randomised controlled trials. Int J Behav Nutr Phys Act 2020; 17:57. [PMID: 32393357 PMCID: PMC7216601 DOI: 10.1186/s12966-020-00955-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/06/2020] [Indexed: 02/08/2023] Open
Abstract
Background To date, it is unclear if consumer wearable activity trackers (CWATs), with or without behaviour multi-component strategies, effectively improve adherence to physical activity and health outcomes under free living conditions in populations with chronic diseases. Therefore, we systematically evaluated the efficacy of CWAT-based interventions to promote physical activity levels and cardiometabolic health in populations with chronic diseases. Methods Randomised controlled trials were collected from five bibliographic databases (PubMed, Embase, Web of Science, The Cochrane Central Register of Controlled Trials and CINAHL). Studies were eligible for inclusion if they evaluated a CWAT-based counselling intervention versus control intervention among patients with chronic respiratory diseases, type 2 diabetes mellitus, cardiovascular diseases, overweight/obesity, cognitive disorders, or sedentary older adults. Data were pooled using a random-effects model. Results After deduplication 8147 were identified of which 35 studies met inclusion criteria (chronic respiratory diseases: 7, type 2 diabetes mellitus: 12, cardiovascular diseases: 6, overweight/obesity: 3, cognitive disorders: 1, sedentary older adults: 6). Compared to control groups, CWAT-based interventions significantly increased physical activity by 2123 steps per day (95% confidence interval [CI], [1605–2641]; p < 0.001). In addition, CWAT-based interventions in these populations significantly decreased systolic blood pressure (− 3.79 mm Hg; 95% CI: [− 4.53, − 3.04] mm Hg; p < 0.001), waist circumference (− 0.99 cm; 95% CI: [− 1.48, − 0.50] cm; p < 0.001) and low-density lipoprotein cholesterol concentration (− 5.70 mg/dl; 95% CI: [− 9.24, − 2.15] mg/dl; p = 0.002). Conclusion CWAT-based interventions increase physical activity and have beneficial effects on important health-related outcomes such as systolic blood pressure, waist circumference and LDL cholesterol concentration in patients with chronic diseases.
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Affiliation(s)
- Wouter M A Franssen
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium. .,BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
| | - Gregor H L M Franssen
- Department of Education and Research Support, University Library, Maastricht University, Maastricht, The Netherlands
| | - Jan Spaas
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Francesca Solmi
- Data Science Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - Bert O Eijnde
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,ADLON Sports Medical Center, Hasselt, Belgium
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25
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Evaluation of Step-Counting Interventions Differing on Intensity Messages. J Phys Act Health 2020; 17:21-28. [PMID: 31698336 DOI: 10.1123/jpah.2018-0439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 07/16/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Step-counting interventions with discrepant intensity emphases may elicit different effects. METHODS A total of 120 sedentary/low-active, postmenopausal women were randomly assigned to one of the following 3 groups: (1) 10,000 steps per day (with no emphasis on walking intensity/speed/cadence; basic intervention, 49 completers), (2) 10,000 steps per day and at least 30 minutes in moderate intensity (ie, at a cadence of at least 100 steps per minute; enhanced intervention, 47 completers), or (3) a control group (19 completers). NL-1000-determined steps and active minutes (a device-specific indicator of time at moderate+ intensity) were collected as process variables during the 12-week intervention. Outcome variables included systolic and diastolic blood pressure, anthropometric measurements, fasting blood glucose and insulin, flow-mediated dilation, gait speed, and ActiGraph GT3X+-determined physical activity and sedentary behavior. RESULTS The "basic group" increased 5173 to 9602 steps per day and 9.2 to 30.2 active minutes per day. The "enhanced group" similarly increased 5061 to 10,508 steps per day and 8.7 to 38.8 active minutes per day. The only significant change over time for clinical variables was body mass index. CONCLUSIONS Interventions that use simple step-counters can achieve elevated volume and intensity of daily physical activity, regardless of emphasis on intensity. Despite this, few clinical outcomes were apparent in this sample of postmenopausal women with generally normal or controlled hypertension.
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Bourne JE, Page A, Leary S, Andrews RC, England C, Cooper AR. Electrically assisted cycling for individuals with type 2 diabetes mellitus: protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2019; 5:136. [PMID: 31788322 PMCID: PMC6875029 DOI: 10.1186/s40814-019-0508-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/01/2019] [Indexed: 01/06/2023] Open
Abstract
Background The global incidence of type 2 diabetes mellitus (T2DM) is increasing. Given the many complications associated with T2DM, effective management of the disease is crucial. Physical activity is considered to be a key component of T2DM management. However, people with T2DM are generally less physically active than individuals without T2DM and adherence to physical activity is often poor following completion of lifestyle interventions. As such, developing interventions that foster sustainable physical activity is of high priority. Electrically assisted bicycles (e-bikes) have been highlighted as a potential strategy for promoting physical activity in this population. E-bikes provide electrical assistance to the rider only when pedalling and could overcome commonly reported barriers to regular cycling. This paper describes the protocol of the PEDAL-2 pilot randomized controlled trial, an e-cycling intervention aimed at increasing physical activity in individuals with T2DM. Methods A parallel-group two-arm randomized waitlist-controlled pilot trial will be conducted. Forty individuals with T2DM will be randomly assigned, in a 1:1 allocation ratio, to an e-cycling intervention or waitlist control. Recruitment and screening will close once 20 participants have been randomized to each study arm. The intervention will involve e-bike training with a certified cycle instructor and provision of an e-bike for 12 weeks. Data will be collected at baseline, during the intervention and immediately post-intervention using both quantitative and qualitative methods. In this trial, the primary interests are determination of effective recruitment strategies, recruitment and consent rates, adherence and retention and delivery and receipt of the intervention. The potential impact of the intervention on a range of clinical, physiological and behaviour outcomes will be assessed to examine intervention promise. Data analyses will be descriptive. Discussion This paper describes the protocol for the PEDAL-2 pilot randomized controlled trial. Results from this trial will provide information on trial feasibility and identify the promise of e-cycling as a strategy to positively impact the health and behaviour of individuals with T2DM. If appropriate, this information can be used to design and deliver a fully powered definitive trial. Trial registration ISRCTN, ISRCTN67421464. Registered 03/01/2019.
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Affiliation(s)
- Jessica E Bourne
- 1Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK.,2NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Angie Page
- 1Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK.,2NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Sam Leary
- 2NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Robert C Andrews
- 3Institute of Biomedical and Clinical Sciences, Medical Research, University of Exeter Medical School, RILD Level 3, Barrack Road, Exeter, Devon EX2 5DW UK
| | - Clare England
- 1Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK.,2NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Ashley R Cooper
- 1Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK.,2NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillan B, Bower P, Panagioti M. Accelerometer- and Pedometer-Based Physical Activity Interventions Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1912895. [PMID: 31596494 PMCID: PMC6802237 DOI: 10.1001/jamanetworkopen.2019.12895] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 01/15/2023] Open
Abstract
Importance Accelerometers and pedometers are accessible technologies that could have a role in encouraging physical activity (PA) in line with current recommendations. However, there is no solid evidence of their association with PA in participants with 1 or more cardiometabolic conditions such as diabetes, prediabetes, obesity, and cardiovascular disease. Objectives To assess the association of accelerometer- and pedometer-based interventions with increased activity and other improved health outcomes in adults with cardiometabolic conditions and to examine characteristics of the studies that could influence the association of both interventions in improving PA. Data Sources Records from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and PsycINFO were searched from inception until August 2018 with no language restriction. Study Selection Randomized clinical trials or cluster randomized clinical trials evaluating the use of wearable technology devices such as pedometers and accelerometers as motivating and monitoring tools for increasing PA were included. After removing duplicates, the searches retrieved 5762 references. Following abstract and title screening of 1439 references and full-text screening of 107 studies, 36 studies met inclusion criteria. Data Extraction and Synthesis Mean difference in PA was assessed by random-effects meta-analysis. Where the scale was different across studies, the standardized mean difference was used instead. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. This study was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures The primary outcome was objectively measured PA in the short to medium term (postintervention to 8 months' follow-up). Results Thirty-six randomized clinical trials (20 using accelerometers and 16 using pedometers) involving 5208 participants were eligible for review. Meta-analysis involving 32 of these trials (4856 participants) showed medium improvements in PA: accelerometers and pedometers combined vs comparator showed a small significant increase in PA overall (standardized mean difference, 0.39 [95% CI, 0.28-0.51]; I2 = 60% [95% CI, 41%-73%]) in studies of short to medium follow-up over a mean (SD) of 32 (28.6) weeks. Multivariable metaregression showed improved association with PA for complex interventions that involved face-to-face consultation sessions with facilitators (β = 0.36; 95% CI, 0.17-0.55; P < .001) and pedometer-based interventions (β = 0.30; 95% CI, 0.08-0.52; P = .002). Conclusions and Relevance In this study, complex accelerometer- and pedometer-based interventions led to significant small to medium improvements in PA levels of people with cardiometabolic conditions. However, longer-term trials are needed to assess their performance over time. This study found no evidence that simple self-monitored interventions using either pedometers or accelerometers are associated with improvements in PA.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, United Kingdom
| | - Brian McMillan
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
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Moderate-Vigorous Physical Activity and Clinical Parameters in Adults with Type 2 Diabetes Mellitus: A Report from the Walking with Diabetes Study. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2019. [DOI: 10.2478/rjdnmd-2019-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background and aims: This study investigate the effects of increases in moderate-vigorous physical activity (MVPA) on several clinical parameters in Indonesian type 2 diabetes mellitus (T2DM) patients.
Material and methods: This study used clinical and physical activity data of forty-two T2DM patients who completed a 6 month-free-living physical activity program, the Walking with Diabetes Study. Upon completion of the program, participants were categorised into a group with increases in MVPA (the MVPA+ group, n=24) or a group with steady/decreases in MVPA (the control group, n=18). High density lipoprotein, triglyceride, routine hematology profiles, blood pressure, body mass index, weight/hip ratio and self-reported MVPA, at baseline, 3 and 6 months were retrospectively analysed. Generalized estimating equation adjusted for age and sex were conducted to assess group and time effects on the clinical parameters.
Results: Hemoglobin (p <0.01), erythrocytes (p<0.05), hematocrits (p<0.001) and thrombocytes (p<0.05) were higher in the MVPA+ group. The 1h and 2h-erythrocyte sedimentation rate (ESR) increased in both groups across time (p<0.001). No changes between groups across time were found for other parameters.
Conclusions: Increases in MVPA improve several hematology parameters in T2DM patients, but it does not have protective effects in controlling systemic inflammation in T2DM patients.
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Alonso-Domínguez R, Patino-Alonso MC, Sánchez-Aguadero N, García-Ortiz L, Recio-Rodríguez JI, Gómez-Marcos MA. Effect of a multifactorial intervention on the increase in physical activity in subjects with type 2 diabetes mellitus: a randomized clinical trial (EMID Study). Eur J Cardiovasc Nurs 2019; 18:399-409. [DOI: 10.1177/1474515119835048] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Regular physical activity is essential for metabolic control in type 2 diabetes mellitus. Aims: The aim of this study was to assess the short and long-term impact of a multifactorial intervention on physical activity and clinically relevant biochemical parameters in patients with type 2 diabetes mellitus. Methods: This randomised, controlled clinical trial (NCT02991079) included two parallel groups aged 25–70 years from a primary care health centre in Salamanca, Spain. The subjects were assigned randomly (1:1) to control and intervention groups, using Epidat 4.0 software. Both were counselled on the importance of physical activity and maintaining a healthy diet. The intervention group also took five low–moderate intensity 4 km nurse-guided walks, received a smartphone application to promote healthy habits and attended a diet workshop. Physical activity was measured objectively using a pedometer and subjectively using a shortened international physical activity questionnaire (at baseline, 3 and 12 months). Results: In total, 204 subjects were included (mean age 60.6 years, 45.6% were women). After 3 months, relative to the control group, the intervention group increased their daily number of steps by 1852, aerobic steps by 1623, distance walked by 994 m, and total metabolic equivalent minutes per week by 1297 and decreased sedentary time by 34.3 minutes per day. Differences from baseline persisted at 12 months, including mean increases of 1141 daily steps, 917 aerobic steps, and 1065 total metabolic equivalent minutes per week in the intervention group relative to the control group ( P<0.05 for all). Conclusions: The success of this multifactorial intervention should help inform future clinical approaches and application designs towards managing type 2 diabetes mellitus and improving patient outcomes.
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Affiliation(s)
| | - María C Patino-Alonso
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, Spain
- Department of Statistics, University of Salamanca, Spain
| | | | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Spain
| | - Jose I Recio-Rodríguez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, Spain
- Department of Medicine, University of Salamanca, Spain
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Arovah NI, Kushartanti BMW, Washington TL, Heesch KC. Walking with Diabetes (WW-DIAB) programme a walking programme for Indonesian type 2 diabetes mellitus patients: A pilot randomised controlled trial. SAGE Open Med 2018; 6:2050312118814391. [PMID: 35154751 PMCID: PMC8826095 DOI: 10.1177/2050312118814391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/30/2018] [Indexed: 11/25/2022] Open
Abstract
Objectives: This pilot study aimed to examine the feasibility and effectiveness of a pedometer-based walking programme in Indonesian type 2 diabetes mellitus patients. Methods: Feasibility was assessed by monitoring participant recruitment, retention, and adherence to the step-monitoring and recording instructions. Effectiveness was assessed in a pilot randomised controlled trial. Participants were type 2 diabetes mellitus patients randomly assigned to a pedometer-only (PED-only) group (n = 22) and a pedometer with text message support (PED+) group (n = 21). Outcomes were step counts, self-reported physical activity, social cognitive constructs, glycaemic parameters, and health-related quality of life. These were assessed at baseline, 12-week intervention, and 12 weeks later. Longitudinal analyses using generalised estimating equations were carried out to assess treatment and time effects on study outcomes. Results: All but one participant (98%) attended 12- and 24-week data collection follow-ups. Throughout the study period, 82% of PED+ participants submitted their daily steps log. Daily steps increased in both groups (p < 0.001) but more in the PED+ group (2064 more steps at week 24, 95% confidence interval: 200–3925, p = 0.03). Self-reported physical activity levels and glycaemic parameters increased similarly in the two groups over time (p < 0.05). Improvements in social cognitive processes were seen only in the PED+ group (p < 0.05). There were no significant improvements in health-related quality of life. Conclusion: This study provides preliminary evidence that a pedometer-based walking programme, with or without additional support, is feasible and improves physical activity and glucose levels in Indonesian type 2 diabetes mellitus patients. Greater increases in step counts can result from the provision of text message support and education materials than from the provision of a pedometer only.
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Affiliation(s)
- Novita Intan Arovah
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Faculty of Sports Science, Yogyakarta State University, Yogyakarta, Indonesia.,Insitute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Tracy L Washington
- Insitute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Faculty of Science and Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kristiann C Heesch
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Insitute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Alghafri TS, Alharthi SM, Al-Farsi Y, Alrawahi AH, Bannerman E, Craigie AM, Anderson AS. 'MOVEdiabetes': a cluster randomized controlled trial to increase physical activity in adults with type 2 diabetes in primary health in Oman. BMJ Open Diabetes Res Care 2018; 6:e000605. [PMID: 30487976 PMCID: PMC6235057 DOI: 10.1136/bmjdrc-2018-000605] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/27/2018] [Accepted: 10/16/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study examined the impact of a multicomponent intervention to increase physical activity (PA) in adults with type 2 diabetes (T2D) in Oman. RESEARCH DESIGN AND METHODS This is a cluster randomized controlled trial in eight primary health centers. Participants were physically inactive, aged ≥18 years, and with no contraindication to PA. Patients attending intervention health centers (n=4) received the 'MOVEdiabetes' intervention, which consisted of personalized, individual face-to-face consultations by dietitians. Pedometers and monthly telephone WhatsApp messages were also used. Patients attending comparison health centers received usual care. The primary outcome was change in PA [Metabolic Equivalent(MET).min/week] after 12 months assessed by the Global Physical Activity Questionnaire. The secondary outcomes were changes in daily step counts, sitting time, weight, body mass index, glycated hemoglobin, blood pressure and lipids. RESULTS Of the 232 participants (59.1% female, mean (SD) age 44.2 (8.1) years), 75% completed the study. At 12 months, the mean change in MET.min/week was +631.3 (95% CI 369.4 to 893.2) in the intervention group (IG) vs +183.2 (95% CI 83.3 to 283.0) in the comparison group, with a significant between-group difference of +447.4 (95% CI 150.7 to 744.1). The odds of meeting PA recommendations were 1.9 times higher in the IG (95% CI 1.2 to 3.3). Significant between-group differences in favor of IG were detected for mean steps/day (+757, 95% CI 18 to 1531) and sitting time hours/ per day (-1.5, 95% CI -2.4 to -0.7). Clinical measures of systolic and diastolic blood pressure and triglycerides also showed significant intervention effects. CONCLUSIONS 'MOVEdiabetes' was effective in increasing PA, the likelihood of meeting PA recommendations, and providing cardioprotective benefits in adults with T2D attending primary care.
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Affiliation(s)
| | | | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Abdul Hakeem Alrawahi
- Department of Planning and Studies, Research Section, Oman Medical Specialty Board, Muscat, Oman
| | - Elaine Bannerman
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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32
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The required step count for a reduction in blood pressure: a systematic review and meta-analysis. J Hum Hypertens 2018; 32:814-824. [DOI: 10.1038/s41371-018-0100-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 12/17/2022]
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The Effects of Structured Exercise or Lifestyle Behavior Interventions on Long-Term Physical Activity Level and Health Outcomes in Individuals With Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Phys Act Health 2018; 15:697-707. [PMID: 29741425 DOI: 10.1123/jpah.2017-0589] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Systematically evaluate the effects of structured exercise and behavioral intervention (physical activity [PA] alone/PA + diet) on long-term PA in type 2 diabetes. METHODS Systematic search of 11 databases (inception to March, 2017). Randomized controlled trials investigating structured exercise/behavioral interventions in type 2 diabetes reporting PA outcomes ≥6 months were selected. RESULTS Among 107,797 citations retrieved, 23 randomized controlled trials (including 18 behavioral programs and 5 structured exercise) met inclusion criteria (n = 9640, 43.6% men, age = 60.0 (4.0) y). All structured exercise trials demonstrated increased objective PA outcomes relative to control (pooling was inappropriate; I2 = 92%). Of 18 behavioral interventions, 10 increased PA significantly, with effect sizes ranging from 0.2 to 6.6 (pooling was inappropriate; I2 = 96%). After removing 1 outlier, the remaining 17 studies significantly improved PA (pooled effect size = 0.34), although smaller compared with structured exercise. After removing the outlier, meta-regression also revealed significant direct relationships between total contacts (r = .50, P < .01) and more face-to-face counseling (r = .75, P < .001) and increased PA. However, long-term changes in PA and HbA1c were not related. CONCLUSION Both structured exercise and behavioral interventions increased PA in type 2 diabetes, although effect sizes were larger for supervised exercise. The effectiveness of behavioral programs was improved when delivery included more extensive and face-to-face contact.
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Fayehun AF, Olowookere OO, Ogunbode AM, Adetunji AA, Esan A. Walking prescription of 10 000 steps per day in patients with type 2 diabetes mellitus: a randomised trial in Nigerian general practice. Br J Gen Pract 2018; 68:e139-e145. [PMID: 29335328 PMCID: PMC5774965 DOI: 10.3399/bjgp18x694613] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/05/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In clinical practice, translating the benefits of a sustained physically active lifestyle on glycaemic control in patients with type 2 diabetes mellitus (T2DM) is difficult. A walking prescription may be an effective alternative. AIM To examine the effect of a 10 000 steps per day prescription on glycaemic control of patients with T2DM. DESIGN AND SETTING Forty-six adults with T2DM attending a general outpatient clinic were randomised into two equal groups. The intervention group was given goals to accumulate 10 000 steps per day for 10 weeks, whereas the control group maintained their normal activity habits. METHOD Daily step count was measured with waist-mounted pedometer and baseline and endline average steps per day. Glycosylated haemoglobin (HbA1c), anthropometric, and cardiovascular measurements were also obtained. An intention-to-treat analysis was done. RESULTS The average baseline step count was 4505 steps per day for all participants, and the average step count in the intervention group for the last 4 weeks of the study period was higher by 2913 steps per day (95% confidence interval [CI] = 1274 to 4551, F (2, 37.7) = 18.90, P<0.001). Only 6.1% of the intervention group participants achieved the 10 000 steps per day goal. The mean baseline HbA1c was 6.6% (range = 5.3 to 9.0). Endline HbA1c was lower in the intervention group than in the control group (mean difference -0.74%, 95% CI = -1.32 to -0.02, F = 12.92, P = 0.015) after adjusting for baseline HbA1c. There was no change in anthropometric and cardiovascular indices. CONCLUSION Adherence to 10 000 steps per day prescription is low but may still be associated with improved glycaemic control in T2DM. Motivational strategies for better adherence would improve glycaemic control.
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Affiliation(s)
| | | | | | | | - Arinola Esan
- Endocrinology Unit, Department of Internal Medicine, University College Hospital, Ibadan
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Raedeke TD, Dlugonski D. High Versus Low Theoretical Fidelity Pedometer Intervention Using Social-Cognitive Theory on Steps and Self-Efficacy. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2017; 88:436-446. [PMID: 28929950 DOI: 10.1080/02701367.2017.1368976] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE This study was designed to compare a low versus high theoretical fidelity pedometer intervention applying social-cognitive theory on step counts and self-efficacy. METHOD Fifty-six public university employees participated in a 10-week randomized controlled trial with 2 conditions that varied in theoretical fidelity. Participants in the high theoretical fidelity condition wore a pedometer and participated in a weekly group walk followed by a meeting to discuss cognitive-behavioral strategies targeting self-efficacy. Participants in the low theoretical fidelity condition met for a group walk and also used a pedometer as a motivational tool and to monitor steps. Step counts were assessed throughout the 10-week intervention and after a no-treatment follow-up (20 weeks and 30 weeks). Self-efficacy was measured preintervention and postintervention. RESULTS Participants in the high theoretical fidelity condition increased daily steps by 2,283 from preintervention to postintervention, whereas participants in the low fidelity condition demonstrated minimal change during the same time period (p = .002). Individuals attending at least 80% of the sessions in the high theoretical fidelity condition showed an increase of 3,217 daily steps (d = 1.03), whereas low attenders increased by 925 (d = 0.40). Attendance had minimal impact in the low theoretical fidelity condition. Follow-up data revealed that step counts were at least somewhat maintained. For self-efficacy, participants in the high, compared with those in the low, theoretical fidelity condition showed greater improvements. CONCLUSION Findings highlight the importance of basing activity promotion efforts on theory. The high theoretical fidelity intervention that included cognitive-behavioral strategies targeting self-efficacy was more effective than the low theoretical fidelity intervention, especially for those with high attendance.
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Muñoz Flórez A, Cortés Ferreira OL. Impacto de la Entrevista Motivacional en la Adherencia de Pacientes Diabéticos Inactivos a la Actividad Física: Estudio Piloto de un Ensayo Clínico EMOACTIF – DM. REVISTA COLOMBIANA DE PSICOLOGÍA 2017. [DOI: 10.15446/rcp.v26n2.59963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Este artículo investiga la factibilidad y aceptabilidad de un ensayo clínico para evaluar el impacto de la entrevista motivacional (EM) en la adherencia a la actividad física (AF) de pacientes inactivos con diabetes mellitus. En este ensayo se incluyeron treinta participantes; dieciséis recibieron em con refuerzo telefónico durante 4 semanas, los restantes recibieron cuidado convencional. Se evaluó AF, índice de masa corporal, nivel de glucosa en la sangre y autoeficacia hacia la AF. El grupo de intervención mostró mejoría significativa en la AF (p<.05) y el nivel de glucosa en la sangre (p<.05). Al tener en cuenta el cambio en imc para un estudio a gran escala, el cálculo de la muestra oscila entre 710 y 950 pacientes. Para estudios de menor escala, si se tiene en cuenta el cambio en METS, glucemia y autoeficacia, el cálculo de la muestra oscila entre 34 y 272 pacientes.
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Dasgupta K, Rosenberg E, Joseph L, Cooke AB, Trudeau L, Bacon SL, Chan D, Sherman M, Rabasa‐Lhoret R, Daskalopoulou SS. Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension. Diabetes Obes Metab 2017; 19:695-704. [PMID: 28074635 PMCID: PMC5412851 DOI: 10.1111/dom.12874] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 01/05/2023]
Abstract
AIMS There are few proven strategies to enhance physical activity and cardiometabolic profiles in patients with type 2 diabetes and hypertension. We examined the effects of physician-delivered step count prescriptions and monitoring. METHODS Participants randomized to the active arm were provided with pedometers and they recorded step counts. Over a 1-year period, their physicians reviewed their records and provided a written step count prescription at each clinic visit. The overall goal was a 3000 steps/day increase over 1 year (individualized rate of increase). Control arm participants were advised to engage in physical activity 30 to 60 min/day. We evaluated effects on step counts, carotid femoral pulse wave velocity (cfPWV, primary) and other cardiometabolic indicators including haemoglobin A1c in diabetes (henceforth abbreviated as A1c) and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) in participants not receiving insulin therapy. RESULTS A total of 79% completed final evaluations (275/347; mean age, 60 years; SD, 11). Over 66% of participants had type 2 diabetes and over 90% had hypertension. There was a net 20% increase in steps/day in active vs control arm participants (1190; 95% CI, 550-1840). Changes in cfPWV were inconclusive; active vs control arm participants with type 2 diabetes experienced a decrease in A1c (-0.38%; 95% CI, -0.69 to -0.06). HOMA-IR also declined in the active arm vs the control arm (ie, assessed in all participants not treated with insulin; -0.96; 95% CI, -1.72 to -0.21). CONCLUSIONS A simple physician-delivered step count prescription strategy incorporated into routine clinical practice led to a net 20% increase in step counts; however, this was below the 3000 steps/day targeted increment. While conclusive effects on cfPWV were not observed, there were improvements in both A1c and insulin sensitivity. Future studies will evaluate an amplified intervention to increase impact.
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Affiliation(s)
- Kaberi Dasgupta
- Division of Clinical Epidemiology, Department of MedicineMcGill University Health CentreMontréalQuébecCanada
- Division of EndocrinologyMcGill UniversityMontrealQuébecCanada
- Division of Internal Medicine, Department of MedicineMcGill UniversityMontrealQuébecCanada
| | - Ellen Rosenberg
- Department of Family Medicine, St. Mary's HospitalMcGill UniversityMontrealQuébecCanada
| | - Lawrence Joseph
- Division of Clinical Epidemiology, Department of MedicineMcGill University Health CentreMontréalQuébecCanada
| | - Alexandra B. Cooke
- Divisions of Experimental Medicine and Clinical Epidemiology, Department of MedicineMcGill University Health CentreMontréalQuébecCanada
| | - Luc Trudeau
- Cardiovascular Prevention Centre, Jewish General HospitalMcGill UniversityMontrealQuébecCanada
| | - Simon L. Bacon
- Division of Exercise ScienceConcordia UniversityMontrealQuébecCanada
| | - Deborah Chan
- Division of Clinical Epidemiology, Department of MedicineMcGill University Health CentreMontréalQuébecCanada
| | - Mark Sherman
- Division of EndocrinologyMcGill UniversityMontrealQuébecCanada
| | - Rémi Rabasa‐Lhoret
- Institut de Recherches Cliniques de MontréalUniversité de MontréalMontrealQuébecCanada
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Baskerville R, Ricci-Cabello I, Roberts N, Farmer A. Impact of accelerometer and pedometer use on physical activity and glycaemic control in people with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2017; 34:612-620. [PMID: 28173623 DOI: 10.1111/dme.13331] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Self-directed pedometer use increases physical activity levels in the general population; however, evidence of benefit for Type 2 diabetes is unclear and has not been systematically reviewed for accelerometers. AIM To examine the impact of using physical activity monitoring devices (pedometers and accelerometers) on free-living physical activity and HbA1c levels in people with Type 2 diabetes. METHODS We conducted a systematic literature review. Bibliographic databases included Medline, Embase, Web of Science, CINAHL, SportDiscus and the Cochrane Central Register of Controlled Trials. We included controlled trials evaluating interventions based on the use of pedometers or accelerometers to promote physical activity in people with Type 2 diabetes. Primary outcomes were physical activity (min/week or steps) and HbA1c [mmol/mol (%)]. Secondary outcomes were weight, blood pressure and lipid profile. RESULTS Twelve trials (1458 participants) were identified, of which nine studied pedometers and three accelerometers. Random-effects meta-analysis showed an overall increase in physical activity (standardized mean difference 0.57, 95% CI 0.24, 0.91) in the intervention groups. Accelerometers and pedometers produced a similar effect size. No significant differences were observed in HbA1c , BMI, blood pressure or lipid profile. CONCLUSIONS People with Type 2 diabetes, provided with an accelerometer or pedometer, substantially increased their free-living physical activity. There is no evidence that monitor use alone improves HbA1c or other clinical outcomes. Further trials are needed to compare the relative effects of activity monitors within differing complex interventions.
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Affiliation(s)
- R Baskerville
- Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - I Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - N Roberts
- Bodleian Libraries, University of Oxford, Oxford, UK
| | - A Farmer
- Nuffield Department of Primary Care Health Sciences, Oxford, UK
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Matthews L, Kirk A, McCallum M, Mutrie N, Gold A, Keen A. The feasibility of a physical activity intervention for adults within routine diabetes care: a process evaluation. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing; University of Glasgow; UK
| | - Alison Kirk
- Physical Activity for Health Group, School of Psychological Sciences and Health; University of Strathclyde; Glasgow UK
| | - Mary McCallum
- JJR Macleod Centre for Diabetes, NHS Grampian; Aberdeen UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences; University of Edinburgh; UK
| | - Ann Gold
- Aberdeen Royal Infirmary, NHS Grampian; Aberdeen UK
| | - Andrew Keen
- JJR Macleod Centre for Diabetes, NHS Grampian; Aberdeen UK
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Barrett JE, Plotnikoff RC, Courneya KS, Raine KD. Physical Activity and Type 2 Diabetes. DIABETES EDUCATOR 2017; 33:128-43. [PMID: 17272799 DOI: 10.1177/0145721706297453] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to explore (1) patterns in physical activity behaviors and (2) the meaning and personal significance of social cognitive theory (SCT) constructs on physical activity, across gender and income groups among people with type 2 diabetes (T2DM). METHODS Albertans, 18 years and older (x- = 63, SD = 12.08) with T2DM (N = 1614) completed self-report measures of demographic characteristics and physical activity. Two-way, between-groups analyses of variance (ANOVAs) assessed main and interaction effects of gender and income on leisure time physical activity (LTPA). A subsample of these participants (n = 20) subsequently completed qualitative telephone interviews to provide contextual understanding of the quantitative data and to explore salient SCT influences on physical activity. RESULTS Significant findings indicated that men participate in more LTPA than women do, and those from the highest income group participate in more LTPA than low- or middle-income groups (P < .01). Interview results suggested that walking is the most popular form of physical activity; however, gender and income groups differ in other leisure and nonleisure physical activities. Furthermore, patterns for SCT constructs related to physical activity were apparent across gender and income, most noticeably for self-efficacy and environmental and situational influences. Specifically among men, noteworthy differences existed between income groups for self-control and reinforcement strategies. CONCLUSIONS The study highlights the need for more sensitive self-report measures and objective measures of physical activity to help distinguish whether true differences exist between certain demographic groups. Moreover, interventions that promote walking may be beneficial for people with T2DM, provided that appropriate environmental and policy changes occur to accommodate walking and other physical activity behaviors.
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Affiliation(s)
- Jennifer E Barrett
- The Centre for Health Promotion Studies, School of Public Health, University of Alberta, Alberta, Canada (Ms Barrett, Dr Plotnikoff, Dr Raine)
| | - Ronald C Plotnikoff
- The Centre for Health Promotion Studies, School of Public Health, University of Alberta, Alberta, Canada (Ms Barrett, Dr Plotnikoff, Dr Raine)
- The Faculty of Physical Education (Dr Plotnikoff, Dr Courneya)
| | | | - Kim D Raine
- The Centre for Health Promotion Studies, School of Public Health, University of Alberta, Alberta, Canada (Ms Barrett, Dr Plotnikoff, Dr Raine)
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Alghafri TS, Alharthi SM, Al-Farsi YM, Craigie AM, Mcleod M, Anderson AS. Study protocol for "MOVEdiabetes": a trial to promote physical activity for adults with type 2 diabetes in primary health care in Oman. BMC Public Health 2017; 17:28. [PMID: 28056933 PMCID: PMC5217303 DOI: 10.1186/s12889-016-3990-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benefits of physical activity in the management of diabetes are well documented. However, evidence on the effectiveness of interventions integrating physical activity in diabetes care is sparse especially in the countries of the Gulf Cooperation Council. The results from this study will increase our understanding of the use of multi-component interventions aimed at increasing physical activity levels in inactive adults with type 2 diabetes in primary health care in Oman. METHODS/DESIGN The study is a one year 1:1 cluster randomized controlled trial of the MOVEdiabetes programme (intervention) versus usual care in eight primary health care centres in Oman. The MOVEdiabetes programme utilizes face to face physical activity consultations promoting 150 min of moderate to vigorous physical activity per week (≥600MET-mins/week), pedometers to self-monitor step counts and monthly telephone WhatsApp messages for follow up support. Inactive adults with type 2 diabetes and no contraindication to physical activity will be recruited over a two months period, and followed up for 12 months. To demonstrate a 50% between group difference in physical activity levels (MET-mins/week) over 12 months, (at a power of 80%, and significance level of 5%), 128 participants would be required to complete the study (64 in each arm). Based on a drop-out rate of 20%, 154 participants would require to be recruited (77 in each arm). Assuming a recruitment rate of 70%, 220 potential eligible participants would need to be approached. The primary outcome is change in levels of physical activity measured by the Global Physical Activity Questionnaire. In addition, accelerometers will be used in a sub group to objectively assess physical activity. Secondary outcomes include changes in metabolic and cardiovascular biomarkers, change in self-reported health, social support, self-efficacy for physical activity, and perceived acceptability of the program. All intervention delivery and support costs will be monitored. DISCUSSION This study will contribute to the evidence on the feasibility, cultural acceptability and efficacy of interventional approaches for increasing physical activity in primary care for persons with type 2 diabetes in Oman. TRIAL REGISTRATION International Standard Randomised Controlled Trials No: ISRCTN14425284 . Registered 12 April 2016.
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Affiliation(s)
- Thamra S Alghafri
- Directorate General of Health Services, Ministry of Health, PO Box 2723, , Postal Code 112, Muscat, Oman.
| | - Saud M Alharthi
- Directorate General of Health Services, Ministry of Health, PO Box 2723, , Postal Code 112, Muscat, Oman
| | - Yahya M Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Maureen Mcleod
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
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de Vries HJ, Kooiman TJM, van Ittersum MW, van Brussel M, de Groot M. Do activity monitors increase physical activity in adults with overweight or obesity? A systematic review and meta-analysis. Obesity (Silver Spring) 2016; 24:2078-91. [PMID: 27670401 DOI: 10.1002/oby.21619] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/18/2016] [Accepted: 06/27/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To systematically assess contemporary knowledge regarding behavioral physical activity interventions including an activity monitor (BPAI+) in adults with overweight or obesity. METHODS PubMed/MEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, and PEDro were searched for eligible full-text articles up to 1 July 2015. Studies eligible for inclusion were (randomized) controlled trials describing physical activity outcomes in adults with overweight or obesity. Methodological quality was independently assessed employing the Cochrane Collaboration's tool for risk of bias. RESULTS Fourteen studies (1,157 participants) were included for systematic review and 11 for meta-analysis. A positive trend in BPAI+ effects on several measures of physical activity was ascertained compared with both wait list or usual care and behavioral physical activity interventions without an activity monitor (BPAI-). No convincing evidence of BPAI+ effectiveness on weight loss was found compared with BPAI-. CONCLUSIONS Behavioral physical activity interventions with an activity monitor increase physical activity in adults with overweight or obesity. Also, adding an activity monitor to behavioral physical activity interventions appears to increase the effect on physical activity, although current evidence has not yet provided conclusive evidence for its effectiveness.
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Affiliation(s)
- Herman J de Vries
- Clinical Health Sciences, Utrecht University/University Medical Center Utrecht, The Netherlands.
- Paramedics PT Center, Assen, The Netherlands.
| | - Thea J M Kooiman
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Miriam W van Ittersum
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, The Netherlands
- Physiotherapy Department, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Marco van Brussel
- Clinical Health Sciences, Utrecht University/University Medical Center Utrecht, The Netherlands
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Martijn de Groot
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, The Netherlands
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Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2016; 25 Suppl 3:1-72. [PMID: 26606383 DOI: 10.1111/sms.12581] [Citation(s) in RCA: 1602] [Impact Index Per Article: 200.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/12/2022]
Abstract
This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.
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Affiliation(s)
- B K Pedersen
- The Centre of Inflammation and Metabolism and The Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Saltin
- The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Schneider PL, Bassett DR, Thompson DL, Pronk NP, Bielak KM. Effects of a 10,000 Steps per Day Goal in Overweight Adults. Am J Health Promot 2016; 21:85-9. [PMID: 17152246 DOI: 10.4278/0890-1171-21.2.85] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. This study was designed (1) to examine the effects of a 10,000 steps·d−1 exercise prescription on sedentary, overweight/obese adults, and (2) to examine the effects of adherence on body composition and cardiovascular risk factors. Methods. Fifty-six overweight/obese adults participated in the study. Body composition and cardiovascular risk factors were determined at baseline, 20 weeks, and 36 weeks. Adherence was defined as averaging ≥ 9500 steps·d−1 from week 4 to week 36. Results. 38 participants (68%) wore pedometers daily for 36 weeks and were available for posttesting. Significant improvements were noted in mean values for walking volume (3994 steps·d−1), body weight (–2.4 kg), body mass index (–0.8 kg·m−2), percentage body fat (–1.9%), fat mass (–2.7 kg), waist circumference (–1.8 cm), hip circumference (–1.9 cm) and high-density lipoprotein (3 mg/dl). The adherers had large improvements in body composition measures, whereas the nonadherers showed little or no change in these variables. Discussion. A 10,000 steps·d−1 exercise prescription resulted in weight loss over 36 weeks in previously sedentary, overweight/obese adults. Adherence to the step goal had a marked effect on the outcome.
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Affiliation(s)
- Patrick L Schneider
- Department of Physical Education, Sport, and Exercise Science, Ball State University, Muncie, Indiana 47306, USA.
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Cai X, Qiu SH, Yin H, Sun ZL, Ju CP, Zügel M, Steinacker JM, Schumann U. Pedometer intervention and weight loss in overweight and obese adults with Type 2 diabetes: a meta-analysis. Diabet Med 2016; 33:1035-44. [PMID: 26926674 PMCID: PMC5071725 DOI: 10.1111/dme.13104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/14/2016] [Accepted: 02/25/2016] [Indexed: 01/04/2023]
Abstract
AIM Although pedometer intervention is effective in increasing physical activity among adults with Type 2 diabetes, its impact on weight loss remains unclear. This meta-analysis was aimed to assess whether pedometer intervention promotes weight loss. METHODS Three different databases were searched for randomized controlled trials (RCTs) published in English up to April 2015. Studies were included if they investigated the effects of pedometer intervention on weight loss, as measured by BMI or weight. Effect sizes were aggregated using a random-effects model. Subgroup and meta-regression analyses were used to identify potential moderators. Eleven RCTs with 1258 participants were included. All enrolled participants were overweight or obese. RESULTS Pedometer intervention led to significantly decreased BMI [weighted mean difference (WMD) -0.15 kg/m(2) , 95% confidence interval (CI) -0.29 to -0.02 kg/m(2) ] and reduced weight (WMD -0.65 kg, 95% CI -1.12 to -0.17 kg). Dietary counselling seemed to be a key predictor of the observed changes. However, none of the following variables had a significant influence: step goal setting, baseline age, BMI, weight, sex distribution, disease duration, intervention duration, and baseline values or change scores for total or moderate-to-vigorous physical activity. After completion of the pedometer intervention, non-significant declines in BMI and weight were observed during the follow-up periods. CONCLUSIONS Pedometer intervention promotes modest weight loss, but its association with physical activity requires further clarification. Future studies are also required to document dietary and sedentary behaviour changes to facilitate the use of pedometers for weight loss in overweight and obese adults with Type 2 diabetes.
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Affiliation(s)
- X Cai
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Nanjing, China
| | - S H Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Nanjing, China
| | - H Yin
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Nanjing, China
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University, Ulm, Germany
| | - Z L Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Nanjing, China
| | - C P Ju
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Nanjing, China
| | - M Zügel
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University, Ulm, Germany
| | - J M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University, Ulm, Germany
| | - U Schumann
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University, Ulm, Germany
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Zou Z, Cai W, Cai M, Xiao M, Wang Z. Influence of the intervention of exercise on obese type II diabetes mellitus: A meta-analysis. Prim Care Diabetes 2016; 10:186-201. [PMID: 26553963 DOI: 10.1016/j.pcd.2015.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/30/2015] [Accepted: 10/03/2015] [Indexed: 12/22/2022]
Abstract
AIM The study aimed to assess the effect of exercise intervention on the management of obese T2DM patients. METHODS The literature retrieval was conducted in relevant databases from their inception to 2015, with predefined searching strategy and selection criteria. The Cochrane Collaboration's tool was utilized to assess the quality of included studies. Weighted mean difference (WMD) with its corresponding 95% CI (confidence interval) was used as the effect size. RESULTS A subset of 13 eligible studies was selected. Exercise significantly reduced the concentration of high sensitivity C reactive protein (4 months: WMD=-1.03, 95% CI: -1.77 to -0.29, P<0.01), triglyceride (6 months: WMD=-24.75, 95% CI: -27.67 to -21.83, P<0.01), diastolic blood pressure (6 months: WMD=-2.70, 95% CI: -4.12 to -1.28, P=0.0002), systolic blood pressure (WMD=-7.98, 95% CI: -9.87 to -6.08, P<0.01)), HbA1c (4 months: WMD=-0.25, 95% CI: -0.49 to -0.02, P=0.04) and homeostasis model assessment-insulin resistance (3 months: WMD=-0.19, 95% CI: -0.37 to -0.01, P=0.04); and a pronounced increase of HDL-C (12 months: WMD=3.57, 95% CI: 1.92 to 5.21, P<0.01). CONCLUSION Exercise was beneficial to obese T2DM patients.
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Affiliation(s)
- Zhichun Zou
- Department of Physical Education, Southwest University for Nationalities, Chendu, PR China; Department of Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Wei Cai
- Department of Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Min Cai
- Department of Physical Education, Shanghai Jiao Tong University, 800 Dongchuan RD. Minhang District, Shanghai 200240, PR China.
| | - Mouyuan Xiao
- Department of Physical Education, Southwest University for Nationalities, Chendu, PR China
| | - Zhijie Wang
- Department of Physical Education, Southwest University for Nationalities, Chendu, PR China
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Baker A, Sirois-Leclerc H, Tulloch H. The Impact of Long-Term Physical Activity Interventions for Overweight/Obese Postmenopausal Women on Adiposity Indicators, Physical Capacity, and Mental Health Outcomes: A Systematic Review. J Obes 2016; 2016:6169890. [PMID: 27293882 PMCID: PMC4884891 DOI: 10.1155/2016/6169890] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/25/2016] [Accepted: 04/14/2016] [Indexed: 11/25/2022] Open
Abstract
Physical activity interventions have recently become a popular strategy to help postmenopausal women prevent and manage obesity. The current systematic review evaluates the efficacy of physical activity interventions among overweight and obese postmenopausal women and sheds light on the behavioral change techniques that were employed in order to direct future research. Method. Five electronic databases were searched to identify all prospective RCT studies that examine the impact of physical activity on adiposity indicators, physical capacity, and/or mental health outcomes among healthy, sedentary overweight, and obese postmenopausal women in North America. The behavior change technique taxonomy was used to identify the various strategies applied in the programs. Results. Five RCTs met the inclusion criteria. The findings showed that adiposity indicators and physical capacity outcomes significantly improved following long-term interventions; however, mental health outcomes showed nonsignificant changes. Furthermore, 17 behavior change techniques were identified with the taxonomy across all trials. The intrapersonal-level techniques were the most common. Conclusion. Physical activity interventions had a positive effect on adiposity measures and physical capacity. Future research should focus on testing the effectiveness of physical activity interventions on mental health and incorporate strategies at the individual and environmental level to maximize the health impact on the population.
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Affiliation(s)
- Amanda Baker
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Street, Ottawa, ON, Canada K1N 6N5
| | - Héloïse Sirois-Leclerc
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Street, Ottawa, ON, Canada K1N 6N5
| | - Heather Tulloch
- Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada K1Y 4W7
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Bailey KJ, Little JP, Jung ME. Self-Monitoring Using Continuous Glucose Monitors with Real-Time Feedback Improves Exercise Adherence in Individuals with Impaired Blood Glucose: A Pilot Study. Diabetes Technol Ther 2016; 18:185-93. [PMID: 26885934 DOI: 10.1089/dia.2015.0285] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Exercise helps individuals with prediabetes or type 2 diabetes (T2D) manage their blood glucose (BG); however, exercise adherence in this population is dismal. In this pilot study we tested the efficacy of a self-monitoring group-based intervention using continuous glucose monitors (CGMs) at increasing exercise adherence in individuals with impaired BG. MATERIALS AND METHODS Thirteen participants with prediabetes or T2D were randomized to an 8-week standard care exercise program (CON condition) (n = 7) or self-monitoring exercise intervention (SM condition) (n = 6). Participants in the SM condition were taught how to self-monitor their exercise and BG, to goal set, and to use CGM to observe how exercise influences BG. We hypothesized that compared with the CON condition, using a real-time CGM would facilitate self-monitoring behavior, resulting in increased exercise adherence. RESULTS Repeated-measures analysis of variance revealed significant Condition × Time interactions for self-monitoring (P < 0.01), goal setting (P = 0.01), and self-efficacy to self-monitor (P = 0.01), such that the SM condition showed greater increases in these outcomes immediately after the program and at the 1-month follow-up compared with the CON condition. The SM condition had higher program attendance rates (P = 0.03), and a greater proportion of participants reregistered for additional exercise programs (P = 0.048) compared with the CON condition. Participants in both conditions experienced improvements in health-related quality of life, waist circumference, and fitness (P values <0.05). CONCLUSIONS These findings provide promising initial support for the use of a real-time CGM to foster self-monitoring and exercise behavior in individuals living with prediabetes or T2D.
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Affiliation(s)
- Kaitlyn J Bailey
- School of Health and Exercise Sciences, University of British Columbia , Kelowna, British Columbia, Canada
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia , Kelowna, British Columbia, Canada
| | - Mary E Jung
- School of Health and Exercise Sciences, University of British Columbia , Kelowna, British Columbia, Canada
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Ackley-Holbrook E, Kang M, Morgan DW. Development and Evaluation of the Walk for Health Program: A Physical Activity Intervention for Adults with Visual Impairments. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2016. [DOI: 10.1177/0145482x1611000204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Although the pervasive comorbidity documented in adults with visual impairments may be linked to physical inactivity, little is known regarding the extent to which mobility and health status can be improved in this population. The aim of this preliminary study was to develop and implement an adaptive, community-based walking program for adults with visual impairments and to evaluate its impact on daily step activity, cardiovascular health, body composition, and lipid function. Methods During an 8-week period, 17 adults (age = 47.3 ± 12.3 years) with visual impairments were prompted at biweekly intervals (weeks 1, 3, 5) to increase their daily step activity by 1,000 steps per day and maintain these gains during weeks 2, 4, and 6. Participants were asked to sustain walking levels achieved by week 6 during the final 2 weeks of the program. Results Following the walking intervention, participants displayed a 78% increase in daily step activity (p < .01), but no improvements in cardiovascular health, body composition, or lipid function were observed. Conclusion Daily step activity was improved after completion of the walking program, but markers of health-related fitness remained unchanged. Future studies should be conducted to quantify the volume of physical activity required to improve the health status of persons with visual impairments.
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Affiliation(s)
- Elizabeth Ackley-Holbrook
- Assistant professor, Department of Health and Human Performance, Roanoke College, 221 College Lane, Salem, VA 24153
| | - Minsoo Kang
- Professor, Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN 37132
| | - Don W. Morgan
- Professor, Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro
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Silfee V, Petosa R, Laurent D, Schaub T, Focht B. Effect of a behavioral intervention on dimensions of self-regulation and physical activity among overweight and obese adults with type 2 diabetes: a pilot study. PSYCHOL HEALTH MED 2016; 21:715-23. [DOI: 10.1080/13548506.2016.1139144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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