Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes.

OBJECTIVES: The aims of this study were to describe the volume and patterns of objectively assessed sedentary behaviour, light intensity physical activity (LPA) and moderate-vigorous physical activity (MVPA), and to examine socio-demographic correlates, among adults living with type 2 diabetes. METHODS: Participants (n = 166) wore an accelerometer (Actigraph® GT3X+) for seven consecutive days during waking hours and completed a questionnaire. Physical activity (PA) and sedentary time were described, and multivariable linear regression was used to estimate associations between socio-demographic characteristics and sedentary time and PA. RESULTS: Participants, 46% of whom were female, had a mean age of 65.4 years (standard deviation (SD) = 9.5), body mass index (BMI) of 31.5 (6.6) kg/m2 and had been living with diabetes for an average of 13.1 (7.6) years. Participants were sedentary for 543.6 minutes/day, spent 273.4 minutes/day and 22.4 minutes/day in LPA and MVPA respectively. BMI was associated with increased sedentary time and reduced LPA (-2.5 minutes/day, 95% CI: -4.33 to -0.70) and MVPA (-0.62 minutes/day, 95% CI: -1.05 to -0.18) time. Compared with males, females had more LPA (34.4 minutes/day, 95% CI: 10.21-58.49) and less MVPA (-6.2 minutes/day, 95% CI: -12.04 to -0.41) time. Unemployed participants had 30.05 minutes more MVPA (95% CI: 3.35-56.75) than those who were employed or homemakers, and those not reporting income had 13 minutes/day more MVPA time than participants in the lowest income category (95% CI: 3.46-22.40). CONCLUSION: Adults living with type 2 diabetes were not sufficiently active and were highly sedentary. Our results emphasize the need for more research exploring the diabetes-related health outcomes of sedentary behaviour and physical inactivity among people living with type 2 diabetes.

Objectively measured sleep and health-related quality of life in older adults with type 2 diabetes: a cross-sectional study from the Alberta's Caring for Diabetes Study.

BACKGROUND AND AIM: Sleep is an important behavior for metabolic control and mental health in type 2 diabetes. The aim was to examine the relationship of objective estimates of sleep quantity and quality with health-related quality of life (HRQL) in adults with type 2 diabetes. MATERIALS AND METHODS: Participants completed a survey where HRQL was measured using the EQ-5D-5 L index score, and the SF-12 v2, which provides physical and mental composite summary (PCS and MCS) scores. Participants also wore wrist actigraphy (Actigraph GT3X+) during sleep to derive estimates of total sleep time (TST), sleep latency (SLAT), and sleep efficiency (SEFF) and wake after sleep onset (WASO). Adjusted multivariable linear regression models were used to examine the associations among actigraphy-derived sleep parameters with PCS, MCS, and EQ-5D-5 L index scores. RESULTS: On average, participants (N=168) were 65 years old (standard deviation [SD] 10), 46% were female, with a diabetes duration of 13 years (SD 9) and body mass index of 31 kg/m2 (SD 6.5). Mean (SD) TST and SLAT were 7.5 (1.0) hours and 9.9 (7.6) minutes, respectively, SEFF was 82.7 (6.1) percent and WASO was 86.7 (53.4) minutes. An inverse association between TST and PCS was found where every additional 60 minutes of sleep was associated with 1.3-unit lower PCS (P=.04). SEFF was positively associated with both PCS and MCS, where a 10% greater SEFF was associated with 2.6-unit higher PCS (P=.008), and 1.8-unit higher MCS (P=.056). CONCLUSIONS: Among this population, better sleep efficiency was associated with better physical and mental health.

Contextualizing the Proven Effectiveness of a Lifestyle Intervention for Type 2 Diabetes in Primary Care: A Qualitative Assessment Based on the RE-AIM Framework.

OBJECTIVE: The Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD) intervention proved effective in increasing daily physical activity among people with type 2 diabetes in 4 community-based primary care networks (PCNs) in Alberta. Here, we contextualize its effectiveness by describing implementation fidelity and PCN staff's perceptions of its success in improving diabetes management. METHODS: We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the HEALD intervention. Qualitative methods used to collect data related to the RE-AIM dimensions of implementation and effectiveness included interviews with PCN staff (n=24), research team reflections (n=4) and systematic documentation. We used content analysis, and data were imported into and managed using Nvivo 10. RESULTS: HEALD was implemented as intended with adequate fidelity across all 4 PCNs. Identified implementation facilitators included appropriate human resources, the training provided, ongoing support, the provision of space and the simplicity of the intervention. However, PCN staff reported varying opinions regarding its potential for improving diabetes management among patients. Rationales for their views included intervention "dose" inadequacy; that the quality of usual care for people with diabetes was already good; patients were already managing their diabetes well; and the potential for cointervention. Recommended improvements to HEALD included increasing the dose of the intervention, expanding it to other modes of exercise and incorporating a medical clearance process. CONCLUSIONS: Based on the high degree of fidelity, the demonstrated effectiveness of HEALD in improving physical activity among patients was a result of sound implementation of an efficacious intervention. Increasing the dose of HEALD could result in additional improvements for patients.

Increase in Daily Steps After an Exercise Specialist Led Lifestyle Intervention for Adults With Type 2 Diabetes In Primary Care: A Controlled Implementation Trial.

OBJECTIVE: To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care. METHODS: Eligible participants from 4 primary care networks in Alberta, Canada were assigned to either a lifestyle program or a control group. The program targeted increased daily walking through individualized daily pedometer step goals for the first 3 months and brisk walking speed, along with substitution of low-relative to high-glycemic index foods over the next 3 months. The outcomes were daily steps, diet, and clinical markers, and were compared using random effects models. RESULTS: 198 participants were enrolled (102 in the intervention and 96 in the control). For all participants, (51% were women), mean age 59.5 (SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.6 kg/m(2) (SD 6.5), systolic BP 125.6 mmHg (SD 16.2), glycemic index 51.7 (4.6), daily steps 5879 (SD 3130). Daily steps increased for the intervention compared with the control at 3-months (1292 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted P = .002). No significant differences were observed for diet or clinical outcomes. CONCLUSIONS: A 6-month lifestyle program delivered in primary care by an exercise specialist can be effective for increasing daily walking among adults with recently diagnosed type 2 diabetes. This short-term increase in daily steps requires longer follow-up to estimate the potential impact on health outcomes.

A primary care based healthy-eating and active living education session for weight reduction in the pre-diabetic population.

AIMS: Many studies have demonstrated the effectiveness of primary prevention strategies in type 2 diabetes, however, questions remain around the feasibility of high resource, intensive interventions within a healthcare setting. We report the results of a dietitian-led pre-diabetes education session targeting healthy eating and active living as strategies for weight reduction. METHODS: Participants were asked to complete a baseline questionnaire prior to completing the pre-diabetes education session and were sent follow-up questionnaires at 3 and 6 months. Differences between participants at baseline, 3 and 6 months were determined using χ(2), t-tests and ANOVA. RESULTS: Of the 211 participants asked to fill out baseline questionnaires, 45 participants completed questionnaires at baseline, 3 months and 6 months. Although we observed general trends towards improvements in diet, physical activity and weight related behaviours among the 45 completers, no significant changes were observed among participants between questionnaire periods. CONCLUSION: A "one-off", theory-guided group education session may be insufficient to support lifestyle modifications in the context of weight management in a pre-diabetic population. Further evaluation of the efficacy and feasibility of the PCN as a setting for lifestyle intervention is required.

Healthy eating and active living for diabetes in primary care networks (HEALD-PCN): rationale, design, and evaluation of a pragmatic controlled trial for adults with type 2 diabetes.

BACKGROUND: While strong and consistent evidence supports the role of lifestyle modification in the prevention and management of type 2 diabetes (T2DM), the best strategies for program implementation to support lifestyle modification within primary care remain to be determined. The objective of the study is to evaluate the implementation of an evidence-based self- management program for patients with T2DM within a newly established primary care network (PCN) environment. METHOD: Using a non-randomized design, participants (total N = 110 per group) will be consecutively allocated in bi-monthly blocks to either a 6-month self-management program lead by an Exercise Specialist or to usual care. Our primary outcome is self-reported physical activity and pedometer steps. DISCUSSION: The present study will assess whether a diabetes self-management program lead by an Exercise Specialist provided within a newly emerging model of primary care and linked to available community-based resources, can lead to positive changes in self-management behaviours for adults with T2DM. Ultimately, our work will serve as a platform upon which an emerging model of primary care can incorporate effective and efficient chronic disease management practices that are sustainable through partnerships with local community partners. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier: NCT00991380.

Relationships of activity and sugar drink intake on fat mass development in youths.

PURPOSE: To determine whether a significant relationship exists between fat mass (FM) development and physical activity (PA) and/or sugar-sweetened drink (SD) consumption in healthy boys and girls aged 8-19 yr. METHODS: A total of 105 males and 103 females were assessed during childhood and adolescence for a maximum of 7 yr and a median of 5 yr. Height was measured biannually. Fat-free mass (FFM) and FM were assessed annually by dual x-ray absorptiometry (DXA). PA was evaluated two to three times annually using the PAQ-C/A. Energy intake and SD were assessed using a 24-h dietary intake questionnaire also completed two to three times per year. Years from peak height velocity were used as a biological maturity age indicator. Multilevel random effects models were used to test the relationship. RESULTS: When controlling for maturation, FFM, and energy intake adjusted for SD, PA level was negatively related to FM development in males (P<0.05) but not in females (P>0.05). In contrast, there was no relationship between SD and FM development of males or females (P>0.05). There was also no interaction effect between SD and PA (P>0.05) with FM development. CONCLUSION: This finding lends support to the idea that increasing PA in male youths aids in the control of FM development. Models employed showed no relationship between SD and FM in either gender.