The relationship between changes in steps/day and health outcomes after a pedometer-based physical activity intervention with telephone support in type 2 diabetes patients.

The study aim was to investigate the health effects of a pedometer-based behavioural modification program in type 2 diabetes patients and to examine the relationship between changes in steps/day (baseline-post and baseline-follow up) and health outcomes. Ninety-two type 2 diabetes patients (69% male, mean age: 62 ± 9 years and mean BMI: 30.0 ± 2.5 kg/m(2)) were recruited and randomly assigned to an intervention or control group. The intervention consisted of one face-to-face session, pedometer use and seven telephone calls. Selection criteria included 35-75 years, 25-35 kg/m(2) and ≤12% HbA1c (108 mmol/mol). Outcome measures were assessed at baseline, post and follow up, and included systolic blood pressure, waist circumference, body mass index, glucose control (HbA1c and fasting glucose), triglycerides, total, HDL and LDL cholesterol and steps/day. The results showed no significant short- or intermediate-term differences in health outcomes between the control and intervention group. However, a threshold was identified, as HbA1c improved significantly in those who increased ≥4000 steps/day between baseline- and post-measurements (n = 18). This threshold was not applicable to any other health outcome. Hence, although the intervention successfully increased steps/day, no direct effect on health outcomes was identified. However, an increase of ≥4000 steps/day seemed a threshold to have a positive impact on HbA1c.

Mediators of physical activity change in a behavioral modification program for type 2 diabetes patients.

BACKGROUND: Many studies have reported significant behavioral impact of physical activity interventions. However, few have examined changes in potential mediators of change preceding behavioral changes, resulting in a lack of information concerning how the intervention worked. Our purpose was to examine mediation effects of changes in psychosocial variables on changes in physical activity in type 2 diabetes patients. METHODS: Ninety-two patients (62 ± 9 years, 30, 0 ± 2.5 kg/m(2), 69% males) participated in a randomized controlled trial. The 24-week intervention was based on social-cognitive constructs and consisted of a face-to-face session, telephone follow-ups, and the use of a pedometer. Social-cognitive variables and physical activity (device-based and self-reported) were collected at baseline, after the 24-week intervention and at one year post-baseline. PA was measured by pedometer, accelerometer and questionnaire. RESULTS: Post-intervention physical activity changes were mediated by coping with relapse, changes in social norm, and social modeling from family members (p ≤ 0.05). One-year physical activity changes were mediated by coping with relapse, changes in social support from family and self-efficacy towards physical activity barriers (p ≤ 0.05) CONCLUSIONS: For patients with type 2 diabetes, initiatives to increase their physical activity could usefully focus on strategies for resuming regular patterns of activity, on engaging family social support and on building confidence about dealing with actual and perceived barriers to activity. TRIAL REGISTRATION: NCT00903500, ClinicalTrials.gov.

Physical environmental correlates of self-reported and objectively assessed physical activity in Belgian type 2 diabetes patients.

Despite the well-known beneficial effects of physical activity (PA) on the long-term outcomes of type 2 diabetes patients, the majority of this patient group remains inactive. Therefore, it is necessary to understand the most important PA determinants in type 2 diabetes patients in order to develop efficacious interventions to increase PA participation. The main aim of this study was to investigate the associations of physical environmental factors with objectively assessed and self-reported PA in type 2 diabetes patients. A total of 133 type 2 diabetes patients participated in this cross-sectional study (response rate: 43.3%). All participants completed the long International PA Questionnaire and two validated questionnaires to measure physical environmental perceptions and psychosocial factors. They also wore an accelerometer and a pedometer to measure PA objectively. Selection criteria were age 35-80, BMI 25-35 kg m(-²), treated for type 2 diabetes and no PA limitations. Data were collected in 2007. Physical environmental factors contributed significantly to the explained variance of all objective and self-reported PA measures (explained variance from 4% to 18%) after controlling for sociodemographic variables. Home PA equipment, walkability, aesthetics and convenience of PA facilities were the most consistent environmental correlates. The contribution of physical environmental factors remained significant for most PA measures after taking into account the variance explained by psychosocial factors (explained variance from 4% to 10%), except for step counts and recreational walking. Physical environmental factors could be important correlates of PA in type 2 diabetes patients, even beyond the contribution of sociodemographic and psychosocial variables, but additional research is needed. Nevertheless, sociodemographic and psychosocial factors remain very important and when developing future interventions, all these multidimensional correlates should be kept in mind.

The effects of a pedometer-based behavioral modification program with telephone support on physical activity and sedentary behavior in type 2 diabetes patients.

OBJECTIVE: Effectiveness of a behavioral modification program on physical activity (PA) and sedentary behavior in diabetes patients. METHODS: Ninety-two patients were randomly assigned to an intervention or control group. The 24-weeks intervention consisted of a face-to-face session, pedometer and seven telephone follow-ups. Mean selection criteria were 35-75 years; 25-35 kg/m(2); ≤ 12% HbA1c, treated for type 2 diabetes; no PA limitations. PA and sedentary behavior were measured by pedometer, accelerometer and questionnaire over the short- (24 weeks) and intermediate- (1 year) term. RESULTS: The intervention group increased their steps/day by 2744, their total PA by 23 min/day (p<0.001) and decreased their sedentary behavior by 23 min/day (p<0.05) post-intervention. After 1 year the intervention group still had an increase of 1872 steps/day, 11 min/day total PA and a decrease of 12 min/day in sedentary behavior (p<0.001). CONCLUSION: This pedometer-based behavioral modification program with telephone support showed lasting positive effects on steps/day, PA and sedentary behavior. PRACTICE IMPLICATIONS: This study tested a convenient way to increase PA among type 2 diabetes patients.

Increasing physical activity in Belgian type 2 diabetes patients: a three-arm randomized controlled trial.

BACKGROUND: Pedometer-based physical activity programs have been typically delivered in a group format by a behavioral expert. An alternative strategy that builds on existing interactions is delivery through individual consultation by a general practitioner (GP). These two delivery strategies have not been directly compared. PURPOSE: To compare effectiveness of a 12-week physical activity (PA) intervention for type 2 diabetes patients delivered by a trained GP via an individual consultation or as group delivery by a behavioral expert. METHOD: Sixty-seven primary care participants (mean age = 67.4 years, 70% male) from three Belgian general practices were randomized into three different treatment arms: (1) individual consultation (n = 22) with three PA contacts with the patient's GP; (2) group counseling (n = 21) with three PA group sessions delivered by a behavioral expert; and (3) a control arm (n = 24) receiving no intervention. Participant inclusion criteria were ≤80 years; 25-35 kg/m²; ≤12% HbA1c and reporting no PA limitations. Outcome measures were pedometer-determined steps/day, self-reported PA, and health parameters (weight, body mass index, waist circumference, total cholesterol, fasting glucose, and HbA1c). RESULTS: Group counseling participants increased 1,706 steps/day over baseline significantly (p ≤ 0.05) more than other treatment arms. Moreover, they increased their self-reported PA (+82 min/day), while control arm participants showed a decrease in PA (p ≤ 0.05). Participants of the individual consultation had a decrease in waist circumference (-1.4 cm) and HbA1c (-0.32%) and a lower increase in total cholesterol (+7.2 mg/dl) compared to the other treatment arms (all p ≤ 0.05). CONCLUSION: Group counseling in type 2 diabetes patients improved PA, whereas individual consultations had an impact on some health outcomes on the short-term.