ObjectivesThe objective was to investigate the feasibility and usability of electronic momentary assessment, goal-setting and personalized phone-calls on adherence to a 12-week self-conducted interval walking training (IWT) program, delivered by the InterWalk smartphone among patients with type 2 diabetes (T2D).MethodsIn a two-arm pilot randomized controlled trial (Denmark, March 2014 to February 2015), patients with T2D (18–80 years with a Body Mass Index of 18 and 40 kg/m2) were randomly allocated to 12 weeks of IWT with (experimental) or without additional support (control). The primary outcome was the difference between groups in accumulated time of interval walking training across 12 weeks. All patients were encouraged to use the InterWalk application to perform IWT for ≥90 minute/week. Patients in the experimental group made individual goals regarding lifestyle change. Once a week inquiries about exercise adherence was made using an ecological momentary assessment (EMA). In case of consistent self-reported non-adherence, the patients would receive a phone-call inquiring about the reason for non-adherence. The control group did not receive additional support. Information about training adherence was assessed objectively. Usability of the EMA was assessed based on response rates and self-reported satisfaction after 12-weeks.ResultsThirty-seven patients with T2D (66 years, 65% female, hemoglobin 1Ac 50.3 mmol/mol) where included (n = 18 and n = 19 in experimental and control group, respectively). The retention rate was 83%. The experimental group accumulated [95%CI] 345 [-7, 698] minutes of IWT more than the control group. The response rate for the text-messages was 83% (68% for males and 90% for females). Forty-one percent of the experimental and 25% of the control group were very satisfied with their participation.ConclusionThe combination inquiry about adherence using EMA, goal-setting with the possibility of follow-up phone calls are considered feasible interventions to attain training adherence when using the InterWalk app during a 12-week period in patients with T2D. Some uncertainty about the effect size of adherence remains.Trial registrationClinicaltrials.gov NCT02089477

BackgroundPrevention of multi-morbidities following non-communicable diseases requires a systematic registration of adverse modifiable risk factors, including low physical fitness. The aim of the study was to establish criterion validity and reliability of a smartphone app (InterWalk) delivered fitness test in patients with type 2 diabetes.MethodsPatients with type 2 diabetes (N = 27, mean (SD) age 64.2 (5.9) years, BMI 30.0 (5.1) kg/m2, (30 % male)) completed a 7-min progressive walking protocol twice (with and without encouragement). VO2 during the test was assessed using indirect calorimetry and the acceleration (vector magnitude) from the smartphone was obtained. The vector magnitude was used to predict VO2peak along with the co-variates weight, height and sex. The validity of the algorithm was tested when the smartphone was placed in the right pocket of the pants or jacket. The algorithm was validated using leave-one-out cross validation. Test-retest reliability was tested in a subset of participants (N = 10).ResultsThe overall VO2peak prediction of the algorithm (R2) was 0.60 and 0.45 when the smartphone was placed in the pockets of the pants and jacket, respectively (p < 0.001). The mean bias (limits of agreement) in the cross validation was−0.4 (38) % (pants) and−0.1 (46) % (jacket). When the smartphone was placed in the jacket a significant intensity dependent bias (r = 0.5, p = 0.02) was observed. The test-retest intraclass correlations were 0.85 and 0.86 (p < 0.001), for the pants and jacket, respectively. No effects of encouragement were observed on test performance.ConclusionIn conclusion, the InterWalk Fitness Test is accurate and reliable for persons with type 2 diabetes when the smartphone is placed in the side pocket of the pants for. The test could give a fair estimate of the CRF in absence of a progressive maximal test during standardized conditions with the appropriate equipment.Trial registration www.clinicaltrials.org (NCT02089477), first registered (prospectively) on March 14th 2014

Background Information technologies (IT) are increasingly implemented in type 2 diabetes (T2D) treatment as a resource for remotely supported health care. However, possible pitfalls of introducing IT in health care are generally overlooked. Specifically, the effectiveness of IT to improve health care may depend on the user’s readiness for health technology. Objective We aim to investigate readiness for health technology in relation to mental well-being, sociodemographic, and disease-related characteristics among individuals with T2D. Methods Individuals with T2D (aged ≥18 years) who had been referred to self-management education, exercise, diet counseling, smoking cessation, or alcohol counseling completed a questionnaire survey covering (1) background information, (2) the 5-item World Health Organization Well-Being Index (WHO-5), (3) receptiveness to IT use in physical activity, and (4) the Readiness and Enablement Index for Health Technology (READHY), constituted by dimensions related to self-management, social support, and eHealth literacy. Individuals were divided into profiles using cluster analysis based on their READHY scores. Outcomes included differences across profiles in mental well-being, sociodemographic, and disease-related characteristics. Results Participants in the study were 155 individuals with T2D with a mean age of 60.2 (SD 10.7) years, 55.5% (86/155) of which were men and 44.5% (69/155) of which were women. Participants were stratified into 5 health technology readiness profiles based on the cluster analysis: Profile 1, high health technology readiness; Profile 2, medium health technology readiness; Profile 3, medium health technology readiness and high level of emotional distress; Profile 4, medium health technology readiness and low-to-medium eHealth literacy; Profile 5, low health technology readiness. No differences in sociodemographic and disease-related characteristics were observed across profiles; however, we identified 3 vulnerable subgroups of individuals: Profile 3 (21/155, 13.5%), younger individuals (mean age of 53.4 years, SD 8.9 years) with low mental well-being (mean 42.7, SD 14.7) and emotional distress (mean 1.69, SD 0.38); Profile 4 (20/155, 12.9%), older individuals (mean age 66.3 years, SD 9.0 years) with less IT use (50.0% used IT for communication) and low-to-medium eHealth literacy; and Profile 5 (36/155, 23.2%) with low mental well-being (mean 43.4, SD 20.1) and low readiness for health technology. Conclusions Implementation of IT in health care of individuals with T2D should be based on comprehensive consideration of mental well-being, emotional distress, and readiness for health technology rather than sociodemographic and disease-related characteristics to identify the individuals in need of social support, self-management education, and extensive IT support. A one-size-fits-all approach to IT implementation in health care will potentially increase the risk of treatment failure among the most vulnerable individuals.