level barriers faced and lessons learned to conduct a randomized controlled trial in patients with diabetes and prediabetes during the COVID-19 pandemic in Brazil. Cardiorespir Physiother Crit Care Rehabil. 2021;1:e42516.
This cross-sectional study evaluated the perception of individuals with prediabetes/diabetes about their living conditions during the COVID-19 pandemic to identify the facilitators, barriers, and reasons to remain physically active at home and adhere to recommended exercise. It included individuals with prediabetes/diabetes who had completed an exercise intervention, which started on-site and moved to a remote home-based regime due to the COVID-19 pandemic and were advised to keep exercising at home. The outcomes were assessed by a bespoke questionnaire that was developed by the research team, the Brazilian Portuguese adapted version of the Exercise Adherence Rating scale, and the Motives for Physical Activity Measure-Revised scale. Of 15 participants (8 female, 58 ± 11 years), most reported positive perceptions about their living conditions and few difficulties maintaining some physical activity at home. However, only 53.8% of them adhered to the recommended exercise. Time flexibility, no need for commuting, and a sense of autonomy were the main facilitators of home exercise, while a lack of adequate space was the main barrier. The descending order of median scores that were obtained in each reason for physical activity was fitness, enjoyment, competence, social, and appearance. Individuals with prediabetes/diabetes maintained some physical activity during the pandemic, mainly motivated by health concerns.
O exercício físico é elemento fundamental no tratamento de pessoas com diabetes, sendo recomendado a realização semanal de pelo menos 150 minutos de exercícios aeróbicos de intensidade moderada e 2 a 3 sessões de exercícios de resistência muscular. Embora os benefícios da prática regular de exercício sejam bem estabelecidos na literatura, cerca de 60% a 70% da população com diabetes é considerada insuficientemente ativa. Diante do cenário da pandemia de COVID-19, os malefícios da inatividade física ganharam ainda mais atenção. Este trabalho objetivou (1) analisar o comportamento de indivíduos com pré diabetes e diabetes em relação ao exercício físico em meio a pandemia de COVID-19, após conclusão de um programa de exercícios estruturado entregue parcialmente de forma remota , levando em consideração as suas percepções acerca das condições de vida, adesão ao exercício orientado, barreiras e facilitadores para a sua prática em ambiente domiciliar, e os motivos que sustentaram a prática daqueles que se mantiveram fisicamente ativos, bem como (2) compreender, a partir do ponto de vista dos indivíduos, as percepções, experiências e perspectivas sobre tratamento de saúde por meio das tecnologias digitais. As variáveis do estudo foram coletadas por meio de um roteiro desenvolvido pela equipe de pesquisa, da Escala de Avaliação de Adesão ao Exercício (EARS-Br), da Escala de Motivos para a Prática de Atividade Física Revisada (MPAM-R) e da realização de um grupo focal online. A amostra do estudo foi composta por 15 indivíduos (8 mulheres, 58 ± 11 anos). A análise dos dados quantitativos foi realizada por meio do cálculo de distribuições de frequência e de medidas de tendência central e dispersão. A análise dos dados qualitativos foi realizada a partir de metodologia de análise de conteúdo temática. Embora a maioria dos participantes tenha relatado percepções positivas sobre sua condição de vida e poucas dificuldades para a manutenção da prática de exercícios físicos em casa, as pontuações alcançadas na EARS-BR revelaram que apenas metade deles aderiram ao exercício físico conforme as orientações recebidas. A maioria dos participantes lidou bem com sua condição de saúde durante a pandemia e relatou poucas dificuldades em se manter fisicamente ativo em casa, motivado principalmente por preocupações com a saúde. A falta de espaço adequado foi a barreira mais significativa para o exercício em casa. A flexibilidade de horário, a não necessidade de deslocamento e o maior senso de autonomia foram os principais facilitadores para a manutenção da atividade física. Sete participantes compareceram ao grupo focal online (4 mulheres, 54 ± 11 anos). Após análise da transcrição da discussão, emergiram 4 categorias temáticas: 1) Compreensão sobre cuidados com a saúde, 2) Pontos positivos e negativos da telessaúde, 3) Relação entre profissional e paciente: “tem que ter uma certa conexão” 4) O mundo digital: “temos que nos adaptar, veio pra ficar”. A telessaúde foi uma ferramenta bem aceita, e os principais benefícios percebidos foram em relação a otimização de tempo no que diz respeito ao deslocamento e a filas de espera. O manuseio das tecnologias e a falta da convivência entre profissional e paciente foram as dificuldades mais citadas
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This study was partly financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) – Finance Code 001, and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil. Background Lifestyle changes are crucial to preventing diabetes and its cardiovascular complications, including maintaining a physically active lifestyle. Morever, patient education is essential to promote diabetes self-management and health condition control. However, programs that combine physical exercise and lifestyle education are still poorly implemented in low- and middle-income countries, such as Brazil. The Diabetes College Brazil Study is a pioneer randomized clinical trial (RCT) designed to promote behavioral changes in adults with diabetes and prediabetes. PURPOSE: To test the feasibility, acceptability, and preliminary effectiveness of Diabetes College Brazil Study interventions (Exercise (Ex) vs. Exercise and Lifestyle Education (ExLE)) as part of the preparation for the development of the RCT. Methods This pilot randomized trial (NCT03914924) had two parallel arms: ExLE program (12 weeks of exercise and educational interventions) and Ex program (12 weeks of exercise intervention only) (Figure 1). Feasibility (eligibility, recruitment, retention, completeness of RCT variables measures and participation rates), acceptability (satisfaction with interventions), and preliminary effectiveness of interventions (comparison of RCT variables measured in pre-and post-assessments) were evaluated. The preliminary effectiveness of the interventions was analyzed from the values of the difference between post-and pre-intervention measures (Δ post-pre) using both per-protocol (PP) and intention to treat (ITT) analysis for the comparison between groups (Ex vs. ExLE). The value 0 was imputed to replace the missing data in the analysis that followed the ITT principle. The results were reported as estimates of effect (95% confidence interval (CI) of the difference) for variables with normal distribution. RESULTS: Thirty-seven individuals participated in the study (ExLE: n = 18, 56.9±9.5 years old, 55.6% female, 5.6% prediabetes; Ex: n = 19, 59.5±7.3 years old, 52.6% female, 21.1% prediabetes). Eligibility, recruitment and retention rates were 16%, 100% and 82% respectively. The completeness of RCT variables measures was higher in the pre-intervention assessment. Missing data in the post-intervention assessment were mainly related to modifications in research procedures due to the COVID-19 pandemic. Participation rates in supervised exercise sessions and education classes were 76% and 71%, respectively (total sample). Interventions were highly acceptable to participants. There was a trend towards better results in the ExLE than Ex for most variables, mainly for physical activity level and quality of life (Table 1). Conclusion The interventions are feasible and acceptable to participants. The results of this trial indicate the potential clinical benefit of lifestyle educational intervention associated with exercise intervention for people with diabetes and prediabetes.
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