The effects of exercise training on psychological outcomes in people with type 2 diabetes are conflicting. Therefore, there is a need for further high-quality RCTs in order to gain greater insight into the role of exercise training in people with type 2 diabetes.

The 13-item ESS had sound psychometric properties in a large sample of primary care type 2 diabetes patients. The 13-item ESS could be useful in (intervention) research on physical activity in type 2 diabetes patients.

Adapted strategies in rising from a chair occur with muscle weakness. To assess whether muscle weakness caused the strategy change, an experimental simulation was performed that allowed to investigate separately effects of reduced muscle capacity and of strategy change on movement dynamics. It was hypothesized that a sit-to-stand (STS) strategy change spares muscles that become overloaded when muscle weakness develops. Ten healthy females participated; seven of them completed all tests. Muscle weakness causes an increased load-over-capacity ratio. In the present study, this ratio was increased by providing participants with a waist-coat containing 45% of their body mass. Participants performed sit-to-stand manoeuvres with and without added mass; moreover they were instructed to perform two different strategies, the moment-transfer-strategy and the stabilization-strategy. During these STS-tasks sagital 2D-video analysis were made and ground reaction forces (GRF) were measured. Joint moments and powers for ankle, knee and hip joint were calculated. The preferred strategy under the normal condition was the moment-transfer strategy. Increasing the load without adapting the strategy resulted in significantly higher (13%) knee-joint extension moments. Allowing a strategy shift in the loaded condition spared the knee-joint extensors (-6%) and transferred effort to hip-joint extensors (57%) and plantar flexor (67%) muscles. These results suggest that the capacity of knee-joint extensors limits the STS-performance when muscle weakness occurs.

BackgroundSufficient exercise is important for people with Type 2 Diabetes Mellitus (T2DM), as it can prevent future health problems. Despite, it is estimated that only 30-40% of people with T2DM are sufficiently active. One of the psychosocial constructs that is believed to influence physical activity behaviour, is exercise self-efficacy. The goal of this study is to evaluate a patient-tailored exercise intervention for people with T2DM that takes exercise self-efficacy into account.Methods/DesignThis study is conducted as a non-randomized controlled clinical trial. Patients are eligible when they are diagnosed with T2DM, exercise less than advised in the ADA guideline of 150 min/week of moderate-intensity aerobic physical activity, have an BMI >25 and are between 18 and 80 years old. Recruitment takes place at a Primary care organization of general practitioners and practice nurses in the south of the Netherlands.Participants are allocated to three groups: An advice intervention -for participants with a high exercise self-efficacy score- in which participants receive a patient-tailored exercise intervention, an intensive intervention -for participants with a low exercise self-efficacy score- in which participants receive a patient-tailored exercise intervention accomplished by a group based intervention, and a control group in which participants receive regular Dutch diabetes care. The primary outcome measure of this study is physical activity. Secondary outcome measures are health status, (symptoms of) depression, exercise self-efficacy, Body Mass Index (BMI), blood pressure and glycemic control.DiscussionWe aimed to design an intervention that can be implemented in Primary care, but also to design an easy accessible program. This study is innovative as it is -to our best knowledge- the first study that takes level of exercise self-efficacy of people with T2DM into account by means of giving extra support to those with the lowest exercise self-efficacy. If the program succeeds in increasing the amount of physical activity it can be implemented in regular primary care.Trial registrationDutch Trial Register NTR2734

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