Changing Physical Activity Behavior in Type 2 Diabetes

Abstract

OBJECTIVEBehavioral interventions targeting “free-living” physical activity (PA) and exercise that produce long-term glycemic control in adults with type 2 diabetes are warranted. However, little is known about how clinical teams should support adults with type 2 diabetes to achieve and sustain a physically active lifestyle.RESEARCH DESIGN AND METHODSWe conducted a systematic review of randomized controlled trials (RCTs) (published up to January 2012) to establish the effect of behavioral interventions (compared with usual care) on free-living PA/exercise, HbA1c, and BMI in adults with type 2 diabetes. Study characteristics, methodological quality, practical strategies for increasing PA/exercise (taxonomy of behavior change techniques), and treatment fidelity strategies were captured using a data extraction form.RESULTSSeventeen RCTs fulfilled the review criteria. Behavioural interventions showed statistically significant increases in objective (standardized mean difference [SMD] 0.45, 95% CI 0.21–0.68) and self-reported PA/exercise (SMD 0.79, 95% CI 0.59–0.98) including clinically significant improvements in HbA1c (weighted mean difference [WMD] –0.32%, 95% CI –0.44% to –0.21%) and BMI (WMD –1.05 kg/m2, 95% CI –1.31 to –0.80). Few studies provided details of treatment fidelity strategies to monitor/improve provider training. Intervention features (e.g., specific behavior change techniques, interventions underpinned by behavior change theories/models, and use of ≥10 behaviour change techniques) moderated effectiveness of behavioral interventions.CONCLUSIONSBehavioral interventions increased free-living PA/exercise and produced clinically significant improvements in long-term glucose control. Future studies should consider use of theory and multiple behavior change techniques associated with clinically significant improvements in HbA1c, including structured training for care providers on the delivery of behavioural interventions.

How can clinical practices pragmatically increase physical activity for patients with type 2 diabetes? A systematic review

“…The existing literature on predictors of effective PA interventions SYSTEMATIC REVIEWS [74][75][76]. What remains unclear is how these evidence-based techniques may be optimally implemented with pragmatic approaches in clinical care.…”

“…Other review articles have lamented the lack of data on fidelity of intervention delivery in RCTs and have noted this as a limitation to identifying key moderators of PA interventions [76]. The highly pragmatic and effective intervention by Di Loreto et al that we studied in the present review balanced the competing clinical demands and fidelity to intervention techniques by condensing several effective behavioral change techniques into a simple yet tailored counseling checklist which identified enjoyable and appropriate PA options at the individual level and encouraged patients to continue with these programs through the use of social support, problem-solving, and PA tracking [45].…”

Can physical activity interventions for adults with type 2 diabetes be translated into practice settings? A systematic review using the RE-AIM framework

“…A 2012 review and meta-analysis by Avery et al [12] found behavioural interventions aimed at increasing physical activity in adults with type 2 diabetes produced significant increases in physical activity in addition to significant improvements in BMI and HbA1c. Guidelines now exist on the development of physical activity interventions for adults with type 2 diabetes [7,8].…”

“…Several reviews of the literature have explored the effectiveness of 1 these factors with various findings. Significant improvements in glycaemic control are associated with interventions of greater than 6 months' duration [12] or where physical activity advice is combined with dietary advice [13]. Significant improvements in levels of physical activity have been demonstrated via the use of one-to-one physical activity consultations [7].…”

Recent randomized controlled trials of psychological interventions in healthcare: A review of their quantity, scope, and characteristics

“…In addition, a majority of patients seem to prefer psychological treatment to pharmacotherapy for mental disorders [3,4]. Importantly, psychological interventions can be applied also to diseases and disorders that are common in healthcare but often difficult to medically manage [5][6][7].…”