Enhanced Fitness: A Randomized Controlled Trial of the Effects of Home‐Based Physical Activity Counseling on Glycemic Control in Older Adults with Prediabetes Mellitus

Abstract

Background/Objective To determine whether a home-based multi-component physical activity counseling (PAC) intervention is effective in reducing glycemic measures in older prediabetic outpatients. Design, Setting, and Participants Controlled clinical trial of 302 overweight (body mass index 25–45 kg/m2), older (ages 60–89) outpatients with impaired glucose tolerance (fasting blood glucose 100–125 mg/dL, HbA1c <7%), randomly assigned to a PAC intervention group (n=180), compared to a Usual Care (UC) control group (n=122) and recruited through primary care clinics of the Durham VA Medical Center between September 29, 2008 and March 25, 2010. Intervention A 12 month, home-based multi-component PAC program including one in-person baseline counseling session, regular telephone counseling, physician endorsement in clinic with monthly automated encouragement, and tailored mailed materials. All study participants, including UC, received a consult to a VA weight management program. Measurements The primary outcome was HOMA-IR, calculated from fasting insulin and glucose levels at baseline, 3 and 12 months. Hemoglobin A1C was the secondary indicator of glycemic control. Other secondary outcomes included anthropometric measures, and self-reported physical activity, health-related quality of life, and physical function. Results There were no significant differences between the PAC or Usual Care groups over time for any of the glycemic indicators. Both groups had small declines over time of approximately 6% in fasting blood glucose, p< 0.001, while other glycemic indicators remained stable. The declines in glucose were not sufficient to affect the change in HOMA-IR scores due to fluctuations in insulin over time. Endurance physical activity increased significantly in PAC group, P<0.001 compared to UC. Conclusion Home-based telephone counseling increased physical activity levels but was insufficient for improving glycemic indicators among older prediabetic outpatients.

PTSD is negatively associated with physical performance and physical function in older overweight military veterans

“…Analyses were conducted using data from the Enhanced Fitness Study, a physical activity counseling trial for older overweight Veterans with impaired glucose tolerance [26–27]. The data presented here are a secondary analysis comparing study participants with and without PTSD.…”

“…The Enhanced Fitness Study compared the effects of a 12 mo home-based physical activity counseling intervention with usual care among older (≥60 yr) overweight Veterans. Although described in full detail elsewhere [26–27], the medical records of all age-eligible individuals from two large, area Department of Veterans Affairs (VA) clinics were prescreened for the following eligibility requirements: impaired fasting glucose (100–125 mg/dL), no diagnosis of diabetes mellitus, glycosylated hemoglobin of less than 7 percent, and body mass index (BMI) between 25 and 45 kg/m 2 . Individuals who exceeded current physical activity recommendations were excluded.…”

Treatment for overweight and obesity in adult populations: a systematic review and meta-analysis

“…Andrews et al 22 (1) Andrews et al 22 (2) Appel et al 19 Balducci et al 25 Bennett et al 27 Burke et al 34 (F) Burke et al 34 (M) Christian et al 33 Cohen et al 35 de Mello et al 50 Dekkers et al 17 DPP 84 (1) Foster-Schubert et al 49 (1F) Foster-Schubert et al 49 (2F) Foster-Schubert et al 49 (3F) Haapala et al 36 Janus et al 53 Kirby et al 23 Kulzer et al 37 Langford et al 38 Lim et al 31 Ma et al 47 Martin et al 39 (F) Morey et al 46 Nakade et al 52 (F) Nakade et al 52 (M) Nanchahal et al 54 Parikh et al 45 Patrick et al 18 (M) Ross et al 28 (F) Ross et al 28 (M) Stevens et al 40 (F) Stevens et al 40 (M) Stevens et al 41 (F) Stevens et al 41 (M) ter Bogt et al 21 Vissers et al 26 (1) Vissers et al 26 (2) Wadden et al 20 Wood et al 42 (1M) Wood et al 42 (2M) Wood et al 43 (1F) Wood et al 43 (1M) Wood et al 43 (2F) Wood et al …”

“…[45][46][47]50,51,55,72,82,84 A diagnosis of new onset type 2 diabetes was less likely to occur in intervention participants compared with the control group (Table 3). There was no evidence that the effect of treatment differed based on focus of intervention (Table 3).…”

“…57,59,[61][62][63][64][65][66][67][68][69][71][72][73][74][75][76][77]79,[81][82][83][84] Likewise, participants in 25 pharmacologic studies were more likely to withdraw from their study because of adverse events compared with control participants (Table 5). 46,56,[58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77]79,81,82 …”