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Raslan EIM, Abdelmoaty SA, Khafagy GM. The effect of patients' empowerment on satisfaction of diabetic patients attending primary care clinics. J Family Community Med 2024; 31:206-213. [PMID: 39176012 PMCID: PMC11338389 DOI: 10.4103/jfcm.jfcm_332_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/06/2024] [Accepted: 04/09/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Different approaches, especially the patient-centered approach with emphasis on the patient's empowerment, were used with diabetic patients to ensure a better quality of life. The study aimed to evaluate the effects of patient empowerment versus traditional health education models on the satisfaction of diabetic patients. MATERIALS AND METHODS A randomized clinical trial was conducted on 130 patients, aged 40-65 years, diagnosed with type 2 diabetes mellitus, and attending a family medicine outpatient clinic. Patients were blinded and randomly allocated into one of the two Groups (A and B) for a health education session with trained family physicians using the empowerment model and the traditional model, respectively. Patient satisfaction was assessed using the consultation satisfaction questionnaire (CSQ). The relations between different qualitative variables were assessed by Chi-square test; differences in various quantitative variables were determined by t-test and ANOVA. Pearson correlation assessed the correlation between age and different domains as well as the total questionnaire scores of both groups. RESULTS A highly statistically significant difference was found between Group A (n = 65) and Group B (n = 65) for the general satisfaction scale, professional care analysis, depth, and length of consultation (P < 0.001). In Group A, 61.5% were highly satisfied and 35.4% were moderately satisfied, while in Group B, 41.5% were moderately satisfied and 43.1% were neutral. Regarding physicians' perceptions of the communication process with patients during the health education sessions, 83% in Group A perceived it as good, while 69.2% in Group B perceived it as average. CONCLUSION The patient empowerment model of health education was linked to higher rates of patient satisfaction and a better physician perception of the communication process during the consultation. The study was self-funded, and no harm was done to the patients.
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Affiliation(s)
- Eman I. M. Raslan
- Department of Family Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sarah A. Abdelmoaty
- Department of Family Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ghada M. Khafagy
- Department of Family Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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He P, Deng Y, Dong S, Li H, Liu C, Ma Y, Tang C, Zhang M. Association of different domains of physical activity with diabetic kidney disease: a population-based study. Front Endocrinol (Lausanne) 2024; 15:1364028. [PMID: 38863925 PMCID: PMC11165133 DOI: 10.3389/fendo.2024.1364028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024] Open
Abstract
Background The aim of this cross-sectional study was to elucidate the associations between various domains of physical activity, such as occupation-related (OPA), transportation-related (TPA), leisure-time (LTPA) and overall physical activity (PA), and diabetic kidney disease. Methods Our study encompassed 2,633 participants, drawn from the cross-sectional surveys of the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018, and employed survey-weighted logistic regression, generalized linear regression, and restricted cubic spline (RCS) analyses to ascertain the relationship between different domains of physical activity and diabetic kidney disease. Results After controlling for all confounders, multivariate logistic regression analyses revealed a lack of correlation between the various domains of physical activity and the prevalence of diabetic kidney disease. Multiple generalized linear regression analyses showed that durations of PA (β = 0.05, 95% CI, 0.01-0.09, P = 0.012) and TPA (β = 0.32, 95% CI, 0.10-0.55, P = 0.006) were positively associated with eGFR levels; and LTPA durations were inversely associated with UACR levels (β = -5.97, 95% CI, -10.50 - -1.44, P = 0.011). The RCS curves demonstrated a nonlinear relationship between PA, OPA, and eGFR, as well as a nonlinear correlation between PA and ACR. Subgroup and sensitivity analyses largely aligned with the outcomes of the multivariate generalized linear regression, underscoring the robustness of our findings. Conclusion Our population-based study explored the association between different domains of physical activity and diabetic kidney disease. Contrary to our expectations, we found no significant association between the duration of physical activity across all domains and the prevalence of diabetic nephropathy. Nonetheless, renal function markers, including eGFR and UACR, exhibited significant correlations with the duration of total physical activity (TPA) and leisure-time physical activity (LTPA), respectively, among diabetic patients. Interestingly, our findings suggest that diabetic patients engage in physical activity to preserve renal function, ensuring moderate exercise durations not exceeding 35 hours per week.
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Affiliation(s)
- Pengfei He
- Department of Nuphrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yuanyuan Deng
- Department of Nephrology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Shaoning Dong
- Department of Nephrology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Hongdian Li
- Department of Nuphrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Cong Liu
- Department of Nuphrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Ma
- Department of Nuphrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Cheng Tang
- Department of Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mianzhi Zhang
- Department of Nuphrology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
- Department of Nephrology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
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Martiskainen T, Lamidi ML, Venojärvi M, Tikkanen H, Laatikainen T. Factors affecting the effectiveness of the physical activity counselling intervention implemented in primary health care in adults with type 2 diabetes. BMC Endocr Disord 2023; 23:166. [PMID: 37550678 PMCID: PMC10405502 DOI: 10.1186/s12902-023-01428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) has become a major public health threat; physical inactivity and obesity are both independent risk factors. Increasing daily physical activity (PA) significantly benefits treatment. Individual PA counselling is helpful for people with T2D, especially those with previous inactivity or with diabetes complications. This study evaluated factors contributing to effectiveness of PA counselling in primary health care (PHC) patients with T2D in a real-world setting and using data elicited from electronic health records (EHRs). METHODS All patients with T2D were offered the opportunity to participate in a PA program organized as part of basic PHC services in the Siun sote region in North Karelia, Finland, from October 2016 to December 2018. The study population consists of patients aged 19 to 87 years (n = 546). During the intervention information on possible other factors in addition to age and sex influencing the intervention effect such as amount of counselling sessions, changes in PA and patients´ motivation was gathered. Changes in the participants' PA activity was generated by following the predefined rules from patient records and by assessing the descriptive documentation of activity patterns. The patients' motivation level was assessed using a Likert scale. RESULTS Over 60% of participants who attended PA counselling more than three times increased their PA compared with 1% of participants with one counselling session. Of the whole intervention group, the participants experiencing the largest weight loss were those with an increased level of PA (-1.36 kg vs. -0.63 kg among those with no change in PA). Age, sex, and baseline motivation did not affect the change the PA nor the main intervention outcomes. CONCLUSIONS Patients' compliance with the intervention was reflected in the number of PA counselling sessions attended which in turn was seen as increased levels of PA as well as better treatment outcomes. In the implementation of lifestyle counselling interventions attention should be paid on sufficient amount and frequency of counselling sessions. The individually tailored PA counselling provided in PHC has similar effects regardless of sex and age.
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Affiliation(s)
- Tuula Martiskainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, Joensuu, 70210, Finland.
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland.
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
| | - Mika Venojärvi
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
| | - Heikki Tikkanen
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
| | - Tiina Laatikainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, Joensuu, 70210, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare, PO BOX 30, Helsinki, 00271, Finland
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Gawlik A, Nacak Y, Kleinert J, Konerding U, Vitinius F. Theoretical Derivation of a Telephone-Based Health Coaching Intervention for Promoting Physical Activity and Healthy Nutrition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6271. [PMID: 37444117 PMCID: PMC10341694 DOI: 10.3390/ijerph20136271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
Present research regarding interventions to change behavior suffers from insufficient communication of their theoretical derivation. This insufficient communication is caused by the restrictions imposed by most of the relevant scientific journals. This impedes further intervention development. In this article, a telephone-based health coaching (TBHC) intervention is introduced using a format outside these restrictions. This intervention is seen as a combination of (1) the activities performed with the target persons, i.e., its core, and (2) measures to ensure the quality of the intervention. The theoretical derivation of the core is presented. The core is seen to consist of (1) the style of coach-patient interaction and (2) the contents of this interaction. The style of coach-patient interaction was derived from self-determination theory and was concretized using motivational interviewing techniques. The contents of the coach-patient interaction were derived from the health action process approach and were concretized using behavior-change techniques. The derivation led to (1) a set of 16 coaching tools referring to the different states in which a patient might be and containing state-specific recommendations for performing the coaching session, and (2) guidelines for selecting the appropriate coaching tool for each session. To ensure the quality of the intervention, a coach-training program before and supervision sessions during the TBHC were added.
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Affiliation(s)
- Angeli Gawlik
- Department of Health & Social Psychology, Institute of Psychology, German Sport University Cologne, 50933 Cologne, Germany;
| | - Yeliz Nacak
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (Y.N.); (F.V.)
| | - Jens Kleinert
- Department of Health & Social Psychology, Institute of Psychology, German Sport University Cologne, 50933 Cologne, Germany;
| | - Uwe Konerding
- Trimberg Research Academy, University of Bamberg, 96045 Bamberg, Germany;
- Department of Psychology and Psychotherapy, Witten/Herdecke University, 58455 Witten, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (Y.N.); (F.V.)
- Department of Psychosomatic Medicine, Robert-Bosch-Krankenhaus Stuttgart, 70376 Stuttgart, Germany
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Rouyard T, Endo M, Nakamura R, Moriyama M, Stanyon M, Kanke S, Nakamura K, Chen C, Hara Y, Ii M, Kassai R. Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change (FEEDBACK): study protocol for a cluster randomised controlled trial. Trials 2023; 24:317. [PMID: 37158959 PMCID: PMC10169507 DOI: 10.1186/s13063-023-07345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The growing burden of type 2 diabetes mellitus (T2DM) and the rising cost of healthcare worldwide make it imperative to identify interventions that can promote sustained self-management behaviour in T2DM populations while minimising costs for healthcare systems. The present FEEDBACK study (Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change) aims to evaluate the effects of a novel behaviour change intervention designed to be easily implemented and scaled across a wide range of primary care settings. METHODS A cluster randomised controlled trial (RCT) with a 6-month follow-up will be conducted to evaluate the effects of the FEEDBACK intervention. FEEDBACK is a personalised, multi-component intervention intended to be delivered by general practitioners during a routine diabetes consultation. It consists of five steps aimed at enhancing doctor-patient partnership to motivate self-management behaviour: (1) communication of cardiovascular risks using a 'heart age' tool, (2) goal setting, (3) action planning, (4) behavioural contracting, and (5) feedback on behaviour. We aim to recruit 264 adults with T2DM and suboptimal glycaemic control from 20 primary care practices in Japan (cluster units) that will be randomly assigned to either the intervention or control group. The primary outcome measure will be the change in HbA1c levels at 6-month follow-up. Secondary outcome measures include the change in cardiovascular risk score, the probability to achieve the recommended glycaemic target (HbA1c <7.0% [53mmol/mol]) at 6-month follow-up, and a range of behavioural and psychosocial variables. The planned primary analyses will be carried out at the individual level, according to the intention-to-treat principle. Between-group comparisons for the primary outcome will be analysed using mixed-effects models. This study protocol received ethical approval from the research ethics committee of Kashima Hospital, Fukushima, Japan (reference number: 2022002). DISCUSSION This article describes the design of a cluster RCT that will evaluate the effects of FEEDBACK, a personalised, multicomponent intervention aimed at enhancing doctor-patient partnership to engage adults with T2DM more effectively in self-management behaviour. TRIAL REGISTRATION The study protocol was prospectively registered in the UMIN Clinical Trials Registry (UMIN-CTR ID UMIN000049643 assigned on 29/11/2022). On submission of this manuscript, recruitment of participants is ongoing.
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Affiliation(s)
- Thomas Rouyard
- Research Center for Health Policy and Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan.
| | - Mei Endo
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Ryota Nakamura
- Research Center for Health Policy and Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan
- Graduate School of Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan
| | - Michiko Moriyama
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan
| | - Maham Stanyon
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Satoshi Kanke
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Koki Nakamura
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Yasushi Hara
- Graduate School of Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan
- Graduate School of Business Administration, Kobe University, 2-1 Rokkōdaichō, Nada Ward, Kobe, Hyogo, 657-0013, Japan
| | - Masako Ii
- Graduate School of Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan
| | - Ryuki Kassai
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
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Latrille C, Chapel B, Héraud N, Bughin F, Hayot M, Boiché J. An individualized mobile health intervention to promote physical activity in adults with obstructive sleep apnea: An intervention mapping approach. Digit Health 2023; 9:20552076221150744. [PMID: 36776408 PMCID: PMC9909081 DOI: 10.1177/20552076221150744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/26/2022] [Indexed: 02/10/2023] Open
Abstract
Objective Combining continuous positive airway pressure with physical activity (PA) might be a promising strategy to treat obstructive sleep apnea (OSA). This article describes how intervention mapping (IM) can guide the development, content, and mechanisms of action of a mobile application to promote PA in adults with OSA. Methods To develop the program, the IM approach was followed. This article presents the first three steps of IM to develop a mixed intervention (with interventionists and a digital application) aiming to: (1) assess patients' health problems and needs in a literature review to determine their expectations and perceived facilitators and barriers to PA behavior change and thus select the determinants of behavior; (2) formulate the expected intervention outcomes and objectives to be met to achieve the overall program goals; and (3) select and implement the behavior change techniques (BCTs) to achieve the change objectives. Results The literature review identified the relevant determinants (e.g., self-efficacy, coping, planning, and habit) of PA behavior using the health action process approach and multiprocess action control. These results were used to specify the program outcomes for PA adapted to physical, psychological, and social parameters. Overall, 11 performance objectives and 30 change objectives were defined. Lastly, BCTs and practical applications were identified. Conclusions The study provides a theoretical and methodological basis for researchers and practitioners given the current paucity of evidence-based PA interventions for adults with OSA. It addresses the lack of BCTs (framing and prompts/cue techniques) and meaningful behavioral determinants (identity and habit) in most interventions.
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Affiliation(s)
- Christophe Latrille
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France,PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France,Christophe Latrille, University of Montpellier, 700 avenue du Pic Saint-Loup, Montpellier 34090, France.
| | - Blandine Chapel
- Montpellier Research of Management MRM, University of Montpellier, Montpellier, France
| | - Nelly Héraud
- Direction de la recherche clinique et de l'innovation en santé, Korian SA, Lodève, France
| | - François Bughin
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France
| | - Julie Boiché
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
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de Leeuwerk ME, Bor P, van der Ploeg HP, de Groot V, van der Schaaf M, van der Leeden M. The effectiveness of physical activity interventions using activity trackers during or after inpatient care: a systematic review and meta-analysis of randomized controlled trials. Int J Behav Nutr Phys Act 2022; 19:59. [PMID: 35606852 PMCID: PMC9125831 DOI: 10.1186/s12966-022-01261-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Promoting physical activity (PA) in patients during and/or after an inpatient stay appears important but challenging. Interventions using activity trackers seem promising to increase PA and enhance recovery of physical functioning. OBJECTIVE To review the effectiveness of physical activity interventions using activity trackers on improving PA and physical functioning, compared to usual care in patients during and/or after inpatient care. In addition, it was determined whether the following intervention characteristics increase the effectiveness of these interventions: the number of behaviour change techniques (BCTs) used, the use of a theoretical model or the addition of coaching by a health professional. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, Cinahl, SportDiscus and Web of Science databases were searched in March 2020 and updated in March 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized controlled trials (RCTs) including interventions using activity trackers and feedback on PA in adult patients during, or less than 3 months after, hospitalization or inpatient rehabilitation. METHODS Following database search and title and abstract screening, articles were screened on full text for eligibility and then assessed for risk of bias by using the Physiotherapy Evidence Database (PEDro) scale. Meta-analyses, including subgroup analysis on intervention characteristics, were conducted for the outcomes PA and physical functioning. RESULTS Overall, 21 RCTs totalling 2355 patients were included. The trials covered a variety of clinical areas. There was considerable heterogeneity between studies. For the 13 studies that measured PA as an outcome variable(N = 1435), a significant small positive effect in favour of the intervention was found (standardized mean difference (SMD) = 0.34; 95%CI 0.12-0.56). For the 13 studies that measured physical functioning as an outcome variable (N = 1415) no significant effect was found (SMD = 0.09; 95%CI -0.02 - 0.19). Effectiveness on PA seems to improve by providing the intervention both during and after the inpatient period and by using a theoretical model, multiple BCTs and coaching by a health professional. CONCLUSION Interventions using activity trackers during and/or after inpatient care can be effective in increasing the level of PA. However, these improvements did not necessarily translate into improvements in physical functioning. Several intervention characteristics were found to increase the effectiveness of PA interventions. TRIAL REGISTRATION Registered in PROSPERO ( CRD42020175977 ) on March 23th, 2020.
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Affiliation(s)
- Marijke E de Leeuwerk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, de Boelelaan, 1117, Amsterdam, the Netherlands. .,Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands.
| | - Petra Bor
- University Medical Centre Utrecht, Utrecht University, Department of Rehabilitation, Physical Therapy Science & Sports, Heidelberglaan, 100, Utrecht, the Netherlands
| | - Hidde P van der Ploeg
- Amsterdam UMC location Vrije universiteit Amsterdam, Public and Occupational Health, de Boelelaan, 1117, Amsterdam, the Netherlands
| | - Vincent de Groot
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, de Boelelaan, 1117, Amsterdam, the Netherlands.,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands.,Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands.,Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Leeden
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, de Boelelaan, 1117, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands
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Overwijk A, Hilgenkamp TIM, van der Schans CP, van der Putten AAJ, Waninge A. Development of a Dutch Training/Education Program for a Healthy Lifestyle of People With Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:163-177. [PMID: 35297990 DOI: 10.1352/1934-9556-60.2.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/18/2021] [Indexed: 06/14/2023]
Abstract
Individuals with intellectual disability (ID) need support from direct support professionals (DSPs) to engage in a healthy lifestyle. However, literature shows DSPs feel insufficiently equipped to support a healthy lifestyle. Therefore, the aim of this study is to develop a theory-based program for DSPs to support physical activity and healthy nutrition for people with moderate to profound levels of ID, and to design its evaluation. The Intervention Mapping Protocol (IM) was followed to develop a theory-based program for DSPs. The program evaluation consists of process and feasibility evaluations. This study provided a theory-based program consisting of a training and education section with online and face-to-face components to support DSPs in promoting health for people with ID.
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Affiliation(s)
- Annelies Overwijk
- Annelies Overwijk, Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences and University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
| | - Thessa I M Hilgenkamp
- Thessa I.M. Hilgenkamp, Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands, and Department of Physical Therapy, University of Nevada
| | - Cees P van der Schans
- Cees P. van der Schans, Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine and Department of Health Psychology
| | - Annette A J van der Putten
- Annette A.J. van der Putten, Department of Inclusive and Special Needs Education, University of Groningen, The Netherlands
| | - Aly Waninge
- Aly Waninge, Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, and University of Groningen, University Medical Center Groningen, Department of Health Psychology, The Netherlands
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Seidu S, Khunti K, Yates T, Almaqhawi A, Davies M, Sargeant J. The importance of physical activity in management of type 2 diabetes and COVID-19. Ther Adv Endocrinol Metab 2021; 12:20420188211054686. [PMID: 34721838 PMCID: PMC8554560 DOI: 10.1177/20420188211054686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
Over time, various guidelines have emphasised the importance of physical activity and exercise training in the management of type 2 diabetes, chronic diseases, including cardiovascular disease and musculoskeletal disorders. The aim of this review is to evaluate the effectiveness of physical activity in people with type 2 diabetes and COVID-19. Most research to date indicates that people with type 2 diabetes who engage in both aerobic and resistance exercise see the greatest improvements in insulin sensitivity. Physical activity is now also known to be effective at reducing hospitalisation rates of respiratory viral diseases, such as COVID-19, due to the beneficial impacts of exercise on the immune system. Preliminary result indicates that home-based exercise may be an essential component in future physical activity recommendations given the current COVID-19 pandemic and the need for social distancing. This home-based physical exercise can be easily regulated and monitored using step counters and activity trackers, enabling individuals to manage health issues that benefit from physical exercise.
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Affiliation(s)
- Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Abdullah Almaqhawi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Dammam, Saudi Arabia
| | - M.J. Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Jack Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, UK
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10
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Al Ghafri T, Anwar H, Al Hinai E, Al Harthi T, Al Jufaili F, Al Siyabi R, Al Harthi S, Al Hasani S, Al Harthi M, Al Harthi S. Study protocol: behaviour change intervention to promote healthy diet and physical activity in overweight/obese adults with diabetes attending health care facilities in Muscat: a cluster rendomised control trial. BMC Public Health 2021; 21:1529. [PMID: 34376181 PMCID: PMC8353738 DOI: 10.1186/s12889-021-11549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthy behavior is an essential component in type 2 diabetes (T2D) management. Promoting healthy lifestyle is one of the priorities of primary health care in Oman. This study aims to evaluate the effectiveness of a multi-component intervention in promoting physical activity (PA) and healthy diet and its implications on body mass index and glycemic control in adults with diabetes attending primary care. METHODS A one year 1:1 cluster randomized controlled trial will be utilized to compare the use of phone consultations, a multi component interactive phone application and pedometers with the usual diabetes care on promoting PA and healthy diet. Participants will be screened for inactivity and should be T2D, aged18-65 years, and overweight or obese. Eight primary centers will be randomly selected in each arm (n = 375). The primary outcome is the between arms differences in PA and diet scores, BMI and HbA1c over 12 months from baseline. Additionally, secondary outcomes will include cardiovascular outcomes (BP, and lipids). The trial has received ethical approval from the Omani Research and Ethical Review and Approval Committee. All eligible participants will be invited to their respected health centers to provide informed consent. DISCUSSION This study will contribute to the integration of healthy lifestyle approach using artificial intelligence to primary diabetes care. Results from this study will be disseminated through workshops, policy briefs, and peer-reviewed publications, local and international conferences. TRIAL REGISTRATION Trial registration number ISRCTN71889430 . Date applied: 28/11/2020. Date assigned: 01/12/2020.
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Affiliation(s)
- Thamra Al Ghafri
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman.
| | - Huda Anwar
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
| | - Eiman Al Hinai
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
| | - Thuraya Al Harthi
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
| | - Fathiya Al Jufaili
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
| | - Reyadh Al Siyabi
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
| | - Shamsa Al Harthi
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
| | - Said Al Hasani
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
| | - Mohammed Al Harthi
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
| | - Saud Al Harthi
- Directorate of health services, Muscat governorate, Oman Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
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11
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Konerding U, Szel C. Promoting physical activity in persons with type 2 diabetes mellitus: A systematic review of systematic reviews. PATIENT EDUCATION AND COUNSELING 2021; 104:1600-1607. [PMID: 33358769 DOI: 10.1016/j.pec.2020.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There is a large amount of studies about interventions for promoting physical activity (PA) in persons with type 2 diabetes (T2D) as well as several systematic reviews referring to these studies. The objective of this contribution is to provide a systematic review of these systematic reviews. METHOD PubMed, PsychInfo and the Cochrane Library were searched for systematic reviews and/or meta-analyses regarding interventions for promoting PA in persons with T2D. The individual reviews and the relationships between the reviews were analysed. RESULTS Eighteen reviews were included. Seventeen of these reviews contained references to included trials, amounting to 113 trials in total. Five of the reviews addressed PA interventions in general; six addressed specific devices for delivering the intervention; five addressed specific approaches for giving the participants feedback about their outcomes; and two addressed specific therapeutic approaches. Only 14 cross-references were found. CONCLUSION Giving feedback about outcomes and helping people to integrate PA in their daily lives seem to be the most effective intervention components. Basing intervention development on theories seems helpful. PRACTICAL IMPLICATIONS Interventions should give feedback about outcomes and help to integrate PA in daily life. Intervention development should be theory-based.
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Affiliation(s)
- Uwe Konerding
- Trimberg Research Academy, University of Bamberg, D-96045, Bamberg, Germany; Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, D-58448, Witten, Germany.
| | - Clarissa Szel
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, D-58448, Witten, Germany
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12
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Collaço N, Henshall C, Belcher E, Canavan J, Merriman C, Mitchell J, Watson E. Patients' and healthcare professionals' views on a pre- and post-operative rehabilitation programme (SOLACE) for lung cancer: A qualitative study. J Clin Nurs 2021; 31:283-293. [PMID: 34114286 DOI: 10.1111/jocn.15907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To explore patients' and healthcare professionals' views and experiences of a pre- and post-operative rehabilitation intervention (SOLACE), for patients undergoing surgery for early-stage lung cancer. BACKGROUND Considerable post-operative complications can occur after surgery. A specialist lung cancer service (SOLACE) was developed to optimise health and fitness levels prior to and following lung cancer resections, as well as reducing morbidity and mortality, and improving the physical and psychological well-being of patients. DESIGN The design was an exploratory, descriptive qualitative interview study. METHODS Seventeen lung cancer patients and eight healthcare professionals were recruited from a large teaching hospital in South England. Data were collected through semi-structured telephone and face-to-face interviews. Transcribed interview data were analysed thematically. The COREQ checklist was used to report on the study process. RESULTS The SOLACE service was positively perceived by patients and healthcare professionals. Patients valued the provision of tailored support/advice and peer support and reported benefits to their health and well-being. Barriers to patient uptake of the classes included time constraints, motivation and access for patients who lived at a distance. CONCLUSIONS There is benefit in providing a personalised approach through a pre- and post-operative rehabilitation service for lung cancer patients. Virtual support may address equality of access to service for those who live at a distance from the hospital. RELEVANCE TO CLINICAL PRACTICE Introduction of a pre- and post-operative rehabilitation service provided by specialist peri-operative rehabilitation nurses and practitioners can yield positive outcomes for patients undergoing surgical treatment of early-stage lung cancer. Engagement of key healthcare professionals, consideration of virtual follow-up services and making patients aware of services could maximise patient uptake. Further consideration is needed of the best way to promote patient self-management and long-term continuation of patient rehabilitation in the community.
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Affiliation(s)
- Nicole Collaço
- Faculty of Health Sciences, University of Southampton, Southampton, UK.,Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Catherine Henshall
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Elizabeth Belcher
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jane Canavan
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charlotte Merriman
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jenny Mitchell
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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13
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Ayre J, Bonner C, Muscat DM, Bramwell S, McClelland S, Jayaballa R, Maberly G, McCaffery K. Type 2 diabetes self-management schemas across diverse health literacy levels: a qualitative investigation. Psychol Health 2021; 37:867-889. [PMID: 33931003 DOI: 10.1080/08870446.2021.1909023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to explore how people with diabetes and diverse health literacy levels conceptualise their experience and efforts to engage in self-management behaviours (their self-management 'schemas'). DESIGN A qualitative design was applied. METHODS Twenty-six people in Sydney, Australia, took part in semi-structured interviews, which were audio-recorded and coded using Framework analysis. RESULTS Half the participants (54%) had limited health literacy, whereas 38% adequate health literacy (using Newest Vital Sign). Regardless of health literacy, people described how monitoring increased self-management awareness and signalled periods of low self-management ('lulls'). Accounts of monitoring to sustain motivation were more apparent for participants with adequate health literacy. Most participants described simple and flexible rules (e.g. use artificial sweeteners; eat in moderation). Two schemas related to 'lulls': a 'problem-solving orientation' depicted lulls as inevitable and was associated with varied coping strategies; a 'willpower orientation' attributed lulls to lack of 'willpower,' and described willpower as a main coping strategy. CONCLUSION There is considerable variation in how people think about their diabetes self-management and the strategies they use. Health literacy may contribute to some of this variation. Self-management interventions could benefit from depicting motivation as fluctuating and challenging ideas about willpower and self-blame.
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Affiliation(s)
- Julie Ayre
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sian Bramwell
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia
| | - Sharon McClelland
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia
| | - Rajini Jayaballa
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia.,School of Medicine, Western Sydney University, Blacktown, Australia
| | - Glen Maberly
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Yao WY, Han MG, De Vito G, Fang H, Xia Q, Chen Y, Liu X, Wei Y, Rothman RL, Xu WH. Physical Activity and Glycemic Control Status in Chinese Patients with Type 2 Diabetes: A Secondary Analysis of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084292. [PMID: 33919529 PMCID: PMC8073010 DOI: 10.3390/ijerph18084292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
This secondary analysis was designed to evaluate the independent effect of physical activity (PA) on hemoglobin A1c (HbA1c) level in Chinese patients with type 2 diabetes mellitus (T2DM). A total of 799 T2DM patients from eight communities of Shanghai, China, were randomized into one control arm and three intervention arms receiving 1-year interventions of health literacy, exercise, or both. PA was measured using the International Physical Activity Questionnaire at baseline, 12 months, and 24 months and quantified as metabolic equivalents (Mets). A multiple level mixed regression model was applied to evaluate the associations between PA and HbA1c level. After adjusting for potential confounders including interaction of PA level with initial PA or HbA1c, a significant improved HbA1c was observed for the patients in the medium versus the lowest tertile groups of overall PA at 12 months (β: −3.47, 95%CI: −5.33, −1.60) and for those in the highest versus the lowest tertile group at 24 months (β: −0.50, 95%CI: −1.00, −0.01), resulting in a β (95%CI) of −3.49 (95%CI: −5.87, −1.11) during the whole two-year period of follow-up. The negative association was also observed when the subjects were classified according to their exercise levels using the World Health Organization (WHO) recommendation as a cut-off point. The beneficial effect of higher PA level was only observed among patients having a lower level of baseline HbA1c or PA or both (all p values for interaction <0.05). Our results provide evidence for the beneficial effect of PA and suggest that the exercise intervention should be addressed to the physically inactive patients to improve their PA level to a physiological threshold.
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Affiliation(s)
- Wei-Yuan Yao
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
| | - Meng-Ge Han
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
| | - Giuseppe De Vito
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy;
| | - Hong Fang
- Minhang District Center for Disease Control and Prevention, Shanghai 201102, China;
| | - Qinghua Xia
- Changning District Center for Disease Control and Prevention, Shanghai 200051, China;
| | - Yingyao Chen
- Key Laboratory of Health Technology Assessment (National Health Commission), School of Public Health, Fudan University, Shanghai 200032, China;
| | - Xiaona Liu
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
| | - Yan Wei
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
- Key Laboratory of Health Technology Assessment (National Health Commission), School of Public Health, Fudan University, Shanghai 200032, China;
| | - Russell L. Rothman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Wang-Hong Xu
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
- Key Laboratory of Health Technology Assessment (National Health Commission), School of Public Health, Fudan University, Shanghai 200032, China;
- Correspondence: ; Tel.: +86-21-54237679
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15
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Kolb L. An Effective Model of Diabetes Care and Education: The ADCES7 Self-Care Behaviors™. Sci Diabetes Self Manag Care 2021; 47:30-53. [PMID: 34078208 DOI: 10.1177/0145721720978154] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The ADCES7 Self-Care Behaviors™ (ADCES7) is a robust framework for self-management of diabetes and other related conditions, such as prediabetes and cardiometabolic diseases. It is the position of the Association of Diabetes Care and Education Specialists (ADCES) that at the cornerstone of diabetes self-management education and support, the ADCES7 is the framework for achieving behavior change that leads to effective self-management through improved behavior and clinical outcome measures. The ADCES7 model guides the health care team in effective person-centered collaboration and goal setting to achieve health-related outcomes and improved quality of life. Continued research and evidence are critical to expand this model and broaden its application to other chronic conditions. Given the advances in the science of diabetes management as well as diabetes self-management education and support, ADCES has evaluated the ADCES7 within the framework of these advances, including the digital and dynamic health care landscape. CONCLUSION This revised position statement blends the updates in research and ADCES's vision and expansion beyond diabetes to refresh the ADCES7 framework. This revision reflects the perspectives of all members of the health care team as they problem solve with individuals who are at risk for or who have diabetes and related conditions to achieve healthier outcomes.
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Affiliation(s)
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- From the Association of Diabetes Care and Education Specialists, Chicago, Illinois
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16
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Morris A, Lycett D. Behavioural strategies to self-manage low-potassium diets in chronic kidney disease. J Ren Care 2021; 47:160-168. [PMID: 33522715 DOI: 10.1111/jorc.12361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dietary potassium restrictions may be challenging to follow, due in part to the restrictive nature of recommendations on foods people enjoy. Little is known how people incorporate low-potassium diets into their lifestyles. OBJECTIVE To examine the self-directed behavioural strategies people employ to follow low-potassium advice. DESIGN Qualitative methodology. PARTICIPANTS Thirty-four adults with chronic kidney disease. APPROACH Semistructured interviews were undertaken in an outpatient department. Thematic analysis was undertaken on transcribed interviews. FINDINGS Analysis identified three themes: 'Differing opinions of food'; 'Food generates positive emotions'; and 'Doing what works'. Participants described foods providing different levels of enjoyment. Favourite foods in their habitual diet held either a physiological or a psychological value to them. Five subthemes underpinned the 'Doing what works' theme that described the self-management behaviours used by participants to follow low-potassium dietary advice. These were positive reframing; reflection; self-talk; social support; decisional balance; paradoxical instruction; and knowledge shaping. These techniques helped overcome the conflict between favourite food preferences and dietary restrictions. Dietary restrictions proved more challenging where an emotional connection to a favourite food existed. Restrictions on less preferred foods did not present participants with the same self-management challenges. CONCLUSIONS Promoting behavioural change techniques such as decisional balance, and social support may be a useful strategy to empower people following dietary restrictions. Practitioners should understand whether suggested dietary restrictions include an individual's favourite food; the value attached to it, and explore specific ways to include favourite foods in some way when discussing a low-potassium diet.
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Affiliation(s)
- Andrew Morris
- Dietetics Department, University Hospital, Coventry, UK.,Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Deborah Lycett
- Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Effects of physical activity on the progression of diabetic nephropathy: a meta-analysis. Biosci Rep 2021; 41:227185. [PMID: 33289502 PMCID: PMC7786348 DOI: 10.1042/bsr20203624] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Diabetic nephropathy (DN) is an important microvascular complication of diabetes. Physical activity (PA) is part of a healthy lifestyle for diabetic patients; however, the role of PA in DN has not been clarified. Our aim was to conduct a meta-analysis to explore the association between PA and DN risk. Methods: PubMed, Embase, Cochrane Library and Web of Science were systematically searched for articles examining PA in diabetic patients and its effect on renal function. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. The study protocol is registered with PROSPERO (CRD42020191379). Results: A total of 38991 participants were identified from 18 studies. The results indicated that PA was associated with increases in the glomerular filtration rate (SMD = 0.01, 95% CI = [0.02–0.17]) and decreases in the urinary albumin creatinine ratio (SMD = −0.53, 95% CI: −0.72 to −0.34), rate of microalbuminuria (OR = 0.61, 95% CI = [0.46–0.81]), rate of acute kidney injury (OR = 0.02, 95% CI = [0.01–0.04]), rate of renal failure (OR = 0.71, 95% CI = [0.52–0.97]) and risk of DN in patients with Type 1 diabetes (OR = 0.67, 95% CI = [0.51–0.89]). Conclusions: This meta-analysis indicated that PA is effective for improving DN and slowing its progression; however, more high-quality randomized controlled trials are required on this topic.
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18
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Zhu X, Zhao L, Chen J, Lin C, Lv F, Hu S, Cai X, Zhang L, Ji L. The Effect of Physical Activity on Glycemic Variability in Patients With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne) 2021; 12:767152. [PMID: 34867812 PMCID: PMC8635769 DOI: 10.3389/fendo.2021.767152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/28/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The effect of physical activity on glycemic variability remains controversial. This meta-analysis aimed to assess the overall effect of physical activity treatment on glycemic variability in patients with diabetes. METHODS PubMed/MEDLINE, Embase, and Cochrane databases were searched for clinical trials that conducted in patients with type 1 diabetes mellitus and type 2 diabetes mellitus with reports of the mean amplitude of glycemic excursion (MAGE), time in range (TIR), time above range (TAR), or time below range (TBR). Eligible trials were analyzed by fixed-effect model, random effect model, and meta-regression analysis accordingly. RESULTS In total, thirteen trials were included. Compared with the control group, physical activity intervention was significantly associated with increased TIR (WMDs, 4.17%; 95% CI, 1.11 to 7.23%, P<0.01), decreased MAGE (WMDs, -0.68 mmol/L; 95% CI, -1.01 to -0.36 mmol/L, P<0.01) and decreased TAR (WMDs, -3.54%; 95% CI, -5.21 to -1.88%, P<0.01) in patients with diabetes, but showed insignificant effects on TBR. Patients with higher baseline BMI levels was associated with a greater decrease in MAGE (β=-0.392, 95% CI: -0.710, -0.074), and patients with lower baseline HbA1c levels was associated with a greater increase in TBR during physical activities (β=-0.903, 95% CI: -1.550, -0.255). CONCLUSION Physical activity was associated with significantly decreased glycemic variability in patients with diabetes. Patients with higher BMI might benefit more from physical activity therapy in terms of a lower MAGE. Hypoglycemia associated with physical activity treatment still warranted caution, especially in patients with intensive glycemic control. SYSTEMATIC REVIEW REGISTRATION PROSPERO [CRD42021259807].
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Affiliation(s)
- Xingyun Zhu
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Lina Zhao
- Department of Endocrinology and Metabolism, Langfang Traditional Chinese Medicine (TCM) Hospital, Hebei, China
| | - Jing Chen
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Chu Lin
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Fang Lv
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Suiyuan Hu
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
- *Correspondence: Xiaoling Cai, ; Li Zhang, ; Linong Ji,
| | - Li Zhang
- China Institute of Sport Science, Beijing, China
- *Correspondence: Xiaoling Cai, ; Li Zhang, ; Linong Ji,
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
- *Correspondence: Xiaoling Cai, ; Li Zhang, ; Linong Ji,
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Taggart L, Doherty AJ, Chauhan U, Hassiotis A. An exploration of lifestyle/obesity programmes for adults with intellectual disabilities through a realist lens: Impact of a 'context, mechanism and outcome' evaluation. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:578-593. [PMID: 33342030 DOI: 10.1111/jar.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/16/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity is higher in people with intellectual disabilities. AIMS There are two aims of this explorative paper. Firstly, using a realist lens, to go beyond 'what works' and examine the 'context, mechanisms and outcomes' (CMO) of lifestyle/obesity programmes for this population. Second, using a logic model framework to inform how these programmes could be implemented within practice. METHOD We explored six-review papers and the individual lifestyle/obesity programmes that these papers reviewed using the CMO framework. RESULTS There were few theoretically underpinned, multi-component programmes that were effective in the short to long-term and many failed to explore the 'context and mechanisms'. We developed a logic model and engaged in two co-production workshops to refine this model. DISCUSSION Using a realist approach, programmes need to be underpinned by both individual and systems change theories, be multi-component, have a closer understanding of the interplay of the 'context and mechanisms', and co-designed using a logic model framework.
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Affiliation(s)
- Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, Co Antrim, UK
| | - Alison Jayne Doherty
- Faculty of Health & Wellbeing, University of Central Lancashire (UCLan), Preston, UK
| | - Umesh Chauhan
- Faculty of Health & Wellbeing, University of Central Lancashire (UCLan), Preston, UK
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20
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Jones BA, Munir F, Harris PS, Bhatnagar P, Stevinson C. Intervention development for exercise promotion at active charity events in the UK. Health Promot Int 2020; 35:1341-1352. [PMID: 32068858 DOI: 10.1093/heapro/daaa012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This study used the Intervention Mapping protocol to design an evidence-based intervention package for organizers of active charity events to support their participants in remaining or becoming regular exercisers. A mixed-methods approach following the Intervention Mapping protocol was used to develop intervention components. A needs assessment was initially performed to identify the behavioural and environmental determinants of exercise for charity event participants (Step 1). Next, the intended intervention outcomes, and performance and change objectives were specified (Step 2). Theory-based change methods were selected and matched with practical strategies (Step 3). This resulted in the design of the first iteration of the intervention which underwent pre-testing with former event participants and feasibility testing at an active charity event (Step 4). The evidence-based interventions included components to implement at events (e.g. an activity and information zone, and exercise planner), along with elements pre- and post-event (e.g. social media). Pre-testing indicated high acceptability of the planned components, but feasibility testing suggested low engagement with the intervention. Despite developing the intervention package through the systematic process of Intervention Mapping, preliminary data suggest that further development and testing is needed to refine the intervention before implementation.
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Affiliation(s)
- Bethany Alice Jones
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
- National Centre of Sport and Exercise Medicine East Midlands, Loughborough University, Loughborough, LE11 3TU, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
- National Centre of Sport and Exercise Medicine East Midlands, Loughborough University, Loughborough, LE11 3TU, UK
| | - Philine S Harris
- Department of Psychology, Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, SO17 1BJ, UK
| | - Prachi Bhatnagar
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention, University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Clare Stevinson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
- National Centre of Sport and Exercise Medicine East Midlands, Loughborough University, Loughborough, LE11 3TU, UK
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Chater AM, Smith L, Ferrandino L, Wyld K, Bailey DP. Health behaviour change considerations for weight loss and type 2 diabetes: nutrition, physical activity and sedentary behaviour. PRACTICAL DIABETES 2020. [DOI: 10.1002/pdi.2311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Angel Marie Chater
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, Faculty of Education and Sport, University of Bedfordshire Bedford UK
- Centre for Behavioural Medicine, University College London UK
| | - Lindsey Smith
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, Faculty of Education and Sport, University of Bedfordshire Bedford UK
| | - Louise Ferrandino
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, Faculty of Education and Sport, University of Bedfordshire Bedford UK
| | - Kev Wyld
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, Faculty of Education and Sport, University of Bedfordshire Bedford UK
| | - Daniel P Bailey
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London Uxbridge UK
- Sedentary Behaviour, Health and Disease Research Group, Brunel University London Uxbridge UK
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Maltinsky W, Swanson V. Behavior change in diabetes practitioners: An intervention using motivation, action planning and prompts. PATIENT EDUCATION AND COUNSELING 2020; 103:2312-2319. [PMID: 32402490 DOI: 10.1016/j.pec.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES It is important for health professionals to have behavior change skills to empower people to manage long-term-conditions. Theoretically derived, competency-based training can be particularly effective where it considers reflective and automatic routes to behavior change. The aim of this study was to develop, deliver and evaluate a motivational, action and prompting behavior change skills intervention for diabetes health practitioners in Scotland, UK. METHODS This was a longitudinal intervention study. A 2-day intervention was delivered to 99 health professionals. Participants set behavioral goals to change practice, completing action and coping plans post-training. Motivation and plan quality were evaluated in relation to goal achievement at 6-week follow-up. RESULTS Post-training, practitioners could develop high quality work-related action and coping plans, which they were motivated to enact. Although under half responded at follow-up, most reported successful goal achievement. There was no difference in plan quality for goal achievers, non-achievers and non-responders. Barriers and facilitators of behavior change included institutional, service-user and individual factors. CONCLUSIONS The intervention successfully used planning to implement participants' behaviour change goals. PRACTICE IMPLICATIONS Planning interventions are helpful to support clinicians to change their practice to help people self-manage diabetes care but may not fit demands of day-to-day clinical practice.
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Affiliation(s)
- Wendy Maltinsky
- Centre for Health and Behaviour Change, Psychology Division, University of Stirling, Stirling FK9 4LA, United Kingdom.
| | - Vivien Swanson
- Centre for Health and Behaviour Change, Psychology Division, University of Stirling, Stirling FK9 4LA, United Kingdom
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Regeer H, Huisman SD, Empelen P, Flim J, Bilo HJG. Improving physical activity within diabetes care: Preliminary effects and feasibility of a national low‐intensity group‐based walking intervention among people with type 2 diabetes mellitus. LIFESTYLE MEDICINE 2020. [DOI: 10.1002/lim2.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Hannah Regeer
- Department of Internal Medicine Leiden University Medical Centre Leiden The Netherlands
- National Diabetes Challenge Bas Van De Goor Foundation Arnhem The Netherlands
| | - Sasja D. Huisman
- Department of Internal Medicine Leiden University Medical Centre Leiden The Netherlands
| | | | - Jeroen Flim
- National Diabetes Challenge Bas Van De Goor Foundation Arnhem The Netherlands
| | - Henk J. G. Bilo
- Diabetes Knowledge Centre Isala Hospitals Zwolle The Netherlands
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Okwose NC, O'Brien N, Charman S, Cassidy S, Brodie D, Bailey K, MacGowan GA, Jakovljevic DG, Avery L. Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study. BMJ Open 2020; 10:e036382. [PMID: 32958484 PMCID: PMC7507843 DOI: 10.1136/bmjopen-2019-036382] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Clinical guidelines recommend regular physical activity for patients with heart failure to improve functional capacity and symptoms and to reduce hospitalisation. Cardiac rehabilitation programmes have demonstrated success in this regard; however, uptake and adherence are suboptimal. Home-based physical activity programmes have gained popularity to address these issues, although it is acknowledged that their ability to provide personalised support will impact on their effectiveness. This study aimed to identify barriers and facilitators to engagement and adherence to a home-based physical activity programme, and to identify ways in which it could be integrated into the care pathway for patients with heart failure. DESIGN A qualitative focus group study was conducted. Data were analysed using thematic analysis. PARTICIPANTS A purposive sample of 16 patients, 82% male, aged 68±7 years, with heart failure duration of 10±9 years were recruited. INTERVENTION A 12-week behavioural intervention targeting physical activity was delivered once per week by telephone. RESULTS Ten main themes were generated that provided a comprehensive overview of the active ingredients of the intervention in terms of engagement and adherence. Fear of undertaking physical activity was reported to be a significant barrier to engagement. Influences of family members were both barriers and facilitators to engagement and adherence. Facilitators included endorsement of the intervention by clinicians knowledgeable about physical activity in the context of heart failure; ongoing support and personalised feedback from team members, including tailoring to meet individual needs, overcome barriers and increase confidence. CONCLUSIONS Endorsement of interventions by clinicians to reduce patients' fear of undertaking physical activity and individual tailoring to overcome barriers are necessary for long-term adherence. Encouraging family members to attend consultations to address misconceptions and fear about the contraindications of physical activity in the context of heart failure should be considered for adherence, and peer-support for long-term maintenance. TRIAL REGISTRATION NUMBER NCT03677271.
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Affiliation(s)
- Nduka C Okwose
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
| | - Nicola O'Brien
- Department of Psychology, Northumbria University - City Campus, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Sarah Charman
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
| | - Sophie Cassidy
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
| | - David Brodie
- School of Health and Social Sciences, Buckinghamshire New University, High Wycombe, Buckinghamshire, United Kingdom
| | - Kristian Bailey
- Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Guy A MacGowan
- Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Djordje G Jakovljevic
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
- Faculty of Health and Life Scienes, Coventry University, Coventry, United Kingdom
| | - Leah Avery
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom
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25
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Lahham A, Burge AT, McDonald CF, Holland AE. How do healthcare professionals perceive physical activity prescription for community-dwelling people with COPD in Australia? A qualitative study. BMJ Open 2020; 10:e035524. [PMID: 32801194 PMCID: PMC7430452 DOI: 10.1136/bmjopen-2019-035524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Clinical practice guidelines recommend that people with chronic obstructive pulmonary disease (COPD) should be encouraged to increase their physical activity levels. However, it is not clear how these guidelines are applied in clinical practice. This study aimed to understand the perspectives of respiratory healthcare professionals on the provision of physical activity advice to people with COPD. These perspectives may shed light on the translation of physical activity recommendations into clinical practice. DESIGN A qualitative study using thematic analysis. SETTING Healthcare professionals who provided care for people with COPD at two major tertiary referral hospitals in Victoria, Australia. PARTICIPANTS 30 respiratory healthcare professionals including 12 physicians, 10 physical therapists, 4 nurses and 4 exercise physiologists. INTERVENTIONS Semistructured voice-recorded interviews were conducted, transcribed verbatim and analysed by two independent researchers using an inductive thematic analysis approach. RESULTS Healthcare professionals acknowledged the importance of physical activity for people with COPD. They were conscious of low physical activity levels among such patients; however, few specifically addressed this in consultations. Physicians described limitations including time constraints, treatment prioritisation and perceived lack of expertise; they often preferred that physical therapists provide more comprehensive assessment and advice regarding physical activity. Healthcare professionals perceived that there were few evidence-based strategies to enhance physical activity. Physical activity was poorly differentiated from the prescription of structured exercise training. Although healthcare professionals were aware of physical activity guidelines, few were able to recall specific recommendations for people with COPD. CONCLUSION Practical strategies to enhance physical activity prescription may be required to encourage physical activity promotion in COPD care.
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Affiliation(s)
- Aroub Lahham
- Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela T Burge
- Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Hospital, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Hospital, Melbourne, Victoria, Australia
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What Competences Are Required to Deliver Person-Person Behaviour Change Interventions: Development of a Health Behaviour Change Competency Framework. Int J Behav Med 2020; 28:308-317. [PMID: 32691397 PMCID: PMC8121720 DOI: 10.1007/s12529-020-09920-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The competence of the person delivering person-to-person behaviour change interventions may influence the effectiveness of the intervention. However, we lack a framework for describing the range of competences involved. The objective of the current work was to develop a competency framework for health behaviour change interventions. METHOD A preliminary framework was developed by two judges rating the relevance of items in the competency framework for cognitive behaviour therapies; adding relevant items from reviews and other competency frameworks; and obtaining feedback from potential users on a draft framework. The Health Behaviour Change Competency Framework (HBCCF) was used to analyse the competency content of smoking cessation manuals. RESULTS Judges identified 194 competency items as relevant, which were organised into two domains: foundation (12 competency topics comprising 56 competencies) and behaviour change (12 topics, 54 competencies); several of the 54 and 56 competencies were composed of sub-competencies (84 subcompetencies in total). Smoking cessation manuals included 14 competency topics from the foundation and behaviour change competency domains. CONCLUSION The HBCCF provides a structured method for assessing and reporting competency to deliver behaviour change interventions. It can be applied to assess a practitioner's competency and training needs and to identify the competencies needed for a particular intervention. To date, it has been used in self-assessments and in developing training programmes. We propose the HBCCF as a practical tool for researchers, employers, and those who design and provide training. We envisage the HBCFF maturing and adapting as evidence that identifies the essential elements required for the effective delivery of behaviour change interventions emerges.
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Jabardo-Camprubí G, Donat-Roca R, Sitjà-Rabert M, Milà-Villarroel R, Bort-Roig J. Drop-out ratio between moderate to high-intensity physical exercise treatment by patients with, or at risk of, type 2 diabetes mellitus: A systematic review and meta-analysis. Physiol Behav 2020; 215:112786. [DOI: 10.1016/j.physbeh.2019.112786] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023]
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An Effective Model of Diabetes Care and Education: Revising the AADE7 Self-Care Behaviors ®. DIABETES EDUCATOR 2020; 46:139-160. [PMID: 31928334 DOI: 10.1177/0145721719894903] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The AADE7 Self-Care Behaviors® (AADE7) is a robust framework for self-management of diabetes and other related conditions, such as prediabetes and cardiometabolic diseases. It is the position of the American Association of Diabetes Educators (AADE) that, at the cornerstone of diabetes self-management education and support, the AADE7 is the framework for achieving behavior change that leads to effective self-management through improved behavior and clinical outcome measures. The AADE7 model guides the health care team in effective person-centered collaboration and goal setting to achieve health-related outcomes and improved quality of life. Continued research and evidence are critical to expand this model and broaden its application to other chronic conditions. Given the advances in the science of diabetes management, as well as in diabetes self-management education and support, AADE has evaluated the AADE7 within the framework of these advances, including the digital and dynamic health care landscape. CONCLUSION This revised position statement blends the updates in research and AADE's vision and expansion beyond diabetes to refresh the AADE7 framework. This revision reflects the perspectives of all members of the health care team as they problem solve with individuals who are at risk for or who have diabetes and related conditions to achieve healthier outcomes.
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Affiliation(s)
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- American Association of Diabetes Educators, Chicago, Illinois
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Cassidy S, Okwose N, Scragg J, Houghton D, Ashley K, Trenell MI, Jakovljevic DG, Hallsworth K, Avery L. Assessing the feasibility and acceptability of Changing Health for the management of prediabetes: protocol for a pilot study of a digital behavioural intervention. Pilot Feasibility Stud 2019; 5:139. [PMID: 31788325 PMCID: PMC6878649 DOI: 10.1186/s40814-019-0519-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/15/2019] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of prediabetes is rapidly rising in the UK, largely associated with an increase in obesity. Lifestyle programmes that provide support to make and sustain dietary and physical activity behavioural changes are necessary to initiate and maintain weight loss. However, these programmes are often intensive and time consuming. Given the magnitude of the problem, there is a need for behavioural interventions that can be delivered at scale. Digital interventions can address some of the aforementioned issues. The primary aim of the present study is to assess the feasibility and acceptability of a digital intervention called Changing Health that provides structured education and lifestyle behaviour change support to adults with prediabetes. Methods A single-group pilot study will be undertaken. We aim to recruit 40 participants with prediabetes defined by HbA1c or fasting plasma glucose (FPG), aged between 18 and 75 years with a BMI ≥ 25. Participants will receive the digital intervention (a mobile phone app incorporating structured education and behavioural tools to support lifestyle behaviour change) with the aim of losing and maintaining 5–6% of their baseline body weight. Each participant will receive 100 min of lifestyle coaching over the 9-month intervention period and will have continued access to the digital intervention. Clinical outcome measures will be collected during four visits to our clinical research facility: two visits at baseline, one visit at month 3, and one visit at month 9. These secondary outcome measures will include diet, physical activity, sleep, metabolic control, body composition, cardiorespiratory fitness, and cardiovascular function. To measure primary outcomes, an embedded qualitative study will be conducted to obtain data on feasibility and acceptability of the intervention. Discussion This pilot study will establish whether Changing Health is feasible and acceptable to adults with prediabetes. Clinical outcome measures will provide estimates of variability to inform sample size calculations, and qualitative data generated will inform any necessary refinements to the intervention. This will provide a platform for a larger evaluation to assess the effectiveness of Changing Health for changing diet and physical activity to initiate and maintain weight loss in adults with prediabetes. Trial registration ISRCTN Registry: ISRCTN69270299.
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Affiliation(s)
- Sophie Cassidy
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Nduka Okwose
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Jadine Scragg
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - David Houghton
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Kirsten Ashley
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Michael I Trenell
- 2NIHR Innovation Observatory, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Kate Hallsworth
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.,3The Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Leah Avery
- 4Centre for Rehabilitation, Exercise and Sports Sciences, School of Health & Social Care, Teesside University, Tees Valley, UK
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30
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Okwose NC, Avery L, O'Brien N, Cassidy S, Charman SJ, Bailey K, Velicki L, Olivotto I, Brennan P, MacGowan GA, Jakovljevic DG. Acceptability, Feasibility and Preliminary Evaluation of a Novel, Personalised, Home-Based Physical Activity Intervention for Chronic Heart Failure (Active-at-Home-HF): a Pilot Study. SPORTS MEDICINE-OPEN 2019; 5:45. [PMID: 31776701 PMCID: PMC6881484 DOI: 10.1186/s40798-019-0216-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/24/2019] [Indexed: 02/08/2023]
Abstract
Purpose Less than 10% of heart failure patients in the UK participate in cardiac rehabilitation programmes. The present pilot study evaluated feasibility, acceptability and physiological effects of a novel, personalised, home-based physical activity intervention in chronic heart failure. Methods Twenty patients (68 ± 7 years old, 20% females) with stable chronic heart failure due to reduced left ventricular ejection fraction (31 ± 8 %) participated in a single-group, pilot study assessing the feasibility and acceptability of a 12-week personalised home-based physical activity intervention aiming to increase daily number of steps by 2000 from baseline (Active-at-Home-HF). Patients completed cardiopulmonary exercise testing with non-invasive gas exchange and haemodynamic measurements and quality of life questionnaire pre- and post-intervention. Patients were supported weekly via telephone and average weekly step count data collected using pedometers. Results Forty-three patients were screened and 20 recruited into the study. Seventeen patients (85%) completed the intervention, and 15 (75%) achieved the target step count. Average step count per day increased significantly from baseline to 3 weeks by 2546 (5108 ± 3064 to 7654 ± 3849, P = 0.03, n = 17) and was maintained until week 12 (9022 ± 3942). Following completion of the intervention, no adverse events were recorded and quality of life improved by 4 points (26 ± 18 vs. 22 ± 19). Peak exercise stroke volume increased by 19% (127 ± 34 vs. 151 ± 34 m/beat, P = 0.05), while cardiac index increased by 12% (6.8 ± 1.5 vs. 7.6 ± 2.0 L/min/m2, P = 0.19). Workload and oxygen consumption at anaerobic threshold also increased by 16% (49 ± 16 vs. 59 ± 14 watts, P = 0.01) and 10% (11.5 ± 2.9 vs. 12.8 ± 2.2 ml/kg/min, P = 0.39). Conclusion The Active-at-Home-HF intervention is feasible, acceptable and effective for increasing physical activity in CHF. It may lead to improvements in quality of life, exercise tolerance and haemodynamic function. Trial Registration www.clinicaltrials.gov NCT0367727. Retrospectively registered on 17 September 2018.
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Affiliation(s)
- Nduka C Okwose
- Cardiovascular Research Theme, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, William Leech Building M4.074, Newcastle upon Tyne, NE2 4HH, UK
| | - Leah Avery
- Centre for Rehabilitation, Exercise and Sports Science, School of Health & Social Care, Teesside University, Tees Valley, UK
| | - Nicola O'Brien
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Sophie Cassidy
- Cardiovascular Research Theme, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, William Leech Building M4.074, Newcastle upon Tyne, NE2 4HH, UK
| | - Sarah J Charman
- Cardiovascular Research Theme, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, William Leech Building M4.074, Newcastle upon Tyne, NE2 4HH, UK
| | - Kristian Bailey
- Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Iacopo Olivotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy
| | - Paul Brennan
- Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Guy A MacGowan
- Cardiovascular Research Theme, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, William Leech Building M4.074, Newcastle upon Tyne, NE2 4HH, UK.,Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Djordje G Jakovljevic
- Cardiovascular Research Theme, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, William Leech Building M4.074, Newcastle upon Tyne, NE2 4HH, UK. .,Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK. .,RCUK Centre for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
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Geerling R, Browne JL, Holmes-Truscott E, Furler J, Speight J, Mosely K. Positive reinforcement by general practitioners is associated with greater physical activity in adults with type 2 diabetes. BMJ Open Diabetes Res Care 2019; 7:e000701. [PMID: 31803479 PMCID: PMC6887508 DOI: 10.1136/bmjdrc-2019-000701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 11/03/2022] Open
Abstract
Objective In a sample of adults with type 2 diabetes mellitus (T2DM), the aim of this study was to examine whether self-reported physical activity level is associated with recall of specific physical activity-related interactions used by general practitioners (GP). Research design and methods Adults with T2DM completed an online survey reporting physical activity behaviors and recall of 14 GP-patient interactions about physical activity, mapped onto discrete behavior change techniques (BCT). Stepped logistical regression examined associations between recommended physical activity (≥600 MET-min/week) and GP-patient interactions, controlling for body mass index, diabetes-related comorbidities, depressive symptoms and self-efficacy. Results In total, 381 respondents (55% men, mean±SD age: 62±10 years and T2DM duration 8±8 years) provided complete data. Most (73%) reported receiving 'general advice', while interactions related to goal setting, monitoring, and relapse prevention were least commonly reported (all <20%). Self-reported achievement of the recommended physical activity level was significantly associated with recall of GP interactions involving praise for 'efforts to be active' (OR 2.1; 95% CI 1.24 to 3.53), 'lost weight' (OR 1.81; 95% CI 1.05 to 3.12) or lowering 'glucose levels as a result of being active' (OR 1.75; 95% CI 1.03 to 2.96). Conclusions Findings suggest GPs can be somewhat effective in promoting physical activity with simple, positive, reinforcing messages/interactions. Future research to develop and evaluate very brief primary care BCT-based physical activity interventions is needed.
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Affiliation(s)
- Ralph Geerling
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Jessica L Browne
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - John Furler
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Kylie Mosely
- BodyMatters Australasia, Sydney, New South Wales, Australia
- University of Technology Sydney, Sydney, New South Wales, Australia
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Hallsworth K, Adams LA. Lifestyle modification in NAFLD/NASH: Facts and figures. JHEP Rep 2019; 1:468-479. [PMID: 32039399 PMCID: PMC7005657 DOI: 10.1016/j.jhepr.2019.10.008] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/16/2022] Open
Abstract
The development of non-alcoholic fatty liver disease is closely linked to lifestyle factors, namely excessive caloric intake coupled with reduced physical activity and exercise. This review aims to examine the evidence behind lifestyle change as a tool to improve hepatic steatosis and liver histology in patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. Furthermore, potential barriers to adopting lifestyle changes and strategies to overcome these barriers in the clinical setting are discussed.
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Affiliation(s)
- Kate Hallsworth
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Liver Unit, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Upon Tyne, UK
- Corresponding author. Address: 4th Floor William Leech Building, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK. Tel.: +44 191 208 8882; fax: +44 191 208 5685.
| | - Leon A. Adams
- Medical School, The University of Western Australia, Perth, WA, Australia
- Department of Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
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Albergoni A, Hettinga FJ, La Torre A, Bonato M, Sartor F. The Role of Technology in Adherence to Physical Activity Programs in Patients with Chronic Diseases Experiencing Fatigue: a Systematic Review. SPORTS MEDICINE - OPEN 2019; 5:41. [PMID: 31512075 PMCID: PMC6739434 DOI: 10.1186/s40798-019-0214-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/19/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The beneficial role of physical activity (PA) to manage the health condition of patients with chronic diseases is well known. However, adherence to PA guidelines in this group is still low. Monitoring and user-interface technology could represent a significant tool to increase exercise adherence to those particular groups who experience difficulties in adhering to regular and substantial physical activity, and could be supportive in increasing the success of PA programs and interventions. This systematic review aimed at evaluating the effect of physical activity monitoring technology in improving adherence to a PA program in patients with chronic diseases experiencing fatigue. METHODS This systematic review was conducted according to PRISMA guidelines. The literature search was performed in Embase, Medline, Biosis, Scopus, and SPORTDiscus. We filtered the literature according to the question: "Does monitoring technology affect adherence to physical activity and exercise programs in patients with chronic diseases perceiving fatigue?". RESULTS The search resulted in 1790 hits; finally, eight studies were included, with a total number of 205 patients. Study quality was moderate except for one study of high quality. Only three disease types emerged, COPD, HF, and cancer. PA programs were rather short (from 8 to 13 weeks) except for one 3-year-long study. Five studies employed pedometers and two an activity monitor. Three studies based their adherence on steps, the remaining studies focused on active minutes. Adherence was explicitly reported in two studies, and otherwise derived. Four studies showed high adherence levels (85% week-10, 89% week-8, 81% week-13, 105% week-13, 83% average week-1-12) and three low levels (56% week-12, 41% year-2, 14 year-3). CONCLUSION The small number of studies identified did not allow to establish whether the use of monitoring technology could improve adherence to PA programs in patients with chronic diseases experiencing fatigue, but the current evidence seems to suggest that this is a field warranting further study, particularly into how monitoring technology can help to engage patients to adhere to PA programs.
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Affiliation(s)
- Andrea Albergoni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands
| | - Florentina J. Hettinga
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Antonio La Torre
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Francesco Sartor
- Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
- College of Health & Behavioural Science, Bangor University, Bangor, UK
- Philips Electronics Nederland B.V, HTC 34 1.011, P.O. Box WB61, 5656 AE Eindhoven, The Netherlands
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Poppe L, De Bourdeaudhuij I, Verloigne M, Shadid S, Van Cauwenberg J, Compernolle S, Crombez G. Efficacy of a Self-Regulation-Based Electronic and Mobile Health Intervention Targeting an Active Lifestyle in Adults Having Type 2 Diabetes and in Adults Aged 50 Years or Older: Two Randomized Controlled Trials. J Med Internet Res 2019; 21:e13363. [PMID: 31376274 PMCID: PMC6696857 DOI: 10.2196/13363] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/16/2023] Open
Abstract
Background Adopting an active lifestyle plays a key role in the prevention and management of chronic diseases such as type 2 diabetes mellitus (T2DM). Web-based interventions are able to alter health behaviors and show stronger effects when they are informed by a behavior change theory. MyPlan 2.0 is a fully automated electronic health (eHealth) and mobile health (mHealth) intervention targeting physical activity (PA) and sedentary behavior (SB) based on the Health Action Process Approach (HAPA). Objective This study aimed to test the short-term effect of MyPlan 2.0 in altering levels of PA and SB and in changing personal determinants of behavior in adults with T2DM and in adults aged ≥50 years. Methods The study comprised two randomized controlled trials (RCTs) with an identical design. RCT 1 was conducted with adults with T2DM. RCT 2 was performed in adults aged ≥50 years. Data were collected via face-to-face assessments. The participants decided either to increase their level of PA or to decrease their level of SB. The participants were randomly allocated with a 2:1 ratio to the intervention group or the waiting-list control group. They were not blinded for their group allocation. The participants in the intervention group were instructed to go through MyPlan 2.0, comprising 5 sessions with an interval of 1 week between each session. The primary outcomes were objectively measured and self-reported PA (ie, light PA, moderate-to-vigorous PA, total PA, number of steps, and domain-specific [eg, transport-related] PA) and SB (ie, sitting time, number of breaks from sitting time, and length of sitting bouts). Secondary outcomes were self-reported behavioral determinants for PA and SB (eg, self-efficacy). Separate linear mixed models were performed to analyze the effects of MyPlan 2.0 in the two samples. Results In RCT 1 (n=54), the PA intervention group showed, in contrast to the control group, a decrease in self-reported time spent sitting (P=.09) and an increase in accelerometer-measured moderate (P=.05) and moderate-to-vigorous PA (P=.049). The SB intervention group displayed an increase in accelerometer-assessed breaks from sedentary time in comparison with the control group (P=.005). A total of 14 participants of RCT 1 dropped out. In RCT 2 (n=63), the PA intervention group showed an increase for self-reported total PA in comparison with the control group (P=.003). Furthermore, in contrast to the control group, the SB intervention group decreased their self-reported time spent sitting (P=.08) and increased their accelerometer-assessed moderate (P=.06) and moderate-to-vigorous PA (P=.07). A total of 8 participants of RCT 2 dropped out. Conclusions For both the samples, the HAPA-based eHealth and mHealth intervention, MyPlan 2.0, was able to improve only some of the primary outcomes. Trial Registration ClinicalTrials.gov NCT03291171; http://clinicaltrials.gov/ct2/show/NCT03291171. ClinicalTrials.gov NCT03799146; http://clinicaltrials.gov/ct2/show/NCT03799146. International Registered Report Identifier (IRRID) RR2-10.2196/12413
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Affiliation(s)
- Louise Poppe
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Maïté Verloigne
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Samyah Shadid
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | | | - Sofie Compernolle
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Dalgetty R, Miller CB, Dombrowski SU. Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews. Br J Health Psychol 2019; 24:334-356. [DOI: 10.1111/bjhp.12356] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/20/2018] [Indexed: 01/08/2023]
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Kebede MM, Zeeb H, Peters M, Heise TL, Pischke CR. Effectiveness of Digital Interventions for Improving Glycemic Control in Persons with Poorly Controlled Type 2 Diabetes: A Systematic Review, Meta-analysis, and Meta-regression Analysis. Diabetes Technol Ther 2018; 20:767-782. [PMID: 30257102 DOI: 10.1089/dia.2018.0216] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Digital interventions may assist patients with type 2 diabetes in improving glycemic control. We aimed to synthesize effect sizes of digital interventions on glycated hemoglobin (HbA1c) levels and to identify effective features of digital interventions targeting patients with poorly controlled type 2 diabetes. MATERIALS AND METHODS MEDLINE, ISI Web of Science, and PsycINFO were searched for randomized controlled trials (RCTs) comparing the effects of digital interventions with usual care. Two reviewers independently assessed studies for eligibility and determined study quality, using the Cochrane Risk of Bias Assessment Tool. The Behavioral Change Technique Taxonomy V1 (BCTTv1) was used to identify BCTs used in interventions. Mean HbA1c differences were pooled using analysis of covariance to adjust for baseline differences and pre-post correlations. To examine effective intervention features and to evaluate differences in effect sizes across groups, meta-regression and subgroup analyses were performed. RESULTS Twenty-three arms of 21 RCTs were included in the meta-analysis (n = 3787 patients, 52.6% in intervention arms). The mean HbA1c baseline differences ranged from -0.2% to 0.64%. The pooled mean HbA1c change was statistically significant (-0.39 {95% CI: [-0.51 to -0.26]} with substantial heterogeneity [I2 statistic, 80.8%]) and a significant HbA1c reduction was noted for web-based interventions. A baseline HbA1c level above 7.5%, β = -0.44 (95% CI: [-0.81 to -0.06]), the BCTs "problem solving," β = -1.30 (95% CI: [-2.05 to -0.54]), and "self-monitoring outcomes of behavior," β = -1.21 (95% CI: [-1.95 to -0.46]) were significantly associated with reduced HbA1c levels. CONCLUSIONS Digital interventions appear effective for reducing HbA1c levels in patients with poorly controlled type 2 diabetes.
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Affiliation(s)
- Mihiretu M Kebede
- 1 Applied Health Intervention Research, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS , Bremen, Germany
- 2 University of Bremen , Health Sciences, Department Public Health, Bremen, Germany
- 3 Institute of Public Health, University of Gondar College of Medicine and Health Sciences , Gondar, Ethiopia
| | - Hajo Zeeb
- 1 Applied Health Intervention Research, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS , Bremen, Germany
- 2 University of Bremen , Health Sciences, Department Public Health, Bremen, Germany
| | - Manuela Peters
- 1 Applied Health Intervention Research, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS , Bremen, Germany
- 2 University of Bremen , Health Sciences, Department Public Health, Bremen, Germany
| | - Thomas L Heise
- 1 Applied Health Intervention Research, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS , Bremen, Germany
- 2 University of Bremen , Health Sciences, Department Public Health, Bremen, Germany
| | - Claudia R Pischke
- 1 Applied Health Intervention Research, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS , Bremen, Germany
- 4 Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf, Germany
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Alghafri TS, Alharthi SM, Al-Farsi Y, Alrawahi AH, Bannerman E, Craigie AM, Anderson AS. 'MOVEdiabetes': a cluster randomized controlled trial to increase physical activity in adults with type 2 diabetes in primary health in Oman. BMJ Open Diabetes Res Care 2018; 6:e000605. [PMID: 30487976 PMCID: PMC6235057 DOI: 10.1136/bmjdrc-2018-000605] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/27/2018] [Accepted: 10/16/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study examined the impact of a multicomponent intervention to increase physical activity (PA) in adults with type 2 diabetes (T2D) in Oman. RESEARCH DESIGN AND METHODS This is a cluster randomized controlled trial in eight primary health centers. Participants were physically inactive, aged ≥18 years, and with no contraindication to PA. Patients attending intervention health centers (n=4) received the 'MOVEdiabetes' intervention, which consisted of personalized, individual face-to-face consultations by dietitians. Pedometers and monthly telephone WhatsApp messages were also used. Patients attending comparison health centers received usual care. The primary outcome was change in PA [Metabolic Equivalent(MET).min/week] after 12 months assessed by the Global Physical Activity Questionnaire. The secondary outcomes were changes in daily step counts, sitting time, weight, body mass index, glycated hemoglobin, blood pressure and lipids. RESULTS Of the 232 participants (59.1% female, mean (SD) age 44.2 (8.1) years), 75% completed the study. At 12 months, the mean change in MET.min/week was +631.3 (95% CI 369.4 to 893.2) in the intervention group (IG) vs +183.2 (95% CI 83.3 to 283.0) in the comparison group, with a significant between-group difference of +447.4 (95% CI 150.7 to 744.1). The odds of meeting PA recommendations were 1.9 times higher in the IG (95% CI 1.2 to 3.3). Significant between-group differences in favor of IG were detected for mean steps/day (+757, 95% CI 18 to 1531) and sitting time hours/ per day (-1.5, 95% CI -2.4 to -0.7). Clinical measures of systolic and diastolic blood pressure and triglycerides also showed significant intervention effects. CONCLUSIONS 'MOVEdiabetes' was effective in increasing PA, the likelihood of meeting PA recommendations, and providing cardioprotective benefits in adults with T2D attending primary care.
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Affiliation(s)
| | | | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Abdul Hakeem Alrawahi
- Department of Planning and Studies, Research Section, Oman Medical Specialty Board, Muscat, Oman
| | - Elaine Bannerman
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Finne E, Glausch M, Exner AK, Sauzet O, Stölzel F, Seidel N. Behavior change techniques for increasing physical activity in cancer survivors: a systematic review and meta-analysis of randomized controlled trials. Cancer Manag Res 2018; 10:5125-5143. [PMID: 30464612 PMCID: PMC6215922 DOI: 10.2147/cmar.s170064] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose The purpose of this systematic review and meta-analysis is to investigate how physical activity (PA) can be effectively promoted in cancer survivors. The effect of PA-promoting interventions in general, behavior change techniques (BCTs), and further variables as moderators in particular are evaluated. Methods This study included randomized controlled trials of lifestyle interventions aiming at an increase in PA that can be carried out independently at home, published by December 2016, for adults diagnosed with cancer after completion of the main treatment. Primary outcomes were subjective and objective measures of PA prior to and immediately after the intervention. Meta-analysis and meta-regression were used to estimate effect sizes (ES) in terms of standardized mean differences, variation between ES in terms of heterogeneity indices (I2), and moderator effects in terms of regression coefficients. Results This study included 30 studies containing 45 ES with an overall significant small positive effect size of 0.28 (95% confidence interval=0.18–0.37) on PA, and I2=54.29%. The BCTs Prompts, Reduce prompts, Graded tasks, Non-specific reward, and Social reward were significantly related to larger effects, while Information about health consequences and Information about emotional consequences, as well as Social comparison were related to smaller ES. The number of BCTs per intervention did not predict PA effects. Interventions based on the Theory of Planned Behavior were associated with smaller ES, and interventions with a home-based setting component were associated with larger ES. Neither the duration of the intervention nor the methodological quality explained differences in ES. Conclusion Certain BCTs were associated with an increase of PA in cancer survivors. Interventions relying on BCTs congruent with (social) learning theory such as using prompts and rewards could be especially successful in this target group. However, large parts of between-study heterogeneity in ES remained unexplained. Further primary studies should directly compare specific BCTs and their combinations.
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Affiliation(s)
- Emily Finne
- School of Public Health, Bielefeld University, Bielefeld, Germany,
| | - Melanie Glausch
- University Cancer Center, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | | | - Odile Sauzet
- School of Public Health, Bielefeld University, Bielefeld, Germany, .,Center for Statistics (ZeSt), Bielefeld University, Bielefeld, Germany
| | - Friederike Stölzel
- University Cancer Center, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Nadja Seidel
- University Cancer Center, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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Granger CL, Parry SM, Edbrooke L, Abo S, Leggett N, Dwyer M, Denehy L. Improving the delivery of physical activity services in lung cancer: A qualitative representation of the patient’s perspective. Eur J Cancer Care (Engl) 2018; 28:e12946. [DOI: 10.1111/ecc.12946] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 08/10/2018] [Accepted: 09/08/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Catherine L. Granger
- Department of Physiotherapy; The University of Melbourne; Parkville Victoria Australia
- Department of Physiotherapy; Royal Melbourne Hospital; Parkville Victoria Australia
| | - Selina M. Parry
- Department of Physiotherapy; The University of Melbourne; Parkville Victoria Australia
| | - Lara Edbrooke
- Department of Physiotherapy; The University of Melbourne; Parkville Victoria Australia
- Peter MacCallum Cancer Centre; Allied Health; Melbourne Victoria Australia
| | - Shaza Abo
- Department of Physiotherapy; Royal Melbourne Hospital; Parkville Victoria Australia
| | - Nina Leggett
- Department of Physiotherapy; The University of Melbourne; Parkville Victoria Australia
- Department of Physiotherapy; Royal Melbourne Hospital; Parkville Victoria Australia
| | - Martha Dwyer
- Department of Physiotherapy; The University of Melbourne; Parkville Victoria Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre; Allied Health; Melbourne Victoria Australia
- Melbourne School of Health Sciences; The University of Melbourne; Parkville Victoria Australia
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Sigal RJ, Armstrong MJ, Bacon SL, Boulé NG, Dasgupta K, Kenny GP, Riddell MC. Physical Activity and Diabetes. Can J Diabetes 2018; 42 Suppl 1:S54-S63. [PMID: 29650112 DOI: 10.1016/j.jcjd.2017.10.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/15/2022]
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Willems M, Waninge A, Hilgenkamp TIM, van Empelen P, Krijnen WP, van der Schans CP, Melville CA. Effects of lifestyle change interventions for people with intellectual disabilities: Systematic review and meta-analysis of randomized controlled trials. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:949-961. [DOI: 10.1111/jar.12463] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Mariël Willems
- Research Group Healthy Ageing; Allied Health Care and Nursing; Hanzehogeschool Groningen; Groningen The Netherlands
| | - Aly Waninge
- Research Group Healthy Ageing; Allied Health Care and Nursing; Hanzehogeschool Groningen; Groningen The Netherlands
| | - Thessa I. M. Hilgenkamp
- Department of General Practice; Intellectual Disability Medicine; Erasmus MC University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Pepijn van Empelen
- Research Group Child Health; Netherlands Institute of Applied Scientific Research; Leiden The Netherlands
| | - Wim P. Krijnen
- Research Group Healthy Ageing; Allied Health Care and Nursing; Hanzehogeschool Groningen; Groningen The Netherlands
| | - Cees P. van der Schans
- Research Group Healthy Ageing; Allied Health Care and Nursing; Hanzehogeschool Groningen; Groningen The Netherlands
| | - Craig A. Melville
- Institute of Health and Wellbeing; College of Medical Veterinary and Life Sciences; Gartnavel Royal Hospital; University of Glasgow; Glasgow UK
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Fredrix M, McSharry J, Flannery C, Dinneen S, Byrne M. Goal-setting in diabetes self-management: A systematic review and meta-analysis examining content and effectiveness of goal-setting interventions. Psychol Health 2018; 33:955-977. [DOI: 10.1080/08870446.2018.1432760] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Milou Fredrix
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Jenny McSharry
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Caragh Flannery
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Sean Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Molly Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
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van Ommen B, Wopereis S, van Empelen P, van Keulen HM, Otten W, Kasteleyn M, Molema JJW, de Hoogh IM, Chavannes NH, Numans ME, Evers AWM, Pijl H. From Diabetes Care to Diabetes Cure-The Integration of Systems Biology, eHealth, and Behavioral Change. Front Endocrinol (Lausanne) 2018; 8:381. [PMID: 29403436 PMCID: PMC5786854 DOI: 10.3389/fendo.2017.00381] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/26/2017] [Indexed: 12/23/2022] Open
Abstract
From a biological view, most of the processes involved in insulin resistance, which drives the pathobiology of type 2 diabetes, are reversible. This theoretically makes the disease reversible and curable by changing dietary habits and physical activity, particularly when adopted early in the disease process. Yet, this is not fully implemented and exploited in health care due to numerous obstacles. This article reviews the state of the art in all areas involved in a diabetes cure-focused therapy and discusses the scientific and technological advancements that need to be integrated into a systems approach sustainable lifestyle-based healthcare system and economy. The implementation of lifestyle as cure necessitates personalized and sustained lifestyle adaptations, which can only be established by a systems approach, including all relevant aspects (personalized diagnosis and diet, physical activity and stress management, self-empowerment, motivation, participation and health literacy, all facilitated by blended care and ehealth). Introduction of such a systems approach in type 2 diabetes therapy not only requires a concerted action of many stakeholders but also a change in healthcare economy, with new winners and losers. A "call for action" is put forward to actually initiate this transition. The solution provided for type 2 diabetes is translatable to other lifestyle-related disorders.
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Affiliation(s)
- Ben van Ommen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Suzan Wopereis
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Pepijn van Empelen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Hilde M. van Keulen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Wilma Otten
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Marise Kasteleyn
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Johanna J. W. Molema
- Netherlands Organization for Applied Scientific Research (TNO), Department of Work Health Technology, Leiden, Netherlands
| | - Iris M. de Hoogh
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Niels H. Chavannes
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Mattijs E. Numans
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Andrea W. M. Evers
- Department of Health, Medical and Neuropsychology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Hanno Pijl
- Leiden University Medical Center (LUMC), Department of Internal Medicine, Leiden, Netherlands
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Barriers to Translation of Physical Activity into the Lung Cancer Model of Care. A Qualitative Study of Clinicians' Perspectives. Ann Am Thorac Soc 2018; 13:2215-2222. [PMID: 27689958 DOI: 10.1513/annalsats.201607-540oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RATIONALE Evidence-based clinical practice guidelines recommend physical activity for people with lung cancer, however evidence has not translated into clinical practice and the majority of patients do not meet recommended activity levels. OBJECTIVES To identify factors (barriers and enablers) that influence clinicians' translation of the physical activity guidelines into practice. METHODS Qualitative study involving 17 participants (three respiratory physicians, two thoracic surgeons, two oncologists, two nurses, and eight physical therapists) who were recruited using purposive sampling from five hospitals in Melbourne, Victoria, Australia. Nine semistructured interviews and a focus group were conducted, transcribed verbatim, and independently cross-checked by a second researcher. Thematic analysis was used to analyze data. MEASUREMENTS AND MAIN RESULTS Five consistent themes emerged: (1) the clinicians perception of patient-related physical and psychological influences (including symptoms and comorbidities) that impact on patient's ability to perform regular physical activity; (2) the influence of the patient's past physical activity behavior and their perceived relevance and knowledge about physical activity; (3) the clinicians own knowledge and beliefs about physical activity; (4) workplace culture supporting or hindering physical activity; and (5) environmental and structural influences in the healthcare system (included clinicians time, staffing, protocols and services). Clinicians described potential strategies, including: (1) the opportunity for nurse practitioners to act as champions of regular physical activity and triage referrals for physical activity services; (2) opportunistically using the time when patients are in hospital after surgery to discuss physical activity; and (3) for all members of the multidisciplinary team to provide consistent messages to patients about the importance of physical activity. CONCLUSIONS Key barriers to implementation of the physical activity guidelines in lung cancer are diverse and include both clinician- and healthcare system-related factors. A combined approach to target a number of these factors should be used to inform research, improve clinical services, and develop policies aiming to increase physical activity and improve survivorship outcomes for patients with lung cancer.
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Alghafri TS, Alharthi SM, Al-Balushi S, Al-Farsi Y, Al-Busaidi Z, Bannerman E, Craigie AM, Anderson AS. Health professionals' perceptions about physical activity promotion in diabetes care within primary health care settings in Oman. Heliyon 2018; 3:e00495. [PMID: 29387824 PMCID: PMC5768664 DOI: 10.1016/j.heliyon.2017.e00495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/24/2022] Open
Abstract
Background As part of formative work to inform an interventional design to increase physical activity (PA) in patients with type 2 diabetes in Oman, this qualitative study aimed to determine health professionals’ perception of barriers and opportunities, personnel responsibilities and plausible PA promotional approaches. Methods Four focus group discussions were carried out with groups of health care professionals (family physicians, dieticians and health educators, managers and general practitioners). All discussions were audio recorded and transcribed. Responses were analysed using a thematic analysis. Results Barriers to PA reported by participants (n = 29) were identified at three levels: health care system (e.g. deficient PA guidelines); individual (e.g. obstructive social norms) and community (e.g. lack of facilities). Participants felt that a multilevel approach is needed to address perceived barriers and to widen current opportunities. In the presence of various diabetes primary care providers, the potential for dieticians to include individualised PA consultations as part of their role was highlighted. Participants felt that consultations should be augmented by approaches within the community (volunteer support and/or appropriate facilities). However, despite lack of experience with technology supported approaches and motivational tools, the telephone application “WhatsApp” and use of pedometers were considered potentially suitable. The need for training in behaviour change techniques and clearly communicated intervention guidelines was emphasised. Conclusions A multi-component approach including PA consultations, possibly led by trained dieticians, technological routes for providing support along with community mapping for resources appear to offer promising approaches for further PA intervention studies within diabetes primary health care.
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Affiliation(s)
- Thamra S Alghafri
- Directorate General of Health Services, Ministry of Health, Muscat, Oman.,Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Saud M Alharthi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Samiya Al-Balushi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Zakiya Al-Busaidi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Elaine Bannerman
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Kebede M, Christianson L, Khan Z, Heise TL, Pischke CR. Effectiveness of behavioral change techniques employed in eHealth interventions designed to improve glycemic control in persons with poorly controlled type 2 diabetes: a systematic review and meta-analysis protocol. Syst Rev 2017; 6:211. [PMID: 29065911 PMCID: PMC5655972 DOI: 10.1186/s13643-017-0609-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 10/16/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The incorporation of Behavioral Change Techniques (BCTs) in eHealth interventions for the management of non-communicable diseases (NCDs), such as type 2 diabetes mellitus (T2DM), might be a promising approach to improve clinical and behavioral outcomes of NCDs in the long run. This 3paper reports a protocol for a systematic review that aims to (a) identify the effects of individual BCTs in eHealth interventions for lowering glycated hemoglobin levels (HbA1c) and (b) investigate which additional intervention features (duration of intervention, tailoring, theory-base, and mode of delivery) affect levels of HbA1c in this population. The protocol follows the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 guideline. METHODS/DESIGN To identify eligible studies, an extensive systematic database search (PubMed, Web of Science, and PsycINFO) using keywords will be conducted. This review will include randomized controlled trials examining the effects of eHealth interventions on HbA1c in persons with poorly controlled T2DM over a minimum follow-up period of 3 months. Relevant data will be extracted from the included studies using Microsoft Excel. The content of the interventions will be extracted from the description of interventions and will be classified according to the BCT taxonomy v1 tool. The quality of studies will be independently assessed by two reviewers using the Cochrane risk of bias tool. If the studies have adequate homogeneity, meta-analysis will be considered. The effect sizes of each BCT will be calculated using the random effect model. The quality of the synthesized evidence will be evaluated employing the Grading of the Recommendations Assessment, Development and Evaluation (GRADE) criteria. DISCUSSION This systematic review is one of the firsts to appraise the effectiveness of eHealth interventions employing BCTs which aimed at improving glycemic control in persons with poorly controlled T2DM. The review will aggregate the effect sizes of BCTs on HbA1c levels. The results may inform future eHealth interventions targeting poorly controlled T2DM populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016049940.
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Affiliation(s)
- Mihiretu Kebede
- University of Bremen, Health Sciences, Grazer Strasse 2, D-28359, Bremen, Germany. .,Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany. .,University of Gondar, College of Medicine and Health Science, Institute of Public Health, Gondar, Ethiopia.
| | - Lara Christianson
- University of Bremen, Health Sciences, Grazer Strasse 2, D-28359, Bremen, Germany
| | - Zohaib Khan
- University of Bremen, Health Sciences, Grazer Strasse 2, D-28359, Bremen, Germany.,Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Khyber Medical University, Peshawar, Pakistan
| | - Thomas L Heise
- University of Bremen, Health Sciences, Grazer Strasse 2, D-28359, Bremen, Germany.,Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Claudia R Pischke
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Kongstad MB, Valentiner LS, Ried-Larsen M, Walker KC, Juhl CB, Langberg H. Effectiveness of remote feedback on physical activity in persons with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. J Telemed Telecare 2017; 25:26-34. [DOI: 10.1177/1357633x17733772] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The objective of this systematic review and meta-analysis was to examine the effectiveness of remote feedback intervention compared with standardized treatment on physical activity levels in persons with type 2 diabetes. Further, to investigate the influence of the length of intervention, number of contacts, study size, delivery of feedback, and preliminary face-to-face sessions. Methods A systematic literature search was conducted in May 2017, with a priori defined eligibility criteria: randomized controlled trials investigating remote feedback interventions in adult persons with type 2 diabetes, using physical activity as outcome. The effect size was calculated as standardized mean difference (SMD) and was pooled in a meta-analysis using a random-effects model. Meta-regression analyses were performed to examine if the observed effect size could be attributed to study- or intervention characteristics using these as covariates. Results The literature search identified 4455 articles of which 27 met the eligibility criteria. The meta-analysis including a total of 4215 participants found an overall effect size in favour of remote feedback interventions compared to standardized treatment, SMD = 0.33 (95% CI: 0.17 to 0.49), I2 = 81.7%). Analyses on study characteristics found that the effect on physical activity was only influenced by study size, with a larger effect in small studies. Conclusion Adding remote feedback to standardized treatments aimed at increasing physical activity in persons with type 2 diabetes showed a small to moderate additional increase in physical activity levels. Systematic review registration: PROSPERO CRD42016033479.
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Affiliation(s)
- Malte Bue Kongstad
- CopenRehab, Section of Social Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, Denmark
| | - Laura Staun Valentiner
- CopenRehab, Section of Social Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, Denmark
- The Danish Diabetes Academy, Department of Endocrinology, Odense University Hospital, Denmark
| | - Karen Christina Walker
- CopenRehab, Section of Social Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Carsten Bogh Juhl
- Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
- Department of Rehabilitation, University of Copenhagen, Herlev and Gentofte Hospital, Denmark
| | - Henning Langberg
- CopenRehab, Section of Social Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, Denmark
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Alghafri TS, Alharthi SM, Al-Farsi Y, Bannerman E, Craigie AM, Anderson AS. Correlates of physical activity and sitting time in adults with type 2 diabetes attending primary health care in Oman. BMC Public Health 2017; 18:85. [PMID: 28764700 PMCID: PMC5539993 DOI: 10.1186/s12889-017-4643-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background Despite evidence of the benefits of physical activity in the management of type 2 diabetes, it is poorly addressed in diabetes care. This study aimed to identify the prevalence and correlates of meeting ≥600MET-min/wk. (150 min/wk) of physical activity and sitting time in adults with type 2 diabetes in Oman. Approaches to encourage physical activity in diabetes care were explored. Methods A cross-sectional study using the Global Physical Activity Questionnaire was conducted in 17 randomly selected primary health centres in Muscat. Clinical data including co-morbidities were extracted from the health information system. Questions on physical activity preferences and approaches were included. Patients were approached if they were ≥18 years, and had been registered in the diabetes clinic for >2 years. Results The questionnaire was completed by 305 people (females 57% and males 43%). Mean age (SD) was 57 (10.8) years and mean BMI (SD) was 31.0 (6.0) kg/m2. Duration of diabetes ranged from 2 to 25 (mean 7.6) years. Hypertension (71%) and dyslipidaemia (62%) were common comorbidities. Most (58.4%) had an HbA1c ≥7% indicating poor glycaemic control (55% in males vs 61% in females). Physical activity recommendations were met by 21.6% of the participants, mainly through leisure activities. Odds of meeting the recommendations were significantly higher in males (OR 4.8, 95% CI 2.5–9.1), individuals ≤57 years (OR 3.0, 95% CI 1.6–5.9), those at active self-reported stages of change for physical activity (OR 2.2, 95% CI 1.2–4.1) and those reporting no barriers to performing physical activity (OR 2.7, 95% CI 1.4–4.9). Median (25th, 75th percentiles) sitting time was 705 (600, 780) min/d. Older age (>57 years) was associated with longer sitting time (>705 min/d) (OR 2.8, 95% CI 1.7–4.6). Preferred methods to support physical activity in routine diabetes care were consultations (38%), structured physical activity sessions (13.4%) and referrals to physical activity facilities (5.6%) delivered by a variety of health care providers. Conclusions The results suggest that intervention strategies should take account of gender, age, opportunities within daily life to promote active behaviour and readiness to change. Offering physical activity consultations is of interest to this study population, thus development and evaluation of interventions are warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4643-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thamra S Alghafri
- Health Services, Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman.
| | - Saud M Alharthi
- Health Services, Ministry of Health, PO Box 2723, Postal Code 112, Muscat, Oman
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Elaine Bannerman
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Henze M, Alfonso H, Flicker L, George J, Chubb SAP, Hankey GJ, Almeida OP, Golledge J, Norman PE, Yeap BB. Profile of diabetes in men aged 79-97 years: the Western Australian Health in Men Study. Diabet Med 2017; 34:786-793. [PMID: 27761946 DOI: 10.1111/dme.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 01/22/2023]
Abstract
AIMS To investigate behavioural, physical and biochemical characteristics associated with diabetes in the oldest age group of elderly men. METHODS We conducted a cross-sectional analysis of community-dwelling men aged 79-97 years from Perth, Western Australia. Lifestyle behaviours, self-rated health, physical function, and fasting glucose and HbA1c levels were assessed. RESULTS Of 1426 men, 315 had diabetes (22%). Men with diabetes were of similar age to men without (84.9 vs 84.5 years; P = 0.14). Only 26.5% of men with diabetes self-rated their health as excellent or very good, compared with 40.6% of men without diabetes (P < 0.001). Diabetes was associated with less involvement with recreational walking (32.7 vs 41.0%; P < 0.01) and leisure activities (19.0 vs 26.5%; P < 0.01). Men with diabetes had poorer physical function on multiple measures, including longer times for the Timed Up-and-Go test (15.0 ± 6.9 s vs 13.4 ± 5.3 s; P < 0.001) and weaker knee extension (20.2 vs 21.9 kg; P < 0.001). In multivariate analyses, diabetes was associated with an increased prevalence of myocardial infarction (odds ratio 1.80, 95% CI 1.25-2.60; P < 0.001) and falls resulting in injury (odds ratio 1.55, 95% CI 1.06-2.26; P = 0.02). Average HbA1c was 49 ± 8 mmol/mol (6.6 ± 0.8%) in men with diabetes, with 90.6% of these men on diet or oral hypoglycaemic therapy. CONCLUSIONS In older men, diabetes is associated with poorer self-perceived health, reduced healthy lifestyle behaviours and physical function, heart disease and injurious falls. The majority of these men with diabetes had good glycaemic control. Encouraging healthy lifestyle behaviours and improving physical function should be evaluated as interventions to improve quality-of-life and health outcomes.
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Affiliation(s)
- M Henze
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - H Alfonso
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - L Flicker
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - J George
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - S A P Chubb
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - G J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - O P Almeida
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia
| | - J Golledge
- Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Queensland, Australia
| | - P E Norman
- School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - B B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Praidou A, Harris M, Niakas D, Labiris G. Physical activity and its correlation to diabetic retinopathy. J Diabetes Complications 2017; 31:456-461. [PMID: 27469296 DOI: 10.1016/j.jdiacomp.2016.06.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/08/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The lack of physical activity, along with obesity, smoking, hypertension and hyperglycaemia are considered as risk factors for the occurrence of diseases such as diabetes. Primary objective of the study was to investigate potential correlation between physical activity and diabetic retinopathy. PATIENTS AND METHODS Three hundred and twenty patients were included in the study: 240 patients with diabetes type 2 (80 patients with mild to moderate non-proliferative diabetic retinopathy, 80 patients with severe to very severe non-proliferative diabetic retinopathy and 80 ones with proliferative diabetic retinopathy) were compared with 80 non-diabetic patients (control group). Physical activity of patients was assessed by the international physical activity questionnaire (IPAQ, 2002). HbA1c and BMI were also measured in diabetic patients. Group comparisons were attempted for levels of physical activity and sedentary behavior. RESULTS Total physical activity was decreased in patients with severe to very severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy as compared to patients with mild to moderate non-proliferative diabetic retinopathy and to the control group (p<0.05). Significant negative correlation was detected between HbA1c levels, BMI and physical activity (both p<0.05). Moreover, significant negative correlation between the severity of diabetic retinopathy and physical activity has been demonstrated (p<0.05). CONCLUSIONS Increased physical activity is associated with less severe levels of diabetic retinopathy, independent of the effects of HbA1c and BMI.
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Affiliation(s)
- Anna Praidou
- Dept. of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom; Faculty of Social Sciences, Hellenic Open University, Patra, Greece.
| | - Martin Harris
- Dept. of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Dimitrios Niakas
- Faculty of Social Sciences, Hellenic Open University, Patra, Greece
| | - Georgios Labiris
- Faculty of Social Sciences, Hellenic Open University, Patra, Greece; Dept. of Ophthalmology, Democritus University of Thrace, Alexandroupolis, Greece
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