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Selles WL, Santos EC, Romero BD, Lunardi AC. Effectiveness of gamified exercise programs on the level of physical activity in adults with chronic diseases: a systematic review. Disabil Rehabil 2024:1-9. [PMID: 38444153 DOI: 10.1080/09638288.2024.2323614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE to assess the effects of supervised and unsupervised gamified exercise programs on physical activity level, sedentary behavior and quality of life in patients with non-communicable chronic diseases. MATERIALS AND METHODS Six database were searched. Methodological quality of included studies, the quality of reporting interventions and the quality of the applications were assessed using the PEDro, TIDieR and MARS, respectively. RESULTS Nine studies were included (n = 974; 60.2 ± 5.7 years). Three of them enrolled individuals with cancer, one with stroke, one with multiple sclerosis, one with COPD, two with Diabetes Mellitus, and one with knee and hip osteoarthritis. Gamification was performed via a smartphone application in three studies (MARS = 13.4 ± 9.75pts, ranging from 10.9 to 16.9pts). The intervention was supervised in six studies. The PEDro and TIDIeR scores were 5.5 ± 1.3 (ranging 0-8pts) and 16.11 ± 3.14 (ranging 10-20pts), respectively. Supervised gamified interventions increased the level of physical activity compared to usual supervised exercises. Quality of life was similar between groups. Unsupervised interventions were similar for all outcomes evaluated. CONCLUSIONS Supervised gamified exercise programs seem to increase the level of physical activity compared to usual exercises in patients with chronic diseases. However, studies with better methodological qualities and subgroup analyzes are needed.
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Affiliation(s)
- William L Selles
- Physical Therapy Programs, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | - Elinaldo C Santos
- Physical Therapy Programs, Universidade Cidade de São Paulo, Sao Paulo, Brazil
- Department of Biological and Health Sciences, Universidade Federal do Amapá, Macapá, Brazil
| | - Bianka D Romero
- Physical Therapy Programs, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | - Adriana C Lunardi
- Physical Therapy Programs, Universidade Cidade de São Paulo, Sao Paulo, Brazil
- Department of Physical Therapy of School of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Masuda H, Iwashima F, Ishiyama D, Nakajima H, Kimura Y, Otobe Y, Suzuki M, Koyama S, Tanaka S, Kojima I, Yamada M. Effect of Exercise Therapy on Incident Admission in Patients with Type 2Diabetes Mellitus Undergoing Inpatient Diabetes Self-manageme ntEducation and Support. Curr Diabetes Rev 2024; 20:e211123223677. [PMID: 37990899 DOI: 10.2174/0115733998269490231106190128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Exercise therapy is the key to preventing admission of patients with type 2 diabetes mellitus (T2DM). However, a few studies have examined the effects of exercise therapy on patients with T2DM undergoing inpatient diabetes self-management education and support (IDSMES). OBJECTIVE This study investigated whether exercise therapy influenced the incidence of admission after discharge in patients with T2DM undergoing IDSMES. METHODS This retrospective cohort study included patients with T2DM who underwent IDSMES between June 2011 and May 2015. Overall, 258 patients were included in this study. The exercise therapy program was implemented in June 2013. Accordingly, patients diagnosed between June 2011 and May 2013 were categorized as the non-exercise therapy program group, while those diagnosed between June 2013 and May 2015 were categorized as the exercise therapy program group. Outcomes were incident diabetes-related and all-cause admissions within 1 year of discharge. Multiple logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the exercise therapy program's impact on the outcomes. RESULTS Within 1 year of discharge, 27 (10.5%) patients underwent diabetes-related admissions and 62 (24.0%) underwent all-cause admissions. Multiple logistic regression analyses showed a significant association of the exercise therapy program with incident diabetes-related and allcause admissions [OR: 0.22 (95% CI: 0.08-0.59) and 0.44 (95% CI: 0.22-0.86), respectively]. CONCLUSION Exercise therapy programs significantly lowered the incidences of diabetes-related and all-cause admissions. This indicates that implementing exercise therapy during hospitalization may be important for preventing admissions of patients with T2DM receiving IDSMES.
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Affiliation(s)
- Hiroaki Masuda
- Department of Rehabilitation, Tokyo Metropolitan Toshima Hospital, Tokyo Metropolitan Hospital Organization, 33-1 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Fumiko Iwashima
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Toshima Hospital, Tokyo Metropolitan Hospital Organization, 33-1 Sakaecho, Itabashi-ku, Tokyo, 173- 0015, Japan
| | - Daisuke Ishiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Hideki Nakajima
- Department of Rehabilitation, Tokyo Metropolitan Toshima Hospital, Tokyo Metropolitan Hospital Organization, 33-1 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Yosuke Kimura
- Health and Sports Technology Course, College of Science and Engineering, Kanto Gakuin University, 1- 50-1 Mutsuura, Kanazawa-ku, Yokohama, 236-8501, Japan
| | - Yuhei Otobe
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, 3-7-30 Habikino, Habikino-city, Osaka, 583-8555, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Shu Tanaka
- Major of Physical Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo, 144-8535, Japan
| | - Iwao Kojima
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
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Wu S, Li G, Shi B, Ge H, Chen S, Zhang X, He Q. Comparative effectiveness of interventions on promoting physical activity in older adults: A systematic review and network meta-analysis. Digit Health 2024; 10:20552076241239182. [PMID: 38601186 PMCID: PMC11005496 DOI: 10.1177/20552076241239182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/27/2024] [Indexed: 04/12/2024] Open
Abstract
Background Despite the well-established health benefits of physical activity, a large population of older adults still maintain sedentary life style or physical inactivity. This network meta-analysis (NMA) aimed to compare the effectiveness of wearable activity tracker-based intervention (WAT), electronic and mobile health intervention (E&MH), structured exercise program intervention (SEP), financial incentive intervention (FI) on promoting physical activity and reducing sedentary time in older adults. Methods The systematic review based on PRISMA guidelines, a systematic literature search of PubMed, Web of Science, Google Scholar, EMbase, Cochrane Library, Scopus were searched from inception to December 10th 2022. The randomized controlled trials (RCT) were included. Two reviewers independently conducted study selection, data extraction, risk of bias and certainty of evidence assessment. The effect measures were standard mean differences (SMD) and 95% confidence interval (CI) in daily steps, moderate-to-vigorous physical activity (MVPA) and sedentary time. Results A total of 69 studies with 14,120 participants were included in the NMA. Among these included studies, the results of daily steps, MVPA and sedentary time was reported by 55, 25 and 15 studies, respectively. The NMA consistency model analysis suggested that the following interventions had the highest probability (surface under the cumulative ranking, SUCRA) of being the best when compared with control: FI + WAT for daily steps (SUCRA = 96.6%; SMD = 1.32, 95% CI:0.77, 1.86), WAT + E&MH + SEP for MVPA (SUCRA = 91.2%; SMD = 0.94, 95% CI: 0.36, 1.52) and WAT + E&MH + SEP for sedentary time (SUCRA = 80.3%; SMD = -0.50, 95% CI: -0.87, -0.14). The quality of the evidences of daily steps, MVPA and sedentary time was evaluated by very low, very low and low, respectively. Conclusions In this NMA, there's low quality evidence that financial incentive combined with wearable activity tracker is the most effective intervention for increasing daily steps of older adults, wearable activity tracker combined with electronic and mobile health and structured exercise program is the most effective intervention to help older adults to increase MVPA and reduce sedentary time.
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Affiliation(s)
- Shuang Wu
- School of Physical Education, Shandong University, Jinan, China
| | - Guangkai Li
- School of Physical Education, Shandong University, Jinan, China
| | - Beibei Shi
- School of Physical Education, Shandong University, Jinan, China
| | - Hongli Ge
- School of Physical Education, Shandong University, Jinan, China
| | - Si Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, China
| | - Qiang He
- School of Physical Education, Shandong University, Jinan, China
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Li X, Chattopadhyay K, Chen X, Li J, Xu M, Chen X, Li L. Association Between Physical Activity and Arterial Stiffness in Patients with Type 2 Diabetes in Ningbo, China: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2023; 16:4133-4141. [PMID: 38145257 PMCID: PMC10740718 DOI: 10.2147/dmso.s438344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023] Open
Abstract
Aim The study aimed to investigate the association between physical activity and arterial stiffness in patients with type 2 diabetes mellitus (T2DM) in Ningbo, China. Methods A cross-sectional study was conducted using the Metabolic Management Center (MMC) dataset of The First Affiliated Hospital of Ningbo University from 1st March 2018 to 28th February 2023. 4444 adults with T2DM were included in the study. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ)-Short and was categorized into high, moderate, and low. Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1800cm/s or common carotid artery intima-media thickness (CCA IMT) ≥1mm. Multiple logistic regression analyses were performed to identify the association between physical activity and arterial stiffness. Results 6.5%, 47.0%, and 46.5% of patients with T2DM had high, moderate, and low physical activity, respectively. 18.8% and 17.5% of patients had arterial stiffness based on baPWV and CCA IMT, respectively. The odds of arterial stiffness (based on baPWV) were lower in patients having moderate to high physical activity (OR 0.82, 95% CI 0.68 to 0.98 and OR 0.58, 95% CI 0.39 to 0.87, respectively). The odds of arterial stiffness (based on CCA IMT) were found to be lower in patients having high physical activity (OR 0.49, 95% CI 0.33 to 0.74). Conclusion Higher physical activity was found to be associated with lower arterial stiffness in patients with T2DM in Ningbo, China. This was a cross-sectional study, and there is a need to conduct longitudinal studies on this topic.
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Affiliation(s)
- Xueyu Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Kaushik Chattopadhyay
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Xiaoting Chen
- School of Medicine, Ningbo University, Ningbo, People’s Republic of China
| | - Jialin Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Miao Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xueqin Chen
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Li Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
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Lefferts EC, Saavedra JM, Song BK, Brellenthin AG, Pescatello LS, Lee DC. Increasing Lifestyle Walking by 3000 Steps per Day Reduces Blood Pressure in Sedentary Older Adults with Hypertension: Results from an e-Health Pilot Study. J Cardiovasc Dev Dis 2023; 10:317. [PMID: 37623330 PMCID: PMC10455876 DOI: 10.3390/jcdd10080317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Increasing daily steps by an additional 3000 steps/day on 5 days/week equates to ~150 min/week of aerobic physical activity to meet the physical activity guidelines; however, its effectiveness for blood pressure control in older adults with hypertension is unknown. A 20-week, single-arm, pilot e-health lifestyle walking intervention was conducted in 21 sedentary older adults (73 ± 5 years old) with hypertension (13 female, 8 male) to investigate the effectiveness of increasing daily steps by an additional 3000 steps/day for blood pressure control. The intervention consisted of two phases, with behavior change assistance provided during the first active phase (weeks 1-10) to help reach step goals and minimal assistance provided during the second self-maintenance phase (weeks 11-20). Nineteen participants (91%) completed both the 10- and 20-week assessments. The participants wore the pedometer for ≥10 h on 97% of the days over 20 weeks. They significantly increased average steps/day from 3899 ± 2198 at baseline to 6512 ± 2633 at 10 weeks and 5567 ± 2587 at 20 weeks. After 20 weeks, both systolic (137 ± 10 to 130 ± 11 mm Hg, p < 0.001) and diastolic (81 ± 6 to 77 ± 6 mm Hg, p = 0.01) blood pressure improved. The response was consistent in participants with (n = 8) and without (n = 13) anti-hypertensive medication. The results of our lifestyle walking intervention are encouraging for reducing blood pressure in older adults with hypertension; however, larger randomized, controlled trials need to be performed to confirm these findings.
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Affiliation(s)
- Elizabeth C. Lefferts
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
| | - Joseph M. Saavedra
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
| | - Bong Kil Song
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
| | - Angelique G. Brellenthin
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
| | | | - Duck-chul Lee
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA; (E.C.L.); (J.M.S.); (A.G.B.)
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Heizmann AN, Chapelle C, Laporte S, Roche F, Hupin D, Le Hello C. Impact of wearable device-based interventions with feedback for increasing daily walking activity and physical capacities in cardiovascular patients: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2023; 13:e069966. [PMID: 37433730 DOI: 10.1136/bmjopen-2022-069966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE To systematically review randomised controlled trials (RCTs) using a wearable physical activity monitoring device as an intervention to increase daily walking activity and improve physical capacities in patients with cardiovascular disease (CVD). DESIGN Systematic review and meta-analysis of RCTs. DATA SOURCES PubMed, Embase and Web of Science from inception to June 2022. ELIGIBILITY CRITERIA Randomised controlled studies including patients with CVD over 18 years of age at the end of a cardiac rehabilitation programme comparing an intervention group using a wearable physical activity monitoring device with feedback with usual care or with a control group receiving no feedback on their physical activity and reporting a change in the daily number of steps and/or a change in the distance covered in the 6-minute walk test (6-MWT) or a change in peak oxygen uptake (V̇O2peak) as endpoints. RESULTS Sixteen RCTs were included. The intervention of wearing a physical activity monitoring device with feedback significantly improved daily number of steps compared with controls (standardised mean difference (SMD) 0.85; 95% CI (0.42; 1.27); p<0.01). The effect was greater when the duration of the intervention was less than 3 months (SMD 1.0; 95% CI (0.18; 1.82); p<0.01) than when the duration of the intervention was 3 months or longer (SMD 0.71; 95% CI (0.27; 1.16); p<0.01), but no significant interaction was found between subgroups (p=0.55). 6-MWT distance and V̇O2peak showed only small effects (SMD 0.34; 95% CI (-0.11; 0.80); p=0.02 and SMD 0.54; 95% CI (0.03; 1.03); p=0.07, respectively). CONCLUSION The use of wearable physical activity monitoring devices appears to help patients with CVD to increase their daily walking activity and thus their physical activity, particularly in the short term. PROSPERO REGISTRATION NUMBER CRD42022300423.
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Affiliation(s)
- Anne-Noëlle Heizmann
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
| | - Céline Chapelle
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Clinical Research Unit, Innovation, Pharmacology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Silvy Laporte
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Clinical Research Unit, Innovation, Pharmacology, Saint-Etienne University Hospital, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
| | - Frederic Roche
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
- Department of Physiology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - David Hupin
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
- Department of Physiology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Claire Le Hello
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
- Department of Vascular and Therapeutic Medicine, Saint-Etienne University Hospital, Saint-Etienne, France
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Wu S, Li G, Du L, Chen S, Zhang X, He Q. The effectiveness of wearable activity trackers for increasing physical activity and reducing sedentary time in older adults: A systematic review and meta-analysis. Digit Health 2023; 9:20552076231176705. [PMID: 37252261 PMCID: PMC10214103 DOI: 10.1177/20552076231176705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Background Traditional interventions such as education and counseling are successful in increasing physical activity (PA) participation, but are usually labor and resource intensive. Wearable activity trackers can objectively record PA and provide feedback to help users to achieve activity goals and are an increasingly popular tool among adults used to facilitate self-monitoring of PA. However, no reviews systematically explored the roles of wearable activity trackers in older populations. Methods We searched PubMed, Web of Science, Google Scholar, Embase, Cochrane Library, and Scopus from inception to September 10, 2022. Randomized controlled trials were included. Two reviewers independently conducted study selection, data extraction, risk of bias, and certainty of evidence assessment. A random-effects model was used to evaluate the effect size. Results A total of 45 studies with 7144 participants were included. A wearable activity tracker was effective in increasing daily steps (standard mean differences (SMD) = 0.59, 95% confidence interval (CI) (0.44, 0.75)), weekly moderate-to-vigorous PA (MVPA) (SMD = 0.54, 95% CI (0.36, 0.72)), and total daily PA (SMD = 0.21, 95% CI (0.01, 0.40)) and reducing sedentary time (SMD = -0.10, 95% CI (-0.19, -0.01)). Subgroup analysis showed that the effectiveness of wearable activity trackers for daily steps was not influenced by participants and intervention features. However, wearable activity trackers seemed more effective in promoting MVPA of participant's age <70 than participant's age ≥70. In addition, wearable activity trackers incorporated with traditional intervention components (e.g. telephone counseling, goal setting, and self-monitoring) could better promote MVPA than alone use. Short-term interventions potentially achieve better MVPA increase than long-term. Conclusion This review showed that wearable activity trackers are an effective tool to increase PA for the old population and also favor reducing sedentary time. When used together with other interventions, wearable activity trackers can achieve better MVPA increase, especially in the short term. However, how to more effectively improve the effectiveness of wearable activity trackers is an important direction of future research.
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Affiliation(s)
- Shuang Wu
- School of Physical Education, Shandong University, Jinan, China
| | - Guangkai Li
- School of Physical Education, Shandong University, Jinan, China
| | - Litao Du
- School of Physical Education, Shandong University, Jinan, China
| | - Si Chen
- School of Nursing and Rehabilitation,
Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, China
| | - Qiang He
- School of Physical Education, Shandong University, Jinan, China
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8
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Knaga J, Buresh R. Personalizing Activity Recommendations for Individuals with Type 2 Diabetes. ACSM'S HEALTH & FITNESS JOURNAL 2022. [DOI: 10.1249/fit.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dasgupta K, Boulé N, Henson J, Chevalier S, Redman E, Chan D, McCarthy M, Champagne J, Arsenyadis F, Rees J, Da Costa D, Gregg E, Yeung R, Hadjiconstantinou M, Dattani A, Friedrich MG, Khunti K, Rahme E, Fortier I, Prado CM, Sherman M, Thompson RB, Davies MJ, McCann GP, Yates T. Remission of type 2 diabetes and improved diastolic function by combining structured exercise with meal replacement and food reintroduction among young adults: the RESET for REMISSION randomised controlled trial protocol. BMJ Open 2022; 12:e063888. [PMID: 36130753 PMCID: PMC9494595 DOI: 10.1136/bmjopen-2022-063888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime risk of cardiovascular disease. Diastolic dysfunction is its earliest cardiac manifestation. Low energy diets incorporating meal replacement products can induce diabetes remission, but do not lead to improved diastolic function, unlike supervised exercise interventions. We are examining the impact of a combined low energy diet and supervised exercise intervention on T2DM remission, with peak early diastolic strain rate, a sensitive MRI-based measure, as a key secondary outcome. METHODS AND ANALYSIS This prospective, randomised, two-arm, open-label, blinded-endpoint efficacy trial is being conducted in Montreal, Edmonton and Leicester. We are enrolling 100 persons 18-45 years of age within 6 years' T2DM diagnosis, not on insulin therapy, and with obesity. During the intensive phase (12 weeks), active intervention participants adopt an 800-900 kcal/day low energy diet combining meal replacement products with some food, and receive supervised exercise training (aerobic and resistance), three times weekly. The maintenance phase (12 weeks) focuses on sustaining any weight loss and exercise practices achieved during the intensive phase; products and exercise supervision are tapered but reinstituted, as applicable, with weight regain and/or exercise reduction. The control arm receives standard care. The primary outcome is T2DM remission, (haemoglobin A1c of less than 6.5% at 24 weeks, without use of glucose-lowering medications during maintenance). Analysis of remission will be by intention to treat with stratified Fisher's exact test statistics. ETHICS AND DISSEMINATION The trial is approved in Leicester (East Midlands - Nottingham Research Ethics Committee (21/EM/0026)), Montreal (McGill University Health Centre Research Ethics Board (RESET for remission/2021-7148)) and Edmonton (University of Alberta Health Research Ethics Board (Pro00101088). Findings will be shared widely (publications, presentations, press releases, social media platforms) and will inform an effectiveness trial. TRIAL REGISTRATION NUMBER ISRCTN15487120.
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Affiliation(s)
- Kaberi Dasgupta
- Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Normand Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Emma Redman
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Deborah Chan
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Matthew McCarthy
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Julia Champagne
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Frank Arsenyadis
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jordan Rees
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Deborah Da Costa
- Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Edward Gregg
- School of Public Health, Imperial College London, London, UK
| | - Roseanne Yeung
- Division of Endocrinology & Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Hadjiconstantinou
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matthias G Friedrich
- Courtois Cardiovascular Signature Centre, McGill University Health Centre and Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and NIHR Applied Research Collaboration - East Midlands (ARC-EM), University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elham Rahme
- Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabel Fortier
- Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Sherman
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
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10
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Hodkinson A, Kontopantelis E, Zghebi SS, Grigoroglou C, McMillan B, Marwijk HV, Bower P, Tsimpida D, Emery CF, Burge MR, Esmiol H, Cupples ME, Tully MA, Dasgupta K, Daskalopoulou SS, Cooke AB, Fayehun AF, Houle J, Poirier P, Yates T, Henson J, Anderson DR, Grey EB, Panagioti M. Association Between Patient Factors and the Effectiveness of Wearable Trackers at Increasing the Number of Steps per Day Among Adults With Cardiometabolic Conditions: Meta-analysis of Individual Patient Data From Randomized Controlled Trials. J Med Internet Res 2022; 24:e36337. [PMID: 36040779 PMCID: PMC9472038 DOI: 10.2196/36337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current evidence supports the use of wearable trackers by people with cardiometabolic conditions. However, as the health benefits are small and confounded by heterogeneity, there remains uncertainty as to which patient groups are most helped by wearable trackers. OBJECTIVE This study examined the effects of wearable trackers in patients with cardiometabolic conditions to identify subgroups of patients who most benefited and to understand interventional differences. METHODS We obtained individual participant data from randomized controlled trials of wearable trackers that were conducted before December 2020 and measured steps per day as the primary outcome in participants with cardiometabolic conditions including diabetes, overweight or obesity, and cardiovascular disease. We used statistical models to account for clustering of participants within trials and heterogeneity across trials to estimate mean differences with the 95% CI. RESULTS Individual participant data were obtained from 9 of 25 eligible randomized controlled trials, which included 1481 of 3178 (47%) total participants. The wearable trackers revealed that over the median duration of 12 weeks, steps per day increased by 1656 (95% CI 918-2395), a significant change. Greater increases in steps per day from interventions using wearable trackers were observed in men (interaction coefficient -668, 95% CI -1157 to -180), patients in age categories over 50 years (50-59 years: interaction coefficient 1175, 95% CI 377-1973; 60-69 years: interaction coefficient 981, 95% CI 222-1740; 70-90 years: interaction coefficient 1060, 95% CI 200-1920), White patients (interaction coefficient 995, 95% CI 360-1631), and patients with fewer comorbidities (interaction coefficient -517, 95% CI -1188 to -11) compared to women, those aged below 50, non-White patients, and patients with multimorbidity. In terms of interventional differences, only face-to-face delivery of the tracker impacted the effectiveness of the interventions by increasing steps per day. CONCLUSIONS In patients with cardiometabolic conditions, interventions using wearable trackers to improve steps per day mostly benefited older White men without multimorbidity. TRIAL REGISTRATION PROSPERO CRD42019143012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143012.
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Affiliation(s)
- Alexander Hodkinson
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom.,Division of Informatics, Imaging & Data Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Salwa S Zghebi
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Christos Grigoroglou
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Brian McMillan
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, United Kingdom
| | - Peter Bower
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Dialechti Tsimpida
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
| | - Charles F Emery
- Department of Psychology, The Ohio State University College of Arts and Sciences, Columbus, OH, United States
| | - Mark R Burge
- Department of Medicine, Endocrinology and Metabolism, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Hunter Esmiol
- Department of Medicine, Endocrinology and Metabolism, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Margaret E Cupples
- Department of General Practice and Primary Care, Centre for Public Heath, Queen's University Belfast, Belfast, United Kingdom
| | - Mark A Tully
- School of Medicine, Ulster University, Londonderry, United Kingdom
| | - Kaberi Dasgupta
- Department of Medicine, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Stella S Daskalopoulou
- Department of Medicine, McGill University, Montreal, QC, Canada.,Centre for Translational Biology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Ayorinde F Fayehun
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Laval, QC, Canada
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Derek R Anderson
- Department of Psychology, The Ohio State University College of Arts and Sciences, Columbus, OH, United States
| | - Elisabeth B Grey
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, United Kingdom
| | - Maria Panagioti
- Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Health Services Research and Primary Care, National Institute for Health Research School for Primary Care Research, Manchester, United Kingdom
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11
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Pimenta N, Félix IB, Monteiro D, Marques MM, Guerreiro MP. Promoting Physical Activity in Older Adults With Type 2 Diabetes via an Anthropomorphic Conversational Agent: Development of an Evidence and Theory-Based Multi-Behavior Intervention. Front Psychol 2022; 13:883354. [PMID: 35903740 PMCID: PMC9315349 DOI: 10.3389/fpsyg.2022.883354] [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: 02/25/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Anthropomorphic conversational agents (ACA) are a promising digital tool to support self-management of type 2 diabetes (T2D), albeit little explored. There is a dearth of literature on the detailed content of these interventions, which may limit effectiveness and replication. Our aim is to describe the development of an evidence and theory-based intervention to improve physical activity in older adults with T2D, subsumed in a multi-behavior intervention via a mobile application with an ACA. Methods Overall decisions on the multi-behavior intervention design, such as the use of standardized behavior change techniques (BCTTv1), guided the development of the physical activity component. Firstly, recommendations on ambulatory activity were used to select the target behavior (walking). Meta-research on effective behavior change techniques (BCTs) was then identified. One meta-analysis linked effective BCTs with the three basic psychological needs of the self-determination theory (SDT). This meta-analysis, taken together with additional evidence on SDT, led to the selection of this theory to inform the design. BCTs were extracted from meta-research; we selected the most appropriate to be operationalized via the conversational agent through multidisciplinary discussions. Rules governing the dialogue flow and BCTs tailoring, taking the form "if some conditions hold then execute some action," were derived based on the Basic Psychological in Exercise Scale (competence, autonomy, and relatedness scores), in conjunction with published evidence and multidisciplinary discussions. Results Thirteen BCTs were implemented in the prototype via the ACA (e.g., goal setting behavior 1.1). Six if-then rules were derived and depicted in the dialogue steps through process flow diagrams, which map how the system functions. An example of a rule is "If competence score ≤ 10 then, apply BCT 1.1 with 500 steps increments as options for the daily walking goal; If competence score > 10 then, apply BCT 1.1 with 1,000 steps increments as options for the daily walking goal." Conclusion Evidence and SDT were translated into a mobile application prototype using an ACA to promote physical activity in older adults with T2D. This approach, which includes 13 BCTs and six if-then rules for their tailoring, may leverage the efforts of others in developing similar interventions.
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Affiliation(s)
- Nuno Pimenta
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Santarém, Portugal
- Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, Cruz-Quebrada, Portugal
- Centro de Investigação Interdisciplinar em Saúde, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Isa Brito Félix
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal
| | - Diogo Monteiro
- ESECS – Polytechnic of Leiria, Leiria, Portugal
- Research Centre in Sport, Health and Human Development (CIDESD), Vila Real, Portugal
- Life Quality Research Centre (CIEQV), Leiria, Portugal
| | - Marta Moreira Marques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Mara Pereira Guerreiro
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
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12
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Graham HE, Madigan CD, Daley AJ. Is a small change approach for weight management effective? A systematic review and meta-analysis of randomized controlled trials. Obes Rev 2022; 23:e13357. [PMID: 34580993 DOI: 10.1111/obr.13357] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 01/09/2023]
Abstract
Traditional weight management interventions typically involve people making large changes to their energy intake and/or expenditure and can be effective in the short term, but weight regain is common. An alternative strategy is a small change approach, which asks people to make small(er) changes to their diet and/or physical activity behaviors (e.g., 100-kcal reduction or increases of 1000 steps/day). This approach may lead to sustained weight management because such energy-deficit goals are easier for people to integrate into their lives and then maintain. This systematic review and meta-analysis of randomized and quasi-randomized controlled trials assessed the effectiveness of a small change approach for weight management; 21 trials were included. In weight gain prevention trials with adults, the mean difference in weight change between groups was -0.7 kg (95% CI -1.0 to -0.4, 95% PI -1.1 to -0.3) at program-end and -0.9 kg (95% CI -1.5 to -0.3, 95% PI -3.1 to 1.3) at last follow-up, favoring small change interventions. A small change approach was not effective for weight loss. Only 2/21 trials had a low risk of bias. Initial evidence supports the effectiveness of a small change approach for weight gain prevention but not weight loss. Further high-quality trials with longer follow-up are required.
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Affiliation(s)
- Henrietta Emily Graham
- The Centre for Lifestyle Medicine and Behaviour (CLIMB), School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Claire Deborah Madigan
- The Centre for Lifestyle Medicine and Behaviour (CLIMB), School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Amanda Jane Daley
- The Centre for Lifestyle Medicine and Behaviour (CLIMB), School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
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13
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Sangarapillai T, Hajizadeh M, Daskalopoulou SS, Dasgupta K. Cost-Comparison Analysis of a Physician-Delivered Step-Count Prescription Strategy. CJC Open 2021; 3:1043-1050. [PMID: 34505044 PMCID: PMC8413227 DOI: 10.1016/j.cjco.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background Increments of 1000 steps/d predict cardiovascular disease (CVD) event reductions. In adults with type 2 diabetes and/or hypertension, our Step Monitoring to Improve Arterial Health (SMARTER) trial demonstrated a physician-delivered step-count prescription strategy to increase steps by more than this amount over 1 year, compared to usual care. In the present analysis, we aimed to determine the costs of the intervention compared to usual care, incorporating 1-year intervention costs and projected savings from lower CVD hospitalizations over the subsequent 5 years. Methods We considered Canadians aged 55 to 74 years with type 2 diabetes and/or hypertension. Using time estimates from our trial, we computed nursing costs corresponding to patient support time over 1 year, and pedometer costs for an anticipated 50% of patients without a smartphone. We estimated the number of CVD hospitalizations, the reduction expected with a mean 1000 steps/d increase, and the associated savings. We calculated the net cost (savings), the proportion of patients with their own device required for cost neutrality, and costs (savings) if all patients needed to be provided with a device. Results At an average intervention cost of $51.28/patient, the total cost would be $168 million. With an estimated 8875 CVD events prevented, $208 million would be saved. This savings would result in ~$40 million in net savings with 50% device ownership, cost neutrality with 25% device ownership, and ~$42 million in net costs if all patients required the healthcare system to provide a device. Conclusions At current levels of smartphone ownership, adoption of the SMARTER strategy is cost-saving to cost-neutral from the healthcare system perspective.
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Affiliation(s)
- Tarsan Sangarapillai
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kaberi Dasgupta
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
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14
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Rossen J, Larsson K, Hagströmer M, Yngve A, Brismar K, Ainsworth B, Åberg L, Johansson UB. Effects of a three-armed randomised controlled trial using self-monitoring of daily steps with and without counselling in prediabetes and type 2 diabetes-the Sophia Step Study. Int J Behav Nutr Phys Act 2021; 18:121. [PMID: 34496859 PMCID: PMC8424865 DOI: 10.1186/s12966-021-01193-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This aimed to evaluate the effects of self-monitoring of daily steps with or without counselling support on HbA1c, other cardiometabolic risk factors and objectively measured physical activity (PA) during a 2-year intervention in a population with prediabetes or type 2 diabetes. METHODS The Sophia Step Study was a three-armed parallel randomised controlled trial. Participants with prediabetes or type 2 diabetes were recruited in a primary care setting. Allocation (1:1:1) was made to a multi-component intervention (self-monitoring of steps with counselling support), a single-component intervention (self-monitoring of steps without counselling support) or standard care. Data were collected for primary outcome HbA1c at baseline and month 6, 12, 18 and 24. Physical activity was assessed as an intermediate outcome by accelerometer (ActiGraph GT1M) for 1 week at baseline and the 6-, 12-, 18- and 24-month follow-up visits. The intervention effects were evaluated by a robust linear mixed model. RESULTS In total, 188 subjects (64, 59, 65 in each group) were included. The mean (SD) age was 64 (7.7) years, BMI was 30.0 (4.4) kg/m2 and HbA1c was 50 (11) mmol/mol, 21% had prediabetes and 40% were female. The dropout rate was 11% at 24 months. Effect size (CI) for the primary outcome (HbA1c) ranged from -1.3 (-4.8 to 2.2) to 1.1 (-2.4 to 4.6) mmol/mol for the multi-component vs control group and from 0.3 (-3.3 to 3.9) to 3.1 (-0.5 to 6.7) mmol/mol for the single-component vs control group. Effect size (CI) for moderate-to-vigorous physical activity ranged from 8.0 (0.4 to 15.7) to 11.1 (3.3 to 19.0) min/day for the multi-component vs control group and from 7.6 (-0.4 to 15.6) to 9.4 (1.4 to 17.4) min/day for the single-component group vs control group. CONCLUSION This 2-year intervention, including self-monitoring of steps with or without counselling, prevented a decrease in PA but did not provide evidence for improved metabolic control and cardiometabolic risk factors in a population with prediabetes or type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov, NCT02374788 . Registered 2 March 2015-Retrospectively registered.
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Affiliation(s)
- Jenny Rossen
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
| | - Kristina Larsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
| | - Agneta Yngve
- Department of Nutrition, Dietetics and Food Studies, Uppsala University, Uppsala, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Barbara Ainsworth
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | | | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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15
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Washburn BD, Ihm JM. Using Step Counts to Prescribe Physical Activity: What Is the Optimal Dose? Curr Sports Med Rep 2021; 20:402-409. [PMID: 34357886 DOI: 10.1249/jsr.0000000000000868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT An activity goal of 10,000 steps per day is widely known but was not initially developed based on scientific evidence. The last several years have seen an increase in both the availability of consumer-based step counting devices and research examining the link between daily step counts and various health outcomes. Daily step counts are an intuitive metric of physical activity and are useful for goal-setting and motivating behavioral change. This article reviews the current evidence for daily step counts as related to common health conditions to determine activity goals to prescribe to patients, and also discusses factors to consider when counseling patients on physical activity.
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16
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Rossen J, Hagströmer M, Yngve A, Brismar K, Ainsworth B, Johansson UB. Process evaluation of the Sophia Step Study- a primary care based three-armed randomized controlled trial using self-monitoring of steps with and without counseling in prediabetes and type 2 diabetes. BMC Public Health 2021; 21:1191. [PMID: 34157994 PMCID: PMC8220758 DOI: 10.1186/s12889-021-11222-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background Describing implementation features of an intervention is required to compare interventions and to inform policy and best practice. The aim of this study was to conduct a process evaluation of the first 12 months of the Sophia Step Study: a primary care based RCT evaluating a multicomponent (self-monitoring of daily steps plus counseling) and a single component (self-monitoring of steps only) physical activity intervention to standard care on cardiometabolic health. Methods The evaluation was guided by the Medical Research Council Guidance for complex interventions. To describe the implementation communication with the health professionals implementing the interventions, attendance records and tracking of days with self-monitored pedometer-determined steps were used. Change in physical activity behaviour was measured at baseline, 6 and 12 months as daily steps by accelerometry. Results During April 2013 to January 2018 188 participants were randomized and intervened directly after inclusion. Response rate was 49% and drop out was 10%. A majority, 78%, had type 2 diabetes and 22% were diagnosed with prediabetes. Mean [Standard deviation (SD)] body mass index was 30.4 (4.4) kg/m2 and steps per day was 6566 (3086). The interventions were delivered as intended with minor deviation from the protocol and dose received was satisfying for both the multicomponent and single component group. The mean [95% Confidence Interval (CI)] change in daily steps from baseline to 6 months was 941(227, 1655) steps/day for the multicomponent intervention group, 990 (145, 1836) step/day for the single component group and − 506 (− 1118, 107) for the control group. The mean (95% CI) change in daily steps from baseline to 12 months was 31(− 507, 570) steps/day for the multicomponent intervention group, 144 (− 566, 853) step/day for the single component group and − 890 (− 1485, − 294) for the control group. There was a large individual variation in daily steps at baseline as well as in step change in all three groups. Conclusions Applying self-monitoring of steps is a feasible method to implement as support for physical activity in the primary care setting both with and without counseling support. Trial registration ClinicalTrials.gov, NCT02374788. Registered 2 March 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11222-9.
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Affiliation(s)
- Jenny Rossen
- Department of Health Promoting Science, Sophiahemmet University, Lindstedsvägen 8, Box 5605, 114 86, Stockholm, Sweden.
| | - Maria Hagströmer
- Department of Health Promoting Science, Sophiahemmet University, Lindstedsvägen 8, Box 5605, 114 86, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
| | - Agneta Yngve
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Barbara Ainsworth
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Lindstedsvägen 8, Box 5605, 114 86, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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17
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Hajna S, Sharp SJ, Cooper AJM, Williams KM, van Sluijs EMF, Brage S, Griffin SJ, Sutton S. Effectiveness of Minimal Contact Interventions: An RCT. Am J Prev Med 2021; 60:e111-e121. [PMID: 33612170 PMCID: PMC7899959 DOI: 10.1016/j.amepre.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/24/2020] [Accepted: 10/05/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Around 23% of adults worldwide are insufficiently active. Wearable devices paired with virtual coaching software could increase physical activity. The effectiveness of 3 minimal contact interventions (paper-based physical activity diaries, activity trackers, and activity trackers coupled with virtual coaching) in increasing physical activity energy expenditure and cardiorespiratory fitness were compared over 12 weeks among inactive adults. METHODS This was an open label, parallel-group RCT. Inactive adults (aged ≥18 years, N=488) were randomized to no intervention (Control; n=121), paper-based diary (Diary; n=124), activity tracker (Activity Band; n=122), or activity tracker plus virtual coaching (Activity Band PLUS; n=121) groups. Coprimary outcomes included 12-week changes in physical activity energy expenditure and fitness (May 2012-January 2014). Analyses were conducted in 2019-2020. RESULTS There were no differences between groups overall (physical activity energy expenditure: p=0.114, fitness: p=0.417). However, there was a greater increase in physical activity energy expenditure (4.21 kJ/kg/day, 95% CI=0.42, 8.00) in the Activity Band PLUS group than in the Diary group. There were also greater decreases in BMI and body fat percentage in the Activity Band PLUS group than in the Control group (BMI= -0.24 kg/m2, 95% CI= -0.45, -0.03; body fat= -0.48%, 95% CI= -0.88, -0.08) and in theActivity Band PLUS group than in the Diary group (BMI= -0.30 kg/m2, 95% CI= -0.50, -0.09; body fat= -0.57%, 95% CI= -0.97, -0.17). CONCLUSIONS Coupling activity trackers with virtual coaching may facilitate increases in physical activity energy expenditure compared with a traditional paper‒based physical activity diary intervention and improve some secondary outcomes compared with a traditional paper‒based physical activity diary intervention or no intervention. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov ISRCTN31844443.
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Affiliation(s)
- Samantha Hajna
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Andrew J M Cooper
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Kate M Williams
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Esther M F van Sluijs
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Soren Brage
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Simon J Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
| | - Stephen Sutton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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18
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Shah SZA, Karam JA, Zeb A, Ullah R, Shah A, Haq IU, Ali I, Darain H, Chen H. Movement is Improvement: The Therapeutic Effects of Exercise and General Physical Activity on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Ther 2021; 12:707-732. [PMID: 33547579 PMCID: PMC7947168 DOI: 10.1007/s13300-021-01005-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/15/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Exercise is considered a cornerstone in achieving an optimized blood glucose level and reducing body weight, body mass index (BMI), and waist circumference. This study aimed to investigate and quantitatively summarize the literature regarding the therapeutic effects of exercise and general physical activity on glycemic control. METHODS A systematic review and meta-analysis of the literature on the therapeutic effects of exercise on glycemic control in patients with type 2 diabetes mellitus (type 2 DM) were conducted using electronic databases. Studies with an exercise intervention lasting more than 8 weeks were included. Both qualitative and quantitative analyses were performed. Qualitative data were presented narratively in table form. Quantitative analysis was performed using a random-effects model with a 95% confidence interval and a significance level of 0.05. The Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk of Bias 2 (RoB2) tool were used to assess the quality of evidence and the risk of bias. RESULTS A total of 21,559 articles were identified through different databases. Out of 21559 studies, only 32 randomized controlled trials were deemed eligible for inclusion in this study. The average exercise session was 45.15 min, while the average follow-up duration was 21.94 weeks. The mean exercise frequency according to our findings was 3.25 days/week. Almost all the studies reported decreases in glycated hemoglobin (HbA1c; P < 0.0001), fasting blood glucose (P = 0.03), BMI (P = 0.04), and waist circumference (P = 0.007) after the exercise intervention. CONCLUSION Exercise plays an important role in optimizing glycemic control and improving quality of life (QoL), BMI, and waist circumference in type 2 DM patients. Exercise could be a safe adjunct therapy to medical treatments in these patients. REGISTRATION PROSPERO: CRD42020210816.
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Affiliation(s)
- Sayed Z A Shah
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jawad A Karam
- Department of applied exercise science, Concordia University Chicago, 7400 Augusta St., River Forest, IL, 60305, United States
| | - Alam Zeb
- School of Health Sciences, Peshawar, Pakistan
| | - Rafi Ullah
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Arif Shah
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Ijaz Ul Haq
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Iftikhar Ali
- Paraplegic Centre, Phase#4, Hayatabad, Peshawar, Pakistan
| | - Haider Darain
- Institute of Physical Medicine and Rehabilitation Sciences, Khyber Medical University, Hayatabad, Peshawar, Pakistan
| | - Hong Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
- WHO Collaborating Center for Training and Research in Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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19
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Moghetti P, Balducci S, Guidetti L, Mazzuca P, Rossi E, Schena F, Moghetti P, Balducci S, Guidetti L, Schena F, Mazzuca P, Rossi E. Walking for subjects with type 2 diabetes: a systematic review and joint AMD/SID/SISMES evidence-based practical guideline. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-020-00690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Aims
Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects.
Data synthesis
Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight, and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior.
Conclusions
There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use.
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20
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Masuda H, Ishiyama D, Yamada M, Iwashima F, Kimura Y, Otobe Y, Tani N, Suzuki M, Nakajima H. Relationship Between Long-Term Objectively Measured Physical Activity and Glycemic Control in Type 2 Diabetes Mellitus Patients: A Prospective Cohort Study. Diabetes Metab Syndr Obes 2021; 14:2057-2063. [PMID: 33994800 PMCID: PMC8112872 DOI: 10.2147/dmso.s307070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/10/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Increasing physical activity (PA) improves glycemic control in patients with type 2 diabetes mellitus (T2DM). However, whether long-term objectively measured PA is related to glycemic control remains unclear. The aim of this study was to investigate the relationship between long-term objectively measured PA and glycemic control in T2DM patients. RESEARCH DESIGN AND METHODS This prospective cohort study recruited T2DM patients admitted to a hospital-based diabetes management and education program. The primary outcome was glycemic control by hemoglobin A1c at 6 months after discharge. We defined poor glycemic control according to the Japanese Clinical Practice Guidelines. The PA was objectively measured using a three-axis accelerometer during 6 months' period after discharge. The representative value of PA was the average daily steps during the measurement period and was divided into quartiles. To determine the relationship between the daily steps and poor glycemic control, we performed a multivariate logistic regression analysis. RESULTS Ninety-four participants were enrolled in the study. Their median age was 59 years, and 38 (40.0%) of them showed poor glycemic control. Multivariate logistic regression analysis showed that the first (Q1, ≤ 6106 steps/day) and second quartiles (Q2, 6107-8258 steps/day) had significantly elevated risks of poor glycemic control compared to Q4 (≥ 10,542 steps/day), with odds ratios of 8.55 [95% confidence intervals (CI) =1.43-51.23] and 15.62 (95% CI 2.63-92.87), respectively. CONCLUSION We found that lesser PA was significantly associated with poor glycemic control in T2DM patients. This finding may be beneficial for clinicians while providing long-term advice to diabetic patients.
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Affiliation(s)
- Hiroaki Masuda
- Department of Rehabilitation, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation, Tokyo, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
- Correspondence: Hiroaki Masuda Department of Rehabilitation, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation, 33-1 Sakaecho, Itabashi-ku, Tokyo, 173-0015, JapanTel +81-3-5375-1234Fax +81-3-5944-3534 Email
| | - Daisuke Ishiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Fumiko Iwashima
- Department of Endocrinology and Metabolism, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation, Tokyo, Japan
| | - Yosuke Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yuhei Otobe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Naoki Tani
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hideki Nakajima
- Department of Rehabilitation, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation, Tokyo, Japan
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21
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Araki E, Tanaka A, Inagaki N, Ito H, Ueki K, Murohara T, Imai K, Sata M, Sugiyama T, Ishii H, Yamane S, Kadowaki T, Komuro I, Node K. Diagnosis, prevention, and treatment of cardiovascular diseases in people with type 2 diabetes and prediabetes: a consensus statement jointly from the Japanese Circulation Society and the Japan Diabetes Society. Diabetol Int 2021; 12:1-51. [PMID: 33479578 PMCID: PMC7790968 DOI: 10.1007/s13340-020-00471-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501 Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohjiro Ueki
- Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenjiro Imai
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Shunsuke Yamane
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501 Japan
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22
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Araki E, Tanaka A, Inagaki N, Ito H, Ueki K, Murohara T, Imai K, Sata M, Sugiyama T, Ishii H, Yamane S, Kadowaki T, Komuro I, Node K. Diagnosis, Prevention, and Treatment of Cardiovascular Diseases in People With Type 2 Diabetes and Prediabetes - A Consensus Statement Jointly From the Japanese Circulation Society and the Japan Diabetes Society. Circ J 2020; 85:82-125. [PMID: 33250455 DOI: 10.1253/circj.cj-20-0865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University
| | | | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kohjiro Ueki
- Diabetes Research Center, Research Institute, National Center for Global Health and Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenjiro Imai
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital
| | - Shunsuke Yamane
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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23
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Pearson E, Prapavessis H, Higgins C, Petrella R, White L, Mitchell M. Adding team-based financial incentives to the Carrot Rewards physical activity app increases daily step count on a population scale: a 24-week matched case control study. Int J Behav Nutr Phys Act 2020; 17:139. [PMID: 33208166 PMCID: PMC7677847 DOI: 10.1186/s12966-020-01043-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/21/2020] [Indexed: 11/12/2022] Open
Abstract
Background Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. Methods A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1–12; intervention: weeks 13–24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). Results The main analysis included 61,170 users (mean age = 32 yrs.; % female = 64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p < 0.0001; ηp2 = 0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2 = 0.699) with each new STC corresponding to approximately 200 more steps per day. Conclusion Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-020-01043-1.
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Affiliation(s)
- Emma Pearson
- Faculty of Health Sciences, School of Kinesiology, Western University, Arts & Humanities Building, Room 3R12B, London, Ontario, N6A 5B9, Canada
| | - Harry Prapavessis
- Faculty of Health Sciences, School of Kinesiology, Western University, Arts & Humanities Building, Room 3R12B, London, Ontario, N6A 5B9, Canada
| | | | - Robert Petrella
- Faculty of Health Sciences, School of Kinesiology, Western University, Arts & Humanities Building, Room 3R12B, London, Ontario, N6A 5B9, Canada.,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Marc Mitchell
- Faculty of Health Sciences, School of Kinesiology, Western University, Arts & Humanities Building, Room 3R12B, London, Ontario, N6A 5B9, Canada. .,Carrot Insights Inc., Toronto, ON, Canada.
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24
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Freene N, Davey R, Sathiyakumar R, McPhail SM. Can physical activity measurement alone improve objectively-measured physical activity in primary care?: A systematic review and meta-analysis. Prev Med Rep 2020; 20:101230. [PMID: 33163332 PMCID: PMC7607506 DOI: 10.1016/j.pmedr.2020.101230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/12/2020] [Accepted: 10/13/2020] [Indexed: 12/02/2022] Open
Abstract
Some evidence of control group increases in self-reported PA in primary care. Meta-analyses found no significant improvement in control group objectively-measured PA. 17% of studies reported increased (≥10%) objectively-measured PA in control groups. Healthy younger adults may increase objectively-measured PA with measurement alone. PA measurement using pedometers alone may be particularly useful to increase PA.
There is evidence that simply measuring physical activity alone can increase self-reported physical activity behaviour. The aim of this review was to describe changes in objectively-measured physical activity within control groups in primary care physical activity intervention studies. Five electronic databases (PubMed, MEDLINE, SPORTDiscus, PsychINFO and CINAHL) were searched from inception to February 2019. Physical activity controlled intervention studies objectively measuring physical activity in primary care with adults were included and meta-analyses were completed. Thirty studies were eligible and 22 studies were included in the meta-analysis. No statistically significant change in steps.day−1, counts.day−1 and counts.minute-1 were found in the meta-analyses within control groups. Moderate-to-vigorous physical activity minutes.day−1 significantly decreased (-3.97; 95% CI −6.31 to −1.64; P < 0.001). Sub-analyses revealed there was a trend for steps.day−1 to increase in participants < 50 years old (504; 95% CI −20 to 1029; P = 0.06). Noteworthy increases (≥10%) in objectively-measured physical activity within control groups were found in 17% of studies. Noteworthy increases were reported in studies with younger participants, one-third of the pedometer studies, one-third of studies with participants at risk of chronic disease and in studies with a shorter duration between measurements. No control group improvements were found in participants with chronic disease. Overall, no significant improvements in objectively-measured physical activity were found within control groups in primary care. Further investigation of noteworthy increases in control group physical activity levels is indicated, particularly in certain sub-groups of participants as this may effect physical activity research and interventions in these populations.
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Affiliation(s)
- Nicole Freene
- Physiotherapy, University of Canberra, Bruce, Australia.,Health Research Institute, University of Canberra, Bruce, Australia
| | - Rachel Davey
- Health Research Institute, University of Canberra, Bruce, Australia
| | | | - Steven M McPhail
- School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia.,Centre for Functioning and Health Research, Metro South Health, Buranda, Australia
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25
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Moghetti P, Balducci S, Guidetti L, Mazzuca P, Rossi E, Schena F. Walking for subjects with type 2 diabetes: A systematic review and joint AMD/SID/SISMES evidence-based practical guideline. Nutr Metab Cardiovasc Dis 2020; 30:1882-1898. [PMID: 32998820 DOI: 10.1016/j.numecd.2020.08.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022]
Abstract
AIMS Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects. DATA SYNTHESIS Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior. CONCLUSIONS There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use. This article is co-published in the journals Sport Sciences for Health and Nutrition, Metabolism and Cardiovascular Diseases.
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Affiliation(s)
- P Moghetti
- Unit of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy; Hospital Trust of Verona, Verona, Italy.
| | - S Balducci
- Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - L Guidetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - P Mazzuca
- Unit of Internal Medicine, Diabetes and Metabolic Disease Center, Romagna Health District, Rimini, Italy; Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - E Rossi
- Diabetes Unit, ASL of Benevento, Benevento, Italy
| | - F Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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26
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Methodological considerations for the measurement of arterial stiffness using applanation tonometry. J Hypertens 2020; 39:428-436. [PMID: 33031179 DOI: 10.1097/hjh.0000000000002665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Accurate comparisons of carotid--femoral pulse wave velocity (cfPWV) within and across studies require standardized procedures. Guidelines suggest reporting the average of at least two cfPWV measurements; if the difference exceeds 0.5 m/s, a third measurement should be taken, and the median reported. Another method involves repeating measurements until two values are within 0.5 m/s. However, in many studies, duplicate measurements are averaged irrespective of the difference between readings. We evaluated the impact of these methods on the reported cfPWV value. METHODS Measurements of cfPWV (SphygmoCor) from five studies included individuals spanning a wide age range, with or without comorbid conditions, and pregnant women. In participants with at least three high-quality measurements, differences between the median value (MED) and the average of the first two cfPWV measurements (AVG1) and the average of two cfPWV measurements within 0.5 m/s (AVG2) were evaluated using paired t-tests and Bland--Altman plots. RESULTS Participants' mean age was 50 ± 14 years and BMI was 28.0 ± 5.5 kg/m2 (N = 306, 79% women). The overall mean difference was -0.10 m/s (95% CI 0.17 to -0.04) between MED and AVG1, and 0.11 m/s (95% CI 0.05--0.17) between MED and AVG2. The absolute difference exceeded 0.5 m/s in 34% (MED-AVG1) and 22% (MED-AVG2) of participants, and 1 m/s in 8% of participants (both MED-AVG1 and MED-AVG2). Scatter around the bias line increased with higher mean cfPWV values. CONCLUSION Although the overall mean difference in cfPWV between protocols was not clinically relevant, large variation led to absolute differences exceeding 0.5 m/s in a large proportion of participants.
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27
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Lystrup R, Carlsen D, Sharon DJ, Crawford P. Wearable and interactive technology to share fitness goals results in weight loss but not improved diabetes outcomes. Obes Res Clin Pract 2020; 14:443-448. [DOI: 10.1016/j.orcp.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 01/22/2020] [Accepted: 08/27/2020] [Indexed: 12/16/2022]
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Abstract
High rates of SARS-CoV-2 infection and mortality in long term care (LTC) facilities epitomize the contextual and biological risk of those frail and vulnerable among us (1). Much ado has been given to the vulnerability of older adults during the COVID-19 pandemic, but this vulnerability likely has much more to do with the reduced physiological resilience inherent to frailty status rather than chronological age per se (2). While strict measures to protect those who are frail are warranted, without careful consideration, these strategies will lead many older adults out of the frying pan and into the fire. The harsh reality is many at-risk adults will face disproportionate social isolation, depression, malnutrition, reduced access to care, decreased physical activity, and increased sedentary time as a result of infection prevention measures. Therefore, even frail adults who do not contract COVID-19, will undoubtedly experience reduced quality of life, accelerated frailty progression and worse clinical outcomes.
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Affiliation(s)
- K F Boreskie
- Kevin F. Boreskie, St. Boniface General Hospital Albrechtsen Research Center, R4012-351 Tache Ave, Winnipeg, MB, R2H 2A6, Canada , Twitter: @kboreskie
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29
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Cooke AB, Dasgupta K, Spronck B, Sharman JE, Daskalopoulou SS. Adults With Type 2 Diabetes Mellitus Exhibit a Greater Exercise-Induced Increase in Arterial Stiffness and Vessel Hemodynamics. Hypertension 2020; 75:1565-1573. [DOI: 10.1161/hypertensionaha.120.14778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Individuals with type 2 diabetes mellitus (T2DM) have a greater blood pressure (BP) response to acute maximal exercise compared to those without T2DM; however, whether they exhibit a different arterial stiffness response to maximal exercise has yet to be explored. Adults with (n=66) and without T2DM (n=61) underwent an arterial stress test: at rest and immediately postexercise, carotid-femoral pulse wave velocity, the gold standard measure of arterial stiffness, brachial BP, heart rate, and other hemodynamic measurements were assessed. Linear regression models were used to evaluate between-group differences at rest, and the response to exercise (postexercise value), adjusting for covariates including BP and heart rate when relevant, and the corresponding baseline value of each parameter. All participants (mean±SD: age 59.3±10.6 years; body mass index 31.2±3.9 kg/m
2
) had hypertension (mean BP 130±14/80±9 mm Hg). At rest, participants with T2DM had significantly higher carotid-femoral pulse wave velocity (10.3±2.7 versus 9.1±1.9 m/s), heart rate (69±11 versus 66±10 beats/min), and lower diastolic BP (79±9 versus 83±9 mm Hg), but systolic BP (129±15 versus 131±13 mm Hg) was similar. In response to exercise, participants with T2DM showed greater increases in carotid-femoral pulse wave velocity (1.6 [95% CI, 0.4–2.9 m/s]) and systolic BP (9 [95% CI, 1–17 mm Hg]) than participants without T2DM. A greater proportion of participants with T2DM had a hypertensive response to exercise compared to participants without T2DM (n=23, 35% versus n=11, 18%;
P
=0.033). By incorporating exercise as a vascular stressor, we provide evidence of a greater increase in arterial stiffness in individuals with T2DM, independently of resting arterial stiffness, and the BP postexercise.
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Affiliation(s)
- Alexandra B. Cooke
- From the Department of Medicine, McGill University Health Centre (A.B.C., K.D., S.S.D.), McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (A.B.C., K.D.), McGill University, Montreal, QC, Canada
| | - Kaberi Dasgupta
- From the Department of Medicine, McGill University Health Centre (A.B.C., K.D., S.S.D.), McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (A.B.C., K.D.), McGill University, Montreal, QC, Canada
| | - Bart Spronck
- Department of Biomedical Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT (B.S.)
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, the Netherlands (B.S.)
| | - James E. Sharman
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia (J.E.S.)
| | - Stella S. Daskalopoulou
- From the Department of Medicine, McGill University Health Centre (A.B.C., K.D., S.S.D.), McGill University, Montreal, QC, Canada
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Cooke AB, Rahme E, Defo AK, Chan D, Daskalopoulou SS, Dasgupta K. A trajectory analysis of daily step counts during a physician-delivered intervention. J Sci Med Sport 2020; 23:962-967. [PMID: 32354681 DOI: 10.1016/j.jsams.2020.04.010] [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: 11/05/2019] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Higher steps are associated with lower mortality and cardiovascular event rates. We previously demonstrated that tailored physician-delivered step count prescriptions successfully increased steps/day in adults with type 2 diabetes mellitus (T2DM) and/or hypertension. In the present analysis, we examined patterns of step count change and the factors that influence different responses. DESIGN Longitudinal observational study METHODS: Active arm participants (n=118) recorded steps/day. They received a step count prescription from their physician every 3-4 months. We computed mean steps/day and changes from baseline for sequential 30-day periods. Group-based trajectory modeling was applied. RESULTS Four distinct trajectories of mean steps/day emerged, distinguishable by differences in baseline steps/day: sedentary (19%), low active (40%), somewhat active (30%) and active (11%). All four demonstrated similar upward slopes. Three patterns emerged for the change in steps from baseline: gradual decrease (30%), gradual increase with late decline (56%), and rapid increase with midpoint decline (14%); thus 70% had an increase from baseline. T2DM (odd ratios [OR]: 3.7, 95% CI 1.7, 7.7) and age (OR per 10-year increment: 2, 95% CI 1.3, 2.8) were both associated with starting at a lower baseline but participants from these groups were no less likely than others to increase steps/day. CONCLUSIONS T2DM and older age were associated with lower baseline values but were not indicators of likelihood of step count increases. A physician-delivered step count prescription and monitoring strategy has strong potential to be effective in increasing steps irrespective of baseline counts and other clinical and demographic characteristics.
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Affiliation(s)
- Alexandra B Cooke
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, McGill University, Canada
| | - Elham Rahme
- Division of Clinical Epidemiology, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alvin Kuate Defo
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Canada
| | - Deborah Chan
- Division of Clinical Epidemiology, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, McGill University, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Canada
| | - Kaberi Dasgupta
- Division of Clinical Epidemiology, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Canada.
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Metsios GS, Fenton SA, Moe HR, van der Esch M, van Zanten JV, Koutedakis Y, Vitalis P, Kennedy N, Brodin NC, Tzika A, Boström C, Swinnen TW, Jester R, Schneider KN, Nikiphorou E, Fragoulis GE, Vlieland TPMV, Van den Ende C, Kitas GD. Implementation of Physical Activity into routine Clinical pracTice in Rheumatic Musculoskeletal Disease: The IMPACT-RMD study protocol and rationale. Mediterr J Rheumatol 2020; 30:231-236. [PMID: 32467876 PMCID: PMC7241658 DOI: 10.31138/mjr.30.4.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Physical activity is an important intervention for improving disease-related symptoms and systemic manifestations in rheumatic and musculoskeletal disease (RMDs). However, studies suggest that RMD patients report that the lack of individualized and consistent information about physical activity from managing doctors and healthcare professionals, acts as a barrier for engagement. On the other hand, managing doctors and healthcare professionals report lack of knowledge in this area and thus lack of confidence to educate and advise RMD patients about the beneficial effects of physical activity. The aim of the present study therefore, is to develop two e-Learning courses for RMD doctors and health professionals: a) the first one to provide consistent information about the collective benefits of physical activity in RMDs and b) the second on how to implement physical activity advice in routine clinical practice. Methods: An international collaboration of seven countries, consisting of one academic institution and one patient organization from each country, will co-develop the two e-Learning courses. The final e-Learning courses will primarily target to improve – through physical activity advice – RMD symptoms which are important for patients. Discussion: The main result of this study will be to co-develop two e-Learning courses that can be used by managing RMD doctors and healthcare professionals to be made aware of the overall benefits of physical activity in RMDs as well as how to implement physical activity advise within their practice.
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Affiliation(s)
- George S Metsios
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, United Kingdom.,School of Physical Education and Sport Science, University of Thessaly, Greece
| | - Sally Am Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Helene Rikke Moe
- National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences. Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Jet Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Yannis Koutedakis
- School of Physical Education and Sport Science, University of Thessaly, Greece
| | - Panagiotis Vitalis
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Nina C Brodin
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Aikaterini Tzika
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | | | - Rebecca Jester
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom
| | - Karin Niedermann Schneider
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, United Kingdom.,School of Physical Education and Sport Science, University of Thessaly, Greece.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences. Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.,School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium.,School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland.,School of Immunology and Microbial Sciences, King's College, London, UK.,Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Elena Nikiphorou
- School of Immunology and Microbial Sciences, King's College, London, UK
| | - George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | | | - George D Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, United Kingdom.,ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences. Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillan B, Bower P, Panagioti M. Accelerometer- and Pedometer-Based Physical Activity Interventions Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1912895. [PMID: 31596494 PMCID: PMC6802237 DOI: 10.1001/jamanetworkopen.2019.12895] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 01/15/2023] Open
Abstract
Importance Accelerometers and pedometers are accessible technologies that could have a role in encouraging physical activity (PA) in line with current recommendations. However, there is no solid evidence of their association with PA in participants with 1 or more cardiometabolic conditions such as diabetes, prediabetes, obesity, and cardiovascular disease. Objectives To assess the association of accelerometer- and pedometer-based interventions with increased activity and other improved health outcomes in adults with cardiometabolic conditions and to examine characteristics of the studies that could influence the association of both interventions in improving PA. Data Sources Records from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and PsycINFO were searched from inception until August 2018 with no language restriction. Study Selection Randomized clinical trials or cluster randomized clinical trials evaluating the use of wearable technology devices such as pedometers and accelerometers as motivating and monitoring tools for increasing PA were included. After removing duplicates, the searches retrieved 5762 references. Following abstract and title screening of 1439 references and full-text screening of 107 studies, 36 studies met inclusion criteria. Data Extraction and Synthesis Mean difference in PA was assessed by random-effects meta-analysis. Where the scale was different across studies, the standardized mean difference was used instead. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. This study was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures The primary outcome was objectively measured PA in the short to medium term (postintervention to 8 months' follow-up). Results Thirty-six randomized clinical trials (20 using accelerometers and 16 using pedometers) involving 5208 participants were eligible for review. Meta-analysis involving 32 of these trials (4856 participants) showed medium improvements in PA: accelerometers and pedometers combined vs comparator showed a small significant increase in PA overall (standardized mean difference, 0.39 [95% CI, 0.28-0.51]; I2 = 60% [95% CI, 41%-73%]) in studies of short to medium follow-up over a mean (SD) of 32 (28.6) weeks. Multivariable metaregression showed improved association with PA for complex interventions that involved face-to-face consultation sessions with facilitators (β = 0.36; 95% CI, 0.17-0.55; P < .001) and pedometer-based interventions (β = 0.30; 95% CI, 0.08-0.52; P = .002). Conclusions and Relevance In this study, complex accelerometer- and pedometer-based interventions led to significant small to medium improvements in PA levels of people with cardiometabolic conditions. However, longer-term trials are needed to assess their performance over time. This study found no evidence that simple self-monitored interventions using either pedometers or accelerometers are associated with improvements in PA.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, United Kingdom
| | - Brian McMillan
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
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Garrett SL, Pina-Thomas DM, Peterson KA, Benton MJ. Tracking physical activity in baccalaureate nursing students in the United States prior to graduation: A longitudinal study. NURSE EDUCATION TODAY 2019; 80:28-33. [PMID: 31228658 DOI: 10.1016/j.nedt.2019.05.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 03/29/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate changes in physical activity among baccalaureate nursing students over time. DESIGN Longitudinal descriptive study. SETTING Baccalaureate nursing program at a four-year university in the United States. PARTICIPANTS Fifty-two male (n = 4) and female (n = 48) nursing students. METHODS At the beginning and end (weeks 1-2 and 15-16) of the three semesters prior to graduation, students completed the International Physical Activity Questionnaire (IPAQ) and their body mass index (BMI) was calculated. Based on the IPAQ, physical activity was calculated as MET-minutes per week of vigorous, moderate, and walking activities, using metabolic equivalents of 8.0 METS for vigorous, 4.0 METS for moderate, and 3.3 METS for walking. RESULTS At baseline, students were 21.3 ± 1.4 years old with a BMI of 23.5 ± 2.9 kg/m2. BMI increased throughout the study and prior to graduation was 23.9 ± 3.2 kg/m2 (p = 0.039). Overall, students maintained high physical activity levels that did not change statistically. Walking was the predominant activity, followed by vigorous and then moderate activity. Walking and vigorous activity displayed opposing patterns. Vigorous activity decreased over the first three measurement periods (p = 0.029), increased for the fourth period, and then decreased again over the last two periods (p = 0.037 compared to baseline). By comparison, walking increased over the first three measurements (p = 0.002) and then decreased again (p = 0.015). When students were grouped by physical activity level (moderate vs. high), there were significant between-group differences in vigorous activity and walking. At baseline and end of study, the moderate activity group participated in 58% and 49% less vigorous activity, and 83% and 45% less walking than the high activity group. CONCLUSION In this group of baccalaureate nursing students, overall physical activity did not decline with time. Students participated in sufficient physical activity to promote health, and after graduation, they are likely to provide effective patient counselling regarding healthy lifestyles.
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Affiliation(s)
- Susan L Garrett
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Deborah M Pina-Thomas
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Kerry A Peterson
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Melissa J Benton
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA.
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S Oliveira J, Sherrington C, R Y Zheng E, Franco MR, Tiedemann A. Effect of interventions using physical activity trackers on physical activity in people aged 60 years and over: a systematic review and meta-analysis. Br J Sports Med 2019; 54:1188-1194. [DOI: 10.1136/bjsports-2018-100324] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 01/28/2023]
Abstract
BackgroundOlder people are at high risk of physical inactivity. Activity trackers can facilitate physical activity. We aimed to investigate the effect of interventions using activity trackers on physical activity, mobility, quality of life and mental health among people aged 60+ years.MethodsFor this systematic review, we searched eight databases, including MEDLINE, Embase and CENTRAL from inception to April 2018. Randomised controlled trials of interventions that used activity trackers to promote physical activity among people aged 60+ years were included in the analyses. The study protocol was registered with PROSPERO, number CRD42017065250.ResultsWe identified 23 eligible trials. Interventions using activity trackers had a moderate effect on physical activity (23 studies; standardised mean difference (SMD)=0.55; 95% CI 0.40 to 0.70; I2=86%) and increased steps/day by 1558 (95% CI 1099 to 2018 steps/day; I2=92%) compared with usual care, no intervention and wait-list control. Longer duration activity tracker-based interventions were more effective than short duration interventions (18 studies, SMD=0.70; 95% CI 0.47 to 0.93 vs 5 studies, SMD=0.14; 95% CI −0.26 to 0.54, p for comparison=0.02). Interventions that used activity trackers improved mobility (three studies; SMD=0.61; 95% CI 0.31 to 0.90; I2=10%), but not quality of life (nine studies; SMD=0.09; 95% CI −0.07 to 0.25; I2=45%). Only one trial included mental health outcomes and it reported similar effects of the activity tracker intervention compared with control.ConclusionsInterventions using activity trackers improve physical activity levels and mobility among older people compared with control. However, the impact of activity tracker interventions on quality of life, and mental health is unknown.
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Höchsmann C, Müller O, Ambühl M, Klenk C, Königstein K, Infanger D, Walz SP, Schmidt-Trucksäss A. Novel Smartphone Game Improves Physical Activity Behavior in Type 2 Diabetes. Am J Prev Med 2019; 57:41-50. [PMID: 31128953 PMCID: PMC7719398 DOI: 10.1016/j.amepre.2019.02.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Many type 2 diabetes patients show insufficient levels of physical activity and are often unmotivated to change physical activity behaviors. This study investigated whether a newly developed smartphone game delivering individualized exercise and physical activity promotion through an elaborate storyline can generate sustained improvements in daily physical activity (steps/day). STUDY DESIGN Thirty-six participants were enrolled in this 24-week RCT between August 2016 and April 2018. After baseline assessment, participants were randomized in equal numbers to the intervention or control condition. Data analysis was performed in May-June 2018. SETTING/PARTICIPANTS Inactive, overweight type 2 diabetes patients, aged 45-70 years, were recruited through advertising and from hospitals and diabetes care centers in the Basel, Switzerland, metropolitan area. INTERVENTION Participants were instructed to play the innovative smartphone game (intervention group) or to implement the recommendations from the baseline lifestyle counseling (control group) autonomously during the 24-week intervention period. MAIN OUTCOME MEASURES Primary outcomes were changes in daily physical activity (steps/day); changes in aerobic capacity, measured as oxygen uptake at the first ventilatory threshold; and changes in glycemic control, measured as HbA1c. RESULTS Daily physical activity increased by an average of 3,998 (SD=1,293) steps/day in the intervention group and by an average of 939 (SD=1,156) steps/day in the control group. The adjusted difference between the two groups was 3,128 steps/day (95% CI=2,313, 3,943, p<0.001). The increase in daily physical activity was accompanied by an improved aerobic capacity (adjusted difference of oxygen uptake at the first ventilatory threshold of 1.9 mL/(kg·min), 95% CI=0.9, 2.9, p<0.001). Glycemic control (HbA1c) did not change over the course of the intervention. CONCLUSIONS A novel, self-developed smartphone game, delivering multidimensional home-based exercise and physical activity promotion, significantly increases daily physical activity (steps/day) and aerobic capacity in inactive type 2 diabetes patients after 24 weeks. The ability of the game to elicit a sustained physical activity motivation may be relevant for other inactive target groups with chronic diseases. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02657018.
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Affiliation(s)
- Christoph Höchsmann
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland; Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Olivia Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Muriel Ambühl
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Christopher Klenk
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Karsten Königstein
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Steffen P Walz
- Centre for Design Innovation, Swinburne University of Technology, Melbourne, Australia
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2017 Roadmap for Innovation-ACC Health Policy Statement on Healthcare Transformation in the Era of Digital Health, Big Data, and Precision Health: A Report of the American College of Cardiology Task Force on Health Policy Statements and Systems of Care. J Am Coll Cardiol 2019; 70:2696-2718. [PMID: 29169478 DOI: 10.1016/j.jacc.2017.10.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Breteler MJ, Janssen JH, Spiering W, Kalkman CJ, van Solinge WW, Dohmen DA. Measuring Free-Living Physical Activity With Three Commercially Available Activity Monitors for Telemonitoring Purposes: Validation Study. JMIR Form Res 2019; 3:e11489. [PMID: 31017587 PMCID: PMC6505372 DOI: 10.2196/11489] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/28/2018] [Accepted: 01/27/2019] [Indexed: 12/25/2022] Open
Abstract
Background Remote monitoring of physical activity in patients with chronic conditions could be useful to offer care professionals real-time assessment of their patient’s daily activity pattern to adjust appropriate treatment. However, the validity of commercially available activity trackers that can be used for telemonitoring purposes is limited. Objective The purpose of this study was to test usability and determine the validity of 3 consumer-level activity trackers as a measure of free-living activity. Methods A usability evaluation (study 1) and validation study (study 2) were conducted. In study 1, 10 individuals wore one activity tracker for a period of 30 days and filled in a questionnaire on ease of use and wearability. In study 2, we validated three selected activity trackers (Apple Watch, Misfit Shine, and iHealth Edge) and a fourth pedometer (Yamax Digiwalker) against the reference standard (Actigraph GT3X) in 30 healthy participants for 72 hours. Outcome measures were 95% limits of agreement (LoA) and bias (Bland-Altman analysis). Furthermore, median absolute differences (MAD) were calculated. Correction for bias was estimated and validated using leave-one-out cross validation. Results Usability evaluation of study 1 showed that iHealth Edge and Apple Watch were more comfortable to wear as compared with the Misfit Flash. Therefore, the Misfit Flash was replaced by Misfit Shine in study 2. During study 2, the total number of steps of the reference standard was 21,527 (interquartile range, IQR 17,475-24,809). Bias and LoA for number of steps from the Apple Watch and iHealth Edge were 968 (IQR −5478 to 7414) and 2021 (IQR −4994 to 9036) steps. For Misfit Shine and Yamax Digiwalker, bias was −1874 and 2004, both with wide LoA of (13,869 to 10,121) and (−10,932 to 14,940) steps, respectively. The Apple Watch noted the smallest MAD of 7.7% with the Actigraph, whereas the Yamax Digiwalker noted the highest MAD (20.3%). After leave-one-out cross validation, accuracy estimates of MAD of the iHealth Edge and Misfit Shine were within acceptable limits with 10.7% and 11.3%, respectively. Conclusions Overall, the Apple Watch and iHealth Edge were positively evaluated after wearing. Validity varied widely between devices, with the Apple Watch being the most accurate and Yamax Digiwalker the least accurate for step count in free-living conditions. The iHealth Edge underestimates number of steps but can be considered reliable for activity monitoring after correction for bias. Misfit Shine overestimated number of steps and cannot be considered suitable for step count because of the low agreement. Future studies should focus on the added value of remotely monitoring activity patterns over time in chronic patients.
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Affiliation(s)
- Martine Jm Breteler
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,FocusCura, Driebergen-Rijsenburg, Netherlands
| | | | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Cor J Kalkman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Cavero-Redondo I, Tudor-Locke C, Álvarez-Bueno C, Cunha PG, Aguiar EJ, Martínez-Vizcaíno V. Steps per Day and Arterial Stiffness. Hypertension 2019; 73:350-363. [DOI: 10.1161/hypertensionaha.118.11987] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Iván Cavero-Redondo
- From the Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain (I.C.-R., C.A.-B., V.M.-V.)
| | - Catrine Tudor-Locke
- Department of Kinesiology, University of Massachusetts Amherst, MA (C.T.-L., E.J.A.)
| | - Celia Álvarez-Bueno
- From the Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain (I.C.-R., C.A.-B., V.M.-V.)
| | - Pedro G. Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Guimarães, Portugal (P.G.C.)
| | - Elroy J. Aguiar
- Department of Kinesiology, University of Massachusetts Amherst, MA (C.T.-L., E.J.A.)
| | - Vicente Martínez-Vizcaíno
- From the Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain (I.C.-R., C.A.-B., V.M.-V.)
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Kirk MA, Amiri M, Pirbaglou M, Ritvo P. Wearable Technology and Physical Activity Behavior Change in Adults With Chronic Cardiometabolic Disease: A Systematic Review and Meta-Analysis. Am J Health Promot 2018; 33:778-791. [PMID: 30586996 DOI: 10.1177/0890117118816278] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of wearable device interventions (eg, Fitbit) to improve physical activity (PA) outcomes (eg, steps/day, moderate to vigorous physical activity [MVPA]) in populations diagnosed with cardiometabolic chronic disease. DATA SOURCE Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses, an electronic search of 5 databases (Medline, PsychINFO, Scopus, Web of Science, and PubMed) was conducted. STUDY INCLUSION AND EXCLUSION CRITERIA Randomized controlled trials (RCTs) published between January 2000 and May 2018 that used a wearable device for the full intervention in adults (18+) diagnosed with a cardiometabolic chronic disease were included. Excluded trials included studies that used devices at pre-post only, devices that administered medication, and interventions with no prospective control group comparison. DATA EXTRACTION Thirty-five studies examining 4528 participants met the inclusion criteria. Study quality and RCT risk of bias were assessed using the Cochrane Collaboration Tool. DATA SYNTHESIS Meta-analyses to compute PA (eg, steps/day) and selected physical dispersion and summary effects were conducted using the raw unstandardized pooled mean difference (MD). Sensitivity analyses were examined. RESULTS Statistically significant increases in PA steps/day (MD = 2592 steps/day; 95% confidence interval [CI]: 1689-3496) and MVPA min/wk (MD = 36.31 min/wk; 95% CI: 18.33-54.29) were found for the intervention condition. CONCLUSION Wearable devices positively impact physical health in clinical populations with cardiometabolic diseases. Future research using the most current technologies (eg, Fitbit) will serve to amplify these findings.
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Affiliation(s)
- Megan A Kirk
- 1 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Mohammad Amiri
- 1 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Meysam Pirbaglou
- 1 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Paul Ritvo
- 1 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.,2 Department of Psychology, York University, Toronto, Ontario, Canada.,3 University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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O'Brien MW, Kivell MJ, Wojcik WR, d'Entremont G, Kimmerly DS, Fowles JR. Step Rate Thresholds Associated with Moderate and Vigorous Physical Activity in Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2454. [PMID: 30400331 PMCID: PMC6266480 DOI: 10.3390/ijerph15112454] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 11/21/2022]
Abstract
Adults are recommended to engage in 150 min of moderate (MPA) to vigorous (VPA) aerobic physical activity per week, with the public health message of obtaining 3000 steps in 30 min. There is a paucity of research on step rate thresholds that correspond to absolute MVPA (moderate = 3 METs, vigorous = 6 METs) with no research evaluating adult relative MVPA (moderate = 40% VO2max, vigorous = 60% VO2max). Anthropometric differences also influence intensity-related step rate thresholds. The purpose of this study was to identify step rates across a range of walking intensities so that mathematical models incorporating anthropometric factors could be used to identify individualized MVPA step rate thresholds. Forty-three adults (25♀; age = 39.4 ± 15.2 years) completed a staged treadmill walking protocol with pedometers and indirect calorimetry: six-minutes at 2.4, 3.2, 4.0, 5.6, 6.4, 7.2 km/h. Mathematical modelling revealed absolute and relative MPA step rate thresholds of ~100 steps/minute (spm) and ~125 spm, respectively. VPA corresponded to step rates of ~133 spm and ~139 spm for absolute and relative thresholds respectively. The current public message of 3000 steps in 30 min is valid for absolute MPA. However, VPA is achieved at higher thresholds than previously reported, more than 130 spm for healthy adults.
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Affiliation(s)
- Myles W O'Brien
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, 15 University Ave., Wolfville, NS B4P 2R6, Canada.
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada.
| | - Matthew J Kivell
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, 15 University Ave., Wolfville, NS B4P 2R6, Canada.
| | - William R Wojcik
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, 15 University Ave., Wolfville, NS B4P 2R6, Canada.
| | - Ghislain d'Entremont
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada.
| | - Derek S Kimmerly
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada.
| | - Jonathon R Fowles
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, 15 University Ave., Wolfville, NS B4P 2R6, Canada.
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O’Brien M, Shields C, Crowell S, Theou O, McGrath P, Fowles J. The effects of previous educational training on physical activity counselling and exercise prescription practices among physicians across Nova Scotia: a cross-sectional study. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e35-e45. [PMID: 30498542 PMCID: PMC6260514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Physicians (MDs) report difficulty including physical activity (PA) and exercise (PAE) as part of routine care. MDs who report previous educational training in PAE may prescribe exercise more frequently. We evaluated the effects of previous training on perceptions and practices of PA counselling and exercise prescriptions among MDs in Nova Scotia. METHODS MDs (n=174) across Nova Scotia completed an online self-reflection survey regarding their current PAE practices. MDs who reported previous training (n=41) were compared to those who reported no training (n=133). RESULTS Trained-MDs were 22% more confident performing PA counselling than untrained-MDs (p<0.005). In patient appointments, trained-MDs included PAE more often (51% vs 39%; p=0.03) but trained-MDs and untrained-MDs had similar rates of exercise prescriptions (12%; p>0.05). The most impactful barriers (on a scale of 1 to 4) were lack of time (2.5) and perceived patient interest (2.4), which were unaffected by previous training (p>0.05). CONCLUSION Previous training was associated with a higher confidence to include PAE discussions with patients by MDs in Nova Scotia, but had minimal influence on their many barriers that prevent exercise prescription. Although some training supports MDs inclusion of PAE into their practice, there is a need for greater, more intensive educational training to assist MDs in prescribing exercise.
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Affiliation(s)
- Myles O’Brien
- School of Kinesiology, Acadia University, Nova Scotia, Canada
- Nova Scotia Health Authority, Nova Scotia, Canada
- Divison of Kinesiology, Dalhousie University, Nova Scotia, Canada
| | | | | | - Olga Theou
- Divison of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Patrick McGrath
- Nova Scotia Health Authority, Nova Scotia, Canada
- Divison of Psychiatry, Dalhousie University, Nova Scotia, Canada
| | - Jonathon Fowles
- School of Kinesiology, Acadia University, Nova Scotia, Canada
- Nova Scotia Health Authority, Nova Scotia, Canada
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Metsios GS, Kitas GD. Physical activity, exercise and rheumatoid arthritis: Effectiveness, mechanisms and implementation. Best Pract Res Clin Rheumatol 2018; 32:669-682. [DOI: 10.1016/j.berh.2019.03.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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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: 100] [Impact Index Per Article: 16.7] [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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O'Brien MW, Wojcik WR, Fowles JR. Medical-Grade Physical Activity Monitoring for Measuring Step Count and Moderate-to-Vigorous Physical Activity: Validity and Reliability Study. JMIR Mhealth Uhealth 2018; 6:e10706. [PMID: 30185406 PMCID: PMC6231750 DOI: 10.2196/10706] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background The use of physical activity (PA) monitors is commonly associated with an increase in habitual PA level in healthy and clinical populations. The PiezoRx is a medical-grade PA monitor that uses adjustable step rate thresholds to estimate moderate-to-vigorous physical activity (MVPA) and is a valid indicator of free-living PA in adults. Laboratory validation of step count derived MVPA in adults is needed to justify the use of these monitors in clinical practice to track individuals’ progress toward meeting PA guidelines that are based on MVPA, not steps. Objective The objective of our study was to assess the validity and interinstrument reliability of the PiezoRx to derive step count and MVPA in a laboratory setting compared with criterion measures and other frequently used PA monitors in a diverse sample of adults. Methods The adult participants (n=43; 39.4 years, SD 15.2) wore an Omron HJ-320 pedometer, an ActiGraph GT3X accelerometer, and four PiezoRx monitors during a progressive treadmill protocol conducted for 6 minutes at speeds of 2.4, 3.2, 4.0, 5.6, 6.4, and 7.2 km/hour, respectively. The four PiezoRx monitors were set at different MVPA step rate thresholds (MPA in steps/minute/VPA in steps/minute) 100/120, 110/130, height adjusted, and height+fitness adjusted. Results The PiezoRx was more correlated (intraclass correlation, ICC=.97; P<.001) to manual step counting than the ActiGraph (ICC=.72; P<.001) and Omron (ICC=.62; P<.001). The PiezoRxs absolute percent error in measuring steps was 2.2% (ActiGraph=15.9%; Omron=15.0%). Compared with indirect calorimetry, the height-adjusted PiezoRx and ActiGraph were accurate measures of the time spent in MVPA (both ICC=.76; P<.001). Conclusions The PiezoRx PA monitor appears to be a valid and reliable measure of step count and MVPA in this diverse sample of adults. The device’s ability to measure MVPA may be improved when anthropometric differences are considered, performing at par or better than a research grade accelerometer.
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Affiliation(s)
- Myles William O'Brien
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS, Canada.,Division of Kinesiology, Dalhousie University, Halifax, NS, Canada
| | - William Robert Wojcik
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS, Canada
| | - Jonathon Richard Fowles
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS, Canada
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Cooke AB, Pace R, Chan D, Rosenberg E, Dasgupta K, Daskalopoulou SS. A qualitative evaluation of a physician-delivered pedometer-based step count prescription strategy with insight from participants and treating physicians. Diabetes Res Clin Pract 2018. [PMID: 29530385 DOI: 10.1016/j.diabres.2018.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIMS The integration of pedometers into clinical practice has the potential to enhance physical activity levels in patients with chronic disease. Our SMARTER randomized controlled trial demonstrated that a physician-delivered step count prescription strategy has measurable effects on daily steps, glycemic control, and insulin resistance in patients with type 2 diabetes and/or hypertension. In this study, we aimed to understand perceived barriers and facilitators influencing successful uptake and sustainability of the strategy, from patient and physician perspectives. METHODS Qualitative in-depth interviews were conducted in a purposive sample of physicians (n = 10) and participants (n = 20), including successful and less successful cases in terms of pedometer-assessed step count improvements. Themes that achieved saturation in either group through thematic analysis are presented. RESULTS All participants appreciated the pedometer-based monitoring combined with step count prescriptions. Accountability to physicians and support offered by the trial coordinator influenced participant motivation. Those who increased step counts adopted strategies to integrate more steps into their routines and were able to overcome weather-related barriers by finding indoor alternative options to outdoor steps. Those who decreased step counts reported difficulty in overcoming weather-related challenges, health limitations and work constraints. Physicians indicated the strategy provided a framework for discussing physical activity and motivating patients, but emphasized the need for support from allied professionals to help deliver the strategy in busy clinical settings. CONCLUSION A physician-delivered step count prescription strategy was feasibly integrated into clinical practice and successful in engaging most patients; however, continual support is needed for maximal engagement and sustained use.
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Affiliation(s)
- Alexandra B Cooke
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Romina Pace
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Deborah Chan
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ellen Rosenberg
- Department of Family Medicine, St. Mary's Hospital, McGill University, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Goss MJ, Nunes MLO, Machado ID, Merlin L, Macedo NB, Silva AMO, Bresolin TMB, Santin JR. Peel flour of Passiflora edulis Var. Flavicarpa supplementation prevents the insulin resistance and hepatic steatosis induced by low-fructose-diet in young rats. Biomed Pharmacother 2018; 102:848-854. [PMID: 29605773 DOI: 10.1016/j.biopha.2018.03.137] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 02/07/2023] Open
Abstract
The increase in fructose consumption in the last decades has an important correlation with the growth of overweight population. Fructose is a monosaccharide found in fruits, vegetables and honey, however, it is widely used in processed food and beverages such as sweeteners. This monosaccharide is metabolized in the liver, so it can produce glucose, lactate, triglycerides, free fatty acids and uric acid, which are responsible for negative effects on the liver and extrahepatic tissues. One effect of the high consumption of fructose is the resistance to Insulin, which appears to be an important issue in the development of metabolic abnormalities observed in animals that were subjected to a high fructose diet. The population and, consequently, the market search for natural sources to manage metabolic abnormalities is increasing, but, adequate scientific proof still is necessary. The Passiflora edulis peel flour (PEPF) is a byproduct of the juice industry, and, represents an important source of fiber and bioactive compounds. The present study investigates the PEPF supplementation (30%) effects on insulin sensitivity, adiposity and metabolic parameters in young rats that were given beverages enriched with 10% of fructose for 8 weeks. Fructose intake induced insulin resistance, increased serum triglycerides levels, growth of fat deposits in the liver and widening of the diameter of adipocytes. In contrast, the group that received PEPF did not present such abnormalities, which could be related to the presence of fiber or bioactive compounds (phenolics compounds, e.g., caffeic acid and isoorientin) in its composition, as identified by analytical methods. Thus, for the first time, it has been demonstrated that PEPF supplementation prevents insulin resistance and hepatic steatosis induced by low-fructose-diet in young rats.
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Affiliation(s)
- M J Goss
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade do Vale do Itajaí, Rua Uruguai, 458, Itajaí, SC, CEP 88302-202, Brazil
| | - M L O Nunes
- NIQFAR CCS, Universidade do Vale do Itajaí, Rua Uruguai, 458, Itajaí, SC, CEP 88302-202, Brazil
| | - I D Machado
- NIQFAR CCS, Universidade do Vale do Itajaí, Rua Uruguai, 458, Itajaí, SC, CEP 88302-202, Brazil
| | - L Merlin
- NIQFAR CCS, Universidade do Vale do Itajaí, Rua Uruguai, 458, Itajaí, SC, CEP 88302-202, Brazil
| | - N B Macedo
- Departamento de Nutrição (DNUT) da Universidade Federal de Sergipe (UFS), Avenida Marechal Rondon, s/n - Rosa Elze, São Cristóvão, SE, CEP 49100-000, Brazil
| | - A M O Silva
- Departamento de Nutrição (DNUT) da Universidade Federal de Sergipe (UFS), Avenida Marechal Rondon, s/n - Rosa Elze, São Cristóvão, SE, CEP 49100-000, Brazil
| | - T M B Bresolin
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade do Vale do Itajaí, Rua Uruguai, 458, Itajaí, SC, CEP 88302-202, Brazil; NIQFAR CCS, Universidade do Vale do Itajaí, Rua Uruguai, 458, Itajaí, SC, CEP 88302-202, Brazil
| | - J R Santin
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade do Vale do Itajaí, Rua Uruguai, 458, Itajaí, SC, CEP 88302-202, Brazil; NIQFAR CCS, Universidade do Vale do Itajaí, Rua Uruguai, 458, Itajaí, SC, CEP 88302-202, Brazil.
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Höchsmann C, Knaier R, Eymann J, Hintermann J, Infanger D, Schmidt-Trucksäss A. Validity of activity trackers, smartphones, and phone applications to measure steps in various walking conditions. Scand J Med Sci Sports 2018; 28:1818-1827. [DOI: 10.1111/sms.13074] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- C. Höchsmann
- Division of Sports and Exercise Medicine; Department of Sport, Exercise and Health; University of Basel; Basel Switzerland
| | - R. Knaier
- Division of Sports and Exercise Medicine; Department of Sport, Exercise and Health; University of Basel; Basel Switzerland
| | - J. Eymann
- Division of Sports and Exercise Medicine; Department of Sport, Exercise and Health; University of Basel; Basel Switzerland
| | - J. Hintermann
- Division of Sports and Exercise Medicine; Department of Sport, Exercise and Health; University of Basel; Basel Switzerland
| | - D. Infanger
- Division of Sports and Exercise Medicine; Department of Sport, Exercise and Health; University of Basel; Basel Switzerland
| | - A. Schmidt-Trucksäss
- Division of Sports and Exercise Medicine; Department of Sport, Exercise and Health; University of Basel; Basel Switzerland
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Hajna S, Ross NA, Dasgupta K. Steps, moderate-to-vigorous physical activity, and cardiometabolic profiles. Prev Med 2018; 107:69-74. [PMID: 29126915 PMCID: PMC6625960 DOI: 10.1016/j.ypmed.2017.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 01/24/2023]
Abstract
The relative benefits of meeting the current moderate-to-vigorous intensity physical activity (MVPA) and active step count recommendations are unknown. Using robust linear regressions, we compared cardiometabolic marker differences (blood pressure, lipid levels, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), hemoglobin A1C, C-reactive protein (CRP), and body mass index (BMI)) across MVPA (150min/week) and step (10,000 steps/day) thresholds and between step categories (low active: 5000 to 7499, somewhat active: 7500 to 9999, and active: ≥10,000 steps/day vs. inactive: <5000 steps/day) in approximately 6000 Canadian adults (41.5years, SD 14.9). Differences across MVPA and step thresholds were similar but additional benefits were observed for BMI and A1C for the MVPA target (i.e., above vs. below 150min/week MVPA: -1.02kg/m2 (95% Confidence Interval [CI] -1.25 to -0.80) and -0.04% (95% CI -0.06 to -0.02); above vs. below ≥10,000 steps/day: -0.40kg/m2 (95% CI -0.63 to -0.16) and 0.01% (95% CI -0.01 to 0.03)). In terms of steps categories, the greatest incremental improvement was achieved at the somewhat active threshold (e.g., somewhat active vs. inactive: -0.90kg/m2, 95% CI -1.28 to -0.53; low active vs. inactive: -0.36kg/m2, 95% CI -0.73 to 0.02). Additional benefits beyond the 10,000 step/day threshold were limited (e.g., -0.93kg/m2, 95% CI -1.30 to -0.57). Given that most benefits to markers of cardiometabolic health were at the ≥7500 step/day threshold and that there was some additional benefit across the 150min/week MVPA threshold compared to a 10,000 steps/day threshold, we suggest aiming for ≥7500 steps/day and then advancing to a 150min/MVPA goal.
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Affiliation(s)
- Samantha Hajna
- MRC Epidemiology Unit, Institute of Metabolic Sciences, University of Cambridge, Cambridge, UK; Department of Geography, McGill University, Montréal, Quebec, Canada
| | - Nancy A Ross
- Department of Geography, McGill University, Montréal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Kaberi Dasgupta
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada; Department of Medicine, Division of Internal Medicine, McGill University Health Centre, Montréal, Quebec, Canada; Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Quebec, Canada; Department of Medicine, Division of Endocrinology and Metabolism, McGill University Health Centre, Montréal, Quebec, Canada.
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Fowles JR, O'Brien MW, Solmundson K, Oh PI, Shields CA. Exercise is Medicine Canada physical activity counselling and exercise prescription training improves counselling, prescription, and referral practices among physicians across Canada. Appl Physiol Nutr Metab 2018; 43:535-539. [PMID: 29316409 DOI: 10.1139/apnm-2017-0763] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Exercise is Medicine Canada (EIMC) is an initiative that promotes physical activity (PA) counselling and exercise prescription within health care. The purpose of this study was to compare physicians' perceptions and practices around PA counselling and exercise prescription following EIMC training. Physicians (n = 46) from 7 different provinces completed questionnaires initially and 3 months following an EIMC workshop. Three months after intervention, physicians reported greater confidence compared with baseline for providing physical activity and exercise (PAE) information to patients (79% vs 55%; p < 0.001), assessing patients' PAE (69% vs 44%, p = 0.005), answering patients' PAE questions (78% vs 54%, p < 0.001), providing PAE advice (71% vs 43%, p < 0.001), and identifying which patients would benefit from referral to qualified exercise professionals (77% vs 52%, p = 0.002). At follow-up, physicians reported PA prescription barriers as less impactful (out of 4; all p < 0.05), including perceived patients' lack of interest (2.75 to 2.25), lack of available resources (2.59 to 2.00), and lack of time (2.41 to 2.14). The proportion of physicians providing written exercise prescriptions increased from 20% to 74%. This study suggests that the completion of a 1-day EIMC workshop increases physicians' confidence, knowledge, and counselling behaviours of physicians in prescribing PAE.
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Affiliation(s)
| | - Myles W O'Brien
- a School of Kinesiology, Acadia University, NS B4P 2R6, Canada.,b Division of Kinesiology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Kara Solmundson
- c Faculty of Medicine, Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Paul I Oh
- d Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute/University Health Network, Toronto, ON M5T 2S8, Canada
| | - Chris A Shields
- a School of Kinesiology, Acadia University, NS B4P 2R6, Canada
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Cooke AB, Daskalopoulou SS, Dasgupta K. The impact of accelerometer wear location on the relationship between step counts and arterial stiffness in adults treated for hypertension and diabetes. J Sci Med Sport 2017; 21:398-403. [PMID: 28855085 DOI: 10.1016/j.jsams.2017.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Accelerometer placement at the wrist is convenient and increasingly adopted despite less accurate physical activity (PA) measurement than with waist placement. Capitalizing on a study that started with wrist placement and shifted to waist placement, we compared associations between PA measures derived from different accelerometer locations with a responsive arterial health indicator, carotid-femoral pulse wave velocity (cfPWV). DESIGN Cross-sectional study. METHODS We previously demonstrated an inverse association between waist-worn pedometer-assessed step counts (Yamax SW-200, 7 days) and cfPWV (-0.20m/s, 95% CI -0.28, -0.12 per 1000 step/day increment) in 366 adults. Participants concurrently wore accelerometers (ActiGraph GT3X+), most at the waist but the first 46 at the wrist. We matched this subgroup with participants from the 'waist accelerometer' group (sex, age, and pedometer-assessed steps/day) and assessed associations with cfPWV (applanation tonometry, Sphygmocor) separately in each subgroup through linear regression models. RESULTS Compared to the waist group, wrist group participants had higher step counts (mean difference 3980 steps/day; 95% CI 2517, 5443), energy expenditure (967kcal/day, 95% CI 755, 1179), and moderate-to-vigorous-PA (138min; 95% CI 114, 162). Accelerometer-assessed step counts (waist) suggested an association with cfPWV (-0.28m/s, 95% CI -0.58, 0.01); but no relationship was apparent with wrist-assessed steps (0.02m/s, 95% CI -0.24, 0.27). CONCLUSIONS Waist but not wrist ActiGraph PA measures signal associations between PA and cfPWV. We urge researchers to consider the importance of wear location choice on relationships with health indicators.
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Affiliation(s)
- Alexandra B Cooke
- Division of Experimental Medicine, Department of Medicine, Faculty of Medicine, McGill University, Canada
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, Faculty of Medicine, McGill University, Canada; Division of Internal Medicine, Department of Medicine, Faculty of Medicine, Research Institute of the McGill University Health Centre, Canada
| | - Kaberi Dasgupta
- Division of Internal Medicine, Department of Medicine, Faculty of Medicine, Research Institute of the McGill University Health Centre, Canada; Division of Clinical Epidemiology, Department of Medicine, Faculty of Medicine, McGill University, Canada.
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