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Ried-Larsen M, Rasmussen MG, Blond K, Overvad TF, Overvad K, Steindorf K, Katzke V, Andersen JLM, Petersen KEN, Aune D, Tsilidis KK, Heath AK, Papier K, Panico S, Masala G, Pala V, Weiderpass E, Freisling H, Bergmann MM, Verschuren WMM, Zamora-Ros R, Colorado-Yohar SM, Spijkerman AMW, Schulze MB, Ardanaz EMA, Andersen LB, Wareham N, Brage S, Grøntved A. Association of Cycling With All-Cause and Cardiovascular Disease Mortality Among Persons With Diabetes: The European Prospective Investigation Into Cancer and Nutrition (EPIC) Study. JAMA Intern Med 2021; 181:1196-1205. [PMID: 34279548 PMCID: PMC8290339 DOI: 10.1001/jamainternmed.2021.3836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/15/2021] [Indexed: 12/23/2022]
Abstract
Importance Premature death from all causes and cardiovascular disease (CVD) causes is higher among persons with diabetes. Objective To investigate the association between time spent cycling and all-cause and CVD mortality among persons with diabetes, as well as to evaluate the association between change in time spent cycling and risk of all-cause and CVD mortality. Design, Setting, and Participants This prospective cohort study included 7459 adults with diabetes from the European Prospective Investigation into Cancer and Nutrition study. Questionnaires regarding medical history, sociodemographic, and lifestyle information were administered in 10 Western European countries from 1992 through 2000 (baseline examination) and at a second examination 5 years after baseline. A total of 5423 participants with diabetes completed both examinations. The final updated primary analysis was conducted on November 13, 2020. Exposures The primary exposure was self-reported time spent cycling per week at the baseline examination. The secondary exposure was change in cycling status from baseline to the second examination. Main Outcomes and Measures The primary and secondary outcomes were all-cause and CVD mortality, respectively, adjusted for other physical activity modalities, diabetes duration, and sociodemographic and lifestyle factors. Results Of the 7459 adults with diabetes included in the analysis, the mean (SD) age was 55.9 (7.7) years, and 3924 (52.6%) were female. During 110 944 person-years of follow-up, 1673 deaths from all causes were registered. Compared with the reference group of people who reported no cycling at baseline (0 min/wk), the multivariable-adjusted hazard ratios for all-cause mortality were 0.78 (95% CI, 0.61-0.99), 0.76 (95% CI, 0.65-0.88), 0.68 (95% CI, 0.57-0.82), and 0.76 (95% CI, 0.63-0.91) for cycling 1 to 59, 60 to 149, 150 to 299, and 300 or more min/wk, respectively. In an analysis of change in time spent cycling with 57 802 person-years of follow-up, a total of 975 deaths from all causes were recorded. Compared with people who reported no cycling at both examinations, the multivariable-adjusted hazard ratios for all-cause mortality were 0.90 (95% CI, 0.71-1.14) in those who cycled and then stopped, 0.65 (95% CI, 0.46-0.92) in initial noncyclists who started cycling, and 0.65 (95% CI, 0.53-0.80) for people who reported cycling at both examinations. Similar results were observed for CVD mortality. Conclusion and Relevance In this cohort study, cycling was associated with lower all-cause and CVD mortality risk among people with diabetes independent of practicing other types of physical activity. Participants who took up cycling between the baseline and second examination had a considerably lower risk of both all-cause and CVD mortality compared with consistent noncyclists.
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Affiliation(s)
- Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- University of Southern Denmark, Odense, Denmark
| | | | - Kim Blond
- Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Thure F. Overvad
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kim Overvad
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
- Aarhus University, Aarhus, Denmark
| | | | - Verena Katzke
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Dagfinn Aune
- Imperial College London, London, England, United Kingdom
| | - Kostas K. Tsilidis
- Imperial College London, London, England, United Kingdom
- University of Ioannina School of Medicine, Ioannina, Greece
| | | | - Keren Papier
- University of Oxford, Oxford, England, United Kingdom
| | | | | | - Valeria Pala
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | | | - W. M. Monique Verschuren
- National Institute for Public Health and the Environment, Utrecht, the Netherlands
- Utrecht University, Utrecht, the Netherlands
| | - Raul Zamora-Ros
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Sandra M. Colorado-Yohar
- Biomedical Research Institute of Murcia(IMIB-Arrixaca), Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- University of Antioquia, Medellín, Colombia
| | | | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Eva M. A. Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Institute of Navarra, Navarra, Spain
- Navarra Institute for Health Research, Navarra, Spain
| | | | - Nick Wareham
- University of Cambridge, Cambridge, England, United Kingdom
| | - Søren Brage
- University of Cambridge, Cambridge, England, United Kingdom
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Fortune J, Norris M, Stennett A, Kilbride C, Lavelle G, Hendrie W, de Souza L, Abdul M, Brewin D, David L, Anokye N, Victor C, Ryan JM. 'I can do this': a qualitative exploration of acceptability and experiences of a physical activity behaviour change intervention in people with multiple sclerosis in the UK. BMJ Open 2020; 10:e029831. [PMID: 32144172 PMCID: PMC7064077 DOI: 10.1136/bmjopen-2019-029831] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The purpose of this study was to explore the experiences of people with multiple sclerosis (MS) who participated in iStep-MS, a feasibility randomised controlled trial of a behaviour change intervention that aimed to increase physical activity and reduce sedentary behaviour. DESIGN A qualitative approach was undertaken embedded in the feasibility randomised controlled trial. One-to-one semi-structured interviews were conducted and analysed using Framework analysis. SETTING Participants were recruited from a single MS therapy centre in the southeast of England, UK. PARTICIPANTS Sixty people with MS were randomly allocated in a 1:1 ratio to the intervention or usual care. Following a purposive sampling strategy, 15 participants from the intervention arm undertook 1:1 semi-structured interviews. INTERVENTIONS The iStep-MS intervention consisted of four therapist-led sessions over 12 weeks, supported by a handbook and pedometer. RESULTS Three themes were identified from the data. "I can do this": developing competence in physical activity highlights the enhanced physical activity confidence gained through goal setting and accomplishment. "I felt valued": the nurturing culture provides an overview of the supportive and non-judgemental environment created by the programme structure and therapeutic relationship. Finally, "What can I do?": empowered enactment describes the transition from the supported iStep-MS intervention to intrinsically motivated physical activity enactment. CONCLUSIONS Overall, this study supports the acceptability of the iStep-MS intervention and identified key areas that supported participants to be physically active. TRIAL REGISTRATION NUMBER ISRCTN15343862.
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Affiliation(s)
- Jennifer Fortune
- University of Dublin Trinity College, Dublin, Ireland
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Meriel Norris
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Andrea Stennett
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Cherry Kilbride
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Grace Lavelle
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | | | - Lorraine de Souza
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | | | | | | | - Nana Anokye
- Health Economics Research Group, Brunel University London, Uxbridge, UK
| | - Christina Victor
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Jennifer M Ryan
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
- Department of Public Health and Epidemiology, RCSI, Dublin, Ireland
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Hickey KT, Wan E, Garan H, Biviano AB, Morrow JP, Sciacca RR, Reading M, Koleck TA, Caceres B, Zhang Y, Goldenthal I, Riga TC, Masterson Creber R. A Nurse-led Approach to Improving Cardiac Lifestyle Modification in an Atrial Fibrillation Population. J Innov Card Rhythm Manag 2019; 10:3826-3835. [PMID: 32494426 PMCID: PMC7252822 DOI: 10.19102/icrm.2019.100902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/01/2018] [Indexed: 02/01/2023] Open
Abstract
Atrial fibrillation (AF) is a major public health problem and the most common cardiac arrhythmia encountered in clinical practice at this time. AF is associated with numerous symptoms such as palpitations, shortness of breath, and fatigue, which can significantly reduce health-related quality of life and result in serious adverse cardiac outcomes. In light of this, the aim of the present pilot study was to test the feasibility of implementing a mobile health (mHealth) lifestyle intervention titled "Atrial Fibrillation and Cardiac Health: Targeting Improving Outcomes via a Nurse-Led Intervention (ACTION)," with the goal of improving cardiac health measures, AF symptom recognition, and self-management. As part of this study, participants self-identified cardiac health goals at enrollment. The nurse used web-based resources from the American Heart Association (Dallas, TX, USA), which included the Life's Simple 7® My Life Check® assessment, to quantify current lifestyle behavior change needs. Furthermore, on the My AFib Experience™ website (American Heart Association, Dallas, TX, USA), the patient used a symptom tracker tool to capture the date, time, frequency, and type of AF symptoms, and these data were subsequently reviewed by the cardiac nurse. Throughout the six-month intervention period, the cardiac nurse used a motivational interviewing approach to support participants' cardiac health goals. Ultimately, the ACTION intervention was tested in 53 individuals with AF (mean age: 59 ± 11 years; 76% male). Participants were predominantly overweight/obese (79%), had a history of hypertension (62%) or hyperlipidemia (61%), and reported being physically inactive/not preforming any type of regular exercise (52%). The majority (88%) of the participants had one or more Life's Simple 7® measures that could be improved. Most of the participants (98%) liked having a dedicated nurse to work with them on a biweekly basis via the mHealth portal. The most commonly self-reported symptoms were palpitations, fatigue/exercise intolerance, and dyspnea. Seventy percent of the participants had an improvement in their weight and blood pressure as documented within the electronic health record as well as a corresponding improvement in their Life's Simple 7® score at six months. On average, there was a three-pound (1.36-kg) decrease in weight and a 5-mmHg decrease in systolic blood pressure between baseline and at six months. In conclusion, this pilot work provides initial evidence regarding the feasibility of implementing the ACTION intervention and supports testing the ACTION intervention in a larger cohort of AF patients to inform existing AF guidelines and build an evidence base for reducing AF burden through lifestyle modification.
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Affiliation(s)
- Kathleen T. Hickey
- Department of Medicine, Columbia University, New York, NY, USA
- Department of Nursing, Columbia University, New York, NY, USA
| | - Elaine Wan
- Department of Medicine, Columbia University, New York, NY, USA
| | - Hasan Garan
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - John P. Morrow
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - Meghan Reading
- Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | | | - Billy Caceres
- Department of Nursing, Columbia University, New York, NY, USA
| | - Yiyi Zhang
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - Teresa C. Riga
- Department of Medicine, Columbia University, New York, NY, USA
| | - Ruth Masterson Creber
- Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
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Boekhout JM, Peels DA, Berendsen BAJ, Bolman C, Lechner L. A Web-Based and Print-Delivered Computer-Tailored Physical Activity Intervention for Older Adults: Pretest-Posttest Intervention Study Comparing Delivery Mode Preference and Attrition. J Med Internet Res 2019; 21:e13416. [PMID: 31464186 PMCID: PMC6737888 DOI: 10.2196/13416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/03/2019] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based interventions can play an important role in promoting physical activity (PA) behavior among older adults. Although the effectiveness of these interventions is promising, they are often characterized by low reach and high attrition, which considerably hampers their potential impact on public health. OBJECTIVE The aim of this study was to identify the participant characteristics associated with the preference for a Web-based or a printed delivery mode and to determine whether an association exists between delivery modes or participant characteristics and attrition in an intervention. This knowledge may enhance implementation, sustainability of participation, and effectiveness of future interventions for older adults. METHODS A real-life pretest-posttest intervention study was performed (N=409) among community-living single adults who were older than 65 years, with physical impairments caused by chronic diseases. Measurements were taken at baseline and 3 months after the start of the intervention. Hierarchical logistic regression was used to assess demographic and behavioral characteristics (age, gender, body mass index, educational attainment, degree of loneliness, and PA level), as well as psychosocial characteristics (social support for PA, modeling, self-efficacy, attitude, and intention) related to delivery mode preference at baseline and attrition after 3 months. RESULTS The printed delivery mode achieved higher participation (58.9%, 241/409) than the Web-based delivery mode (41.1%, 168/409). Participation in the Web-based delivery mode was associated with younger age (B=-0.10; SE 0.02; Exp (B)=0.91; P<.001) and higher levels of social support for PA (B=0.38; SE 0.14; Exp (B)=1.46; P=.01); attrition was associated with participation in the Web-based delivery mode (B=1.28; SE 0.28; Exp (B)=3.58; P<.001) and low educational attainment (B=-0.53; SE 0.28; Exp (B)=0.59; P=.049). CONCLUSIONS A total of 41% of the participants chose the Web-based delivery mode, thus demonstrating a potential interest of single older adults with physical impairments in Web-based delivered interventions. However, attrition was demonstrated to be higher in the Web-based delivery mode, and lower educational attainment was found to be a predictor for attrition. Characteristics predicting a preference for the printed delivery mode included being older and receiving less social support. Although Web-based delivery modes are generally less expensive and easier to distribute, it may be advisable to offer a printed delivery mode alongside a Web-based delivery mode to prevent exclusion of a large part of the target population. TRIAL REGISTRATION Netherlands Trial Register NTR2297; https://www.trialregister.nl/trial/2173. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-DOI: 10.2196/resprot.8093.
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Affiliation(s)
- Janet Maria Boekhout
- Department of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | - Denise Astrid Peels
- Department of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | | | - Catherine Bolman
- Department of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | - Lilian Lechner
- Department of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
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Rees JL, Chang CR, François ME, Marcotte-Chénard A, Fontvieille A, Klaprat ND, Dyck RA, Funk DR, Snydmiller G, Bastell K, Godkin FE, Dubé MC, Riesco E, McGavock JM, Yardley JE, Sigal RJ, Gibala MJ, Weisnagel SJ, Prado CM, Jung M, Manders R, Lee T, Singer J, Boulé NG, Little JP. Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study. Acta Diabetol 2019; 56:755-765. [PMID: 31093764 DOI: 10.1007/s00592-019-01358-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022]
Abstract
AIM To examine the effect of walking before dinner on 24-h glycemic control in individuals with type 2 diabetes using the standardized multi-site Exercise-Physical Activity and Diabetes Glucose Monitoring (E-PAraDiGM) Protocol. METHODS Eighty participants were studied under two conditions (exercise vs. non-exercise control) separated by 72 h in a randomized crossover design. Each condition lasted 2 days during which standardized meals were provided. Exercise consisted of 50 min of treadmill walking at 5.0 km/h before the evening meal, while control involved 50 min of sitting. The primary outcome measure was mean glucose during the 24-h period following exercise (or sitting) measured by continuous glucose monitoring. RESULTS Of the 80 participants who were initially randomized, 73 completed both exercise and control. Sixty-three participants [29 males, 34 females; age = 64 ± 8 years, body mass index = 30.5 ± 6.5 kg/m2 and HbA1c = 51 ± 8 mmol/mol (6.8 ± 0.7%), mean ± SD] complied with the standardized diets and had complete continuous glucose monitoring data. Exercise did not affect mean 24-h glucose compared to control (0.03 mmol/L; 95% CI - 0.17, 0.22, P = 0.778) but individual differences between conditions ranged from - 2.8 to +1.8 mmol/L. Exercise did not affect fasting glucose, postprandial glucose or glucose variability. Glucose concentrations measured by continuous glucose monitoring were reduced during the 50 min of walking in exercise compared to sitting in control (- 1.56 mmol/L; 95% CI - 2.18, - 0.95, p < 0.001). CONCLUSION Contrary to previous acute exercise studies, 50 min of walking before dinner in the E-PAraDiGM protocol did not affect 24-h glucose profiles. However, highly heterogeneous responses to exercise were observed. TRIAL REGISTRATION NCT02834689.
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Affiliation(s)
- Jordan L Rees
- Faculty of Kinesiology, Sport, and Recreation, and Alberta Diabetes Institute, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Courtney R Chang
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Monique E François
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Alexis Marcotte-Chénard
- Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada
- Research Center on Aging, CIUSSSE - CHUS, Sherbrooke, QC, J1H 4C4, Canada
| | - Adeline Fontvieille
- Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada
- Research Center on Aging, CIUSSSE - CHUS, Sherbrooke, QC, J1H 4C4, Canada
| | - Nika D Klaprat
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Rebecca A Dyck
- Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada
| | - Deanna R Funk
- Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada
| | - Gary Snydmiller
- Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada
| | - Kent Bastell
- Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Florence E Godkin
- Department of Kinesiology, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Marie-Christine Dubé
- Department of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada
- Department of Agriculture and Food Science, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Eléonor Riesco
- Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada
- Research Center on Aging, CIUSSSE - CHUS, Sherbrooke, QC, J1H 4C4, Canada
| | - Jon M McGavock
- DREAM Research Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, R3E 3P4, Canada
| | - Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, and Alberta Diabetes Institute, University of Alberta, Edmonton, AB, T6G 2H9, Canada
- Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada
| | - Ronald J Sigal
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Martin J Gibala
- Department of Kinesiology, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - S John Weisnagel
- Department of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada
- Department of Agriculture and Food Science, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Mary Jung
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Ralph Manders
- Faculty of Health and Medical Sciences, University of Surrey, Guilford, GU2 7WG, UK
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, and Alberta Diabetes Institute, University of Alberta, Edmonton, AB, T6G 2H9, Canada.
| | - Jonathan P Little
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada.
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Dintsios CM, Chernyak N, Grehl B, Icks A. Quantified patient preferences for lifestyle intervention programs for diabetes prevention-a protocol for a systematic review. Syst Rev 2018; 7:214. [PMID: 30497536 PMCID: PMC6264623 DOI: 10.1186/s13643-018-0884-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 11/14/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The 20-70% participation of diabetes patients in lifestyle interventions (LSI) worldwide seems to be rather sub-optimal, in spite of all intents of such interventions to delay further progress of the disease. Positive effects through LSI are expected in particular for patients who suffer less from diabetes-related limitations or other chronic diseases. Seeing that diabetes prevalence and with it mortality are increasing, LSI have become an inherent part of diabetes treatment standards. Various qualitative studies have been carried out to identify participation barriers for LSI. However, these have not resulted in more detailed knowledge about the relative importance of factors with an inhibiting impact on participation. Since it cannot be assumed that all of the influencing factors have equivalent values, it is necessary to investigate their individual importance with regard to a positive or negative decision about participating. There are no systematic reviews on patient preferences for LSI programs in diabetes prevention. As a result, the main objectives of this systematic review are to (i) identify existing patient preference elicitation studies related to LSI for diabetic patients, (ii) summarize the methods applied and findings, and (iii) appraise the reporting and methodological quality of such studies. METHODS We will perform systematic literature searches to identify suitable studies from 14 electronic databases. Retrieved study records will be included based on predefined eligibility criteria as defined in this protocol. We will run abstract and full-text screenings and then extract data from all selected studies by filling in a predefined data extraction spreadsheet. We will undertake a descriptive, narrative synthesis of findings to address the study objectives, since no pooling for quantified preferences is for methodological reasons implementable. We will pay special attention to aspects of methodological quality of preference elicitation by applying established evaluation criteria of the ISPOR and some own developed criteria for different elicitation techniques. All critical stages within the screening, data extraction, and synthesis processes will be conducted by two pairs of authors. This protocol adheres to PRISMA and PRISMA-P standards. DISCUSSION The proposed systematic review will provide an overview of the methods used and current practice in the elicitation and quantification of patients' preferences for diabetes prevention lifestyle interventions. Furthermore, the methodological quality of the identified studies will be appraised as well. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086988.
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Affiliation(s)
- Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40255 Düsseldorf, Germany
| | - Nadja Chernyak
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40255 Düsseldorf, Germany
| | - Benjamin Grehl
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40255 Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40255 Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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7
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Walker KC, Valentiner LS, Langberg H. Motivational factors for initiating, implementing, and maintaining physical activity behavior following a rehabilitation program for patients with type 2 diabetes: a longitudinal, qualitative, interview study. Patient Prefer Adherence 2018; 12:145-152. [PMID: 29403266 PMCID: PMC5779276 DOI: 10.2147/ppa.s150008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To explore motivational factors for initiating, implementing, and maintaining physical activity following a rehabilitation program for patients with type 2 diabetes mellitus. METHODS Semi-structured, individual, qualitative interviews with five informants from the InterWalk trial were conducted at three separate occasions; at initiation of the rehabilitation program, at completion of the 12-week program, and 52 weeks after enrolment. Interviews were audio-recorded, transcribed, and analyzed according to Systematic Text Condensation. The framework of Self-Determination Theory was applied to guide analysis after identification of preliminary themes. RESULTS Commitment and obligation were emphasized as being motivational in initiating physical activity. Toward the termination of the program, this was challenged by an expressed need for autonomy. Successful behavioral change was characterized by transfer of commitment to a new structure in everyday life, which also honored the request for autonomy. Feeling capable of participating in physical activity was facilitated through knowledge, practical experience, and progress and considered motivational, whereas lack of progress extinguished motivation. Finally, enjoyment of the activity was determining for long-term maintenance of physical activity behavior. CONCLUSION Satisfaction of innate psychological needs leads to more autonomous regulation of behavior and, through this study, we investigated determining factors for extrinsically motivated behavior and factors of importance to the internalization process.
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Affiliation(s)
- Karen Christina Walker
- CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health
- Correspondence: Karen Christina Walker, CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health, Henrik Pontoppidans Vej 6, 1st floor DK-2200 Copenhagen N, Denmark, Tel +45 35 33 3942, Email
| | - Laura Staun Valentiner
- CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health
- Center for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henning Langberg
- CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health
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Rees JL, Johnson ST, Boulé NG. Aquatic exercise for adults with type 2 diabetes: a meta-analysis. Acta Diabetol 2017; 54:895-904. [PMID: 28691156 DOI: 10.1007/s00592-017-1023-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
AIMS The purpose of this systematic review and meta-analysis was to examine the effects of aquatic exercise (AquaEx) on indicators of glycemic control (i.e., glycated hemoglobin [A1c] and fasting plasma glucose) in adults with type 2 diabetes mellitus (T2DM). It was hypothesized that AquaEx would improve glycemic control to a similar extent as land-based exercise (LandEx), but to a greater extent than non-exercise control (Ctrl). METHODS A literature search was completed in February 2017 for studies examining AquaEx training in adults with T2DM. Assessment of glycemic control was necessary for inclusion, while secondary outcomes such as quality of life and cardiometabolic risk factors (i.e., blood pressure, triglycerides and total cholesterol) were considered, but not required for inclusion. Outcomes were measured before and after at least 8 weeks of AquaEx, and data were analyzed using weighted mean differences (WMDs) and fixed effect models, when appropriate. RESULTS Nine trials including 222 participants were identified. Three trials compared AquaEx to LandEx, two compared AquaEx to Crtl, and four had a pre-/post-design without a comparison group. Results indicate no difference in A1c between LandEx and AquaEx (WMD = -0.02%, 95% confidence interval = [-0.71, 0.66]). Post-intervention A1c was lower in AquaEx when compared to Crtl (WMD = -0.96%, [-1.87, -0.05]). Post-AquaEx A1c was lower compared to baseline (WMD = -0.48%, [-0.66, -0.30]). CONCLUSIONS A1c can be reduced after eight-twelve weeks of AquaEx. However, at this time few studies have examined whether changes in A1c are different from LandEx or Crtl.
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Affiliation(s)
- Jordan L Rees
- Faculty of Physical Education and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada
- Alberta Diabetes Institute, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Steven T Johnson
- Alberta Diabetes Institute, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada
| | - Normand G Boulé
- Faculty of Physical Education and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
- Alberta Diabetes Institute, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
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Ashton LM, Morgan PJ, Hutchesson MJ, Rollo ME, Collins CE. Young Men's Preferences for Design and Delivery of Physical Activity and Nutrition Interventions: A Mixed-Methods Study. Am J Mens Health 2017; 11:1588-1599. [PMID: 28675118 PMCID: PMC5675188 DOI: 10.1177/1557988317714141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Young adult men are under-represented in health research, and little is known about how to reach and engage them in lifestyle interventions. This mixed-methods study aimed to explore young males' preferences for recruitment strategies, content, format (delivery mode and program duration and frequency), and facilitator characteristics for future physical activity and nutrition interventions. Ten focus groups involving 61 men (aged 18-25 years) in the Hunter region, New South Wales, Australia and an online survey distributed within Australia were completed by 282 males (aged 18-25 years). Key focus group themes included a preference for recruitment via multiple sources, ensuring images and recruiters were relatable; intervention facilitators to be engaging and refrain from discussing negative consequences of being unhealthy. Key program content preferences included skill development and individualized goals and feedback. Focus groups and the survey confirmed a preference for multiple delivery modes, including; face-to-face (group and individual), with support using eHealth technologies. Survey results confirmed the most favored program content as: "healthy eating on a budget," "quick and easy meals," and "resistance training." Focus group responses suggested a program duration of ≥6 months, with 2-3 combined face-to-face and supportive eHealth sessions per week. Survey intervention duration preference was 3 months with 4 face-to-face sessions per month. Findings can guide the design, conduct, and evaluation of relevant contemporary physical activity and or nutrition interventions for young men. There is a need to identify the most effective ways to address young men's individual preferences in intervention research.
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Affiliation(s)
- Lee M Ashton
- 1 School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Philip J Morgan
- 2 School of Education, Faculty of Education and Arts, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Melinda J Hutchesson
- 1 School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Megan E Rollo
- 1 School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Clare E Collins
- 1 School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
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Gray E, Shields C, Fowles JR. Building Competency and Capacity for Promotion of Effective Physical Activity in Diabetes Care in Canada. Can J Diabetes 2017; 41:491-498. [PMID: 28392023 DOI: 10.1016/j.jcjd.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of the present study was to examine the impact of the Canadian Diabetes Association's (CDA) resource titled Building Competency in Diabetes Education: Physical Activity and Exercise and associated workshops, on diabetes care providers' (DCPs) confidence and practices regarding physical-activity promotion 8 to 12 months after attending a workshop. METHODS In this action research study, 2 separate cross-sectional samples of DCPs were recruited. DCPs at baseline (N=462) completed a questionnaire assessing their current physical-activity promotion practices, intended changes in practice and intended implementation of the toolkit. At follow up, DCPs (n=132) completed an online questionnaire assessing their physical-activity counselling practices, confidence in their physical-activity counselling, use of the specific CDA resources as well as changes to practice and ongoing challenges. RESULTS At baseline, 58% of DCPs incorporated physical-activity content in the majority of their sessions; however, 66% of DCPs discussed physical activity in >50% of their sessions following the launch of the training initiative. Following the training, DCPs reported increased confidence across all 6 aspects of physical-activity counselling that were examined. Improvements were most frequently found in providing advice regarding the benefits of activity (86%) and providing instruction regarding resistance training (86%). DCPs most often changed their practices by discussing physical activity more frequently and confidently (27%); however, lack of time was frequently reported (37%) as an ongoing challenge to providing physical-activity counselling. CONCLUSIONS This evaluation highlights the impact of this national initiative and suggests that the resource is effective in improving physical-activity promotion in diabetes care.
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Affiliation(s)
- Emily Gray
- Acadia University, Wolfville, Nova Scotia, Canada
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Boudreau F, Moreau M, Côté J. Effectiveness of Computer Tailoring Versus Peer Support Web-Based Interventions in Promoting Physical Activity Among Insufficiently Active Canadian Adults With Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e20. [PMID: 26869015 PMCID: PMC4768043 DOI: 10.2196/resprot.5019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/10/2015] [Accepted: 11/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that less than half of people with type 2 diabetes in Canada are sufficiently active to meet the Canadian Diabetes Association's guidelines, effective programs targeting the adoption of regular physical activity are in demand for this population. Many researchers have argued that Web-based interventions targeting physical activity are a promising avenue for insufficiently active populations; however, it remains unclear if this type of intervention is effective among people with type 2 diabetes. OBJECTIVE This research project aims to evaluate the effectiveness of two Web-based interventions targeting the adoption of regular aerobic physical activity among insufficiently active adult Canadian Francophones with type 2 diabetes. METHODS A 3-arm, parallel randomized controlled trial with 2 experimental groups and 1 control group was conducted in the province of Quebec, Canada. A total of 234 participants were randomized at a 1:1:1 ratio to receive an 8-week, fully automated, computer-tailored, Web-based intervention (experimental group 1); an 8-week peer support (ie, Facebook group) Web-based intervention (experimental group 2); or no intervention (control group) during the study period. RESULTS The primary outcome of this study is self-reported physical activity level (total min/week of moderate-intensity aerobic physical activity). Secondary outcomes are attitude, social influence, self-efficacy, type of motivation, and intention. All outcomes are assessed at baseline and 3 and 9 months after baseline with a self-reported questionnaire filled directly on the study websites. CONCLUSIONS By evaluating and comparing the effectiveness of 2 Web-based interventions characterized by different behavior change perspectives, findings of this study will contribute to advances in the field of physical activity promotion in adult populations with type 2 diabetes. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN15747108; http://www.isrctn.com/ISRCTN15747108 (Archived by WebCite at http://www.webcitation.org/6eJTi0m3r).
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Affiliation(s)
- François Boudreau
- Interdisciplinary Group of Health Applied Research, Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
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Chen TT, Tung TH, Hsueh YSA, Tsai MH, Liang HM, Li KL, Chung KP, Tang CH. Measuring Preferences for a Diabetes Pay-for-Performance for Patient (P4P4P) Program using a Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:578-586. [PMID: 26297085 DOI: 10.1016/j.jval.2015.03.1793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/30/2015] [Accepted: 03/22/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To elicit a patient's willingness to participate in a diabetes pay-for-performance for patient (P4P4P) program using a discrete choice experiment method. METHODS The survey was conducted in March 2013. Our sample was drawn from patients with diabetes at five hospitals in Taiwan (International Classification of Diseases, Ninth Revision, Clinical Modification code 250). The sample size was 838 patients. The discrete choice experiment questionnaire included the attributes monthly cash rewards, exercise time, diet control, and program duration. We estimated a bivariate probit model to derive willingness-to-accept levels after accounting for the characteristics (e.g., severity and comorbidity) of patients with diabetes. RESULTS The preferred program was a 3-year program involving 30 minutes of exercise per day and flexible diet control. Offering an incentive of approximately US $67 in cash per month appears to increase the likelihood that patients with diabetes will participate in the preferred P4P4P program by approximately 50%. CONCLUSIONS Patients with more disadvantageous characteristics (e.g., elderly, low income, greater comorbidity, and severity) could have less to gain from participating in the program and thus require a higher monetary incentive to compensate for the disutility caused by participating in the program's activities. Our result demonstrates that a modest financial incentive could increase the likelihood of program participation after accounting for the attributes of the P4P4P program and patients' characteristics.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| | - Tao-Hsin Tung
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Medical Research and Education, Cheng Hsin General Hospital, Taipei City, Taiwan
| | - Ya-Seng Arthur Hsueh
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ming-Han Tsai
- Division of Endocrinology Metabolism, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Hsiu-Mei Liang
- Division of Endocrinology Metabolism, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Kay-Lun Li
- Division of Metabolism and Endocrinology, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei City, Taiwan
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Moreau M, Gagnon MP, Boudreau F. Development of a fully automated, web-based, tailored intervention promoting regular physical activity among insufficiently active adults with type 2 diabetes: integrating the I-change model, self-determination theory, and motivational interviewing components. JMIR Res Protoc 2015; 4:e25. [PMID: 25691346 PMCID: PMC4376153 DOI: 10.2196/resprot.4099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 12/24/2022] Open
Abstract
Background Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that fewer than half of people with type 2 diabetes in Canada are sufficiently active to meet the recommendations, effective programs targeting the adoption of regular physical activity (PA) are in demand for this population. Many researchers argue that Web-based, tailored interventions targeting PA are a promising and effective avenue for sedentary populations like Canadians with type 2 diabetes, but few have described the detailed development of this kind of intervention. Objective This paper aims to describe the systematic development of the Web-based, tailored intervention, Diabète en Forme, promoting regular aerobic PA among adult Canadian francophones with type 2 diabetes. This paper can be used as a reference for health professionals interested in developing similar interventions. We also explored the integration of theoretical components derived from the I-Change Model, Self-Determination Theory, and Motivational Interviewing, which is a potential path for enhancing the effectiveness of tailored interventions on PA adoption and maintenance. Methods The intervention development was based on the program-planning model for tailored interventions of Kreuter et al. An additional step was added to the model to evaluate the intervention’s usability prior to the implementation phase. An 8-week intervention was developed. The key components of the intervention include a self-monitoring tool for PA behavior, a weekly action planning tool, and eight tailored motivational sessions based on attitude, self-efficacy, intention, type of motivation, PA behavior, and other constructs and techniques. Usability evaluation, a step added to the program-planning model, helped to make several improvements to the intervention prior to the implementation phase. Results The intervention development cost was about CDN $59,700 and took approximately 54 full-time weeks. The intervention officially started on September 29, 2014. Out of 2300 potential participants targeted for the tailored intervention, approximately 530 people visited the website, 170 people completed the registration process, and 83 corresponded to the selection criteria and were enrolled in the intervention. Conclusions Usability evaluation is an essential step in the development of a Web-based tailored intervention in order to make pre-implementation improvements. The effectiveness and relevance of the theoretical framework used for the intervention will be analyzed following the process and impact evaluation. Implications for future research are discussed.
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Affiliation(s)
- Michel Moreau
- Interdisciplinary Group of Health Applied Research, Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Fowles JR, Shields C, d’Entremont L, McQuaid S, Barron B, Dunbar P. Implementation of Resources to Support Patient Physical Activity through Diabetes Centres in Nova Scotia: The Effectiveness of Enhanced Support for Exercise Participation. Can J Diabetes 2014; 38:423-31. [DOI: 10.1016/j.jcjd.2014.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 11/15/2022]
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Fowles JR, Shields C, Barron B, McQuaid S, Dunbar P. Implementation of Resources to Support Patient Physical Activity Through Diabetes Centres in Atlantic Canada: The Effectiveness of Toolkit-Based Physical Activity Counselling. Can J Diabetes 2014; 38:415-22. [DOI: 10.1016/j.jcjd.2014.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 02/12/2014] [Accepted: 02/13/2014] [Indexed: 11/15/2022]
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The effect of including an opt-out option in discrete choice experiments. PLoS One 2014; 9:e111805. [PMID: 25365169 PMCID: PMC4218820 DOI: 10.1371/journal.pone.0111805] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 10/06/2014] [Indexed: 11/19/2022] Open
Abstract
Objective to determine to what extent the inclusion of an opt-out option in a DCE may have an effect on choice behaviour and therefore might influence the attribute level estimates, the relative importance of the attributes and calculated trade-offs. Methods 781 Dutch Type 2 Diabetes Mellitus patients completed a questionnaire containing nine choice tasks with an opt-out option and nice forced choice tasks. Mixed-logit models were used to estimate the relative importance of the five lifestyle program related attributes that were included. Willingness to pay (WTP) values were calculated and it was tested whether results differed between respondents who answered the choice tasks with an opt-out option in the first or second part of the questionnaire. Results 21.4% of the respondents always opted out. Respondents who were given the opt-out option in the first part of the questionnaire as well as lower educated respondents significantly more often opted out. For both the forced and unforced choice model, different attributes showed significant estimates, the relative importance of the attributes was equal. However, due to differences in relative importance weights, the WTP values for the PA schedule differed significantly between both datasets. Conclusions Results show differences in opting out based on the location of the opt-out option and respondents' educational level; this resulted in small differences between the forced and unforced choice model. Since respondents seem to learn from answering forced choice tasks, a dual response design might result in higher data quality compared to offering a direct opt-out option. Future research should empirically explore how choice sets should be presented to make them as easy and less complex as possible in order to reduce the proportion of respondents that opts-out due to choice task complexity. Moreover, future research should debrief respondents to examine the reasons for choosing the opt-out alternative.
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The effect of out-of-pocket costs and financial rewards in a discrete choice experiment: an application to lifestyle programs. BMC Public Health 2014; 14:870. [PMID: 25151503 PMCID: PMC4153916 DOI: 10.1186/1471-2458-14-870] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/18/2014] [Indexed: 12/04/2022] Open
Abstract
Background Both out-of-pocket costs and financial rewards can be used to influence health related behavior. However, it is unclear which of these two has a larger effect on health related behavior. The aim of this study was to explore the possible difference in effect size between out-of-pocket costs and financial rewards on the willingness of diabetes mellitus type 2 (DM2) patients to participate in a lifestyle program. Methods A discrete choice experiment (DCE) questionnaire was sent to 767 DM2 patients in a geographically defined area (De Leidsche Rijn, Utrecht) in The Netherlands and completed by 206 of them. The questionnaire comprised of 18 choice tasks of which 9 contained a financial reward for lifestyle program completion, while the other 9 included out-of-pocket costs for program participation. In a second version of the questionnaire, the order of out-of-pocket cost and financial reward choice tasks was counterbalanced to reduce bias with respect to the position (first or second) of the two types of choice tasks. Panel-mixed-multinomial-logit models were used for data analysis. Results Increasing out-of-pocket costs were associated with a decreasing willingness to participate in a lifestyle program and, contrary to our expectations, increasing financial rewards were also associated with a decreasing willingness to participate in a lifestyle program. In addition, this willingness to participate changed to the same extent for both increasing out-of-pocket costs and increasing financial rewards. Conclusions As expected, increasing out-of-pocket costs may prevent people from deciding to participate in a lifestyle program. However, offering a financial reward to persuade people to participate in a lifestyle program, may result in decreasing willingness to participate in a lifestyle program as well.
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Short CE, Vandelanotte C, Duncan MJ. Individual characteristics associated with physical activity intervention delivery mode preferences among adults. Int J Behav Nutr Phys Act 2014; 11:25. [PMID: 24568611 PMCID: PMC3938301 DOI: 10.1186/1479-5868-11-25] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 02/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background People have different preferences on how health behaviour change interventions are delivered to them; intervention implementation, retention and effectiveness may be improved if preferences can be matched. Purpose This study aims to explore factors related to preference of face-to-face, and group-, print- or web-based physical activity intervention delivery modes among adults recruited from the general population. Methods A question relating to physical activity intervention preference was included in the telephone administered 2010 Queensland Social Survey. Multinomial regression models were used to explore socio-demographic (e.g., age, marital status, location), health (e.g., BMI, chronic disease status) and behavioral factors (e.g., internet use, physical activity, diet, social networking) related to intervention preferences, using ‘a face-to-face intervention’ as the reference category. Results 35.2% of those approached took part in the telephone interviews (n = 1,261). Preference for a web-based intervention was positively associated with being in the 35–44 age group (compared to the 18–34 age group; RR = 2.71), living in a rural area (RR = 2.01), and high internet use (RR = 1.03); and negatively associated with female gender (RR = 0.52), obesity (RR = 0.42), and higher physical activity participation (RR = 0.99). Preference for a print-based intervention was positively associated with older age (RR = 5.50); and negatively associated with female gender (RR = 0.48) and obesity (RR = 0.47). Preference for a group-based program was positively associated with living in a regional town (RR = 1.48) and negatively associated with being separated (RR = 0.45) and obesity (RR =0.56). Conclusion Findings from this study help to delineate what physical activity intervention delivery modes are likely to be appealing for specific target groups, especially in relation to people of different weight status, age, gender and living environment. As such, this information will be useful in the development of interventions targeted at these groups.
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Affiliation(s)
- Camille E Short
- School of Human, Health and Social Sciences, Centre for Physical activity studies, Central Queensland University, Rockhampton, Australia.
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Veldwijk J, Lambooij MS, van Gils PF, Struijs JN, Smit HA, de Wit GA. Type 2 diabetes patients' preferences and willingness to pay for lifestyle programs: a discrete choice experiment. BMC Public Health 2013; 13:1099. [PMID: 24289831 PMCID: PMC3909291 DOI: 10.1186/1471-2458-13-1099] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 11/19/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Participation rates of lifestyle programs among type 2 diabetes mellitus (T2DM) patients are less than optimal around the globe. Whereas research shows notable delays in the development of the disease among lifestyle program participants. Very little is known about the relative importance of barriers for participation as well as the willingness of T2DM patients to pay for participation in such programs. The aim of this study was to identify the preferences of T2DM patients with regard to lifestyle programs and to calculate participants' willingness to pay (WTP) as well as to estimate the potential participation rates of lifestyle programs. METHODS A Discrete Choice Experiment (DCE) questionnaire assessing five different lifestyle program attributes was distributed among 1250 Dutch adults aged 35-65 years with T2DM, 391 questionnaires (31%) were returned and included in the analysis. The relative importance of the program attributes (i.e., meal plan, physical activity (PA) schedule, consultation structure, expected program outcome and out-of-pocket costs) was determined using panel-mixed logit models. Based on the retrieved attribute estimates, patients' WTP and potential participation rates were determined. RESULTS The out-of-pocket costs (β = -0.75, P < .001), consultation structure (β = -0.46, P < .001) and expected outcome (β =0.72, P < .001) were the most important factors for respondents when deciding whether to participate in a lifestyle program. Respondents were willing to pay €128 per year for individual instead of group consultation and €97 per year for 10 kilograms anticipated weight loss. Potential participation rates for different lifestyle-program scenarios ranged between 48.5% and 62.4%. CONCLUSIONS When deciding whether to participate in a lifestyle program, T2DM patients are mostly driven by low levels of out-of-pocket costs. Thereafter, they prefer individual consultation and high levels of anticipated outcomes with respect to weight loss.
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Affiliation(s)
- Jorien Veldwijk
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1 (101), Bilthoven, BA 3720, The Netherlands
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Mattijs S Lambooij
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1 (101), Bilthoven, BA 3720, The Netherlands
| | - Paul F van Gils
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1 (101), Bilthoven, BA 3720, The Netherlands
| | - Jeroen N Struijs
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1 (101), Bilthoven, BA 3720, The Netherlands
| | - Henriëtte A Smit
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - G Ardine de Wit
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1 (101), Bilthoven, BA 3720, The Netherlands
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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Abstract
Diabetes is a major public health problem that affects certain ethnicities disproportionately. Physical activity (PA) (exercise) is a key component necessary for the prevention and treatment of type 2 diabetes. Adults with and without diabetes may face challenges that interfere with following exercise recommendations. This article reviews the relationships among PA, race/ethnicity, behaviors, and health outcomes of adults with prediabetes and type 2 diabetes. The authors review recent cross-sectional and intervention studies and assess their relevance to clinical practice. This is a focused review of the literature from January 2010 to September 2012 on the relationship among PA, type 2 diabetes, and race/ ethnicity with respect to the following components: (1) PA and the likelihood of persons with prediabetes developing diabetes; (2) PA and improvements in health outcomes of persons with prediabetes; (3) PA and improvements in health outcomes of persons with type 2 diabetes; and (4) enablers of and barriers to PA for persons with type 2 diabetes. The initiation of effective PA programs designed to reduce the incidence of type 2 diabetes or improve diabetes outcomes rely on a critical interpretation of current research findings.
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Madsen W. 'This is a forever project': supporting lifestyle changes in a regional Queensland community-based cardiac rehabilitation program. Aust J Prim Health 2012; 19:178-83. [PMID: 22950845 DOI: 10.1071/py11137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 05/22/2012] [Indexed: 11/23/2022]
Abstract
Cardiac rehabilitation programs throughout the world have struggled for several years to attract more participants and facilitate behaviour changes in these clients. Over the past few years, there has been an increased level of attention in the role that self-efficacy and social support may play in this respect. The main aim of this study was to explore self-efficacy and social support within a regional, community-based cardiac rehabilitation program that does not adhere to traditional cardiac rehabilitation structures. Twelve participants were interviewed and two major themes emerged from the thematic analysis of the interview transcripts: making personal lifestyle changes; and supportive environment for lifestyle changes. Although this study is exploratory in nature, it has highlighted the significance of social support from within a program as opposed to participants' friends and family, the subject of most social-support research. It also contributes to the challenges others are starting to make regarding the limited timeframes associated with traditional cardiac rehabilitation programs, suggesting more time may be needed to build firmer psychosocial foundations for behaviour change after cardiac events.
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Affiliation(s)
- Wendy Madsen
- CQUniversity, Locked Bag 3333, Bundaberg, Qld 4670, Australia.
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Abrantes AM, Friedman JH, Brown RA, Strong DR, Desaulniers J, Ing E, Saritelli J, Riebe D. Physical activity and neuropsychiatric symptoms of Parkinson disease. J Geriatr Psychiatry Neurol 2012; 25:138-45. [PMID: 22914597 DOI: 10.1177/0891988712455237] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Neuropsychiatric symptoms of Parkinson disease (PD) such as fatigue, depression, and apathy are common and detract from quality of life. There is little published on the impact of physical activity on the neuropsychiatric symptoms of PD. A convenience sample of 45 patients with PD (mean age = 66.1 years; 33% female) completed questionnaires on physical activity, neuropsychiatric symptoms, and specific exercise preferences. Covarying for age and gender, higher levels of physical activity were associated with significantly less fatigue, as well as a trend for less apathy and depression and greater positive affect. Exercise preferences included moderate intensity (73%), at home (56%), in the morning (73%), scheduled (69%), options for varied activities (73%), and preference for both structured/supervised (50%), and unsupervised/self-paced (50%) programs. Preferred activities included the use of aerobic exercise equipment, resistance training, and yoga. Developing and tailoring exercise programs that incorporate specific preferences may result in more effective interventions for patients with PD.
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Huebschmann AG, Crane LA, Belansky ES, Scarbro S, Marshall JA, Regensteiner JG. Fear of injury with physical activity is greater in adults with diabetes than in adults without diabetes. Diabetes Care 2011; 34:1717-22. [PMID: 21700920 PMCID: PMC3142033 DOI: 10.2337/dc10-1801] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Physical activity is a cornerstone of treatment for diabetes, yet people with diabetes perform less moderate and vigorous physical activity (MVPA) than people without diabetes. In contrast, whether differences in walking activity exist has been understudied. Diabetes-specific barriers to physical activity are one possible explanation for lower MVPA in diabetes. We hypothesized that people with diabetes would perform less walking and combined MVPA and would be less likely to anticipate increasing physical activity if barriers were theoretically absent, compared with people without diabetes. RESEARCH DESIGN AND METHODS We surveyed 1,848 randomly selected rural Colorado adult residents by telephone from 2002 to 2004. Respondents reported weekly walking and MVPA duration and their likelihood of increasing physical activity if each of seven barriers was theoretically absent. RESULTS People with diabetes (n = 129) had lower odds of walking and MVPA than people without diabetes (walking: adjusted odds ratio 0.62 [95% CI 0.40-0.95]; MVPA: adjusted odds ratio 0.60 [0.36-0.99]; ≥10 vs. <10 min/week, adjusted for age, sex, BMI, and ethnicity). Respondents with diabetes reported fear of injury as a barrier to physical activity more often than respondents without diabetes (56 vs. 39%; P = 0.0002), although this relationship was attenuated after adjusting for age and BMI (adjusted odds ratio 1.36 [0.93-1.99]). CONCLUSIONS Although walking is a preferred form of activity in diabetes, people with diabetes walk less than people without diabetes. Reducing fear of injury may potentially increase physical activity for people with diabetes, particularly in older and more overweight individuals.
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Affiliation(s)
- Amy G Huebschmann
- Department of Medicine, University of Colorado Schoolof Medicine, Aurora, CO, USA.
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