1
|
Smith S, Salmani B, LeSarge J, Dillon-Rossiter K, Morava A, Prapavessis H. Interventions to reduce sedentary behaviour in adults with type 2 diabetes: A systematic review and meta-analysis. PLoS One 2024; 19:e0306439. [PMID: 39078846 PMCID: PMC11288443 DOI: 10.1371/journal.pone.0306439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/18/2024] [Indexed: 08/02/2024] Open
Abstract
Treatment and management of Type 2 Diabetes (T2D) includes physical activity, nutrition, and pharmacological management. Recently, the importance of reducing and breaking up sedentary behaviour has become recognized. This review aimed to summarize and synthesize the effectiveness of interventions in reducing and/or breaking up sedentary behaviour and cardiometabolic biomarkers in adults with T2D. A study protocol was preregistered on PROSPERO (CRD42022357281) and a database search (PubMed, EMBASE, Scopus, Web of Science, PsycINFO, SPORTDiscus, CINAHL, and Cochrane Library) was conducted on 16/09/2022 and updated on 03/01/2024. This review followed PRISMA guidelines and study quality was assessed with the Cochrane risk of Bias Tools. Twenty-eight articles were included in the review. The meta-analysis of short-term (Range: 3 hours- 4 days) sedentary behaviour interventions found significant improvement in continuous interstitial glucose measured for 24 hours after the sedentary behaviour intervention compared to control (SMD:-0.819,95%CI:-1.255,-0.383,p<0.001). Similarly, there was a significant improvement in postprandial interstitial glucose after the sedentary behaviour intervention compared to control (SMD:-0.347,95%CI:-0.584,-0.110,p = 0.004). Ten out of eleven longer-term (Range: 5 weeks- 3 years) sedentary behaviour interventions improved at least one measure of sedentary behaviour compared to control. Eight out of eight longer-term sedentary behaviour interventions improved at least one cardiometabolic biomarker compared to control. Reducing sedentary behaviour, independent of physical activity, can improve glycemic control in adults with T2D. Further, sedentary behaviour may be a feasible/ sustainable behaviour change.
Collapse
Affiliation(s)
- Siobhan Smith
- Department of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Babac Salmani
- Department of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jordan LeSarge
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kirsten Dillon-Rossiter
- Department of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Anisa Morava
- Department of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Harry Prapavessis
- Department of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Zangger G, Bricca A, Liaghat B, Juhl CB, Mortensen SR, Andersen RM, Damsted C, Hamborg TG, Ried-Larsen M, Tang LH, Thygesen LC, Skou ST. Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e46439. [PMID: 37410534 PMCID: PMC10359919 DOI: 10.2196/46439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Digital health interventions for managing chronic conditions have great potential. However, the benefits and harms are still unclear. OBJECTIVE This systematic review and meta-analysis aimed to investigate the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions. METHODS We searched the MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to October 2022. Eligible randomized controlled trials were included if they used a digital component in physical activity promotion in adults with ≥1 of the following conditions: depression or anxiety, ischemic heart disease or heart failure, chronic obstructive pulmonary disease, knee or hip osteoarthritis, hypertension, or type 2 diabetes. The primary outcomes were objectively measured physical activity and physical function (eg, walk or step tests). We used a random effects model (restricted maximum likelihood) for meta-analyses and meta-regression analyses to assess the impact of study-level covariates. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Of 14,078 hits, 130 randomized controlled trials were included. Compared with usual care or minimal intervention, digital health interventions increased objectively measured physical activity (end of intervention: standardized mean difference [SMD] 0.29, 95% CI 0.21-0.37; follow-up: SMD 0.17, 95% CI 0.04-0.31) and physical function (end of intervention: SMD 0.36, 95% CI 0.12-0.59; follow-up: SMD 0.29, 95% CI 0.01-0.57). The secondary outcomes also favored the digital health interventions for subjectively measured physical activity and physical function, depression, anxiety, and health-related quality of life at the end of the intervention but only subjectively measured physical activity at follow-up. The risk of nonserious adverse events, but not serious adverse events, was higher in the digital health interventions at the end of the intervention, but no difference was seen at follow-up. CONCLUSIONS Digital health interventions improved physical activity and physical function across various chronic conditions. Effects on depression, anxiety, and health-related quality of life were only observed at the end of the intervention. The risk of nonserious adverse events is present during the intervention, which should be addressed. Future studies should focus on better reporting, comparing the effects of different digital health solutions, and investigating how intervention effects are sustained beyond the end of the intervention. TRIAL REGISTRATION PROSPERO CRD42020189028; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189028.
Collapse
Affiliation(s)
- Graziella Zangger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alessio Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Evidence-Based Orthopedics (CEBO), Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Carsten B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen, Herlev and Gentofte, Denmark
| | - Sofie Rath Mortensen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Camma Damsted
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Trine Grønbek Hamborg
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Mathias Ried-Larsen
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Peng P, Zhang N, Huang J, Jiao X, Shen Y. Effectiveness of Wearable Activity Monitors on Metabolic Outcomes in Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis. Endocr Pract 2023; 29:368-378. [PMID: 36804969 DOI: 10.1016/j.eprac.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Wearable activity monitors are promising tools for improving metabolic outcomes in patients with type 2 diabetes mellitus (T2DM); however, no uniform conclusive evidence is available. This study aimed to evaluate the effects of the intervention using wearable activity monitors on blood glucose, blood pressure, blood lipid, weight, waist circumference, and body mass index (BMI) in individuals with T2DM. METHODS Two independent reviewers searched 4 online databases (PubMed, Cochrane Library, Web of Science, and Embase) to identify relevant studies published from January 2000 to October 2022. The primary outcome indicator was hemoglobin A1c (HbA1c), and the secondary outcome indicators included physical activity (steps per day), fasting blood glucose, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, BMI, waist circumference, and weight. RESULTS A total of 25 studies were included. The HbA1c level (standardized mean difference [SMD], -0.14; 95% confidence interval [CI], -0.27 to -0.02; P = .02; I2 = 48%), BMI (SMD, -0.16; 95% CI, -0.26 to -0.05; P = .002; I2 = 0), waist circumference (SMD, -0.21; 95% CI, -0.34 to -0.09; P < .001; I2 = 0), and steps/day (SMD, 0.55; 95% CI, 0.36-0.94; P < .001; I2 = 77%) significantly improved. CONCLUSION Wearable activity monitor-based interventions could facilitate the improvement of the HbA1c level, BMI, and waist circumference and increase in physical activity in individuals with T2DM. Wearable technology appeared to be an effective tool for the self-management of T2DM; however, there is insufficient evidence about its long-term effect.
Collapse
Affiliation(s)
- Ping Peng
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Neng Zhang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Jingjing Huang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Xiaojuan Jiao
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Yunfeng Shen
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China.
| |
Collapse
|
5
|
Ahmad E, Lim S, Lamptey R, Webb DR, Davies MJ. Type 2 diabetes. Lancet 2022; 400:1803-1820. [PMID: 36332637 DOI: 10.1016/s0140-6736(22)01655-5] [Citation(s) in RCA: 227] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/06/2022]
Abstract
Type 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies improves person-centred outcomes beyond glycaemic control. Precision medicine, including multiomics and pharmacogenomics, hold promise to enhance understanding of disease heterogeneity, leading to targeted therapies. Technology might improve outcomes, but its potential is yet to be realised. Despite advances, substantial barriers to changing the course of the epidemic remain. This Seminar offers a clinically focused review of the recent developments in type 2 diabetes care including controversies and future directions.
Collapse
Affiliation(s)
- Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Roberta Lamptey
- Family Medicine Department, Korle Bu Teaching Hospital, Accra Ghana and Community Health Department, University of Ghana Medical School, Accra, Ghana
| | - David R Webb
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK.
| |
Collapse
|
6
|
Long-Term Effectiveness of a Smartphone App and a Smart Band on Arterial Stiffness and Central Hemodynamic Parameters in a Population with Overweight and Obesity (Evident 3 Study): Randomised Controlled Trial. Nutrients 2022; 14:nu14224758. [PMID: 36432446 PMCID: PMC9695348 DOI: 10.3390/nu14224758] [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: 10/02/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND mHealth technologies could help to improve cardiovascular health; however, their effect on arterial stiffness and hemodynamic parameters has not been explored to date. OBJECTIVE To evaluate the effect of a mHealth intervention, at 3 and 12 months, on arterial stiffness and central hemodynamic parameters in a sedentary population with overweight and obesity. METHODS Randomised controlled clinical trial (Evident 3 study). 253 subjects were included: 127 in the intervention group (IG) and 126 in the control group (CG). The IG subjects were briefed on the use of the Evident 3 app and a smart band (Mi Band 2, Xiaomi) for 3 months to promote healthy lifestyles. All measurements were recorded in the baseline visit and at 3 and 12 months. The carotid-femoral pulse wave velocity (cfPWV) and the central hemodynamic parameters were measured using a SphigmoCor System® device, whereas the brachial-ankle pulse wave velocity (baPWV) and the Cardio Ankle Vascular Index (CAVI) were measured using a VaSera VS-2000® device. RESULTS Of the 253 subjects who attended the initial visit, 237 (93.7%) completed the visit at 3 months of the intervention, and 217 (85.3%) completed the visit at 12 months of the intervention. At 12 months, IG showed a decrease in peripheral augmentation index (PAIx) (-3.60; 95% CI -7.22 to -0.00) and ejection duration (ED) (-0.82; 95% CI -1.36 to -0.27), and an increase in subendocardial viability ratio (SEVR) (5.31; 95% CI 1.18 to 9.44). In CG, cfPWV decreased at 3 months (-0.28 m/s; 95% CI -0.54 to -0.02) and at 12 months (-0.30 m/s, 95% CI -0.54 to -0.05), central diastolic pressure (cDBP) decreased at 12 months (-1.64 mm/Hg; 95% CI -3.19 to -0.10). When comparing the groups we found no differences between any variables analyzed. CONCLUSIONS In sedentary adults with overweight or obesity, the multicomponent intervention (Smartphone app and an activity-tracking band) for 3 months did not modify arterial stiffness or the central hemodynamic parameters, with respect to the control group. However, at 12 months, CG presented a decrease of cfPWV and cDBP, whereas IG showed a decrease of PAIx and ED and an increase of SEVR.
Collapse
|
7
|
Recio-Rodríguez JI, Gonzalez-Sanchez S, Tamayo-Morales O, Gómez-Marcos MA, Garcia-Ortiz L, Niño-Martín V, Lugones-Sanchez C, Rodriguez-Sanchez E. Changes in lifestyles, cognitive impairment, quality of life and activity day living after combined use of smartphone and smartband technology: a randomized clinical trial (EVIDENT-Age study). BMC Geriatr 2022; 22:782. [PMID: 36203135 PMCID: PMC9535859 DOI: 10.1186/s12877-022-03487-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to assess the efficacy of the combined use of smartphone and smartband technology for 3-months alongside brief lifestyle counselling, versus counselling alone, in increasing physical activity. As secondary objectives, the effects of the intervention on dietary habits, body composition, quality of life, level of functionality and cognitive performance were assessed. Methods This study employed a randomized clinical trial of two-parallel groups design – control group (CG) and intervention group (IG). The study was conducted in 3 Spanish health-centres between October 2018-February 2020. Eligible participants were people of both sexes and aged between 65–80 years attending the health-centres with a score ≥ 24 points on the Mini-Mental State Examination. Key variables included physical activity, dietary pattern, body composition, cognitive performance, level of functionality and quality of life. All variables were measured at baseline and after 3-months. Both groups received a brief nutritional and physical activity advice. Intervention group participants were instructed to use a smartphone application for a period of 3-months. This application integrates information on physical activity received from a fitness bracelet and self-reported information on the patient’s daily nutritional composition. Results The study population comprised 160 participants (IG = 81, CG = 79), with a mean age of 70.8 ± 4.0 years (61.3% women). No difference was found in the primary and secondary outcomes analyzed (physical activity (steps/min -0.4 (-1.0 to 0.2) p = 0.174), and dietary habits (Mediterranean diet score 0.0 (-0.6 to 0.6) p = 0.956) that could be attributed to either group after an ANCOVA test. A difference attributable to the intervention was observed in the total Clock test score (0.7 (0.1 to 1.2) p = 0.018. Conclusions In a sample of people over 65 years of age, the combined use of the EVIDENT 3 smartphone app and an activity tracking bracelet for 3-months did not result in lifestyles changes related to the amount and level of physical activity or the eating habits, compared to brief lifestyle advice. Other clinical parameters were not changed either, although at the cognitive level, a slight improvement was observed in the score on the Clock test assessing a variety of cognitive functions such as memory. Trial registration The study was registered in ClinicalTrials.gov Identifier: NCT03574480. Date of trial Registration 02/07/2018.
Collapse
Affiliation(s)
- José I Recio-Rodríguez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain. .,Facultad de Enfermería Y Fisioterapia, Universidad de Salamanca, Donantes de Sangre S/N, 37007, Salamanca, Spain.
| | - Susana Gonzalez-Sanchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
| | - Olaya Tamayo-Morales
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain.,Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Luis Garcia-Ortiz
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain.,Departamento de Ciencias Biomédicas Y del Diagnóstico, Universidad de Salamanca, Salamanca, Spain
| | | | - Cristina Lugones-Sanchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain
| | - Emiliano Rodriguez-Sanchez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de investigación en cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS) (RD21/0016), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla Y León (SACyL), Salamanca, Spain.,Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| |
Collapse
|
8
|
Kettle VE, Madigan CD, Coombe A, Graham H, Thomas JJC, Chalkley AE, Daley AJ. Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials. BMJ 2022; 376:e068465. [PMID: 35197242 PMCID: PMC8864760 DOI: 10.1136/bmj-2021-068465] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the effectiveness of physical activity interventions delivered or prompted by primary care health professionals for increasing moderate to vigorous intensity physical activity (MVPA) in adult patients. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Databases (Medline and Medline in progress, Embase, PsycINFO, CINAHL, SPORTDiscus, Sports Medicine and Education Index, ASSIA, PEDro, Bibliomap, Science Citation Index, Conference Proceedings Citation Index), trial registries (Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, TRoPHI), and grey literature (OpenGrey) sources were searched (from inception to September 2020). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials of aerobic based physical activity interventions delivered or prompted by health professionals in primary care with a usual care control group or another control group that did not involve physical activity. STUDY SELECTION AND ANALYSIS Two independent reviewers screened the search results, extracted data from eligible trials and assessed the risk of bias using the Cochrane risk of bias tool (version 2). Inverse variance meta-analyses using random effects models examined the primary outcome of difference between the groups in MVPA (min/week) from baseline to final follow-up. The odds of meeting the guidelines for MVPA at follow-up were also analysed. RESULTS 14 566 unique reports were identified and 46 randomised controlled trials with a range of follow-ups (3-60 months) were included in the meta-analysis (n=16 198 participants). Physical activity interventions delivered or prompted by health professionals in primary care increased MVPA by 14 min/week (95% confidence interval 4.2 to 24.6, P=0.006). Heterogeneity was substantial (I2=91%, P<0.001). Limiting analyses to trials that used a device to measure physical activity showed no significant group difference in MVPA (mean difference 4.1 min/week, 95% confidence interval -1.7 to 9.9, P=0.17; I2=56%, P=0.008). Trials that used self-report measures showed that intervention participants achieved 24 min/week more MVPA than controls (95% confidence interval 6.3 to 41.8, P=0.008; I2=72%, P<0.001). Additionally, interventions increased the odds of patients meeting guidelines for MVPA by 33% (95% confidence interval 1.17 to 1.50, P<0.001; I2=25%, P=0.11) versus controls. 14 of 46 studies were at high risk of bias but sensitivity analyses excluding these studies did not alter the results. CONCLUSIONS Physical activity interventions delivered or prompted by health professionals in primary care appear effective at increasing participation in self-reported MVPA. Such interventions should be considered for routine implementation to increase levels of physical activity and improve health outcomes in the population. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021209484.
Collapse
Affiliation(s)
- Victoria E Kettle
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Claire D Madigan
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - April Coombe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Henrietta Graham
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jonah J C Thomas
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Anna E Chalkley
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| |
Collapse
|
9
|
D'Amore C, Reid JC, Chan M, Fan S, Huang A, Louie J, Tran A, Chauvin S, Beauchamp MK. Title: Systematic review and meta-analysis of interventions including smart-technology compared to face-to-face physical activity interventions in older adults (Preprint). J Med Internet Res 2022; 24:e36134. [DOI: 10.2196/36134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/31/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
|
10
|
Clarkson P, Stephenson A, Grimmett C, Cook K, Clark C, Muckelt PE, O’Gorman P, Saynor Z, Adams J, Stokes M, McDonough S. Digital tools to support the maintenance of physical activity in people with long-term conditions: A scoping review. Digit Health 2022; 8:20552076221089778. [PMID: 35433017 PMCID: PMC9005829 DOI: 10.1177/20552076221089778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This scoping review aimed to bring together and identify digital tools that support people with one or more long-term conditions to maintain physical activity and describe their components and theoretical underpinnings. Methods Searches were conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, EMBASE, IEEE Xplore, PsycINFO, Scopus, Google Scholar and clinical trial databases, for studies published between 2009 and 2019, across a range of long-term conditions. Screening and data extraction was undertaken by two independent reviewers and the Preferred Reporting Items for Scoping Reviews guidelines informed the review's conduct and reporting. Results A total of 38 results were identified from 34 studies, with the majority randomised controlled trials or protocols, with cardiovascular disease, type 2 diabetes mellitus and obesity the most common long-term conditions. Comorbidities were reported in >50% of studies but did not clearly inform intervention development. Most digital tools were web-browser-based ± wearables/trackers, telerehabilitation tools or gaming devices/components. Mobile device applications and combination short message service/activity trackers/wearables were also identified. Most interventions were supported by a facilitator, often for goal setting/feedback and/or monitoring. Physical activity maintenance outcomes were mostly reported at 9 months or 3 months post-intervention, while theoretical underpinnings were commonly social cognitive theory, the transtheoretical model and the theory of planned behaviour. Conclusions This review mapped the literature on a wide range of digital tools and long-term conditions. It identified the increasing use of digital tools, in combination with human support, to help people with long-term conditions, to maintain physical activity, commonly for under a year post-intervention. Clear gaps were the lack of digital tools for multimorbid long-term conditions, longer-term follow-ups, understanding participant's experiences and informs future questions around effectiveness.
Collapse
Affiliation(s)
- Paul Clarkson
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration Wessex, Southampton, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Southampton, UK
| | - Aoife Stephenson
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research, Southampton Biomedical Research Unit, Southampton, UK
| | - Katherine Cook
- Faculty of Health and Wellbeing, School of Health and Care Professions, University of Winchester, Winchester, UK
| | - Carol Clark
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Paul E Muckelt
- School of Health Sciences, University of Southampton, Southampton, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Southampton, UK
| | - Philip O’Gorman
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Zoe Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, Faculty of Science and Health, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Jo Adams
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration Wessex, Southampton, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Southampton, UK
| | - Maria Stokes
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration Wessex, Southampton, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Southampton, UK
- National Institute for Health Research, Southampton Biomedical Research Unit, Southampton, UK
| | - Suzanne McDonough
- School of Health Sciences, University of Southampton, Southampton, UK
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
11
|
Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2021; 17:794-825. [PMID: 34957864 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
Collapse
Affiliation(s)
- Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Sisse H Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
| | - Jonas D Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
12
|
Madigan CD, Fong M, Howick J, Kettle V, Rouse P, Hamilton L, Roberts N, Gomersall SR, Daley AJ. Effectiveness of interventions to maintain physical activity behavior (device-measured): Systematic review and meta-analysis of randomized controlled trials. Obes Rev 2021; 22:e13304. [PMID: 34129276 DOI: 10.1111/obr.13304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
Physical activity has many physical, mental, and social health benefits. Interventions can be successful at helping people initiate participation, but there is a lack of evidence about the ability of these interventions to help adults maintain their physical activity. This systematic review and meta-analysis aims to address this evidence gap. We investigated the extent to which successful physical activity interventions with demonstrated success within randomized controlled trials result in maintenance of device-measured physical activity (at least 3 months post-intervention end). Five databases were searched, and 8919 titles and abstracts were screened for eligibility, and 29 trials met the inclusion criteria. Of these, 22 were included in the meta-analysis. We found that 60% to 80% of physical activity behavior was maintained, as equivalent to an additional 45 min/week of moderate-to-vigorous physical activity and 945 steps per day compared with comparators. We also examined trials that randomized participants to maintenance interventions after an initial physical activity intervention (n = 7) and we found small effects (standardized mean difference 0.14, 95% confidence interval [CI] 0.1 to 0.27). The evidence suggests that most (60%-80%) of the increases in physical activity in successful programs are maintained for at least 3 months and there are small effects from providing a maintenance intervention to the public. Registration: CRD42019144585.
Collapse
Affiliation(s)
- Claire D Madigan
- The School of Sport, Exercise and Health Sciences, The Centre for Lifestyle Medicine and Behaviour (CLiMB), Loughborough University, Loughborough, UK
| | - Mackenzie Fong
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Victoria Kettle
- The School of Sport, Exercise and Health Sciences, The Centre for Lifestyle Medicine and Behaviour (CLiMB), Loughborough University, Loughborough, UK
| | - Peter Rouse
- Department for Health, University of Bath, Bath, UK
| | - Louisa Hamilton
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Nia Roberts
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Sjaan R Gomersall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda J Daley
- The School of Sport, Exercise and Health Sciences, The Centre for Lifestyle Medicine and Behaviour (CLiMB), Loughborough University, Loughborough, UK
| |
Collapse
|
13
|
Mobile health strategies for blood pressure self-management in urban populations with digital barriers: systematic review and meta-analyses. NPJ Digit Med 2021; 4:114. [PMID: 34294852 PMCID: PMC8298448 DOI: 10.1038/s41746-021-00486-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/21/2021] [Indexed: 12/17/2022] Open
Abstract
Mobile health (mHealth) technologies improve hypertension outcomes, but it is unknown if this benefit applies to all populations. This review aimed to describe the impact of mHealth interventions on blood pressure outcomes in populations with disparities in digital health use. We conducted a systematic search to identify studies with systolic blood pressure (SBP) outcomes located in urban settings in high-income countries that included a digital health disparity population, defined as mean age ≥65 years; lower educational attainment (≥60% ≤high school education); and/or racial/ethnic minority (<50% non-Hispanic White for US studies). Interventions were categorized using an established self-management taxonomy. We conducted a narrative synthesis; among randomized clinical trials (RCTs) with a six-month SBP outcome, we conducted random-effects meta-analyses. Twenty-nine articles (representing 25 studies) were included, of which 15 were RCTs. Fifteen studies used text messaging; twelve used mobile applications. Studies were included based on race/ethnicity (14), education (10), and/or age (6). Common intervention components were: lifestyle advice (20); provision of self-monitoring equipment (17); and training on digital device use (15). In the meta-analyses of seven RCTs, SBP reduction at 6-months in the intervention group (mean SBP difference = -4.10, 95% CI: [-6.38, -1.83]) was significant, but there was no significant difference in SBP change between the intervention and control groups (p = 0.48). The use of mHealth tools has shown promise for chronic disease management but few studies have included older, limited educational attainment, or minority populations. Additional robust studies with these populations are needed to determine what interventions work best for diverse hypertensive patients.
Collapse
|
14
|
Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillian B, Bower P, Panagioti M. Interventions Using Wearable Physical Activity Trackers Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2116382. [PMID: 34283229 PMCID: PMC9387744 DOI: 10.1001/jamanetworkopen.2021.16382] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic conditions, such as diabetes, prediabetes, obesity, and cardiovascular disease, is unknown. OBJECTIVE To assess the association of interventions using wearable PA trackers (accelerometers, fitness trackers, and pedometers) with PA levels and other health outcomes in adults with cardiometabolic conditions. DATA SOURCES For this systematic review and meta-analysis, searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO were performed from January 1, 2000, until December 31, 2020, with no language restriction. A combination of Medical Subject Heading terms and text words of diabetes, obesity, cardiovascular disease, pedometers, accelerometers, and Fitbits were used. STUDY SELECTION Randomized clinical trials or cluster randomized clinical trials that evaluated the use of wearable PA trackers, such as pedometers, accelerometers, or fitness trackers, were included. Trials were excluded if they assessed the trackers only as measuring tools of PA before and after another intervention, they required participants to be hospitalized, assessors were not blinded to the trackers, or they used a tracker to measure the effect of a pharmacological treatment on PA among individuals. DATA EXTRACTION AND SYNTHESIS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A random-effects model was used for the meta-analysis. MAIN OUTCOMES AND MEASURES The primary outcome was mean difference in PA levels. When the scale was different across studies, standardized mean differences were calculated. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. RESULTS A total of 38 randomized clinical trials with 4203 participants were eligible in the systematic review; 29 trials evaluated pedometers, and 9 evaluated accelerometers or fitness trackers. Four studies did not provide amenable outcome data, leaving 34 trials (3793 participants) for the meta-analysis. Intervention vs comparator analysis showed a significant association of wearable tracker use with increased PA levels overall (standardized mean difference, 0.72; 95% CI, 0.46-0.97; I2 = 88%; 95% CI, 84.3%-90.8%; P < .001) in studies with short to medium follow-up for median of 15 (range, 12-52) weeks. Multivariable metaregression showed an association between increased PA levels and interventions that involved face-to-face consultations with facilitators (23 studies; β = -0.04; 95% CI, -0.11 to -0.01), included men (23 studies; β = 0.48; 95% CI, 0.01-0.96), and assessed pedometer-based interventions (26 studies; β = 0.20; 95% CI, 0.02-0.32). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, interventions that combined wearable activity trackers with health professional consultations were associated with significant improvements in PA levels among people with cardiometabolic conditions.
Collapse
Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health,
Brighton and Sussex Medical School, University of Brighton, Brighton, United
Kingdom
| | - Brian McMillian
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| |
Collapse
|
15
|
Vilafranca Cartagena M, Tort-Nasarre G, Rubinat Arnaldo E. Barriers and Facilitators for Physical Activity in Adults with Type 2 Diabetes Mellitus: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5359. [PMID: 34069859 PMCID: PMC8157366 DOI: 10.3390/ijerph18105359] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 11/21/2022]
Abstract
The treatment of Type 2 Diabetes Mellitus (DM2) comprises physical activity (PA), diet, and medication. PA provides important benefits for people with diabetes. However, the majority of patients with DM2 do not attain the recommended levels of PA. Despite the evidence of the benefits to health of engaging in PA, the recommendations have not been fully translated into clinical improvements. Using a scoping review, this study aimed to identify the factors that influence levels of physical activity in adults with DM2. Eighteen studies published from 2009-2020 were identified by a search of relevant systematic databases between March 2019 and December 2020. The scoping review was carried out in accordance with the model defined by Arksey and O'Malley. The synthesis revelated sociodemographic characteristics, and six components-personal, motivation, social, mental, clinical, and self-efficacy-were identified as factors. Those that were most frequently identified were motivation and social support. In conclusion, these results should be considered to implement strategies to encourage people with DM2 to engage in physical exercise and thus improve the management of their condition.
Collapse
Affiliation(s)
- Mireia Vilafranca Cartagena
- Department of Nursing, Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Av. Universitaria 4-6, 08242 Manresa, Spain;
- Althaia Fundation, C/Dr Joan Soler 1-3, 08243 Manresa, Spain
| | - Glòria Tort-Nasarre
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig, 25198 Lleida, Spain;
- Health Education Research Group (GREpS), Faculty of Nursing and Physiotherapy, University of Lleida, Carrer de Montserrat Roig, 25198 Lleida, Spain
- Calaf Primary Care Center, Gerència Territorial Catalunya Central, Catalan Health Institute (ICS), Cta. Llarg19, 08280 Calaf, Spain
| | - Esther Rubinat Arnaldo
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig, 25198 Lleida, Spain;
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, 28220 Madrid, Spain
| |
Collapse
|
16
|
McDonough DJ, Su X, Gao Z. Health wearable devices for weight and BMI reduction in individuals with overweight/obesity and chronic comorbidities: systematic review and network meta-analysis. Br J Sports Med 2021; 55:917-925. [PMID: 33731385 PMCID: PMC10116995 DOI: 10.1136/bjsports-2020-103594] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyse the comparative effectiveness of different health wearable-based physical activity (PA) promotion intervention strategies against each other and control for reducing body weight and body mass index (BMI) in individuals with overweight/obesity and chronic comorbidities. DESIGN Systematic review and network meta-analysis (PROSPERO identifier: CRD42020158191). DATA SOURCES We performed two independent searches from December 2019 to September 2020 in PubMed, MEDLINE, Scopus, Web of Science, Central Register of Controlled Trials, EMBASE and PsycINFO databases for articles published in English between 2007 and 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Inclusion criteria were based on the PICOS framework. We included randomised controlled trials of health wearable-based interventions using two or more PA intervention arms/strategies and compared their effects on participants' body weight (kg) and BMI (kg/m2) with a control group. Data were analysed using a Bayesian network meta-analysis to directly and indirectly compare the effects of the six different intervention strategies (comparators). The six comparators were: (1) control group (ie, usual care, waitlist); (2) comparison group (ie, traditional, non-health wearable PA interventions); (3) commercial health wearable-only intervention (eg, Fitbit, Polar M400); (4) research grade health wearable-only intervention (ie, accelerometers or pedometers); (5) multicomponent commercial health wearable intervention (eg, Fitbit + nutrition counselling); and (6) multicomponent research grade health wearable intervention. The results were reported as standardised mean differences (SMDs) with associated 95% credible intervals (CrIs). RESULTS From 641 screened records, 31 studies were included. For body weight reduction in individuals with overweight/obesity and chronic comorbidities, accelerometer/pedometer-only (SMD -4.44, 95% CrI -8.94 to 0.07) and commercial health wearable-only (SMD -2.76, 95% CrI -4.80 to -0.81) intervention strategies were the most effective compared with the three other treatments and control. For BMI reduction, multicomponent accelerometer/pedometer (SMD -3.43, 95% CrI -4.94 to -2.09) and commercial health wearable-only (SMD -1.99, 95% CrI -4.95 to 0.96) intervention strategies were the most effective compared with the other four conditions. CONCLUSION Health wearable devices are effective intervention tools/strategies for reducing body weight and BMI in individuals with overweight/obesity and chronic comorbidities.
Collapse
Affiliation(s)
- Daniel J McDonough
- School of Kinesiology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Xiwen Su
- School of Kinesiology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Zan Gao
- School of Kinesiology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| |
Collapse
|
17
|
Hadgraft NT, Winkler E, Climie RE, Grace MS, Romero L, Owen N, Dunstan D, Healy G, Dempsey PC. Effects of sedentary behaviour interventions on biomarkers of cardiometabolic risk in adults: systematic review with meta-analyses. Br J Sports Med 2021; 55:144-154. [PMID: 32269058 PMCID: PMC7841485 DOI: 10.1136/bjsports-2019-101154] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 01/28/2023]
Abstract
CONTEXT/PURPOSE Observational and acute laboratory intervention research has shown that excessive sedentary time is associated adversely with cardiometabolic biomarkers. This systematic review with meta-analyses synthesises results from free living interventions targeting reductions in sedentary behaviour alone or combined with increases in physical activity. METHODS Six electronic databases were searched up to August 2019 for sedentary behaviour interventions in adults lasting for ≥7 days publishing cardiometabolic biomarker outcomes covering body anthropometry, blood pressure, glucose and lipid metabolism, and inflammation (54 studies). The pooled effectiveness of intervention net of control on 15 biomarker outcomes was evaluated using random effects meta-analyses in the studies with control groups not providing other relevant interventions (33 studies; 6-25 interventions analysed). RESULTS Interventions between 2 weeks and <6 months in non-clinical populations from North America, Europe and Australia comprised much of the evidence base. Pooled effects revealed small, significant (p<0.05) beneficial effects on weight (≈ -0.6 kg), waist circumference (≈ -0.7 cm), percentage body fat (≈ -0.3 %), systolic blood pressure (≈ -1.1 mm Hg), insulin (≈ -1.4 pM) and high-density lipoprotein cholesterol (≈ 0.04 mM). Pooled effects on the other biomarkers (p>0.05) were also small, and beneficial in direction except for fat-free mass (≈ 0.0 kg). Heterogeneity ranged widely (I2=0.0-72.9). CONCLUSIONS Our review of interventions targeting sedentary behaviour reductions alone, or combined with increases in physical activity, found evidence of effectiveness for improving some cardiometabolic risk biomarkers to a small degree. There was insufficient evidence to evaluate inflammation or vascular function. Key limitations to the underlying evidence base include a paucity of high-quality studies, interventions lasting for ≥12 months, sensitive biomarkers and clinical study populations (eg, type 2 diabetes). PROSPERO TRIAL REGISTRATION NUMBER CRD42016041742.
Collapse
Affiliation(s)
- Nyssa T Hadgraft
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Elisabeth Winkler
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Rachel E Climie
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Megan S Grace
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - David Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Central Clinical School/Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Institute of Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC, Australia
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, WA, Australia
| | - Genevieve Healy
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Paddy C Dempsey
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| |
Collapse
|
18
|
Cai X, Qiu S, Luo D, Wang L, Lu Y, Li M. Mobile Application Interventions and Weight Loss in Type 2 Diabetes: A Meta-Analysis. Obesity (Silver Spring) 2020; 28:502-509. [PMID: 31965748 DOI: 10.1002/oby.22715] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/20/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This meta-analysis aimed to assess the effect of mobile application (app) interventions on weight loss in patients with type 2 diabetes. METHODS Electronic databases were searched for randomized controlled trials examining the use of mobile app interventions with outcomes on weight loss evaluated by body weight or other measures such as BMI or waist circumference. A random-effects model was applied to obtain weight mean differences and 95% CIs. RESULTS Fourteen studies enrolling 2,129 patients with type 2 diabetes were included. Mobile app interventions could significantly reduce body weight (weight mean difference, -0.84 kg; 95% CI: -1.51 to -0.17 kg) and lower waist circumference (-1.35 cm; 95% CI: -2.16 to -0.55 cm) but may not decrease BMI (-0.08 kg/m2 ; 95% CI: -0.41 to 0.25 kg/m2 ). The reductions appeared to be more pronounced in patients with obesity or among studies using mobile app interventions combined with other behavior components. However, weight loss was not moderated by the functionalities of the mobile apps (all Pinteraction > 0.05) or by the intervention duration (all P > 0.87). CONCLUSIONS Mobile app interventions lead to weight loss in patients with type 2 diabetes and are worth recommending for weight loss promotion.
Collapse
Affiliation(s)
- Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Limin Wang
- School of Nursing, Peking University, Beijing, China
| | - Yanhu Lu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
19
|
Do Older Adults with Multimorbidity Meet the Recommended Levels of Physical Activity? An Analysis of Scottish Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193748. [PMID: 31590293 PMCID: PMC6801591 DOI: 10.3390/ijerph16193748] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022]
Abstract
There is a positive association between physical activity (PA) and improved health in older adults. The objective of this study was to assess the prevalence and determinants of meeting recommended levels of PA among older adults with multimorbidity. Data has been derived from the nationally representative Scottish Health Surveys (2014–2017). A sub-sample of 2230 older adults (aged 65+) with multimorbidity were the study participants. Physical activity was evaluated using current recommended guidelines. Overall, 32.3% of the participants met the recommended levels of PA. Independent predictors of meeting the recommended levels of PA include male gender [odds ratio (OR) 2.00 (95% confidence interval (CI) 1.58–2.54)], living in the least deprived areas [OR 1.79 (95% CI 1.20–2.69)]; being a non-smoker [OR 2.22 (95% CI 1.48–3. 34)]. Also, meeting recommended PA decreased with age [OR 0.92 (95% CI 0.90–0.94)] and body mass index [OR 0.93 (95% CI 0.91–0.95]; but increased per additional portion of fruit and vegetables taken [OR 1.19 (95% CI 1.12–1.25)] and with increase in well-being scale score [OR 1.05 (95% CI 1.03 to 1.06)]. Adherence to PA guidelines seems to be more related to age, BMI, gender (i.e. higher PA adherence in men vs. women), social support (i.e. social deprivation), dietary habits (i.e. fruit and vegetable intake) and social isolation among the elderly. In the one-third of older population, adherence to PA was associated to better mental health. Therefore, adaptation of PA guideline to suit theses determinants factors would reduce the gap difference among older adults with multimorbidity and enhance their mental well-being.
Collapse
|