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Woodhead G, Sivaramakrishnan D, Baker G. Promoting physical activity to patients: a scoping review of the perceptions of doctors in the United Kingdom. Syst Rev 2023; 12:104. [PMID: 37355661 PMCID: PMC10290366 DOI: 10.1186/s13643-023-02245-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/24/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND The physician-patient encounter presents an ideal opportunity for physical activity (PA) promotion. This review aims to (i) explore the breadth and depth of existing literature investigating doctors' perceptions of PA promotion in the United Kingdom (UK) and (ii) identify factors influencing the extent to which doctors engage in PA promotion during patient interactions. METHODS A five-stage scoping review methodology and the PRISMA-ScR guidance were followed: Stage 1-research questions specified; Stage 2-relevant studies identified by searching five electronic databases and manual screening of references; Stage 3-studies screened using Covidence™; Stage 4-study data extracted and charted; and Stage 5-findings from included studies were analysed, summarised and reported using (i) descriptive numerical analysis to provide insight into study characteristics and (ii) narrative summary of the evidence categorised by factors that influence doctors' engagement with PA promotion. RESULTS In total, 16,961 studies were screened. Nineteen studies were included in the review with most conducted in primary care focusing on the perceptions of general practitioners. Seven influencing factors were identified: knowledge and training, personal interest and PA level, time, resources, confidence, the perceived role of the doctor and patient relevance. CONCLUSION This review provides new evidence that historical barriers and influencing factors have a persisting impact on the ability and willingness of UK doctors to engage with PA promotion with patients. Previous efforts to address these factors would appear to have had limited success. Further intervention efforts are required to ensure more widespread and effective PA promotion to patients.
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Affiliation(s)
- Gemma Woodhead
- Edinburgh Medical School, University of Edinburgh, Scotland, UK
| | - Divya Sivaramakrishnan
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Sciences, University of Edinburgh, Scotland, UK
| | - Graham Baker
- Physical Activity for Health Research Centre, Moray House School of Education & Sport, University of Edinburgh, Scotland, UK.
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Cockcroft EJ, Wooding EL, Narendran P, Dias RP, Barker AR, Moudiotis C, Clarke R, Andrews RC. Factors affecting the support for physical activity in children and adolescents with type 1 diabetes mellitus: a national survey of health care professionals' perceptions. BMC Pediatr 2023; 23:131. [PMID: 36949473 PMCID: PMC10031957 DOI: 10.1186/s12887-023-03940-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/02/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Many children and adolescents with Type 1 Diabetes Mellitus (T1DM) don't meet the recommended levels of physical activity. Healthcare professionals (HCPs) have a key role in supporting and encouraging children and adolescents with T1DM to be physically active. This study aims to understand the perspectives of HCPs in relation to supporting physical activity and implementing guidelines relating to physical activity. METHODS An online mixed methods survey was circulated to HCPs in pediatric diabetes units in England and Wales. Participants were asked about how they support physical activity in their clinic and their perceptions of barriers/enablers of providing physical activity support to children and adolescents with T1DM. Quantitative data were analysed descriptively. An deductive thematic approach was applied to the free text responses using the Capability Opportunity Motivation model of Behaviour (COM-B) as a framework. RESULTS Responses were received from 114 individuals at 77 different pediatric diabetes units (45% of pediatric diabetes units in England and Wales). HCPs surveyed felt that the promotion of physical activity is important (90%) and advised patients to increase levels of physical activity (88%). 19% of the respondents felt they did not have sufficient knowledge to provide support. HCPs reported limited knowledge and confidence, time and resources as barriers to providing support. They also felt the current guidance was too complicated with few practical solutions. CONCLUSION Pediatric HCPs need training and support to be able to encourage and support children and adolescents with T1D to be a physical activity. In addition, resources that provide simple and practical advice to manage glucose around exercise are needed.
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Affiliation(s)
| | - Eva L Wooding
- University of Exeter Medical School, Exeter, EX1 2JP, UK
- Department of Paediatrics, Royal Devon University Healthcare NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Parth Narendran
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Renuka P Dias
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, EX1 2JP, UK
| | - Christopher Moudiotis
- Department of Paediatrics, Royal Devon University Healthcare NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Ross Clarke
- University of Exeter Medical School, Exeter, EX1 2JP, UK
| | - Robert C Andrews
- University of Exeter Medical School, Exeter, EX1 2JP, UK
- Department of Diabetes, Taunton and Somerset NHS Foundation Trust, Taunton, UK
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Hammersen J, Tittel SR, Khodaverdi S, Reschke F, Flury M, Menzel U, Mönkemöller K, Meissner T, Karges B, Holl RW. Metabolic control during the first two years of the COVID-19 pandemic in pediatric patients with type 1 diabetes: results from the German DPV initiative. Acta Diabetol 2023; 60:757-766. [PMID: 36871116 PMCID: PMC9985474 DOI: 10.1007/s00592-023-02050-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/04/2023] [Indexed: 03/06/2023]
Abstract
AIM To assess effects of the SARS-CoV2 pandemic on metabolic control in youth with type 1 diabetes (T1D) in Germany in a population-based analysis. METHODS Data from 33,372 pediatric T1D patients from the Diabetes Prospective Follow-up (DPV) registry, with face-to-face visits or telemedicine contacts in the years 2019-2021, were available. Datasets from eight time periods between March 15, 2020, and December 31, 2021, according to SARS-CoV2 incidence waves, were compared to those from five control time periods. Parameters of metabolic control were assessed with adjustment for sex, age, diabetes duration, and repeated measurements. Laboratory-measured HbA1c values and those estimated from CGM were aggregated into a combined glucose indicator (CGI). RESULTS There was no clinically relevant difference in metabolic control between pandemic and control time periods with adjusted CGI values ranging from 7.61% [7.60-7.63] (mean [95% confidence interval (CI)]) in the third quarter of 2019 to 7.83% [7.82-7.85] in the time period from January 1 to March 15 2020, in the other control periods, and during the pandemic, CGI values lay between these values. BMI-SDS rose during the pandemic from 0.29 [0.28-0.30] (mean [95% CI]) in the third quarter of 2019 to 0.40 [0.39-0.41] during the fourth wave. Adjusted insulin dose rose during the pandemic. Event rates for hypoglycemic coma and diabetic ketoacidosis remained unchanged. CONCLUSIONS We found no clinically relevant change of glycemic control or incidence of acute diabetes complications during the pandemic. The observed BMI increase may represent an important health risk for youth with T1D.
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Affiliation(s)
- Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany.
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Semik Khodaverdi
- Clinic for Children and Adolescent Medicine, Clinical Centre Hanau, Hanau, Germany
| | - Felix Reschke
- Diabetes Center for Children and Adolescents, Children's Hospital Auf Der Bult, Hannover, Germany
| | - Monika Flury
- Children's Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Ulrike Menzel
- Department of Paediatric Endocrinology, AKK Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Kirsten Mönkemöller
- Department of Pediatrics, Kinderkrankenhaus Amsterdamer Strasse, Cologne, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital, Duesseldorf, Germany
| | - Beate Karges
- Division of Endocrinology and Diabetology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Pediatrics, Bethlehem Hospital Stolberg, Stolberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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DI Gioia A, DI Mauro A, Astuto L, Caputi G, Gallone MS, Notarnicola A, Tafuri S. Promoting physical activity for children: an audit among Italian family pediatricians. Minerva Pediatr (Torino) 2023; 75:8-13. [PMID: 28882027 DOI: 10.23736/s2724-5276.17.04843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND This survey aimed to investigate the perception of Italian Pediatricians regarding the promotion of physical activity. METHODS From January to May 2015, a survey was conducted among family pediatricians working in Puglia, interviewed by a standardized questionnaire, that investigated demographic information, participation in sporting activity by the pediatrician, opinion on obesity and the promotion of physical activity, and attitude towards enquiring about the physical activity of patients with and without chronic diseases. RESULTS We collected 200 questionnaires (35.7% of target population): 51.5% of enrolled pediatricians stated that they were participating in sporting activities at the time of the survey. The average opinion regarding the relevance of the obesity was 9±1.4/10 and about the promotion of physical activity 9.6±0.8. All enrolled pediatricians asked for their patients' physical activity and encouraged inactive children to begin an appropriate activity. Pediatricians who took part in sport had a high probability of encouraging physical activity, among patients affected by chronic diseases. CONCLUSIONS Family pediatricians declared a good attitude regarding the promotion of physical activity for their patients according to national and international recommendations. The main concern emerging from our results is the risk of an "inappropriate interdiction" of physical activity in children affected by chronic diseases, in particular physicians that have never participated in a sport.
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Affiliation(s)
- Alberto DI Gioia
- School of Medicine, Course of Sport Sciences, University of Bari, Bari, Italy
| | - Antonio DI Mauro
- Department of Biomedical Science and Human Oncology, University of Bari, Bari Italy
| | - Leopoldo Astuto
- School of Medicine, Course of Sport Sciences, University of Bari, Bari, Italy
| | - Giovanni Caputi
- Department of Public Health, Taranto Local Health Trust, Taranto, Italy
| | - Maria S Gallone
- School of Medicine, Course of Sport Sciences, University of Bari, Bari, Italy
| | - Angela Notarnicola
- School of Medicine, Course of Sport Sciences, University of Bari, Bari, Italy
| | - Silvio Tafuri
- School of Medicine, Course of Sport Sciences, University of Bari, Bari, Italy - .,Department of Biomedical Science and Human Oncology, University of Bari, Bari Italy
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Pereira WVC, Vancea DMM, de Andrade Oliveira R, de Freitas YGPC, Lamounier RN, Silva Júnior WS, Fioretti AMB, Macedo CLD, Bertoluci MC, Zagury RL. 2022: Position of Brazilian Diabetes Society on exercise recommendations for people with type 1 and type 2 diabetes. Diabetol Metab Syndr 2023; 15:2. [PMID: 36593495 PMCID: PMC9806892 DOI: 10.1186/s13098-022-00945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/04/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION For individuals diagnosed with diabetes mellitus, the practice of properly oriented physical exercises brings significant benefits to the individual's health and is considered an indispensable tool for metabolic management. The individualization of exercise routines is an essential aspect for therapeutic success, despite the need to consider some general recommendations. This review is an authorized literal translation of the Brazilian Society of Diabetes (SBD) Guidelines 2021-2022, which is based on scientific evidence and provides guidance on physical activities and exercises aimed at individuals with type 1 and 2 diabetes. METHODS SBD designated 9 specialists from its "Department of Diabetes, Exercise & Sports" to author chapters on physical activities and exercises directed to individuals with type 1 and 2 diabetes. The aim of these chapters was to highlight recommendations in accordance with Evidence Levels, based on what is described in the literature. These chapters were analyzed by the SBD Central Committee, which is also responsible for the SBD 2021-2022 guidelines. Main clinical inquiries were selected to perform a narrated review by using MEDLINE via PubMed. Top available evidence, such as high-quality clinical trials, large observational studies and meta-analyses related to physical activity and exercise advisory, were analyzed. The adopted MeSh terms were [diabetes], [type 1 diabetes], [type 2 diabetes], [physical activity] [physical exercise]. RESULTS 17 recommendations were defined by the members. For this review, it was considered different Evidence Levels, as well as different Classes of Recommendations. As to Evidence Levels, the following levels were contemplated: Level A) More than one randomized clinical trial or a randomized clinical trial meta-analysis with low heterogeneity. Level B) Meta analysis with observational studies, one randomized clinical trial, sizeable observational studies and sub-groups analysis. Level C) Small non-randomized studies, cross-sectional studies, case control studies, guidelines or experts' opinions. In respect to Recommendation Classes, the following criteria were adopted: I. "Recommended": Meaning there was a consent of more than 90% of the panel; IIa. "Must be considered": meaning there is a general preference of the panel which 70-90% agrees; IIb. "Can be considered". 50-70% agrees; III Not recommended: There is a consensus that the intervention should not be performed. CONCLUSION Physical exercise aids on the glycemic control of type 2 diabetes individuals while also decreasing cardiovascular risk in individuals with type 1 and 2 diabetes. Individuals diagnosed with diabetes should perform combined aerobic and resistance exercises in order to manage the disease. In addition, exercises focusing on flexibility and balance should be specially addressed on elderly individuals. Diabetes individuals using insulin as therapeutic treatment should properly monitor glycemia levels before, during and after exercise sessions to minimize health incidents, such as hypoglycemia.
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Affiliation(s)
- William Valadares Campos Pereira
- Research Group on Physical Exercise and Non-Transmissible Chronic Diseases from the Physical Education School of the University of Pernambuco (UPE), Recife, Brazil
| | - Denise Maria Martins Vancea
- Research Group on Physical Exercise and Non-Transmissible Chronic Diseases from the Physical Education School of the University of Pernambuco (UPE), Recife, Brazil
- Physical Education School of the University of Pernambuco (UPE), Avenida Agamenon Magalhães, S/N-Santo Amaro, Recife,, PE CEP 50100-010 Brazil
| | - Ricardo de Andrade Oliveira
- Department of Obesity and Associated Diseases of the Brazilian Obesity Association (ABESO), Board of Directors of the Rio de Janeiro Society of Exercise Medicine and Sports, Rio de Janeiro, Brazil
| | | | | | - Wellington S. Silva Júnior
- Endocrinology Discipline, Department of Medicine I, Faculty of Medicine, Center of Biological Sciences, Federal University of Maranhão (UFMA), Praça Gonçalves Dias, 21, Centro, São Luís, MA CEP 65020-240 Brazil
| | | | | | - Marcello Casaccia Bertoluci
- Internal Medicine Department, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2350 Building 12, 4th Floor, Porto Alegre, RS Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350 Building 12, 4th Floor, Porto Alegre, RS Brazil
| | - Roberto Luis Zagury
- Luiz Capriglione State Institute of Diabetes and Endocrinology (IEDE), Rio de Janeiro, Brazil
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Giblin S, Scully P, Evers J, Dalton N, Hayes G, Donnelly A, Orla Neylon O, O'Gorman C. Physical Activity Surveillance in Adolescents with Type 1 Diabetes: A Pilot Mixed-Methods Investigation. J Diabetes Res 2022; 2022:4202561. [PMID: 35342770 PMCID: PMC8941581 DOI: 10.1155/2022/4202561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/08/2021] [Accepted: 02/26/2022] [Indexed: 12/23/2022] Open
Abstract
Type 1 diabetes (T1D) affects over 2,500 children in Ireland. Insulin replacement is the mainstay of treatment for T1D, and physical activity (PA) is an important, modifiable lifestyle factor for sustaining health. Surveillance of PA for both research and clinical purposes in paediatric T1D has been limited. This study deployed both quantitative (accelerometry) and qualitative (self-report) measures to assess habitual PA patterns in children with T1D. Twenty-one participants (9 females, 12 males) between 10 and 17 years (mean 13.7 ± 1.94 years) were recruited from an Outpatients Paediatric Diabetes Clinic. Total steps, standing time (minutes (mins)) and sitting time (mins) were recorded using the activPAL 3 microactivity monitor. Clinical parameters (HbA1c, insulin regimen, and weight centiles) were measured. A self-report diary was used to measure perceived activity levels. The findings of this study show that participant children with T1D are not achieving the required steps per day to sustain physical health (recommended minimum 11,500). Females (mean = 7,306 steps ± 5,468) achieved significantly less (p = 0.001) steps per day compared to males (10,806 steps ± 5,904). No significant differences were found between genders for sitting time or standing time. Overweight or obesity was identified in 44% of female participants and 15% of male participants. Mean HbA1c for both females 8.25% (67 mmol/mol) and males 7.97% (64 mmol/mol) was above the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommended <7.0% (53 mmol/mol) for children. Further research is warranted to investigate PA promotion strategies in populations of children with paediatric T1D.
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Affiliation(s)
- Susan Giblin
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
| | - Paul Scully
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
| | - Julie Evers
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
| | - Niall Dalton
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
- Department of Paediatrics, University Hospital Limerick, Ireland
| | - Grainne Hayes
- Department of Physical Education and Sports Science, Physical Activity for Health Research Cluster & Health Research Institute, University of Limerick, Ireland
| | - Alan Donnelly
- Department of Physical Education and Sports Science, Physical Activity for Health Research Cluster & Health Research Institute, University of Limerick, Ireland
| | - O. Orla Neylon
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
- Department of Paediatrics, University Hospital Limerick, Ireland
| | - Clodagh O'Gorman
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
- Department of Paediatrics, University Hospital Limerick, Ireland
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Quirk H, Heller B, Wright N. Feasibility and Acceptability of Physical Activity Monitoring as an Educational Tool in Management of Pediatric Type 1 Diabetes. Can J Diabetes 2020; 44:688-696. [PMID: 33023835 DOI: 10.1016/j.jcjd.2020.06.013] [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: 03/23/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The spontaneous, sporadic and sometimes unpredictable nature of children's physical activity causes fluctuations in blood glucose level and challenges for children with type 1 diabetes. Physical activity monitoring has potential utility. In this study, we explored the perceptions of physical activity monitoring among health-care professionals and assessed the feasibility and acceptability of using it in the management of pediatric type 1 diabetes. METHODS Seven health-care professionals from 1 pediatric diabetes centre in the United Kingdom were involved in a focus group. Data were analyzed thematically. Physical activity monitoring using a wrist-worn monitor was tested for feasibility with 13 children aged 7 to 11 years with type 1 diabetes. The primary outcome was feasibility (i.e. recruitment, adherence, data completion, adverse events and acceptability). Secondary measures were glycemic control, parental self-efficacy for diabetes management and parental fear of hypoglycemia. RESULTS Health-care professionals valued having an awareness of the level, type and intensity of children's physical activity. They identified unmet training and resource needs that would facilitate them in being able to give physical activity advice to children and families. Recruitment rate was 20%, adherence to the activity monitoring was good and the study completion rate was 62%. No adverse events were reported. Physical activity monitoring was considered acceptable by parents. CONCLUSIONS Physical activity monitoring could be a feasible part of routine clinical practice, but further research is needed to understand whether health-care professionals are best placed to implement it and what impact it has on health outcomes.
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Affiliation(s)
- Helen Quirk
- Academy of Sport and Physical Activity, Sheffield Hallam University, United Kingdom.
| | - Ben Heller
- Sports Engineering Research Group (SERG), Sport and Physical Activity Research Centre, Advanced Wellbeing Research Centre, Sheffield Hallam University, United Kingdom
| | - Neil Wright
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
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Dash K, Goyder EC, Quirk H. A qualitative synthesis of the perceived factors that affect participation in physical activity among children and adolescents with type 1 diabetes. Diabet Med 2020; 37:934-944. [PMID: 32181959 DOI: 10.1111/dme.14299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 12/29/2022]
Abstract
AIMS To explore the qualitative literature on the perceived factors, positive and negative, affecting participation by children and adolescents with type 1 diabetes in physical activity, from the perspective of children and adolescents with type 1 diabetes, their family members, teachers or sports coaches, and healthcare professionals. METHODS MEDLINE, SPORTDiscus, PsycINFO, CINAHL and Scopus were systematically searched in July 2019. Eligible studies included any that reported qualitative findings on the perceived factors that affect participation in physical activity from either the perspective of children or adolescents with type 1 diabetes, their family members, teachers or coaches, and healthcare professionals. RESULTS The literature search yielded a total of 7859 studies, of which 14 (13 qualitative studies and one mixed-methods study) met the review inclusion criteria. In total there were 12 unique populations containing 270 individuals, 105 children or adolescents with type 1 diabetes,108 family members, 37 teachers and 20 healthcare professionals. The main factors thought to influence physical activity for this population were the individual characteristics of children and adolescents, the requirement for self-blood glucose regulation, support systems including friends, family, teachers and professionals, education and knowledge, and communication. CONCLUSIONS This review synthesizes views on the perceived factors from several different perspectives. The findings suggest that it is important to consider the needs of the wider support network, as well as the child's or adolescent's concerns and preferences, when developing new or existing strategies and programmes to promote physical activity in children and adolescents with type 1 diabetes.
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Affiliation(s)
- K Dash
- School of Health and Related Research, University of Sheffield, Sheffield
| | - E C Goyder
- School of Health and Related Research, University of Sheffield, Sheffield
| | - H Quirk
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield
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Ash GI, Joiner KL, Savoye M, Baker JS, Gerosa J, Kleck E, Patel NS, Sadler LS, Stults-Kolehmainen M, Weinzimer SA, Grey M. Feasibility and safety of a group physical activity program for youth with type 1 diabetes. Pediatr Diabetes 2019; 20:450-459. [PMID: 30834621 PMCID: PMC6508986 DOI: 10.1111/pedi.12841] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/OBJECTIVE Many adolescents with type 1 diabetes do not achieve 60 minutes of daily moderate-to-vigorous intensity physical activity (MVPA). Recognizing the importance of peer influence during adolescence, we evaluated the feasibility and safety of a group MVPA intervention for this population. METHODS Eighteen adolescents with type 1 diabetes (age 14.1 ± 2 .3 years, female 67%, black or Latino 67%, median body mass index 92%'ile, A1c 79.9 ± 25.1 mmol/mol, 9.5 ± 2.3%). Intervention sessions (35 minutes MVPA and 45 minutes discussion) occurred 1×/week for 12 weeks. Feasibility and safety metrics were enrollment, completion of intervention and assessments, cost, and hypoglycemia rates. Participants completed MVPA (accelerometry), and exploratory nutritional, psychosocial, clinical, and fitness variable assessments at baseline, 3 months, and 7 months. Hedges' effect sizes were calculated. RESULTS Enrollment was 16%, and intervention completion was 56%. Assessment completion at 7 months was 67% for MVPA, nutrition, and fitness, 83% for psychosocial assessments, and 94% for clinical assessments. Cost was $1241 per completing participant. One episode of mild hypoglycemia occurred during the sessions (0.6%). Self-reported daily fruit/vegetable servings (d = -0.72) and diabetes self-management behaviors decreased over time (d = -0.40). In the 10 completers, endurance run score improved (d = 0.49) from low baseline levels, while systolic blood pressure decreased (d = -0.75) and low-density lipoprotein increased (d = 0.49) but stayed within normal ranges. CONCLUSIONS The protocol for the group MVPA intervention was safe and had some feasibility metrics meriting further investigation. MVPA levels and glycemic control remained suboptimal, suggesting the need for more intensive interventions for this population.
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Affiliation(s)
- Garrett I. Ash
- Yale University School of Nursing, West Haven, CT, USA, 06516
| | - Kevin L. Joiner
- Yale University School of Nursing, West Haven, CT, USA, 06516
| | - Mary Savoye
- Yale University, Department of Pediatric Endocrinology, New Haven, CT, USA, 06520
| | - Julien S. Baker
- University of the West of Scotland, Institute of Clinical Exercise and Health Sciences, Paisley, Scotland, UK, PA1 2BE
| | - James Gerosa
- Southern Connecticut State University Exercise Science Department, New Haven, CT, USA, 06515
| | - Emma Kleck
- Yale University School of Nursing, West Haven, CT, USA, 06516
| | - Neha S. Patel
- Penn State Milton S. Hershey Medical Center Division of Endocrinology, Hershey, PA, USA, 17033
| | - Lois S. Sadler
- Yale University School of Nursing, West Haven, CT, USA, 06516
| | | | - Stuart A. Weinzimer
- Yale University, Department of Pediatric Endocrinology, New Haven, CT, USA, 06520
| | - Margaret Grey
- Yale University School of Nursing, West Haven, CT, USA, 06516
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10
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Quirk H, Glazebrook C, Blake H. A physical activity intervention for children with type 1 diabetes- steps to active kids with diabetes (STAK-D): a feasibility study. BMC Pediatr 2018; 18:37. [PMID: 29415687 PMCID: PMC5804086 DOI: 10.1186/s12887-018-1036-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 01/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background This study describes the development and feasibility evaluation of a physical activity intervention for children with type 1 diabetes called ‘Steps to Active Kids with Diabetes’ (STAK-D). It aims to explore the feasibility and acceptability of the intervention and study design. Methods Thirteen children aged 9–11 years and their parents were recruited from one paediatric diabetes clinic. A process evaluation was conducted alongside a two-arm randomised feasibility trial, including assessment of rate of recruitment, adherence, retention, data completion and burden, implementation fidelity and adverse events. Qualitative interviews with children (n = 9), parents (n = 8), healthcare professionals (n = 3) and STAK-D volunteers (n = 8) explored intervention acceptability. Interviews were analysed thematically. Results Rate of recruitment was 25%, with 77% retention at 3-month follow-up. Study burden was low, data completion was high and the intervention was delivered as per protocol. No serious adverse event was reported. Engagement with intervention materials was generally good, but attendance at group activity sessions was low due to logistical barriers. Interview analysis identified preferred methods of recruitment, motivations for recruitment, barriers and facilitators to adherence, the experience of data collection, experience of the STAK-D programme and its perceived benefits. Conclusions STAK-D was feasible and acceptable to children, their parents and healthcare professionals, but group sessions may present logistical issues. Recruitment and retention may be improved with a clinic-wide approach to recruitment. Trial registration This trial was registered on ClinicalTrials.gov: NCT02144337 (16/01/2014). Electronic supplementary material The online version of this article (10.1186/s12887-018-1036-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helen Quirk
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, S10 2BP, UK.
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, Jubilee Campus, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Holly Blake
- School of Health Sciences, A Floor, South Block Link, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
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11
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Driscoll KA, Corbin KD, Maahs DM, Pratley R, Bishop FK, Kahkoska A, Hood KK, Mayer-Davis E. Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps. Curr Diab Rep 2017; 17:58. [PMID: 28660565 PMCID: PMC6053070 DOI: 10.1007/s11892-017-0892-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This review aims to summarize the type 1 diabetes (T1D) and weight literature with an emphasis on barriers associated with weight management, the unique T1D-specific factors that impact weight loss success, maladaptive and adaptive strategies for weight loss, and interventions to promote weight loss. RECENT FINDINGS Weight gain is associated with intensive insulin therapy. Overweight and obese weight status in individuals with T1D is higher than the general population and prevalence is rising. A variety of demographic (e.g., female sex), clinical (e.g., greater insulin needs), environmental (e.g., skipping meals), and psychosocial (e.g., depression, stress) factors are associated with overweight/obese weight status in T1D. Fear of hypoglycemia is a significant barrier to engagement in physical activity. Studies evaluating adaptive weight loss strategies in people with T1D are limited. There is a growing literature highlighting the prevalence and seriousness of overweight and obesity among both youth and adults with T1D. There is an urgent need to develop evidence-based weight management guidelines and interventions that address the unique concerns of individuals with T1D and that concurrently address glycemic control.
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Affiliation(s)
- Kimberly A Driscoll
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO, 80045, USA.
| | - Karen D Corbin
- Florida Hospital Translational Research Institute for Metabolism and Diabetes, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Richard Pratley
- Florida Hospital Translational Research Institute for Metabolism and Diabetes, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Franziska K Bishop
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO, 80045, USA
| | - Anna Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Korey K Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition, The University of North Carolina Chapel Hill, Chapel Hill, NC, 27599-7461, USA
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12
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Wilkie L, Mitchell F, Robertson K, Kirk A. Motivations for physical activity in youth with type 1 diabetes participating in the ActivPals project: a qualitative study. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Louise Wilkie
- University of Glasgow, (Current post: General Practitioner locum and Lecturer at St Andrews University School of Medicine, UK); UK
| | | | - Kenneth Robertson
- Greater Glasgow and Clyde Children's Diabetes Service; Royal Hospital for Sick Children; Glasgow UK
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13
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Michaud I, Henderson M, Legault L, Mathieu ME. Physical activity and sedentary behavior levels in children and adolescents with type 1 diabetes using insulin pump or injection therapy - The importance of parental activity profile. J Diabetes Complications 2017; 31:381-386. [PMID: 27989545 DOI: 10.1016/j.jdiacomp.2016.11.016] [Citation(s) in RCA: 14] [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: 02/24/2016] [Revised: 10/31/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
In children and adolescents, treatments for type 1 diabetes (T1D) have recently evolved with the introduction of the insulin pump. However, little is known about how a pump is associated with physical activity (PA) patterns. The goal of the study was to examine the activity profile of Canadian children and adolescents with T1D according to their insulin treatment (pump vs. injections), as well as barriers to exercise and parental lifestyle habits. A self-administered questionnaire was completed by 188 subjects with T1D aged 6 to 17 and their parents at the endocrinology clinic of Sainte-Justine's University Hospital Center (Montreal, Canada). Sixty percent of patients used an insulin pump. There were no significant differences in any components of the PA profile, sedentary habits, and exercise barriers between subjects using injections and those using a pump. Fear of hypoglycemia was the main PA barrier in both treatment groups. A more diverse PA practice by parents was associated with more moderate-to-vigorous PA and less screen time in adolescents. In conclusion, type of treatment was not associated with more activity in pediatric patients with T1D and a varied parental PA profile was the main factor of interest for healthier habits in adolescents with T1D.
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Affiliation(s)
- Isabelle Michaud
- Department of Kinesiology, University of Montreal, Montreal, QC, Canada, H3C 3J7; Data Analysis Resource Center, Statistics Canada, Ottawa, ON, Canada, K1A 0T6; Department of Pediatrics, University of Montreal and CHU Sainte-Justine, Montreal, QC, Canada, H3T 1C5
| | - Mélanie Henderson
- Department of Pediatrics, University of Montreal and CHU Sainte-Justine, Montreal, QC, Canada, H3T 1C5
| | - Laurent Legault
- The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada, H3H 1P3
| | - Marie-Eve Mathieu
- Department of Kinesiology, University of Montreal, Montreal, QC, Canada, H3C 3J7; Department of Pediatrics, University of Montreal and CHU Sainte-Justine, Montreal, QC, Canada, H3T 1C5.
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14
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Blake H, Quirk H, Leighton P, Randell T, Greening J, Guo B, Glazebrook C. Feasibility of an online intervention (STAK-D) to promote physical activity in children with type 1 diabetes: protocol for a randomised controlled trial. Trials 2016; 17:583. [PMID: 27931254 PMCID: PMC5146845 DOI: 10.1186/s13063-016-1719-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/22/2016] [Indexed: 01/02/2023] Open
Abstract
Background Regular physical activity has important health benefits for children with type 1 diabetes mellitus (T1DM), yet children and their parents face barriers to participation such as lack of self-efficacy or concerns around hypoglycaemia. Multimedia interventions are useful for educating children about their health and demonstrate potential to improve children’s health-related self-efficacy, but few paediatric clinics offer web-based resources as part of routine care. The Steps to Active Kids with Diabetes (STAK-D) programme is an online intervention grounded in psychological theory (social cognitive theory) and informed by extensive preliminary research. The aim of the programme is to encourage and support safe engagement with physical activity for children with T1DM. The aim of this research is to explore the feasibility of delivering the STAK-D programme to children aged 9–12 years with T1DM, and to assess the feasibility of further research to demonstrate its clinical and cost-effectiveness. Methods Up to 50 children aged 9–12 years with T1DM and their parents will be recruited from two paediatric diabetes clinics in the UK. Child-parent dyads randomised to the intervention group will have access to the intervention website (STAK-D) and a wrist-worn activity monitor for 6 months. The feasibility of intervention and further research will be assessed by rate of recruitment, adherence, retention, data completion and adverse events. Qualitative interviews will be undertaken with a subsample of children and parents (up to 25 dyads) and health care professionals (up to 10). Health outcomes and the feasibility of outcome measurement tools will be assessed. These include self-efficacy (CSAPPA), objective physical activity, self-reported physical activity (PAQ), fear of hypoglycaemia (CHFS; PHFS), glycaemic control (HbA1c), insulin dose, Body Mass Index (BMI), health-related quality of life (CHU9D; CHQ-PF28), health service use and patient-clinician communication. Assessments will be taken at baseline (T0), 8 weeks (T1) and at 6-month follow-up (T2). Discussion The goal of this feasibility trial is to assess the delivery of STAK-D to promote physical activity among children with T1DM, and to assess the potential for further, definitive research to demonstrate its effectiveness. Results will provide the information necessary to design a larger randomised controlled trial and maximise the recruitment rate, intervention delivery and trial retention. Trial registration ISRCTN, ISRCTN48994721. Registered on 28 October 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1719-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Holly Blake
- University of Nottingham School of Health Sciences, A Floor, Queen's Medical Centre, Nottingham, NG7 2HA, UK.
| | - Helen Quirk
- University of Nottingham School of Health Sciences, A Floor, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Paul Leighton
- University of Nottingham School of Medicine, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology and Diabetes, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - James Greening
- Children's Hospital, Leicester Royal Infirmary, Children's Diabetes and Endocrinology, Infirmary Square, Leicester, LE1 5WW, UK
| | - Boliang Guo
- Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Cris Glazebrook
- Institute of Mental Health, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
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