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How can clinical practices pragmatically increase physical activity for patients with type 2 diabetes? A systematic review

  • Systematic Reviews
  • Published:
Translational Behavioral Medicine

Abstract

Although regular physical activity (PA) is a cornerstone of treatment for type 2 diabetes (T2D), most adults with T2D are sedentary. Randomized controlled trials (RCTs) have proven the effectiveness of PA behavioral interventions for adults with T2D but have rarely been conducted in healthcare settings. We sought to identify PA interventions that are effective and practical to implement in clinical practice settings. Our first aim was to use the valid Pragmatic-Explanatory Continuum Indicator Summary 2 (PRECIS-2) tool to assess the potential for future implementation of PA interventions in clinical practice settings. Our second aim was to identify interventions that effectively increased PA and glycemic control among the interventions in the top tertile of PRECIS-2 scores. We searched PubMed MEDLINE from January 1980 through May 2015 for RCTs of behavioral PA interventions coordinated by clinical practices for patients with T2D. Dual investigators assessed pragmatism by PRECIS-2 scores, and study effectiveness was extracted from original RCT publications. The PRECIS-2 scores of the 46 behavioral interventions (n = 13,575 participants) ranged from 3.0 to 4.8, where 5 is the most pragmatic score. In the most pragmatic tertile of interventions (n = 16) by PRECIS-2 scores, 30.8 and 31.3% of interventions improved PA outcomes and hemoglobin A1c, respectively. A minority of published evidence-based PA interventions for adults with T2D were both effective and pragmatic for clinical implementation. These should be tested for dissemination using implementation trial designs.

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Author notes

  1. Kelsey A. Luoma and Ian M. Leavitt contributed equally to this manuscript.

Authors and Affiliations

  1. School of Medicine, New York University, New York, NY, USA

    Kelsey A. Luoma MD

  2. School of Medicine, University of Colorado, Aurora, CO, USA

    Ian M. Leavitt MS, Andrea L. Nederveld MD, Judith G. Regensteiner PhD, Russell E. Glasgow PhD & Amy G. Huebschmann MD, MS

  3. School of Pharmacy, University of Colorado, Aurora, CO, USA

    Joel C. Marrs PharmD

  4. Center for Women’s Health Research, School of Medicine, University of Colorado, Aurora, CO, USA

    Judith G. Regensteiner PhD & Amy G. Huebschmann MD, MS

  5. AL Dunn Health Consulting, LLC, Loveland, CO, USA

    Andrea L. Dunn PhD

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  1. Kelsey A. Luoma MD
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Corresponding author

Correspondence to Ian M. Leavitt MS.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the studies. No IRB approval was required for the completion of this review study.

Findings reported here have not been previously published, and this manuscript is under no consideration at other journals. Data here is original and has not been previously published. All authors had full control of all primary data and agree to allow Translational Behavioral Medicine to review this data, if requested. This study was primarily funded by the National Heart, Lung, and Blood Institute (5K23HL118133).

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Implications

Practice: Health system administrators may consider implementing the interventions that we identified as effective and pragmatic when the costs are deemed reasonable and the characteristics of the trials are a good match with their health systems.

Policy: Future RCTs of PA interventions in real-world settings must report on key practical feasibility factors that have been typically ignored, including intervention costs and sustainability.

Research: Future research should focus on implementing the four identified highly pragmatic and effective trials in diverse real-world settings.

Appendix

Appendix

Fig. 4
figure 4

Terms used in literature search strategy

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Fig. 5
figure 5

Prevalence of studies reporting on RE-AIM practical feasibility factors

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Fig. 6
figure 6

Prevalence of Cochrane risk of bias categories

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Table 2 Inclusion and exclusion criteria for inclusion in systematic review
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Table 3 Characteristics related to external validity for trials in PRECIS-2 bottom two tertiles
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Luoma, K.A., Leavitt, I.M., Marrs, J.C. et al. How can clinical practices pragmatically increase physical activity for patients with type 2 diabetes? A systematic review. Behav. Med. Pract. Policy Res. 7, 751–772 (2017). https://doi.org/10.1007/s13142-017-0502-4

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