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Increasing Physical Activity in Belgian Type 2 Diabetes Patients: a Three-Arm Randomized Controlled Trial

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Abstract

Background

Pedometer-based physical activity programs have been typically delivered in a group format by a behavioral expert. An alternative strategy that builds on existing interactions is delivery through individual consultation by a general practitioner (GP). These two delivery strategies have not been directly compared.

Purpose

To compare effectiveness of a 12-week physical activity (PA) intervention for type 2 diabetes patients delivered by a trained GP via an individual consultation or as group delivery by a behavioral expert.

Method

Sixty-seven primary care participants (mean age = 67.4 years, 70% male) from three Belgian general practices were randomized into three different treatment arms: (1) individual consultation (n = 22) with three PA contacts with the patient's GP; (2) group counseling (n = 21) with three PA group sessions delivered by a behavioral expert; and (3) a control arm (n = 24) receiving no intervention. Participant inclusion criteria were ≤80 years; 25–35 kg/m²; ≤12% HbA1c and reporting no PA limitations. Outcome measures were pedometer-determined steps/day, self-reported PA, and health parameters (weight, body mass index, waist circumference, total cholesterol, fasting glucose, and HbA1c).

Results

Group counseling participants increased 1,706 steps/day over baseline significantly (p ≤ 0.05) more than other treatment arms. Moreover, they increased their self-reported PA (+82 min/day), while control arm participants showed a decrease in PA (p ≤ 0.05). Participants of the individual consultation had a decrease in waist circumference (−1.4 cm) and HbA1c (−0.32%) and a lower increase in total cholesterol (+7.2 mg/dl) compared to the other treatment arms (all p ≤ 0.05).

Conclusion

Group counseling in type 2 diabetes patients improved PA, whereas individual consultations had an impact on some health outcomes on the short-term.

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References

  1. Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, et al. American College of Sports Medicine position stand. Exercise and type 2 diabetes. Med Sci Sports Exerc. 2000;32:1345–60.

    Article  PubMed  CAS  Google Scholar 

  2. Toledo FGS, Menshikova EV, Ritov VB, Azuma K, Radikova Z, DeLany J, et al. Effects of physical activity and weight loss on skeletal muscle mitochondria and relationship with glucose control in type 2 diabetes. Diabetes. 2007;56:2142–7.

    Article  PubMed  CAS  Google Scholar 

  3. Thomas DR, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;2:1–41 (Online: Updated Software).

    Google Scholar 

  4. Hu FB, Stampfer MJ, Solomon C, Liu SM, Colditz GA, Speizer FE, et al. Physical activity and risk for cardiovascular events in diabetic women. Ann Int Med. 2001;134:96–105.

    PubMed  CAS  Google Scholar 

  5. Gregg EW, Gerzoff RB, Caspersen CJ, Williamson DF, Narayan KMV. Relationship of walking to mortality among US adults with diabetes. Arch Int Med. 2003;163:1440–7.

    Article  Google Scholar 

  6. Department of Health, Physical Activity, Health Improvement, & Prevention. At least five a week: evidence of the impact of physical activity and its relationship to health. A report from the chief medical officer. London: Department of Health; 2004.

    Google Scholar 

  7. LaMonte MJ, Blair SN, Church TS. Physical activity and diabetes prevention. J Appl Physiol. 2005;99:1205–13.

    Article  PubMed  Google Scholar 

  8. Kirk AF, Barnett J, Mutrie N. Physical activity consultation for people with type 2 diabetes. Evidence and guidelines. Diabet Med. 2007;24:809–16.

    Article  PubMed  CAS  Google Scholar 

  9. Dutton GR, Johnson J, Whitehead D, Bodenlos JS, Brantley PJ. Barriers to physical activity among predominantly low-income African-American patients with type 2 diabetes. Diab Care. 2005;28:1209–10.

    Article  Google Scholar 

  10. Constans T, Lecomte P. Non pharmacological treatments in elderly diabetics. Diab Metab. 2007;33:S79–86.

    Article  Google Scholar 

  11. Pham DT, Fortin F, Thibaudeau MF. The role of the health belief model in amputees' self-evaluation of adherence to diabetes self-care behaviors. Diab Educ. 1996;22:126–32.

    Article  CAS  Google Scholar 

  12. Wilson W, Ary DV, Biglan A, Glasgow RE, Toobert DJ, Campbell DR. Psychosocial predictors of self-care behaviors (compliance) and glycemic control in non-insulin-dependent diabetes-mellitus. Diab Care. 1986;9:614–22.

    Article  CAS  Google Scholar 

  13. Ary DV, Toobert D, Wilson W, Glasgow RE. Patient perspective on factors contributing to nonadherence to diabetes regimen. Diab Care. 1986;9:168–72.

    Article  CAS  Google Scholar 

  14. INAMI—RIZIV. Zorgtrajecten, of hoe de aanpak van chronische ziekten verbeteren. Available at:http://www.zorgtraject.be. 2009.

  15. Harris SB, Petrella RJ, Leadbetter W. Lifestyle interventions for type 2 diabetes—relevance for clinical practice. Can Fam Physician. 2003;49:1618–25.

    PubMed  Google Scholar 

  16. Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl HW, Blair SN. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. JAMA. 1999;281:327–34.

    Article  PubMed  CAS  Google Scholar 

  17. Richter H, Kraft K, Kleinwechter H, Demandt N, Meincke G, Dabelstein A, et al. Effects of a telephone intervention in patients with type 2 diabetes: increase of physical activity and reduction of cardiovascular risk factors. Dtsch Med Wochenschr. 2008;133:2203–8.

    Article  PubMed  CAS  Google Scholar 

  18. Eakin E, Reeves M, Lawler S, Graves N, Oldenburg B, Del Mar C, et al. Telephone counseling for physical activity and diet in primary care patients. Am J Prev Med. 2009;36:142–9.

    Article  PubMed  Google Scholar 

  19. Liebreich T, Plotnikoff RC, Courneya KS, Boule N. Diabetes NetPLAY: a physical activity website and linked email counselling randomized intervention for individuals with type 2 diabetes. Int J Behav Nutr Phys Act. 2009;6:18.

    Article  PubMed  Google Scholar 

  20. Mckay HG, King D, Eakin EG, Seeley JR, Glasgow RE. The diabetes network internet-based physical activity intervention—a randomized pilot study. Diab Care. 2001;24:1328–34.

    Article  CAS  Google Scholar 

  21. Tudor-Locke C, Lauzon N, Myers AM, Bell RC, Chan CB, McCargar L, et al. Effectiveness of the first step program delivered by professionals versus peers. J Phys Act Health. 2009;6:456–62.

    PubMed  Google Scholar 

  22. Tudor-Locke C, Bell RC, Myers AM, Harris SB, Ecclestone NA, Lauzon N, et al. Controlled outcome evaluation of the first step program: a daily physical activity intervention for individuals with type II diabetes. Int J Obes. 2004;28:113–9.

    Article  CAS  Google Scholar 

  23. Furber S, Monger C, Franco L, Mayne D, Jones LA, Laws R, et al. The effectiveness of a brief intervention using a pedometer and step-recording diary in promoting physical activity in people diagnosed with type 2 diabetes or impaired glucose tolerance. Health Prom J Aus. 2008;19:189–95.

    Google Scholar 

  24. Toobert DJ, Strycker LA, Glasgow RE, Barrera M, Angell K. Effects of the Mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease. Ann Behav Med. 2005;29:128–37.

    Article  PubMed  Google Scholar 

  25. Cheong SH, Hanson J, Fitzpatrick JJ, McCargar L, Paty B, Tudor-Locke C, et al. First step first bite program: increasing physical activity and low glycemic index foods among individuals with type 2 diabetes. Diabetes. 2005;54:A561.

    Google Scholar 

  26. Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, et al. Effectiveness of the diabetes education and self-management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. Br Med J. 2008;336:491–5.

    Article  CAS  Google Scholar 

  27. Vincent D. Culturally tailored education to promote lifestyle change in Mexican Americans with type 2 diabetes. J Am Acad Nurse Pract. 2009;21:520–7.

    Article  PubMed  Google Scholar 

  28. Johnson ST, Bell GJ, McCargar LJ, Welsh RS, Bell RC. Improved cardiovascular health following a progressive walking and dietary intervention for type 2 diabetes. Diab Obes Metab. 2009;11:836–43.

    Article  CAS  Google Scholar 

  29. De Greef K, Deforche B, Tudor-Locke C, De Bourdeaudhij I. A cognitive-behavioural pedometer-based group intervention on physical activity and sedentary behaviour in individuals with type 2 diabetes. Health Educ Res. 2010; doi: 10.1093/her/cyq017

  30. Kirk A, Mutrie N, MacIntyre P, Fisher M. Effects of a 12-month physical activity counselling intervention on glycaemic control and on the status of cardiovascular risk factors in people with type 2 diabetes. Diabetologia. 2004;47:821–32.

    Article  PubMed  CAS  Google Scholar 

  31. Kim CJ, Hwang AR, Yoo JS. The impact of a stage-matched intervention to promote exercise behavior in participants with type 2 diabetes. Int J Nurs Stud. 2004;41:833–41.

    Article  PubMed  Google Scholar 

  32. Kirk A, Mutrie N, MacIntyre P, Fisher M. Increasing physical activity in people with type 2 diabetes. Diab Care. 2003;26:1186–92.

    Article  Google Scholar 

  33. Clark M, Hampson SE, Avery L, Simpson R. Effects of a tailored lifestyle self-management intervention in patients with type 2 diabetes. Br J Health Psychol. 2004;9:365–79.

    Article  PubMed  Google Scholar 

  34. Gleeson-Kreig JM. Self-monitoring of physical activity—effects on self-efficacy and behavior in people with type 2 diabetes. Diab Educ. 2006;32:69–77.

    Article  Google Scholar 

  35. Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De CA, Parlanti N, et al. Validation of a counseling strategy to promote the adoption and the maintenance of physical activity by type 2 diabetic subjects. Diab Care. 2003;26:404–8.

    Article  Google Scholar 

  36. van Sluijs EMF, van Poppel MNM, Twisk JWR, Paw MJCA, Calfas KJ, van Mechelen W. Effect of a tailored physical activity intervention delivered in general practice settings: results of a randomized controlled trial. Am J Public Health. 2005;95:1825–31.

    Article  PubMed  Google Scholar 

  37. Jackson R, Asimakopoulou K, Scammell A. Assessment of the transtheoretical model as used by dietitians in promoting physical activity in people with type 2 diabetes. J Hum Nutr Diet. 2007;20:27–36.

    Article  PubMed  CAS  Google Scholar 

  38. Bjorgaas MR, Vik JT, Stolen T, Lydersen S, Grill V. Regular use of pedometer does not enhance beneficial outcomes in a physical activity intervention study in type 2 diabetes mellitus. Metabolism. 2008;57:605–11.

    Article  PubMed  Google Scholar 

  39. Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med. 2008;168:141–6.

    Article  PubMed  Google Scholar 

  40. Mehuys E, De Bolle L, Van Bortel L. Behandeling van diabetes type 2 in Vlaanderen. Available at: www.hospitals.be/pdf/vol6n2p30.pdf. 2008.

  41. Jaffiol C. Current management of type 2 diabetes is France. Bull Acad Natl Méd. 2009;193:16450–1661.

    Google Scholar 

  42. Ashenden R, Silagy C, Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Prac. 1997;14:160–75.

    Article  CAS  Google Scholar 

  43. Van Den Berg MJ, Kolthof ED, De Bakker DH. Tweede nationale studie naar ziekten en verrichting in de huisartspraktijk. De werkbelasting van de huisartsen. Nivel: Utrecht; 2004.

    Google Scholar 

  44. Harris SB, Petrella RJ, Lambert-Lanning A, Leadbetter W, Cranston L. Lifestyle management for type 2 diabetes—are family physicians ready and willing? Can Fam Physician. 2004;50:1235–43.

    PubMed  Google Scholar 

  45. Harris SB, Stewart M, Brown JB, Wetmore S, Faulds C, Webster-Bogaert S, et al. Type 2 diabetes in family practice—room for improvement. Can Fam Physician. 2003;49:778–85.

    PubMed  Google Scholar 

  46. Larme AC, Pugh JA. Attitudes of primary care providers toward diabetes—barriers to guideline implementation. Diab Care. 1998;21:1391–6.

    Article  CAS  Google Scholar 

  47. Pinto BM, Goldstein MG, Ashba J, Sciamanna CN, Jette A. Randomized controlled trial of physical activity counseling for older primary care patients. Am J Prev Med. 2005;29:247–55.

    Article  PubMed  Google Scholar 

  48. Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M. The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus. Fam Prac. 2002;19:344–9.

    Article  Google Scholar 

  49. Lawlor DA, Keen S, Neal RD. Increasing population levels of physical activity through primary care: GPs' knowledge, attitudes and self-reported practice. Fam Prac. 1999;16:250–4.

    Article  CAS  Google Scholar 

  50. Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counselling practices. Br J Sports Med. 2009;43:89–92.

    Article  PubMed  CAS  Google Scholar 

  51. Clark M, Hampson SE. Implementing a psychological intervention to improve lifestyle self-management in patients with type 2 diabetes. Patient Educ Couns. 2001;42:247–56.

    Article  PubMed  CAS  Google Scholar 

  52. Wolpert HA, Anderson BJ. Management of diabetes: are doctors framing the benefits from the wrong perspective? BMJ. 2001;323:994–6.

    Article  PubMed  CAS  Google Scholar 

  53. Poskiparta M, Kasila K, Kiuru P. Dietary and physical activity counselling on type 2 diabetes and impaired glucose tolerance by physicians and nurses in primary healthcare in Finland. Scand J Prim Health Care. 2006;24:206–10.

    Article  PubMed  Google Scholar 

  54. Huang J, Yu H, Marin E, Brock S, Carden D, Davis T. Physicians' weight loss counseling in two public hospital primary care clinics. Acad Med. 2004;79:156–61.

    Article  PubMed  Google Scholar 

  55. Kenny SJ, Smith PJ, Goldschmid MG, Newman JM, Herman WH. Survey of physician practice behaviors related to diabetes-mellitus in the United States. Diab Care. 1993;16:1507–10.

    Article  CAS  Google Scholar 

  56. McKenna J, Naylor PJ, McDowell N. Barriers to physical activity promotion by general practitioners and practice nurses. Br J Sports Med. 1998;32:242–7.

    Article  PubMed  CAS  Google Scholar 

  57. Burke LE, Fair J. Promoting prevention: skill sets and attributes of health care providers who deliver behavioral interventions. J Cardiovasc Nurs. 2003;18:256–66.

    PubMed  Google Scholar 

  58. Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, et al. Clinical inertia. Ann Intern Med. 2001;135:825–34.

    PubMed  CAS  Google Scholar 

  59. Wens J, Vermeire E, Royen PV, Sabbe B, Denekens J. GPs' perspectives of type 2 diabetes patients' adherence to treatment: a qualitative analysis of barriers and solutions. BMC Fam Pract. 2005;6:20.

    Article  PubMed  Google Scholar 

  60. Tudor-Locke CE, Bell RC, Myers AM, Harris SB, Lauzon N, Rodger NW. Pedometer-determined ambulatory activity in individuals with type 2 diabetes. Diab Res Clin Pract. 2002;55:191–9.

    Article  Google Scholar 

  61. Crouter SE, Schneider PL, Karabulut M, Bassett DR. Validity of ten electronic pedometers for measuring steps, distance, and energy cost. Med Sci Sports Exerc. 2003;35:1455–60.

    Article  PubMed  Google Scholar 

  62. De Cocker K, Cardon G, De Bourdeaudhuij I. Pedometer-determined physical activity and its comparison with the international physical activity questionnaire in a sample of Belgian adults. Res Q Exerc Sport. 2007;78:429–37.

    PubMed  Google Scholar 

  63. Rzewnicki R, Auweele YV, De Bourdeaudhij I. Addressing overreporting on the International Physical Activity Questionnaire (IPAQ) telephone survey with a population sample. Public Health Nutr. 2003;6:299–305.

    Article  PubMed  Google Scholar 

  64. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95.

    Article  PubMed  Google Scholar 

  65. Vandelanotte C, De Bourdeaudhuij I, Sallis JF, Philippaerts R, Sjostrom M. Reliability and validity of a computerised International Physical Activity Questionnaire (IPAQ). JPAH. 2005;2:63–75.

    Google Scholar 

  66. Welschen LMC, van Oppen P, Dekker JM, Bouter LM, Stalman WAB, Nijpels G. The effectiveness of adding cognitive behavioural therapy aimed at changing lifestyle to managed diabetes care for patients with type 2 diabetes: design of a randomised controlled trial. BMC. 2007;7:74.

    Article  Google Scholar 

  67. The Diabetes Prevention Program (DPP). Description of lifestyle intervention. Diab Care. 2002;25:2165–71.

    Article  Google Scholar 

  68. Tudor-Locke CE, Myers AM, Rodger NW. Development of a theory-based daily activity intervention for individuals with type 2 diabetes. Diab Educ. 2001;27:85–93.

    Article  CAS  Google Scholar 

  69. Resnicow K, Dilorio C, Soet JE, Borrelli B, Hecht J, Ernst D. Motivational interviewing in health promotion: it sounds like something is changing. Health Psychol. 2002;21:444–51.

    Article  PubMed  Google Scholar 

  70. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health—a systematic review. JAMA. 2007;298:2296–304.

    Article  PubMed  CAS  Google Scholar 

  71. Tudor-Locke CE. Taking steps toward increased physical activity: using pedometer to measure and motivate. Presidents Counc Phys Fit Sports Ser. 2002;3:17.

    Google Scholar 

  72. Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the environment: where do we go from here? Science. 2003;299:853–5.

    Article  PubMed  CAS  Google Scholar 

  73. Yamanouchi K, Shinozaki T, Chikada K, Nishikawa T, Ito K, Shimizu S, et al. Daily walking combined with diet therapy is a useful means for obese NIDDM patients not only to reduce body-weight but also to improve insulin sensitivity. Diab Care. 1995;18:775–8.

    Article  CAS  Google Scholar 

  74. Maldonato A, Bloise D, Ceci M, Fraticelli E, Fallucca F. Diabetes-mellitus—lessons from patient education. Patient Educ Couns. 1995;26:57–66.

    Article  PubMed  CAS  Google Scholar 

  75. van Dam HA, van der Horst FG, Knoops L, Ryckman RM, Crebolder HFJM, van den Borne BHW. Social support in diabetes: a systematic review of controlled intervention studies. Patient Educ Couns. 2005;59:1–12.

    Article  PubMed  Google Scholar 

  76. Wee CC. Physical activity counseling in primary care—the challenge of effecting behavioral change. JAMA. 2001;286:717–9.

    Article  PubMed  CAS  Google Scholar 

  77. Simons-Morton DG, Blair SN, King AC, Morgan TM, Applegate WB, O’Toole M, et al. Effects of physical activity counseling in primary care—the activity counseling trial: a randomized controlled trial. JAMA. 2001;286:677–87.

    Article  Google Scholar 

  78. Absetz P, Valve R, Oldenburg B, Heinonen H, Nissinen A, Fogelholm M, et al. Type 2 diabetes prevention in the “Real world”—1-year results of the GOAL implementation trail. Diab Care. 2007;30:2465–70.

    Article  Google Scholar 

  79. Clemes SA, Parker RA. Increasing our understanding of reactivity to pedometers in adults. Med Sci Sports Exerc. 2009;41:674–80.

    Article  PubMed  Google Scholar 

  80. Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol. 2008;27:379–87.

    Article  PubMed  Google Scholar 

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Acknowledgements

We are much indebted to Stephanie Degomme, Evelyne Courteyn, and Ellen Van Puyvelde for their collaboration in this study. They followed the train-the-trainer session, gave the GP interventions, and assisted with the data collection. Further, we thank the patients who participated in this study.

Conflict of Interest

We confirm that we have no conflict of interest. We have full control of all primary data and we agree to allow the journal to review our data if requested. All patient/personal identifier have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story.

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Authors and Affiliations

  1. Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium

    Benedicte Deforche & Ilse De Bourdeaudhuij

  2. Research Foundation Flanders (FWO), Ghent, Belgium

    Benedicte Deforche

  3. Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels, Belgium

    Benedicte Deforche

  4. Walking Behavior Laboratory, Pennington Biomedical Research Center, Baton Rouge, USA

    Catrine Tudor-Locke

  5. Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium

    Karlijn De Greef & Ilse De Bourdeaudhuij

Authors
  1. Karlijn De Greef
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  2. Benedicte Deforche
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  3. Catrine Tudor-Locke
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  4. Ilse De Bourdeaudhuij
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Corresponding author

Correspondence to Ilse De Bourdeaudhuij.

Additional information

The trial is registered at ClinicalTrials.gov, number NCT00903500.

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De Greef, K., Deforche, B., Tudor-Locke, C. et al. Increasing Physical Activity in Belgian Type 2 Diabetes Patients: a Three-Arm Randomized Controlled Trial. Int.J. Behav. Med. 18, 188–198 (2011). https://doi.org/10.1007/s12529-010-9124-7

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