A Website to Promote Physical Activity in People With Type 2 Diabetes Living in Remote or Rural Locations: Feasibility Pilot Randomized Controlled Trial

Background Research supports the use of Web-based interventions to promote physical activity in diabetes management. However, previous interventions have found poor levels of engagement or have not included health professionals and people with diabetes in the design of the tool. Objective To develop and explore the feasibility and indicative effect of a Web-based physical activity promotion intervention in people diagnosed with type 2 diabetes living in remote or rural locations. Methods A qualitative approach using focus groups that included patients with diabetes and health professionals were run to identify key concepts, ideas, and features, which resulted in the design of a physical activity website. This site was tested using a quantitative approach with a qualitative 6-month pilot study that adopted a three-armed approach. Participants were randomized into three groups: a control group who received written diabetes-specific physical activity advice; an information Web group, a Web-based group who received the information online; and an intervention Web group, an interactive Web-based group who received online information plus interactive features, such as an activity log, personalized advice, and goal setting. Results A website was designed based on patient and health professional ideas for effective physical activity promotion. This website was tested with 31 participants, 61% (19/31) male, who were randomized into the groups. Website log-ins decreased over time: 4.5 times in month 1, falling to 3 times in month 6. Both the information Web group—mean 134.6 (SD 123.9) to mean 154.9 (SD 144.2) min—and the control group—mean 118.9 (SD 103.8) to mean 126.1 (SD 93.4) min, d=0.07—increased time spent in moderate-to-vigorous physical activity, but this decreased in the intervention Web group—mean 131.9 (SD 126.2) to mean 116.8 (SD 107.4) min. Conclusions Access to online diabetes-specific physical information was effective in promoting physical activity in people with type 2 diabetes; access to interactive features was not associated with increases in activity. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN): 96266587; http://www.isrctn.com/ISRCTN96266587 (Archived by WebCite at http://www.webcitation.org/6tzX6YesZ)

[1]  Robin Christensen,et al.  Effects of Nordic Walking and Exercise in Type 2 Diabetes Mellitus: A Randomized Controlled Trial , 2010, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[2]  R. J. Shephard,et al.  Breaks in Sedentary Time: Beneficial associations with metabolic risk , 2010 .

[3]  David R Bassett,et al.  2011 Compendium of Physical Activities: a second update of codes and MET values. , 2011, Medicine and science in sports and exercise.

[4]  J. Holloszy.  Exercise-induced increase in muscle insulin sensitivity. , 2005, Journal of applied physiology.

[5]  D. J. van der Valk,et al.  How accurately can sitting and the intensity of walking and cycling be classified using an accelerometer on the waist for the purpose of the “Global recommendations on physical activity for health”? , 2015 .

[6]  C. Matthews,et al.  Sedentary behavior: emerging evidence for a new health risk. , 2010, Mayo Clinic proceedings.

[7]  G. Bray,et al.  Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. , 2016, The lancet. Diabetes & endocrinology.

[8]  P S Freedson,et al.  Calibration of the Computer Science and Applications, Inc. accelerometer. , 1998, Medicine and science in sports and exercise.

[9]  V. Araújo-Soares,et al.  Web-Based Weight Loss Intervention for Men With Type 2 Diabetes: Pilot Randomized Controlled Trial , 2017, JMIR diabetes.

[10]  S MacRury,et al.  The use of technology to promote physical activity in Type 2 diabetes management: a systematic review , 2013, Diabetic medicine : a journal of the British Diabetic Association.

[11]  Audie A Atienza,et al.  A review of eHealth interventions for physical activity and dietary behavior change. , 2007, American journal of preventive medicine.

[12]  I. Ockene,et al.  Seasonal variation in food intake, physical activity, and body weight in a predominantly overweight population , 2006, European Journal of Clinical Nutrition.

[13]  D. Dunstan,et al.  Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association , 2016, Diabetes Care.

[14]  N. Mutrie,et al.  The feasibility of a physical activity intervention for adults within routine diabetes care: a process evaluation , 2017 .

[15]  J O Prochaska,et al.  Self change processes, self efficacy and decisional balance across five stages of smoking cessation. , 1984, Progress in clinical and biological research.

[16]  C. Matthews,et al.  Too much sitting: the population health science of sedentary behavior. , 2010, Exercise and sport sciences reviews.

[17]  N. Cheung,et al.  A pilot randomised controlled trial of resistance exercise bands in the management of sedentary subjects with type 2 diabetes. , 2009, Diabetes research and clinical practice.

[18]  D. Haire-Joshu,et al.  Exercise Habits and Exercise Relapse in Persons With Non-Insulin-Dependent Diabetes Mellitus , 1991, The Diabetes educator.

[19]  R. Brazier,et al.  Scottish Government , 1998, A Diverse Assembly.

[20]  Chun-Ja Kim,et al.  Utility of a Web-based Intervention for Individuals With Type 2 Diabetes: The Impact on Physical Activity Levels and Glycemic Control , 2006, Computers, informatics, nursing : CIN.

[21]  R. Lehmann,et al.  Alterations of lipolytic enzymes and high‐density lipoprotein subfractions induced by physical activity in type 2 diabetes mellitus , 2001, European journal of clinical investigation.

[22]  F. Griffiths,et al.  Why Are Health Care Interventions Delivered Over the Internet? A Systematic Review of the Published Literature , 2006, Journal of medical Internet research.

[23]  Rosaline S Barbour,et al.  Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? , 2001, BMJ : British Medical Journal.

[24]  Ilse De Bourdeaudhuij,et al.  Implementation of an online tailored physical activity intervention for adults in Belgium. , 2006, Health promotion international.

[25]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[26]  H Garth McKay,et al.  The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results. , 2003, Preventive medicine.

[27]  P. Brunetti,et al.  Validation of a counseling strategy to promote the adoption and the maintenance of physical activity by type 2 diabetic subjects. , 2003, Diabetes care.