Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 21, 2021
Date Accepted: Mar 22, 2022
The effects of a lifestyle intervention supported by the InterWalk smart-phone application on increasing physical activity among persons with type 2 diabetes: A parallel-group, randomized trial
ABSTRACT
Background:
Effective and sustainable implementation of physical activity (PA) in type 2 diabetes (T2D) health care has in general not been successful. Efficacious and contemporary approaches to support PA adherence and adoption are required.
Objective:
The primary objective of this study was to investigate the effectiveness of an app-based (InterWalk®) approach to increase moderate-and-vigorous PA (MVPA) across 52 weeks compared with standard care among individuals with T2D.
Methods:
The study was designed as a parallel-group, randomized trial with 52 weeks intervention and subsequent follow-up for effectiveness (52 weeks from baseline). Participants were recruited between January 2015 and December 2016 and randomly allocated (2:1) into 12 weeks of (1) standard care + InterWalk app-based interval walking training (IWT) (IWT group; n=140), or (2) standard care + the standard exercise program (StC group, n=74). Following 12 weeks, the IWT group was encouraged to maintain InterWalk app-based IWT (3 times per week for 30-60 minutes) and the StC group was encouraged to maintain exercise without structured support. Moreover, half of the IWT group (IWTsupport group, n=54) received additional motivational support following the 12-week program until 52-week follow-up. The primary outcome was change in objectively measured MVPA time (min/day) from baseline to 52-week follow-up. Key secondary outcomes included changes in self-rated physical and mental health-related quality of life (HRQoL), physical fitness, weight and waist circumference.
Results:
Participants had a mean (SD) age of 59.6 (10.6) years of which 128 (59.8%) were men. No changes in MVPA time were observed from baseline to the 52-week follow-up in the StC and IWT groups (least squares means [95% CI]: 0.6 [-4.6 to 5.8] and -0.2 [-3.8 to 3.3], respectively) and no differences were observed between the groups (mean difference [95% CI]: -0.8 [-8.1 to 6.4] min/day, P=.82). Physical HRQoL increased by 4.3 (1.8 to 6.9) SF-12 points more in the IWT group compared with the StC group (Benjamini-Hochberg adjusted P=.007) and waist circumference apparently decreased 2.3 [-4.1 to -0.4] cm more in the IWT group compared with the StC group (Benjamini-Hochberg adjusted P=.06). No between-group differences were observed among the remaining key secondary outcomes.
Conclusions:
Among individuals with T2D referred to municipality-based lifestyle programs, randomization to InterWalk app-based IWT did not increase objectively measured MVPA time over 52 weeks compared with standard health care, although apparent benefits were observed for physical HRQoL. Clinical Trial: NCT02341690
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