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Higgs C1, Spontelli Gisselman A2, Hale L1, Mani R1
1University of Otago, School of Physiotherapy, Dunedin, New Zealand, 2High Point University, Department of Physical Therapy, High Point, United States
Background: Exercise combined with health education and lifestyle change is effective for successfully managing individuals with Type-2 Diabetes (T2D) / prediabetes and associated multimorbidity. However, indigenous peoples and those living in high socioeconomic deprivation have barriers to engaging with successful T2D/prediabetes management. In order to improve access to care, positively influence and maintain health outcomes for those with T2D/prediabetes and associated multimorbidity; tailored, affordable, interprofessional community-based interventions are needed. The Diabetes Community Exercise and Education Programme (DCEP) is a 12-week (bi-weekly) comprehensive community-based programme for people with T2D/prediabetes led by a clinical team (physiotherapist and nurse). Each session typically provides 45 mins of exercise, followed by 45 mins of education. Education on health-related topics is presented by the lead clinicians or a dietitian, pharmacist, podiatrist or diabetes nurse specialist. It has been demonstrated that DCEP is safe, culturally accepted, and feasible and delivers clinically meaningful health outcomes (six-minute walk distance (6MWD) increases and waist circumference reduction) at programme completion.
Purpose: In this single-group cohort study, the medium (6 months) to long-term (one-year) changes to aerobic capacity, waist circumference and general health status following DCEP completion are investigated.
Methods: Participants were recruited from the community via physician referrals, word-of-mouth, and advertisements. Of the 49 enrolled participants, 35 provided written consent to use the data for research purposes. Aerobic capacity (6MWD, m), waist circumference (WC, cm), and general health status (In general, would you say your health is: Excellent (100), Very good (75), Good (50), Fair (25), Poor (0)) were recorded at baseline (T0), programme completion (T1), six-months (T2) and one-year follow-up (T3). Repeated measures (6MWD, WC) and Friedman ANOVAs (general health status) were conducted. Statistical significance was set at the .05 level for assessing the differences between measurement time points. Bonferroni correction was used to adjust for multiple comparisons.
Results: Data from 35 participants (age 59 ± 13 years; 51% males; BMI 38 ± 7.5) with T2D/prediabetes and associated multimorbidity were analysed. Results include data from high-risk populations including indigenous peoples (23%) and individuals from areas of high socioeconomic deprivation (74% living in decile ≥ 6, with 10 representing area of highest deprivation). Results demonstrate significant differences (F=19.6; p=0.001) in 6MWD and general health status (chi-square=9.7; p=0.021) at all-time points in comparison to baseline. However, significant difference for WC (F=7.1; p=0.012) was observed between T2-T0 only. Mean differences include 6MWD: T1-T0, 63.8; T2-T0, 63.8; and T3-T0, 59.0 m; general health status: T1-T0, 7.8; T2-T0, 8.5; and T3-T0, 9.3; and WC T1-T0, 2.3; T2-T0, 3.9; and T3-T0, 2.0 cm. No significant differences between T1, T2 and T3 was demonstrated for all the measures of interest.
Conclusion(s): This study demonstrated that DCEP resulted in positive changes to aerobic capacity, waist circumference and general health status and that these changes were maintained at both 6-month and one-year following programme completion.
Implications: This community-based, interprofessional T2D/prediabetes programme was effective at the medium and long term in improving and maintaining health outcomes. Ongoing quantitative and qualitative research is examining the health efficacy, cost-effectiveness and deliverability of DCEP.
Keywords: Type II Diabetes Mellitus, Multimorbidity, Exercise
Funding acknowledgements: WellSouth Primary Health Network
Purpose: In this single-group cohort study, the medium (6 months) to long-term (one-year) changes to aerobic capacity, waist circumference and general health status following DCEP completion are investigated.
Methods: Participants were recruited from the community via physician referrals, word-of-mouth, and advertisements. Of the 49 enrolled participants, 35 provided written consent to use the data for research purposes. Aerobic capacity (6MWD, m), waist circumference (WC, cm), and general health status (In general, would you say your health is: Excellent (100), Very good (75), Good (50), Fair (25), Poor (0)) were recorded at baseline (T0), programme completion (T1), six-months (T2) and one-year follow-up (T3). Repeated measures (6MWD, WC) and Friedman ANOVAs (general health status) were conducted. Statistical significance was set at the .05 level for assessing the differences between measurement time points. Bonferroni correction was used to adjust for multiple comparisons.
Results: Data from 35 participants (age 59 ± 13 years; 51% males; BMI 38 ± 7.5) with T2D/prediabetes and associated multimorbidity were analysed. Results include data from high-risk populations including indigenous peoples (23%) and individuals from areas of high socioeconomic deprivation (74% living in decile ≥ 6, with 10 representing area of highest deprivation). Results demonstrate significant differences (F=19.6; p=0.001) in 6MWD and general health status (chi-square=9.7; p=0.021) at all-time points in comparison to baseline. However, significant difference for WC (F=7.1; p=0.012) was observed between T2-T0 only. Mean differences include 6MWD: T1-T0, 63.8; T2-T0, 63.8; and T3-T0, 59.0 m; general health status: T1-T0, 7.8; T2-T0, 8.5; and T3-T0, 9.3; and WC T1-T0, 2.3; T2-T0, 3.9; and T3-T0, 2.0 cm. No significant differences between T1, T2 and T3 was demonstrated for all the measures of interest.
Conclusion(s): This study demonstrated that DCEP resulted in positive changes to aerobic capacity, waist circumference and general health status and that these changes were maintained at both 6-month and one-year following programme completion.
Implications: This community-based, interprofessional T2D/prediabetes programme was effective at the medium and long term in improving and maintaining health outcomes. Ongoing quantitative and qualitative research is examining the health efficacy, cost-effectiveness and deliverability of DCEP.
Keywords: Type II Diabetes Mellitus, Multimorbidity, Exercise
Funding acknowledgements: WellSouth Primary Health Network
Topic: Health promotion & wellbeing/healthy ageing; Primary health care; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: University of Otago
Ethics committee: Human Ethics Committee
Ethics number: H15/038
All authors, affiliations and abstracts have been published as submitted.
