Increase in Daily Steps After an Exercise Specialist Led Lifestyle Intervention for Adults with Type 2 Diabetes In Primary Care: A Controlled Implementation Trial
Abstract
OBJECTIVE: To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care. METHODS: Eligible participants from 4 primary care networks in Alberta, Canada were assigned to either a lifestyle program or a control group. The program targeted increased daily walking through individualized daily pedometer step goals for the first 3 months and brisk walking speed, along with substitution of low-relative to high-glycemic index foods over the next 3 months. The outcomes were daily steps, diet, and clinical markers, and were compared using random effects models. RESULTS: 198 participants were enrolled (102 in the intervention and 96 in the control). For all participants, (51% were women), mean age 59.5 (SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.6 kg/m(2) (SD 6.5), systolic BP 125.6 mmHg (SD 16.2), glycemic index 51.7 (4.6), daily steps 5879 (SD 3130). Daily steps increased for the intervention compared with the control at 3-months (1292 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted P = .002). No significant differences were observed for diet or clinical outcomes. CONCLUSIONS: A 6-month lifestyle program delivered in primary care by an exercise specialist can be effective for increasing daily walking among adults with recently diagnosed type 2 diabetes. This short-term increase in daily steps requires longer follow-up to estimate the potential impact on health outcomes.
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In the absence of such structure, the device's ability to support sustained clinical improvement may be significantly reduced.
“In the absence of such structure, the device’s ability to support sustained clinical improvement may be significantly reduced [8,12,20,31,32,35].”
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“One alternative way of ensuring advice remains consistent is to include exercise specialists as part of the existingmulti-disciplinary teams (42, 43).”
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Wozniak, L., Soprovich, A., Mundt, C., Johnson, J. A., & Johnson, S. T. (2015) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2015.05.003 · Cited by 15 · see citing works
“Given the large volume of data collected for our comprehensive evaluation (19), our findings related to the other RE-AIM dimensions are reported elsewhere, in previous (25) and accompanying papers (28,29).”
BackgroundMethodResultInfluentialSelf-citationArovah, N. I., Kushartanti, B. M. W., Washington, T. L., & Heesch, K. C. (2018) · SAGE Open Medicine · doi:10.1177/2050312118814391 · Cited by 14 · see citing works
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Wozniak, L., Soprovich, A., Rees, S., Johnson, S. T., Majumdar, S. R., & Johnson, J. A. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1577-1 · Cited by 11 · see citing works
“Both interventions were previously demonstrated to be efficacious in controlled studies [14–16], and proved effective when implemented in Alberta’s PCN settings [17, 18].”
BackgroundSelf-citationWozniak, L., Soprovich, A., Rees, S., Johnson, S. T., Majumdar, S. R., & Johnson, J. A. (2015) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2015.05.001 · Cited by 10 · see citing works
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“Interventions focused almost exclusively on step targets remained neutral with respect to BP, despite improving other metabolic markers [28,31,34,35].”
InfluentialJohnson, S. T., Lier, D. A., Soprovich, A., Mundt, C., & Johnson, J. A. (2015) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2015.08.001 · Cited by 9 · see citing works
“…demonstrated that an exercise specialist-led lifestyle program for adults with recently diagnosed T2D in primary care, was effective for increasing daily steps compared to usual care controls (Johnson et al., 2015), along with a comprehensive evaluation of the intervention (Wozniak et al., 2012).”
InfluentialSelf-citationWozniak, L., Soprovich, A., Rees, S., Frank, L., Johnson, S. T., Majumdar, S. R., & Johnson, J. A. (2015) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2015.05.002 · Cited by 7 · see citing works
Self-citationJohnson, S. T., Lubans, D. R., Mladenovic, A. B., Plotnikoff, R. C., Karunamuni, N. D., & Johnson, J. A. (2016) · Psychology Health & Medicine · doi:10.1080/13548506.2016.1140900 · Cited by 4 · see citing works
“…for mediation; however there was a significant action theory test for implementation intentions, which are the concrete action plans concerned with the ‘when, where, and how’ of achieving a specific goal (Gollwitzer, 1999; Knäuper, Pillay, Lacaille, McCollam, & Kelso, 2011; Knäuper et al., 2011).”
BackgroundSelf-citationJohnson, S. T., Mladenovic, A. B., Mathe, N., Davenport, M. H., Butalia, S., Qiu, W., & Johnson, J. A. (2017) · Contemporary Clinical Trials · doi:10.1016/j.cct.2017.07.008 · Cited by 4 · see citing works
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Arovah, N. I., & Kushartanti, B. M. W. (2019) · Romanian Journal of Diabetes Nutrition and Metabolic Diseases · doi:10.2478/rjdnmd-2019-0012 · Cited by 3 · see citing works
“764 Basophil 1-hour Erythrocyte sedimentation rate 13 [9, 17] 25 [18, 32] 24 [15, 34] 16 [11, 21] 29 [22, 36] 29 [21, 38] 0.”
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“[14] In addition, it was aimed to increase the activity level from Category 1 to Category 2 according to the IPAQ2.”
MethodAlberta's Caring for Diabetes Project: Engaged Scholarship Informing Quality Improvement
Edwards, A. L., & Noseworthy, T. (2015) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2015.06.003
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Rossen, J., Larsson, K., Hagströmer, M., Yngve, A., Brismar, K., Ainsworth, B., Åberg, L., & Johansson, U.-B. (2021) · Figshare · doi:10.6084/m9.figshare.16590483
Rossen, J., Larsson, K., Hagströmer, M., Yngve, A., Brismar, K., Ainsworth, B. E., Åberg, L., & Johansson, U.-B. (2021) · Figshare · doi:10.6084/m9.figshare.16590489
Rossen, J., Larsson, K., Hagströmer, M., Yngve, A., Brismar, K., Ainsworth, B., Åberg, L., & Johansson, U.-B. (2021) · Figshare · doi:10.6084/m9.figshare.16590474
Rossen, J., Larsson, K., Hagströmer, M., Yngve, A., Brismar, K., Ainsworth, B., Åberg, L., & Johansson, U.-B. (2021) · Figshare · doi:10.6084/m9.figshare.16590477
Rossen, J., Larsson, K., Hagströmer, M., Yngve, A., Brismar, K., Ainsworth, B., Åberg, L., & Johansson, U.-B. (2021) · Figshare · doi:10.6084/m9.figshare.16590480
Rossen, J., Larsson, K., Hagströmer, M., Yngve, A., Brismar, K., Ainsworth, B., Åberg, L., & Johansson, U.-B. (2021) · Figshare · doi:10.6084/m9.figshare.16590468
Rossen, J., Larsson, K., Hagströmer, M., Yngve, A., Brismar, K., Ainsworth, B., Åberg, L., & Johansson, U.-B. (2021) · Figshare · doi:10.6084/m9.figshare.16590465
Rossen, J., Hagströmer, M., Yngve, A., Brismar, K., Ainsworth, B., & Johansson, U.-B. (2021) · Figshare · doi:10.6084/m9.figshare.14826079
- Authors
- Johnson, S. T., Mundt, C., Qiu, W., Soprovich, A., Wozniak, L., Plotnikoff, R. C., & Johnson, J. A.
- Affiliations
- Athabasca University (CA)
- University of Alberta (CA)
- University of Newcastle Australia (AU)
- ORCID
- Venue
- Journal of Physical Activity and Health
- Publisher
- Human Kinetics
- Published
- 2015-11
- Volume
- 12
- Issue
- 11
- Pages
- 1492-1499
- ISSN
- 1543-3080 (ISSN-L)
- 1543-5474
- OpenAlex
- W2001438078
- Cited by
- 30
- References
- 0
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 2 · 2021: 11 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 5
- FWCI
- 2.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Physical Activity and Health (publishedVersion)
- PubMed (publishedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- Alberta Innovates - Health Solutions
- National Health and Medical Research Council
- National Medical Research Council
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, lifestyle intervention, daily step count, walking, brisk walking, glycemic index, diet, exercise specialists, primary care, physical activity
- MeSH terms
- Adult, Aged, Alberta, Blood Pressure, Canada, Combined Modality Therapy, Diabetes Mellitus, Type 2, Diet, Diabetic, Female, Humans, Life Style, Male, Middle Aged, Primary Health Care, Exercise, Walking, Actigraphy
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