The Effects of a Lifestyle Intervention Supported by the InterWalk Smartphone App on Increasing Physical Activity Among Persons With Type 2 Diabetes: Parallel-Group, Randomized Trial
Open accessAbstract
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 including an app-based (InterWalk) approach in municipality-based rehabilitation 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 (minutes/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 age of 59.6 (SD 10.6) years and 128/214 (59.8%) were men. No changes in MVPA time were observed from baseline to 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] minutes/day; P=.82). Physical HRQoL increased by a mean of 4.3 (95% CI 1.8 to 6.9) 12-item Short-Form Health Survey (SF-12) points more in the IWT group compared with the StC group (Benjamini-Hochberg adjusted P=.007) and waist circumference apparently decreased a mean of –2.3 (95% CI –4.1 to –0.4) cm more in the IWT group compared with the StC group but with a 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. Trial Registration: ClinicalTrials.gov NCT02341690; https://clinicaltrials.gov/ct2/show/NCT02341690
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Of 52 included RCTs, 8 (15%) assessed the effects of 7 different DHI strategy combinations on weight loss in patients with T2DM.
“Of 52 included RCTs, 8 (15%) RCTs [50,52,70,72,73,84,85,98] assessed the effects of 7 different DHI strategy combinations on weight loss in patients with T2DM.”
From Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis (2025) · cites this paper as [73]
Of 52 included RCTs, 11 (21%) assessed the effects of 9 different DHI strategy combinations on BMI levels in patients with T2DM.
“Of 52 included RCTs, 11 (21%) RCTs [60,66,70,72-74,78,84,85,97,98] assessed the effects of 9 different DHI strategy combinations on BMI levels in patients with T2DM.”
From Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis (2025) · cites this paper as [73]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
WARE, J. E., KOSINSKI, M., & KELLER, S. D. (1996) · Medical Care · doi:10.1097/00005650-199603000-00003 · Cited by 17,392 · cited 2× · see citing works
“Physical and mental HRQoL were assessed using the 12-item Short-Form Health Survey (SF-12), including 8 subscales [32].”
MethodSaeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Colagiuri, S., Guariguata, L., Motala, A. A., Ogurtsova, K., et al. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.107843 · Cited by 10,792 · see citing works
Calibration of the Computer Science and Applications, Inc. accelerometer
FREEDSON, P. S., MELANSON, E., & SIRARD, J. (1998) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199805000-00021 · Cited by 3,825 · see citing works
Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases
Pedersen, B. K., & Saltin, B. (2015) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.12581 · Cited by 3,514 · see citing works
Self-citationMotivational Interviewing: Preparing People for Change, 2nd ed.
Miller, W., & Rollnick, S. (2003) · Journal For Healthcare Quality · doi:10.1097/01445442-200305000-00013 · Cited by 2,634 · see citing works
Reduction in Weight and Cardiovascular Disease Risk Factors in Individuals With Type 2 Diabetes
The Look AHEAD Research Group (2007) · Diabetes Care · doi:10.2337/dc07-0048 · Cited by 1,522 · see citing works
Markland, D., & Tobin, V. (2004) · Journal of Sport and Exercise Psychology · doi:10.1123/jsep.26.2.191 · Cited by 1,444 · cited 7× · see citing works
“Exercise motivation was assessed using the Relative Autonomy Index (RAI) for the Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2) [35].”
MethodInfluential(2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.334 · Cited by 1,162 · see citing works
Church, T. S., Blair, S. N., Cocreham, S., Johannsen, N., Johnson, W., Kramer, K., Mikus, C. R., Myers, V., Nauta, M., Rodarte, R. Q., et al. (2010) · JAMA · doi:10.1001/jama.2010.1710 · Cited by 944 · see citing works
KANALEY, J. A., COLBERG, S. R., CORCORAN, M. H., MALIN, S. K., RODRIGUEZ, N. R., CRESPO, C. J., KIRWAN, J. P., & ZIERATH, J. R. (2022) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002800 · Cited by 931 · see citing works
Exercise as an anti-inflammatory therapy for rheumatic diseases—Myokine regulation
Benatti, F. B., & Pedersen, B. K. (2015) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2014.193 · Cited by 474 · cited 1× · see citing works
“Thus, the observed 3-cm decrease in waist circumference is likely associated with substantial reductions in visceral fat mass, which potentially lead to considerable improvements in glycemic control and decreased low-grade inflammation [19,47,48].”
BackgroundSelf-citationDetection of Physical Activity Types Using Triaxial Accelerometers
Skotte, J. H., Korshøj, M., Kristiansen, J., Hanisch, C., & Holtermann, A. (2013) · Journal of Physical Activity and Health · doi:10.1123/jpah.2011-0347 · Cited by 448 · see citing works
(2019) · Diabetes Care · doi:10.2337/dc20-s005 · Cited by 346 · see citing works
Karstoft, K., Winding, K., Knudsen, S. H., Nielsen, J. S., Thomsen, C., Pedersen, B. K., & Solomon, T. P. J. (2013) · Diabetes Care · doi:10.2337/dc12-0658 · Cited by 339 · see citing works
Self-citationMatthews, C. E., Keadle, S. K., Troiano, R. P., Kahle, L., Koster, A., Brychta, R. J., Domelen, D. R. V., Caserotti, P., Chen, K. Y., Harris, T. B., et al. (2016) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.116.135129 · Cited by 304 · see citing works
Andrews, R., Cooper, A., Montgomery, A., Norcross, A., Peters, T., Sharp, D., Jackson, N., Fitzsimons, K., Bright, J., Coulman, K., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60442-x · Cited by 302 · see citing works
Besson, H., Brage, S., Jakes, R. W., Ekelund, U., & Wareham, N. J. (2009) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2009.28432 · Cited by 263 · see citing works
Johansen, M. Y., MacDonald, C. S., Hansen, K. B., Karstoft, K., Christensen, R., Pedersen, M., Hansen, L. S., Zacho, M., Wedell-Neergaard, A.-S., Nielsen, S. T., et al. (2017) · JAMA · doi:10.1001/jama.2017.10169 · Cited by 244 · see citing works
Self-citationPhysical exercise as therapy for type 2 diabetes mellitus
Balducci, S., Sacchetti, M., Haxhi, J., Orlando, G., D'Errico, V., Fallucca, S., Menini, S., & Pugliese, G. (2014) · Diabetes/Metabolism Research Reviews · doi:10.1002/dmrr.2514 · Cited by 201 · see citing works
Ross, R., Hudson, R., Stotz, P. J., & Lam, M. (2015) · Annals of Internal Medicine · doi:10.7326/m14-1189 · Cited by 188 · see citing works
Ekelund, U., Brage, S., Griffin, S. J., & Wareham, N. J. (2009) · Diabetes Care · doi:10.2337/dc08-1895 · Cited by 186 · see citing works
Minimal Clinically Important Difference in Quality of Life for Patients With Low Back Pain
Díaz-Arribas, M. J., Fernández-Serrano, M., Royuela, A., Kovacs, F. M., Gallego-Izquierdo, T., Ramos-Sánchez, M., Llorca-Palomera, R., Pardo-Hervás, P., & Martín-Pariente, O. S. (2017) · Spine · doi:10.1097/brs.0000000000002298 · Cited by 184 · see citing works
Multiple Comparison Procedures
Cao, J., & Zhang, S. (2014) · JAMA · doi:10.1001/jama.2014.9440 · Cited by 168 · see citing works
Balducci, S., D’Errico, V., Haxhi, J., Sacchetti, M., Orlando, G., Cardelli, P., Vitale, M., Bollanti, L., Conti, F., Zanuso, S., et al. (2019) · JAMA · doi:10.1001/jama.2019.0922 · Cited by 158 · see citing works
van der Weegen, S., Verwey, R., Spreeuwenberg, M., Tange, H., van der Weijden, T., & de Witte, L. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4579 · Cited by 154 · see citing works
Patient-Driven Diabetes Care of the Future in the Technology Era
Ashrafzadeh, S., & Hamdy, O. (2019) · Cell Metabolism · doi:10.1016/j.cmet.2018.09.005 · Cited by 111 · see citing works
Poppe, L., De Bourdeaudhuij, I., Verloigne, M., Shadid, S., Van Cauwenberg, J., Compernolle, S., & Crombez, G. (2019) · Journal of Medical Internet Research · doi:10.2196/13363 · Cited by 104 · see citing works
Accelerometer data reduction in adolescents: effects on sample retention and bias
Toftager, M., Kristensen, P. L., Oliver, M., Duncan, S., Christiansen, L. B., Boyle, E., Brønd, J. C., & Troelsen, J. (2013) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-10-140 · Cited by 99 · see citing works
Self-citationPhysiological basis of brief vigorous exercise to improve health
Gibala, M. J., & Little, J. P. (2019) · The Journal of Physiology · doi:10.1113/jp276849 · Cited by 90 · see citing works
Socioeconomic inequality of diabetes patients’ health care utilization in Denmark
Sortsø, C., Lauridsen, J. T., Emneus, M., Green, A., & Jensen, P. B. (2017) · Health Economics Review · doi:10.1186/s13561-017-0155-5 · Cited by 79 · see citing works
Ried‐Larsen, M., Johansen, M. Y., MacDonald, C., Hansen, K. B., Christensen, R., Wedell‐Neergaard, A., Pilmark, N. S., Langberg, H., Vaag, A. A., Pedersen, B. K., et al. (2019) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13802 · Cited by 70 · see citing works
Self-citationChurch, T. S., & Blair, S. N. (2008) · British Journal of Sports Medicine · doi:10.1136/bjsm.2008.053850 · Cited by 66 · see citing works
The Potential Impact of Displacing Sedentary Time in Adults with Type 2 Diabetes
Falconer, C., Page, A. S., Andrews, R. C., & Cooper, A. R. (2015) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000651 · Cited by 62 · see citing works
Verwey, R., van der Weegen, S., Spreeuwenberg, M. D., Tange, H. J., van der Weijden, T., & de Witte, L. (2014) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x13519057 · Cited by 61 · see citing works
Plotnikoff, R. C., Wilczynska, M., Cohen, K. E., Smith, J. J., & Lubans, D. R. (2017) · Preventive Medicine · doi:10.1016/j.ypmed.2017.08.027 · Cited by 60 · see citing works
Death by effectiveness: exercise as medicine caught in the efficacy trap!
Beedie, C., Mann, S., Jiménez, A., Kennedy, L., Lane, A. M., Domone, S., Wilson, S., & Whyte, G. P. (2015) · British Journal of Sports Medicine · doi:10.1136/bjsports-2014-094389 · Cited by 54 · see citing works
Four-year physical activity levels among intervention participants with type 2 diabetes
UNICK, J. L., GAUSSOIN, S. A., HILL, J. O., JAKICIC, J. M., BOND, D. S., HELLGREN, M., JOHNSON, K. C., PETERS, A. L., CODAY, M., KITZMAN, D. W., et al. (2016) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001054 · Cited by 52 · see citing works
on behalf of the ADDITION-Plus study team, Griffin, S. J., Simmons, R. K., Prevost, A. T., Williams, K. M., Hardeman, W., Sutton, S. R., Brage, S., Ekelund, U., Parker, R. A., et al. (2014) · Diabetologia · doi:10.1007/s00125-014-3236-6 · Cited by 43 · see citing works
MacDonald, C., Nielsen, S. M., Bjørner, J. B., Johansen, M. Y., Christensen, R., Vaag, A. A., Lieberman, D. E., Pedersen, B. K., Langberg, H., Ried‐Larsen, M., et al. (2021) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-001840 · Cited by 36 · see citing works
Self-citationPetersen, T. L., Brønd, J. C., Kristensen, P. L., Aadland, E., Grøntved, A., & Jepsen, R. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-01067-7 · Cited by 35 · see citing works
Self-citationValentiner, L. S., Thorsen, I. K., Kongstad, M. B., Brinkløv, C. F., Larsen, R. T., Karstoft, K., Nielsen, J. S., Pedersen, B. K., Langberg, H., & Ried‐Larsen, M. (2019) · PLoS ONE · doi:10.1371/journal.pone.0208181 · Cited by 32 · see citing works
Self-citationThe erosion of physical activity in Western societies: an economic death march
Booth, F. W., & Hawley, J. A. (2015) · Diabetologia · doi:10.1007/s00125-015-3617-5 · Cited by 29 · see citing works
Why prescribe exercise as therapy in type 2 diabetes? We have a pill for that!
Ried‐Larsen, M., MacDonald, C. S., Johansen, M. Y., Hansen, K. B., Christensen, R., Almdal, T. P., Pedersen, B. K., & Karstoft, K. (2018) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2999 · Cited by 29 · see citing works
Self-citationRoss, R., Hudson, R., Day, A. G., & Lam, M. (2012) · Contemporary Clinical Trials · doi:10.1016/j.cct.2012.10.010 · Cited by 28 · see citing works
The ActiGraph counts processing and the assessment of vigorous activity
Brønd, J. C., Aadland, E., Andersen, L. B., Resaland, G. K., Andersen, S. A., & Arvidsson, D. (2019) · Clinical Physiology and Functional Imaging · doi:10.1111/cpf.12571 · Cited by 23 · see citing works
Self-citationRied‐Larsen, M., Thomsen, R. W., Berencsi, K., Brinkløv, C. F., Brøns, C., Valentiner, L. S., Karstoft, K., Langberg, H., Vaag, A. A., Pedersen, B. K., et al. (2016) · Clinical Epidemiology · doi:10.2147/clep.s97303 · Cited by 18 · see citing works
Self-citationBrinkløv, C. F., Thorsen, I. K., Karstoft, K., Brøns, C., Valentiner, L. S., Langberg, H., Vaag, A. A., Nielsen, J. S., Pedersen, B. K., & Ried‐Larsen, M. (2016) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-016-0056-7 · Cited by 18 · see citing works
Self-citationValentiner, L. S., Ried‐Larsen, M., Karstoft, K., Brinkløv, C. F., Brøns, C., Nielsen, R. O., Christensen, R., Nielsen, J. S., Vaag, A. A., Pedersen, B. K., et al. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-014036 · Cited by 16 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Li, M., Liu, S., Yu, B., Li, N., Lyu, A., Yang, H., He, H., Zhang, N., Ma, J., Sun, M., et al. (2025) · Journal of Medical Internet Research · doi:10.2196/63209 · Cited by 12 · see citing works
“The effectiveness of these strategies may stem from their ability to comprehensively influence the patient’s lifestyle and behavioral habits, thereby promoting the achievement of treatment goals [73,79,94].”
- Authors
- Thorsen, I. K., Yang, Y., Valentiner, L. S., Glümer, C., Karstoft, K., Brønd, J. C., Nielsen, R. O., Brøns, C., Christensen, R., Nielsen, J. S., Vaag, A. A., Pedersen, B. K., Langberg, H., & Ried-Larsen, M.
- Affiliations
- Copenhagen University Hospital (DK)
- Odense University Hospital (DK)
- University of Copenhagen (DK)
- Copenhagen Municipality (DK)
- Bispebjerg Hospital (DK)
- University of Southern Denmark (DK)
- Aarhus University (DK)
- Rigshospitalet (DK)
- Steno Diabetes Center Copenhagen (DK)
- Corresponding author
- Thorsen, Ida Kær
- ORCID
- Venue
- JMIR mHealth and uHealth
- Publisher
- JMIR Publications Inc.
- Published
- 2022-09-28
- Volume
- 10
- Issue
- 9
- Pages
- e30602
- ISSN
- 2291-5222 (ISSN-L)
- PMC
- PMC9557767
- OpenAlex
- W4297458492
- Cited by
- 24
- References
- 49
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 10 · 2022: 1
- FWCI
- 4.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR mhealth and uhealth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
- Funders
- Strategiske Forskningsråd (09–067009, 09 – 075724)
- Parker Institute for Cancer Immunotherapy (OCAY-18-774-OFIL)
- Steno Diabetes Center Copenhagen (SDCC 3.F CMP)
- Vissing Fonden
- National Research Foundation
- Danmarks Grundforskningsfond (09-067009, DNRF55, 09-075724)
- Novo Nordisk
- Odense Universitetshospital
- Augustinus Fonden
- TrygFonden (20045, 125132, 101390)
- Novo Nordisk Fonden (NNF17SA0030962-2)
- Diabetesforeningen
- Center for Strategic Research
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 2 diabetes, physical activity, mobile application, exercise adherence, motivational support, health-related quality of life, physical fitness, moderate-to-vigorous physical activity, exercise program comparison, digital health interventions, exercise enjoyment, exercise self-efficacy
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Life Style, Male, Middle Aged, Quality of Life, Exercise, Mobile Applications
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
