The Diabetes Network Internet-Based Physical Activity Intervention
Open accessAbstract
OBJECTIVE—Because of other competing priorities, physical activity (PA) is seldom addressed in a consistent way in either primary care or diabetes education . This 8-week pilot study evaluated the short-term benefits of an Internet-based supplement to usual care that focused on providing support for sedentary patients with type 2 diabetes to increase their PA levels. RESEARCH DESIGN AND METHODS—A total of 78 type 2 diabetic patients (53% female, average age 52.3 years) were randomized to the Diabetes Network (D-Net) Active Lives PA Intervention or an Internet information-only condition. The intervention condition received goal-setting and personalized feedback, identified and developed strategies to overcome barriers, received and could post messages to an on-line “personal coach,” and were invited to participate in peer group support areas. Key outcomes included minutes of PA per week and depressive symptomatology. RESULTS—There was an overall moderate improvement in PA levels within both intervention and control conditions, but there was no significant improvement in regard to condition effects. There was substantial variability in both site use and outcomes within the intervention and control conditions. Internal analyses revealed that among intervention participants, those who used the site more regularly derived significantly greater benefits, whereas those in the control condition derived no similar benefits with increased program use. CONCLUSIONS—Internet-based self-management interventions for PA and other regimen areas have great potential to enhance the care of diabetes and other chronic conditions. We conclude that greater attention should be focused on methods to sustain involvement with Internet-based intervention health promotion programs over time.
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Website exposure and program usage was positively correlated with outcomes in interventions targeting smokeless tobacco, depression, and physical activity.
“Website exposure and program usage was positively correlated with outcomes in interventions targeting smokeless tobacco [64], depression [65], and physical activity [66].”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [66]
Six studies used multiple subjective measures of physical activity.
“One study used an objective measure to assess the amount of physical activity (activity monitor), and six studies used multiple subjective measures of physical activity.”
From Internet-based physical activity interventions: a systematic review of the literature. (2007) · cites this paper as [40]
Six studies used one or more theoretical models to compose the contents of the interventions.
“Six studies used one or more theoretical models to compose the contents of the interventions.”
From Internet-based physical activity interventions: a systematic review of the literature. (2007) · cites this paper as [40]
Of the seven studies comparing two types of Internet-based interventions, four had the main difference as intensity of contact between participants and supervisors.
“Seven studies compared two types of Internet-based physical activity interventions in which the main difference was either the intensity of contact between the participants and supervisors (4 studies) or the type of treatment procedures applied (3 studies).”
From Internet-based physical activity interventions: a systematic review of the literature. (2007) · cites this paper as [40]
Six of the 10 studies were specifically targeted at adults who were sedentary at baseline; the other four did not employ any inclusion criteria regarding baseline physical activity level.
“Six of the 10 studies were specifically targeted at adults who were sedentary at baseline [32,37,39-41,43]; the other four studies did not employ any inclusion criteria regarding baseline physical activity level [34-36,42].”
From Internet-based physical activity interventions: a systematic review of the literature. (2007) · cites this paper as [40]
Six of the 10 studies compared the characteristics of dropouts with the subjects that completed all outcome measurements.
“All studies reported a dropout rate, with six of the 10 studies comparing the characteristics of these dropouts with the subjects that completed all outcome measurements [32,35,36,39-41].”
From Internet-based physical activity interventions: a systematic review of the literature. (2007) · cites this paper as [40]
The number of physical activity outcome parameters varied: four studies included one, five included two, and one reported more than two.
“Four studies included one physical activity outcome parameter [32,35,36,41], five studies included two physical activity parameters [34,39,40,42,43], and one study reported more than two physical activity parameters [37].”
From Internet-based physical activity interventions: a systematic review of the literature. (2007) · cites this paper as [40]
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Van Den Berg, M. H., Ronday, H. K., Peeters, A. J., Le Cessie, S., Van Der Giesen, F. J., Breedveld, F. C., & Vliet Vlieland, T. P. M. (2006) · Arthritis Care & Research · doi:10.1002/art.22339 · Cited by 160 · see citing works
“In patients with type 2 diabetes, McKay (19) demonstrated the potential of an 8-week Internet-based personalized physical activity program including online personal counseling and support.”
BackgroundInfluentialCho, J.-H., Lee, H.-C., Lim, D.-J., Kwon, H.-S., & Yoon, K.-H. (2009) · Journal of Telemedicine and Telecare · doi:10.1258/jtt.2008.080412 · Cited by 155 · see citing works
Internet-based Patient Self-care: The Next Generation of Health Care Delivery
Forkner-Dunn, J. (2003) · Journal of Medical Internet Research · doi:10.2196/jmir.5.2.e8 · Cited by 162 · see citing works
“A study by McKay et al [10] found that patients who participated in an online diabetes education and support group lowered their blood glucose levels more than controls did.”
BackgroundChronic Health Conditions and Internet Behavioral Interventions
Schubart, J. R., Stuckey, H. L., GANESHAMOORTHY, A., & Sciamanna, C. (2011) · CIN Computers Informatics Nursing · doi:10.1097/ncn.0b013e3182155274 · Cited by 154 · see citing works
SCHUBART, J. R., STUCKEY, H. L., GANESHAMOORTHY, A., & SCIAMANNA, C. N. (2011) · CIN: Computers, Informatics, Nursing · doi:10.1097/ncn.0b013e3182065eed · Cited by 135 · see citing works
“McKay et al 57 reported that overall attrition was 13%, yet usage dropped from a mean of 2.7 log-ins during the first 2 weeks to 0.5 log-ins during the last 2 weeks.”
InfluentialA systematic review of IT for diabetes self-management: Are we there yet?
El-Gayar, O., Timsina, P., Nawar, N., & Eid, W. (2013) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2013.05.006 · Cited by 148 · see citing works
“5 Satisfaction Yes McKay (2001) [111] T2 Internet Two-way 78 2 Physical activity McKay (2002) [112] T2 Internet Two-way 160 3 Healthy behavior Yes McMohan (2005) [44] T1&2 Internet Two-way 104 12 HbA1c Yes >1% Meneghini (1998) [52] ND Phone Two-way 30 12 HbA1c Yes >0.”
Sarkar, U., Piette, J. D., Gonzales, R., Lessler, D. S., Chew, L. D., Reilly, B. M., Johnson, J. L., Brunt, M., Huang, J. C., Regenstein, M., et al. (2007) · Patient Education and Counseling · doi:10.1016/j.pec.2007.09.008 · Cited by 148 · see citing works
Nguyen, H. Q., Carrieri-Kohlman, V., Rankin, S. H., Slaughter, R., & Stulbarg, M. S. (2004) · Computers in Biology and Medicine · doi:10.1016/s0010-4825(03)00046-5 · Cited by 147 · see citing works
“[34] RCT × 8 weeks Subjects with Type 2 Diabetes Age = 52 78 Active lives physical activity (EXP): action planning, personalized feedback from coach, peer support via email, physical activity diary with graphical summaries (n= 38) vs.”
BackgroundInfluentialGuertler, D., Vandelanotte, C., Kirwan, M., & Duncan, M. J. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4339 · Cited by 147 · see citing works
“Most studies report that overall engagement decreases over time (eg, [38]) and high attrition is widely seen as a challenge of Web-based interventions.”
InfluentialInternet-Based Physical Activity Interventions
Joseph, R. P., Durant, N. H., Benitez, T. J., & Pekmezi, D. (2013) · American Journal of Lifestyle Medicine · doi:10.1177/1559827613498059 · Cited by 142 · see citing works
“Three studies did not report how missing data were accounted for in statistical analyses.(30,40,57) Assessment of Physical Activity The majority of the studies (n = 68) reported a physical activity outcome immediately following the conclusion of the Internet-based intervention.”
BackgroundMacIntyre, P., Fisher, M., Kirk, A., & Mutrie, N. (2004) · Diabetologia · doi:10.1007/s00125-004-1396-5 · Cited by 139 · see citing works
Geraghty, A. W. A., Torres, L. D., Leykin, Y., Pérez‐Stable, E. J., & Muñoz, R. F. (2012) · Health Promotion International · doi:10.1093/heapro/das029 · Cited by 136 · see citing works
“…been shown to help individuals stop smoking (Mun˜oz et al ., 2009; Shahab and McEwen, 2009) and lose weight (Weinstein, 2006), reduce depression and anxiety (Griffiths et al ., 2010), encourage effective management of diabetes (McKay et al ., 2001), and improve insomnia (Ritterband et al ., 2009).”
BackgroundSmoking cessation treatment on the Internet: Content, quality, and usability
Bock, B., Graham, A., Sciamanna, C., Ph.D, J. K., Whiteley, J., Carmona-Barros, R., Niaura, R., & Abrams, D. (2004) · Nicotine & Tobacco Research · doi:10.1080/14622200410001676332 · Cited by 137 · see citing works
van Wier, M. F., Ariëns, G. A., Dekkers, J. C., Hendriksen, I. J. M., Smid, T., & van Mechelen, W. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-6 · Cited by 137 · see citing works
“Those that did, found positive effects on body weight, mixed effects on diet [19,20] and no effect on physical activity [19-21].”
Plotnikoff, R. C., McCargar, L. J., Wilson, P. M., & Loucaides, C. A. (2005) · American Journal of Health Promotion · doi:10.4278/0890-1171-19.6.422 · Cited by 134 · see citing works
“004) and stage of change for generally avoiding eating high-fat foods (F[12,114] 5 5.”
BackgroundMethodInfluentialBowen, A., Williams, M. L., Daniel, C. M., & Clayton, S. (2008) · Journal of Behavioral Medicine · doi:10.1007/s10865-008-9171-6 · Cited by 131 · see citing works
Kim, H.-S. (2007) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2006.01.011 · Cited by 130 · see citing works
Bond, G. E., Burr, R. L., Wolf, F. M., & Feldt, K. S. (2010) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721710366758 · Cited by 131 · see citing works
Self-management interventions for chronic disease: a systematic scoping review
Richardson, J. A., Sánchez, A. L., Sinclair, S., Harris, J. E., Letts, L. J., MacIntyre, N. J., Wilkins, S., Burgos-Martínez, G., Wishart, L. R., McBay, C., et al. (2014) · Clinical Rehabilitation · doi:10.1177/0269215514532478 · Cited by 125 · see citing works
Adamse, C., Dekker-Van Weering, M. G., van Etten-Jamaludin, F. S., & Stuiver, M. M. (2018) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x17716576 · Cited by 115 · see citing works
Status of computerized cognitive behavioural therapy for adults
Titov, N. (2007) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670601109873 · Cited by 120 · see citing works
“CCBT or similar computer education and training programs have already been widely used to help manage a range of health conditions including smoking cessation [20], headaches [21], weight loss [22], tinnitus [23], and physical activity [24].”
BackgroundDiabetes self-management education: A review of published studies
Clark, M. (2008) · Primary care diabetes · doi:10.1016/j.pcd.2008.04.004 · Cited by 122 · see citing works
“One of the most definitive studies of Internet-based diabetes supports [33] evaluated a web-based self-management pro2 ( 2 0 0 8 ) 113–120”
BackgroundBond, G. E., Burr, R. L., Wolf, F. M., Price, M. J., McCurry, S. M., & Teri, L. L. (2007) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2006.0057 · Cited by 121 · see citing works
“15,16,21,22 Sixty-two participants (including a 15% attrition rate), based on a 0.5 correlation between the pre-intervention/ post-intervention scores, would provide for an intervention–control comparison of the magnitude demonstrated in the literature to detect a moderate effect size of 0.55 with…”
InfluentialHansel, B., Giral, P., Gambotti, L., Lafourcade, A., Pérès, G., Filipecki, C., Kadouch, D., Hartemann, A., Oppert, J., Bruckert, É., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7947 · Cited by 120 · see citing works
“Only five such studies were identified in the literature [5,17-21].”
BackgroundUsing the Internet to Translate an Evidence-Based Lifestyle Intervention into Practice
McTigue, K. M., Conroy, M. B., Hess, R., Bryce, C. L., Fiorillo, A. B., Fischer, G. S., Milas, N. C., & Simkin‐Silverman, L. R. (2009) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2009.0036 · Cited by 119 · see citing works
“9 kg/m2) Class 3 obesity (≥40 kg/m2) 10 (20) 13 (26) 11 (22) 16 (32)”
Interactive Health Communication Applications for people with chronic disease
Murray, E., Burns, J., Tai, S. S., Lai, R., & Nazareth, I. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004274.pub3 · Cited by 112 · see citing works
van der Heijden, M. M. P., van Dooren, F. E. P., Pop, V. J., & Pouwer, F. (2013) · Diabetologia · doi:10.1007/s00125-013-2871-7 · Cited by 110 · see citing works
“Discussion This is the first systematic review focusing on the effects of exercise training on quality of life, symptoms of depression, Table 3 Symptoms of depression: results Source Interval Evaluation test Results SMD Aerobic McKay et al 2001 [41] 8 weeks CES-D No significant between-group difference, adjusted for s…”
BackgroundInfluentialSlootmaker, S. M., Chinapaw, M. J. M., Schuit, A. J., Seidell, J. C., & Van Mechelen, W. (2009) · Journal of Medical Internet Research · doi:10.2196/jmir.1139 · Cited by 99 · see citing works
“5 times per week) [35,36].”
Effects of an Internet-Based Intervention for HIV Prevention: The Youthnet Trials
Bull, S. S., Pratte, K., Whitesell, N. R., RIETMEIJER, C. A. M., & McFarlane, M. (2008) · AIDS and Behavior · doi:10.1007/s10461-008-9487-9 · Cited by 109 · see citing works
“…Computers as Intervention Tools Rigorous studies using the Internet to promote healthy behavior show the promise of the medium for promotion of weight loss (Tate et al. 2001), diabetes self-management (Glasgow et al. 2003; Gottlieb 2000; McKay et al. 2001), and healthy eating (Oenema et al. 2001).”
BackgroundMackert, M., Kahlor, L. A., Tyler, D. O., & Gustafson, J. (2009) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2009.0012 · Cited by 107 · see citing works
Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials
Qiu, S., Cai, X., Chen, X., Yang, B., & Sun, Z. (2014) · BMC Medicine · doi:10.1186/1741-7015-12-36 · Cited by 106 · see citing works
Minimal in-person support as an adjunct to internet obesity treatment
Micco, N., Gold, B., Buzzell, P., Leonard, H., Pintauro, S., & Harvey-Berino, J. (2007) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm3301_6 · Cited by 100 · see citing works
Mclaughlin, M., Delaney, T., Hall, A., Byaruhanga, J., Mackie, P., Grady, A., Reilly, K., Campbell, E., Sutherland, R., Wiggers, J., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/23180 · Cited by 105 · see citing works
“McKay et al [21] additionally found website exposure (usage) to be associated with higher increases in physical activity.”
BackgroundMethodThe Frequency and Behavioral Outcomes of Goal Choices in the Self-management of Diabetes
Estabrooks, P. A., Nelson, C. C., Xu, S., King, D. K., Bayliss, E. A., Gaglio, B., Nutting, P. A., & Glasgow, R. E. (2005) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721705276578 · Cited by 104 · see citing works
Self-citationComparing Two Web-Based Smoking Cessation Programs: Randomized Controlled Trial
McKay, H. G., Danaher, B. G., Seeley, J. R., Lichtenstein, E., & Gau, J. M. (2008) · Journal of Medical Internet Research · doi:10.2196/jmir.993 · Cited by 99 · see citing works
“The Active Lives program was based primarily on Bandura’s Social Cognitive Theory [25,26], research on interventions to promote physical activity [33,34], and our earlier research on an online diabetes self-management intervention [35].”
MethodSelf-citationSun, P., Unger, J. B., Palmer, P. H., Gallaher, P., Chou, C.-P., Baezconde-Garbanati, L., Sussman, S., & Johnson, C. A. (2005) · CyberPsychology & Behavior · doi:10.1089/cpb.2005.8.441 · Cited by 101 · see citing works
Liebreich, T., Plotnikoff, R. C., Courneya, K. S., & Boulé, N. G. (2009) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-6-18 · Cited by 100 · see citing works
Rosser, B. A., Vowles, K. E., Keogh, E., Eccleston, C., & Mountain, G. A. (2009) · Journal of Telemedicine and Telecare · doi:10.1258/jtt.2009.090116 · Cited by 101 · see citing works
eHealth Promotion: The Use of the Internet for Health Promotion
Evers, K. E. (2006) · American Journal of Health Promotion · doi:10.4278/0890-1171-20.4.1 · Cited by 96 · see citing works
Bilde, P. E., Kliim‐Due, M., Rasmussen, B. A., Petersen, L. Z., Petersen, T. H., & Nielsen, J. B. (2011) · BMC Neurology · doi:10.1186/1471-2377-11-32 · Cited by 99 · see citing works
“Such internet-based training has been tested in trials on patients with diabetes [ 8-10 ] and rheumatoid arthritis [11] with positive results, but to our knowledge there are no reports on a home-based training system for supervised motor and cognitive training of children (or other patients) with brain damage.”
BackgroundParent-Child Interaction Using a Mobile and Wireless System for Blood Glucose Monitoring
Gammon, D., Årsand, E., Walseth, O. A., Andersson, N., Jenssen, M., & Taylor, T. (2005) · Journal of Medical Internet Research · doi:10.2196/jmir.7.5.e57 · Cited by 96 · see citing works
“Much of this work has centered on Internet applications that facilitate information, decision support, and social support [10-12].”
BackgroundAlam, R., Sturt, J. A., Lall, R., & Winkley, K. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2008.08.026 · Cited by 96 · see citing works
Enhancing Theoretical Fidelity: An E-mail—Based Walking Program Demonstration
Rovniak, L. S., Hovell, M. F., Wojcik, J. R., Winett, R. A., & Martinez-Donate, A. P. (2005) · American Journal of Health Promotion · doi:10.4278/0890-1171-20.2.85 · Cited by 90 · see citing works
Peer-Based Social Media Features in Behavior Change Interventions: Systematic Review
Elaheebocus, R., Weal, M. J., Morrison, L. G., & Yardley, L. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.8342 · Cited by 93 · see citing works
“The lower percentages were attributed to a “lack of critical mass” in the number of participants engaging actively in the forums to change others’ perception positively [93] or could be based on participants’ preferring personal email counseling compared with peer-to-peer support from online forums [86].”
Background
- Authors
- McKay, H. G., King, D., Eakin, E. G., Seeley, J. R., & Glasgow, R. E.
- Affiliations
- Oregon Research Institute (US)
- AMC Cancer Research Center, Denver, Colorado
- Queensland University of Technology (AU)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2001-08-01
- Volume
- 24
- Issue
- 8
- Pages
- 1328-1334
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2119360108
- Cited by
- 363
- References
- 28
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 6 · 2022: 9 · 2021: 7 · 2020: 3 · 2019: 6 · 2018: 9 · 2017: 9 · 2016: 13 · 2015: 14 · 2014: 19 · 2013: 25 · 2012: 23
- FWCI
- 37.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk051581-04)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-51581)
- 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, online intervention, goal setting, personalized feedback, online coaching, peer support, sedentary patients, depressive symptoms, program use
- MeSH terms
- Computer-Assisted Instruction, Computer Communication Networks, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Patient Education as Topic, Pilot Projects, Exercise, Walking, Treatment Outcome, Internet
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