Abstract
BackgroundMetabolic syndrome is a cluster of cardiovascular risk factors that greatly increase the risk of developing cardiovascular disease and type 2 diabetes. Regular exercise improves the risk profile, but most people do not successfully change their exercise habits to beneficially reduce risk. Tailored exercise prescribed by a family physician has shown promise as a means to increase fitness and reduce cardiometabolic risk, but optimal implementation practices remain unknown. Mobile health technologies have proved to be a beneficial tool to achieve blood pressure and blood glucose control in patients with diabetes. These technologies may address the limited access to health interventions in rural and remote regions. However, the potential as a tool to support exercise-based prevention activities is not well understood. This study was undertaken to investigate the effects of a tailored exercise prescription alone or supported by mobile health technologies to improve metabolic syndrome and related cardiometabolic risk factors in rural community-dwelling adults at risk for cardiovascular disease and type 2 diabetes.Methods/DesignAdults (n = 149) with at least two metabolic syndrome risk factors were recruited from rural communities and randomized to either: 1) an intervention group receiving an exercise prescription and devices for monitoring of risk factors with a smartphone data portal equipped with a mobile health application; or 2) an active control group receiving only an exercise prescription. All participants reported to the research centre at baseline, and at 12-, 24- and 52-week follow-up visits for measurement of anthropometrics and blood pressure and for a blood draw to test blood-borne markers of cardiometabolic health. Vascular and autonomic function were examined. Fitness was assessed and exercise prescribed according to the Step Test and Exercise Prescription protocol.DiscussionThis study tested the effects of a prescriptive exercise intervention alone, versus one supported by mobile health technology on cardiometabolic risk factors. The intervention was designed to be translated into clinical or community-based programming. Results will contribute to the current literature by investigating the utility of mobile health technology support for exercise prescription interventions to improve cardiometabolic risk status and maintain improvements over time; particularly in rural communities.Trial registrationClinical trials registration: NCT01944124
Highlights
Metabolic syndrome is a cluster of cardiovascular risk factors that greatly increase the risk of developing cardiovascular disease and type 2 diabetes
This study tested the effects of a prescriptive exercise intervention alone, versus one supported by mobile health technology on cardiometabolic risk factors
Results will contribute to the current literature by investigating the utility of mobile health technology support for exercise prescription interventions to improve cardiometabolic risk status and maintain improvements over time; in rural communities
Summary
This study investigated the effects of an exercise prescription supported by mobile health technology compared to an exercise prescription alone to improve metabolic syndrome and global cardiometabolic risk factors in rural community-dwelling adults. This study included adults from a rural community with greater prevalence of obesity, diabetes and hypertension than the provincial average [42] and reduced access to healthcare compared to urban communities [20] It was considered an ideal setting for an intervention leveraging novel mobile health technologies to promote increased physical activity to reduce cardiovascular risk. Intensive lifestyle intervention programs reduced the risk of developing type 2 diabetes mellitus in patients with prediabetes and improvements were maintained over a long-term follow-up; there was a strong relationship between reduced disease progression and continuance of lifestyle intervention behaviours [53] This finding highlights the importance of post-program support for long-term maintenance. Learnings from this study will be used to enhance the delivery of lifestyle interventions aimed at improving cardiometabolic risk, with the intention of reducing incident cardiovascular diseases and type 2 diabetes mellitus.
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