Effect of behavior change techniques based remote diabetes exercise support on exercise self-efficacy in patients with type 2 diabetes mellitus

Abstract

Objective To investigate the effects of remote exercise rehabilitation support based on behavior change techniques on exercise self-efficacy and glycosylated hemoglobin A1c (HbA1c) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 381 patients with T2DM who were followed up for more than 6 months in Peking University First Hospital Diabetes Shared Care Clinic from January to December 2018 were enrolled. The patients who voluntarily received a 3-month behavior change techniques based remote exercise intervention were assigned to exercise intervention group [45 cases, (50.4±12.8) year-old, female 24 cases (53.3%), diabetes duration was 4.6 (0.8, 12.0) year] and the rest were in non-exercise intervention group [336 cases, (57.8±11.6) year-old, female 155 cases (46.1%), diabetes duration was 10.3 (2.8, 16.0) year]. After evaluated by exercise coach, patients in exercise intervention group with higher baseline self-efficacy scale scores only received exercise reminders and electronic exercise prescription, and those with lower self-efficacy received individualized video exercise prescription based on behavior change techniques. Including age, disease duration, gender, body mass index, and baseline HbA1c were used as covariates, the propensity score analysis was used to compare the change of HbA1c at six months for patients with uncontrolled baseline HbA1c between exercise intervention group and non-exercise intervention group. The t test and Wilcoxoh test were used for data analysis. Results Compared with baseline, both exercise self-efficacy score [40 (31, 54) vs 55 (26, 83) points, Z=-2.229, P=0.026] and exercise self-management ability score [2 (2, 4) vs 4 (3, 5) points, Z=-2.401, P=0.016] were significantly improved after six month in low exercise self-efficacy group. HbA1c were significantly lower in the exercise intervention group compared with baseline (8.9%±2.0% vs 6.9%±0.8%, t=5.723, P<0.000 01). Conclusion In the context of effective multidisciplinary management of diabetes, implementation of behavioral change technique-based remote exercise support can improve exercise self-efficacy and HbA1c in patients with poor controlled T2DM. Key words: Diabetes mellitus; Hemoglobin A, glycosylated; Diabetes shared care; Exercise support; Behavior change technique; Exercise self-efficacy