Efficiency of an mHealth App and Chest-Wearable Remote Exercise Monitoring Intervention in Patients With Type 2 Diabetes: A Prospective, Multicenter Randomized Controlled Trial.

Jing Li,Shuyi Liu,Yuelei Wu,Li Chen,Dong Wei,Nanwei Tong,Cuixia Tan,Mingxia Li,Wen Zhou,Hongdao Meng,Xi Chen,Lingyun Ouyang

doi:10.2196/23338

Abstract

BackgroundExercise has been recommended as a cornerstone for diabetes management. Supervised exercise is more efficient than unsupervised exercise but is less convenient and accessible.ObjectiveWe aimed to determine the efficiency of exercise using a fitness app and heart rate band to remotely monitor patients with type 2 diabetes in comparison with that of traditional exercise.MethodsPatients with type 2 diabetes without severe complications or comorbidities were recruited to participate in this multicenter randomized controlled trial and were allocated to either the intervention or control group (1:1 ratio). Participants in both groups were asked to engage in moderate to vigorous physical activity for at least 150 minutes per week; each participant was prescribed individualized exercises. Participants in the intervention group were asked to follow exercise videos on the app and to wear a chest band; heart rate, exercise duration, and exercise intensity were recorded by the app. Participants in the control group self-reported exercise intensity and duration. Cardiopulmonary endurance, body composition, blood glucose level, and insulin level were assessed before and after a 3-month exercise program.ResultsOf the 101 participants who were enrolled, the majority of them (85/101, 84.2%) completed the study. Both groups had similar baseline characteristics, with the exception that participants in the intervention group were slightly younger and less likely to have hypertension. Self-reported exercise duration was longer than app-recorded exercise duration (control: mean 214 minutes/week; intervention: mean 193 minutes/week); in addition, a higher proportion of participants in the control group (29/41, 71%) than in the intervention group (18/44, 41%) met the 150-minute target for moderate to vigorous physical activity. However, compared with the control group, the intervention group had a larger increase in cardiopulmonary endurance (mean difference –2.0 bpm [beats per minute] vs 1.0 bpm; P=.02) and a larger decrease in body fat percentage (mean difference –1.8% vs –0.8%; P=.01). There was no difference in hemoglobin A1c level reduction between the two groups, yet more participants in the intervention group stopped taking their antidiabetic drugs or had their dosages lowered by an endocrinologist, compared with those in the control group. There were no serious adverse events in either group.ConclusionsThis was the first randomized controlled trial in China, to our knowledge, to test the efficiency of exercise using a fitness app and heart rate band to remotely monitor prescribed exercise in patients with type 2 diabetes. The findings of our study suggest that exercise programs may be more efficient if participants are remotely monitored with an app and heart rate band than if participants are not monitored.Trial RegistrationChinese Clinical Trial Register ChiCTR1800015963; http://www.chictr.org.cn/showprojen.aspx?proj=27080

Highlights

Cardiovascular disease and microvascular complications related to type 2 diabetes are significant causes of premature mortality and morbidity, resulting in a heavy economic burden [1,2]
JMIR Mhealth Uhealth 2021 | vol 9 | iss. 2 | e23338 | p. 1 study suggest that exercise programs may be more efficient if participants are remotely monitored with an app and heart rate band than if participants are not monitored
A total of 119 patients were assessed for eligibility, of which 101 individuals met the inclusion criteria and were randomized to either the intervention group (55/101, 54.5%) or the control group (46/101, 45.5%); 85 participants out of 101 (84.2%) completed the study: 44 (52%) from the intervention group and 41 (48%) from the control group

Summary

Introduction

Cardiovascular disease and microvascular complications related to type 2 diabetes are significant causes of premature mortality and morbidity, resulting in a heavy economic burden [1,2]. Individuals are likely to benefit more from regular exercise that is longer in duration, of greater intensity, or both [9]. Accurate monitoring and quantification of exercise intensity, duration, and adherence affect exercise efficiency. Supervised exercise, such that the features of exercise and its adherence are monitored by trained staff, is typically performed in specialized facilities. Unsupervised exercise is more convenient, it may be less efficient. The American Diabetes Association recommends supervised exercise, when feasible, for patients with type 2 diabetes [8]. Exercise has been recommended as a cornerstone for diabetes management. Supervised exercise is more efficient than unsupervised exercise but is less convenient and accessible

Methods

Results

Discussion

Conclusion