Mobile exergaming in Type 2 Diabetes mellitus – innovative ways to overcome physical inactivity and increase exercise adherence

Abstract

Background Type 2 diabetes has developed into a worldwide pandemic in recent years that is associated with vast comorbidity and mortality and has created an enormous financial strain on health care systems all around the globe. Physical inactivity is known to be one of the most important risk factors for the development of type 2 diabetes and responsible for much of the diabetes‐related comorbidity. An increase in regular physical activity is therefore an essential component of a successful type 2 diabetes treatment. However, despite the proven benefits of regular physical activity, the vast majority of patients with type 2 diabetes remain inactive – often due to low motivation and lack of physical activity enjoyment. A recent and promising approach to motivate sedentary individuals to be more physically active and sustainably adhere to regular physical activity is exergames. These games integrate physical activity and personal health information into a game or game‐like setting and thereby promote physical activity through playful and enjoyable challenges. Aims The aims of this Ph.D. project were: (1) to systematically review the current evidence for the effectiveness of exergaming in overweight and type 2 diabetes and (2) to evaluate the suitability of the Wii Fit Plus exergame to improve cardiorespiratory fitness in individuals with type 2 diabetes. The aim was further (3) to develop a behavior change technique‐based smartphone game that delivers individualized exercise and physical activity promotion with the intention to motivate inactive type 2 diabetes patients to become sustainably physically active and to plan a 24‐week randomized controlled trial evaluating the game’s effectiveness. In addition, it was aimed (4) to assess the accuracy of a commercial activity wristband and of iOS and Android smartphones to measure steps during various walking conditions as those devices were intended to be used to measure the primary outcome (steps per day) in the 24‐week randomized controlled trial. Finally, the aims were (5) to examine the effectiveness of the smartphone game to increase daily physical activity and improve glycemic control and aerobic capacity as well as (6) to evaluate the game’s suitability to increase the intrinsic physical activity motivation and elicit sustained improvements in physical activity adherence in inactive individuals with type 2 diabetes over a 24‐week period. Methods In this Ph.D. project, one systematic review and three studies were conducted. In the systematic review, electronic bibliographic databases (PubMed, Embase, Web of Science, OpenGrey, and the Cochrane Central Register of Controlled Trials) were searched up to March 2015. Randomized controlled trials and cross‐sectional studies published in English in peer‐reviewed journals were included. Included studies were required to have analyzed the effects of exergames on objectively measured intensity parameters of physical activity (oxygen uptake, energy expenditure, and heart rate) in…