Abstract
BackgroundPhysical activity is associated with a reduced risk of type 2 diabetes and cardiovascular disease but limited evidence exists for the sustained promotion of increased physical activity within diabetes prevention trials. The aim of the study was to investigate the long-term effectiveness of the Walking Away programme, an established group-based behavioural physical activity intervention with pedometer use, when delivered alone or with a supporting mHealth intervention.MethodsThose at risk of diabetes (nondiabetic hyperglycaemia) were recruited from primary care, 2013–2015, and randomised to (1) Control (information leaflet); (2) Walking Away (WA), a structured group education session followed by annual group-based support; or (3) Walking Away Plus (WAP), comprising WA annual group-based support and an mHealth intervention delivering tailored text messages supported by telephone calls. Follow-up was conducted at 12 and 48 months. The primary outcome was accelerometer measured ambulatory activity (steps/day). Change in primary outcome was analysed using analysis of covariance with adjustment for baseline, randomisation and stratification variables.ResultsOne thousand three hundred sixty-six individuals were randomised (median age = 61 years, ambulatory activity = 6638 steps/day, women = 49%, ethnic minorities = 28%). Accelerometer data were available for 1017 (74%) individuals at 12 months and 993 (73%) at 48 months. At 12 months, WAP increased their ambulatory activity by 547 (97.5% CI 211, 882) steps/day compared to control and were 1.61 (97.5% CI 1.05, 2.45) times more likely to achieve 150 min/week of moderate-to-vigorous physical activity. Differences were not maintained at 48 months. WA was no different to control at 12 or 48 months. Secondary anthropometric and health outcomes were largely unaltered in both intervention groups apart from small reductions in body weight in WA (~ 1 kg) at 12- and 48-month follow-up.ConclusionsCombining a pragmatic group-based intervention with text messaging and telephone support resulted in modest changes to physical activity at 12 months, but changes were not maintained at 48 months.Trial registrationISRCTN 83465245 (registered on 14 June 2012).
Highlights
Physical activity is associated with a reduced risk of type 2 diabetes and cardiovascular disease but limited evidence exists for the sustained promotion of increased physical activity within diabetes prevention trials
Large trials have demonstrated that intensive lifestyle interventions targeting diet, physical activity and weight loss reduce the risk of developing type 2 diabetes (T2D) by 50% [1]
The PACE-UP pedometer intervention for inactive adults demonstrated increases in ambulatory activity of between 600 and 700 steps/day over 36 months, but the effect for ambulatory activity was not sustained in 298 older adults aged 60– 75 years over 48 months with differences in moderate-to-vigorous intensity physical activity (MVPA) compared to control diminishing to 4.6 min/day [24]
Summary
Physical activity is associated with a reduced risk of type 2 diabetes and cardiovascular disease but limited evidence exists for the sustained promotion of increased physical activity within diabetes prevention trials. Translational research has demonstrated that lifestyle diabetes prevention programmes lead to modest weight loss when implemented within routine clinical settings [2]. Whilst the intensive interventions in the seminal diabetes prevention trials achieved initial weight loss, there is little evidence of sustained increases in physical activity over the longer term (> 12 months) [5]. This is important as even modest increases in physical activity decrease the risk of cardiovascular disease and improve glycaemic control independently of changes in weight in high risk groups [6, 7] and facilitate maintenance of weight loss. Uptake of and retention in real-world diabetes prevention programmes is sub-optimal [3, 4], suggesting alternative strategies are required
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
