Kirk, Alison Fiona (2003) Promoting and maintaining physical activity in people with type 2 diabetes. PhD thesis. http://theses.gla.ac.uk/1994/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Glasgow Theses Service http://theses.gla.ac.uk/ [email protected] PROMOTING AND MAINTAINING PHYSICAL ACTIVITY IN PEOPLE WITH TYPE 2 DIABETES by Alison Fiona Kirk (BSc) A Doctoral Thesis Submitted in fulfilment for degree the the partial of requirements of Doctor Philosophy of University Glasgow of Department Medicine Therapeutics of and 2003 ABSTRACT The benefits frequent for of regular, physical activity and exercise the management of Type 2 diabetes documented. Current American College Sports Medicine are well of (ACSM) for guidelines physical activity recommend that people should aim to least accumulate 30 intensity 5 days at minutes of moderate physical activity a week or 20 60 to high intensity 3 5 days continuous minutes of moderate to exercise, to a week. Around 80 Type 2 diabetes do To percent of people with not achieve these guidelines. date, research that addresses the promotion of physical activity in people with Type 2 diabetes has been limited. The the successful results of a pilot study evaluating in Type 2 effectiveness of exercise consultation to promote physical activity people with diabetes 5 led development PhD. This builds over weeks to the of this thesis on the foundations intervention 12 the the this of pilot study and evaluates effectiveness of over in Type 2 diabetes. months people with Accurate habitual is key importance to this to assessment of physical activity of research Accelerometers the true the examine effect of exercise consultation on physical activity. have become for Studies a popular objective method physical activity measurement. investigating have been the to validity of accelerometers restricted children and young Prior PhD further investigate to the to adults. main research a pilot study was conducted Computer Science Applications (CSA) the the to accuracy of and uniaxial accelerometer in Type 2 diabetes. 13 Type 2 diabetes measure physical activity people with people with (8M 5F, 54.2±6.5yrs, BMI 33.4±4.1) Participants mean age were recruited. walked at a brisk daily living (e. slow, normal and pace and performed other activities g. stair hoovering, loaded bags loaded climbing, carrying shopping and pushing a shopping During trolley at the normal walking pace). each activity steady state oxygen uptake breath by breath (Cosmed K4b2) (Vo2ml/kg/min) was measured using a portable system CSA the and activity counts/min were recorded using accelerometers worn at waist, ankle and wrist. demonstrated The this results of study oxygen uptake and activity counts at all increase increased (p<0.05). placements significantly as walking speed accelerometer bags loaded for Oxygen the the trolley carrying and pushing shopping were uptake higher (p<O. 01). Compared than to normal walking normal and significantly similar, bags higher the activity counts when carrying were significantly and activity walking, counts when pushing the cart were significantly lower (p<0.05). Results were similar at Ankle all accelerometer higher placements. counts were consistently than wrist and waist for counts all activities except vacuuming when wrist counts were highest. No significant differences found between for were wrist and waist counts all activities except It from in vacuuming. was concluded the results of this study that changes oxygen during daily living by in uptake activities are not always reflected changes activity counts. To in Type 2 diabetes accurately assess physical activity people with several methods be should used. The the to the primary aim of main study was evaluate effectiveness of exercise for 12 in consultation promoting and maintaining physical activity over months people Type 2 diabetes. Secondary investigate from baseline to 6 with aims were changes to and 12 in biochemical life 70 months a number of physiological, and quality of variables. inactive Type 2 diabetes (35M 35F, 57.6±7.9yrs, BMI 34.6±6.8) people with mean age information to were given standard exercise and randomised receive an exercise intervention (experimental (control consultation group n=35) or not group n=35). Exercise based the transtheoretical theory consultation, on model, combines motivational behavioural into individualised intervention to and cognitive strategies an promote and Exercise delivered baseline 6 maintain physical activity. consultations were at and months 1 3 and support phone calls were given and months after each exercise consultation. Changes from baseline 6 12 in (7-day to and months were assessed a) physical activity behaviour recall) accelerometer, stage and processes of exercise change and fitness), b) (body index blood cardiorespiratory physiological mass and pressure), c) biochemical (glycaemic lipid fibrinogen d) control, profile, and microalbuminuria) and life (Short form-36 Well-being quality of and questionnaire). illustrated between differences in Results recorded group minutes of moderate activity 6 12 (p<O. 01). The and total accelerometer counts per week at and months experimental from increased total group minutes of moderate activity and accelerometer counts baseline 6 (P<0.01), decrease from 6 to 12 to months with no significant months (P>0.05). From baseline 12 increase in the to months a significant was recorded for (p<O. 01), but total experimental group minutes of moderate activity not decrease in (p=0.7). The accelerometer counts per week control group recorded a from baseline 12 (p=0.03). to months accelerometer counts per week At 6 12 to controls, and months significantly more experimental participants, compared 11 ACSM (6M were meeting physical activity guidelines x2=22.0, p<0.01,12M X2=15.2. P<0.01) being in and a greater proportion reported (action an active stage or behaviour (6M maintenance) of exercise change X2=26.4, p<0.01,12M X2=19.9, 01). Significant between differences p<O. for frequency group were recorded the of using behaviour change processes self-liberation, counter conditioning & reinforcement (p<0.05) 6 (p<0.01), management dramatic & at months and all processes except relief 12 Experimental increased stimulus control at months. participants significantly their use the & of processes self-liberation, counter conditioning reinforcement management (p<O. 01) from baseline 6 to the months and processes self-liberation, counter & helping (p<0.01) from baseline conditioning, reinforcement management relationships to 12 The in frequency months. control group recorded no significant changes the of behaviour using any processes of exercise change. Analyses in illustrated increase in of change exercise testing variables an total exercise duration from baseline 6 (p<O. 01) in and peak gradient to months the experimental decrease from 6 12 (p>0.05). The to group, with no significant months control group decrease in from baseline 6 12 recorded a significant oxygen uptake to and months (p<0.05). Significant between differences for in the group were recorded change systolic blood HbAI, fibrinogen from baseline 6 (p<0.05) in to total pressure, and months and from baseline 12 (p=0.03 ). In both life to cholesterol months quality of questionnaires on the to most sub-scales experimental group recorded small moderate positive effect size from baseline 6 12 In to the scores and months. comparison control group recorded from baseline 6 12 A to to small moderate negative effect size scores and months. between difference from baseline 12 in the to the significant group of change months functioning SF-36 (p<O. 01). At 6 the physical score on was recorded months a greater improvement in health by the number of experimental participants reported an recorded Short form-36 (p=0.04). questionnaire improvements in in The the greater all physical activity outcomes experimental group, demonstrated intervention to that the compared controls, exercise consultation was more information for than effective standard exercise promoting and maintaining physical behaviour 12 in Type 2 diabetes. Participants change over months people with activity intervention improvements in receiving the exercise consultation also experienced factors. Exercise glycaemic control and a number of cardiovascular risk consultation be by training the requires minimal resources and with could conducted any member of 111 diabetes This base for team. the multidisciplinary research provides evidence an innovative diabetes to addition current management. Iv PUBLICATIONS FROM RESEARCH PAPERS 1. Kirk AF, Fisher BM, Mutrie N, Maclntyre PD. Promoting in physical activity people Type 2 diabetes. Journal with Diabetes Cardiovascular of and Disease 2002,2: 211 - 213. 2. Kirk AF, Mutrie N, Maclntyre PD Fisher BM. Increasing in physical activity people Type 2 diabetes. Diabetes Care with 2003; 26: 1186-1192 BOOKS 1. Kirk AF, Maclntyre PD. Physical Activity Exercise. In B. M. Fisher, and editors. Heart Disease Diabetes. Glasgow: Martin Dunitz Publishers, 2002. and POLICY DOCUMENTS/TRAINING RESOURCES 1. Kirk AF. 2000. Regional Guidelines for Care Elderly People Diabetes in the of with Nursing Homes. "Exercise for diabetes". prescription elderly people with 2. Kirk AF 2001. Physical for Greater Glasgow Health training the activity resource board. "Exercise Diabetes" "Exercise in and and weight management" 3. Mutrie N, Kirk AF 2001. Scottish Intercollegiate Guidelines Network (SIGN). Management Diabetes Lifestyle Edinburgh SIGN (SIGN of management. - 55) publication no. ABSTRACTS 1. Kirk AF, Higgins LA, Hughes AR, Fisher BM, Mutrie N, McLean J, Maclntyre PD. in The effectiveness of exercise consultation on promotion of physical activity a Type 2 diabetics: A Presented American College Sports group of pilot study. at of Medicine Annual Conference 2000 (Indianapolis, USA). Med Sci Sports & Exerc 2000; 32: P 177. 2. Kirk AF, Hughes AR, Fisher BM, Mutrie N, Hillis WS, Maclntyre PD. in Presented Diabetes UK Measurement of physical activity clinical populations. at Conference 2001 (Glasgow, UK) Diabe Med 2001; 18: P99. Annual Professional 3. Kirk AF, Higgins LA, Hughes AR, Fisher BM, Mutrie N, Maclntyre PD. Promotion in Type 2 diabetes. Presented 16th International at of physical activity people with Puijo Symposium 2001 (Kupio, Finland). V 4. Kirk AF, Hughes AR, Fisher BM, Mutrie N, Hillis WS, Maclntyre PD. Accuracy of CSA the accelerometer to in measure Presented physical activity clinical populations. 16`x' International at Puijo Symposium 2001 (Kupio, Finland). 5. Kirk AF, McKay M, Hughes AR, Fisher BM, Mutrie N, Hillis WS, Maclntyre PD. Physical behaviour low activity levels in and correlates of physical activity people Type 2 diabetes. Presented with The European Association for Study at the of Diabetes Annual Conference 2001 (Glasgow, UK) Diabetologia 2001; 44: P255. 6. Kirk AF, Hughes AR, Fisher BM, Mutrie N, Maclnytre PD. Exercise consultation improves behaviour in physical activity Type 2 diabetes. Presented people with at American College Sports Medicine Annual Conference 2002 (St Louis, USA). of Med Sci Sports & Exerc 2002; 34: P97. 7. Kirk AF, Hughes AR, Fisher BM, Mutrie N, Maclnytre PD. Exercise in consultation Type 2 diabetes: Physiological, biochemical life people with and quality of effects. Presented the Diabetes UK Annual Professional Conference 2002 (Birmingham, at UK) Diabe Med 2002; 19: P97. 8. Kirk AF, Mutrie N, Maclntyre PD, Fisher BM. Promoting in physical activity people Type 2 diabetes. Presented the Diabetes in Scotland Conference 2002 with at (Glasgow, UK). Published Diabetes in Scotland Available from the on website. http: //www. show. scot. nhs. uk 9. Kirk A, Fisher B. Mutrie N. Maclnytre P. Promoting and maintaining physical in Type 2 Presented Diabetes UK Annual Professional activity people with at Conference 2003 (Glasgow, UK) Diabe Med 2003; 20: 25-26. 10. Kirk A, Fisher B, Mutrie N, Maclnytre P. Promoting and maintaining physical behaviour in Type 2 diabetes in Scotland. Presented activity change people with at American College Sports Medicine Annual Conference 2003, (San Francisco, of USA) Med Sci Sports Exerc 2003; 35: P233. Awarded American Collge Sports Medicine International Student for this the of abstract presentation in 11. Kirk AF, Mutrie N. Maclntyre PD, Fisher BM. Promotig physical activity people biochemical Presented Type 2 diabetes: the physiological and effects. at with International Diabetes Federation Congress 2003, (Paris, France) Diabetologia 2003 (In Press). VI ACKNOWLEDGEMENTS A number important of people provided A big an to this contribution thankyou research. to: My 3 supervisors. Paul Maclntyre. The initiator indecisive in 2 an moment resulted - PhD Thank for students. the Nanette Mutrie. Thank for you pulling strings. you continued perfect supervision and encouragement. Miles Fisher. Thank for you introducing to the diabetes for me world of and your continued motivation, financial encouragement and support. To friend fellow PhD Adrienne Hughes. We my and student. the climbed peaks and troughs together had laugh. I don't I have and still a think to this would got stage without you. To Without have been the the them this thesis all participants of study. would not possible. To diabetes Royal Alexandra Hospital for the team the the training at all and education I to the this you gave me support running of research. am now an expert phlebotomist! To Chief Cardiac Scientific Officers (CCSO) the Royal Alexandra Hospital the at all in 230 tests. who assisted me conducting exercise To family (mum, dad Debbie). I to and promise move out soon. my To Paul Gartland. For changing my priorities. funded by diabetes funds the Royal This the cardiac and research at research was by TENOVUS Scotland (project 30967). Alexandra Hospital number and N-11 DECLARATION I declare I that composed the work submitted in this thesis that data and all were by collected and analysed myself Neither the thesis the nor original work contained has been therein submitted to this institution for higher degree. or any other a 'tom V........ Signed ^2sO.... Date ........ ..... . ... ............. ALISON F KIRK "The belongs United this thesis to the the terms the copyright of author, under of Kingdom by University Glasgow Due the copyright act, as qualified of regulations. be in, the acknowledgement must always made of use of any material contained or delivered from, this thesis" vi"