(31-01-13) Changing Physical Activity Behavior in Type 2 Diabetes: A systematic review and meta-analysis of behavioral interventions.

Avery L, Flynn D, van Wersch A, Sniehotta FF, Trenell MI.
Source
Corresponding author: Leah Avery, [email protected].
Abstract
OBJECTIVE Behavioral interventions targeting "free-living" physical activity
(PA) and exercise that produce long-term glycemic control in adults with type 2
diabetes are warranted. However, little is known about how clinical teams
should support adults with type 2 diabetes to achieve and sustain a physically
active lifestyle. RESEARCH DESIGN AND METHODS We conducted a systematic review
of randomized controlled trials (RCTs) (published up to January 2012) to
establish the effect of behavioral interventions (compared with usual care) on
free-living PA/exercise, HbA(1c), and BMI in adults with type 2 diabetes. Study
characteristics, methodological quality, practical strategies for increasing
PA/exercise (taxonomy of behavior change techniques), and treatment fidelity
strategies were captured using a data extraction form. RESULTS Seventeen RCTs
fulfilled the review criteria. Behavioural interventions showed statistically
significant increases in objective (standardized mean difference [SMD] 0.45,
95% CI 0.21-0.68) and self-reported PA/exercise (SMD 0.79, 95% CI 0.59-0.98)
including clinically significant improvements in HbA(1c) (weighted mean
difference [WMD] -0.32%, 95% CI -0.44% to -0.21%) and BMI (WMD -1.05 kg/m(2),
95% CI -1.31 to -0.80). Few studies provided details of treatment fidelity
strategies to monitor/improve provider training. Intervention features (e.g.,
specific behavior change techniques, interventions underpinned by behavior
change theories/models, and use of ??10 behaviour change techniques) moderated
effectiveness of behavioral interventions. CONCLUSIONS Behavioral interventions
increased free-living PA/exercise and produced clinically significant
improvements in long-term glucose control. Future studies should consider use
of theory and multiple behavior change techniques associated with clinically
significant improvements in HbA(1c), including structured training for care


SOURCE : Diabetes Care. 2012 Dec;35(12):2681-9. doi: 10.2337/dc11-2452.

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