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Fitness consultations in routine care of patients with type 2 diabetes in general practice: an 18-month non-randomised intervention study.

Lohmann H, Siersma V, Olivarius NF - BMC Fam Pract (2010)

Bottom Line: The results were used in a subsequent motivational interview conducted by one of the GPs.In this 18-month study, participants who had repeated fitness consultations, including physical testing and motivational interviewing to improve physical activity, improved VO2max, muscle strength, and lipid profile.Our results indicate that physical testing combined with motivational interviewing is feasible in a primary health care setting.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Lohmann@dadlnet.dk

ABSTRACT

Background: Increasing physical activity is a cornerstone in the treatment of type 2 diabetes and in general practice it is a challenge to achieve long-term adherence to this life style change. The aim of this study was to investigate in a non-randomised design whether the introduction of motivational interviewing combined with fitness tests in the type 2 diabetes care programme was followed by a change in cardio-respiratory fitness expressed by VO2max, muscle strength of upper and lower extremities, haemoglobin A1c (HbA1c) and HDL-cholesterol.

Methods: Uncontrolled 18-month intervention study with follow-up and effect assessment every 3 months in a primary care unit in Denmark with six general practitioners (GPs). Of 354 eligible patients with type 2 diabetes, 127 (35.9%) were included. Maximum work capacity was tested on a cycle ergometer and converted to VO2max. Muscle strength was measured with an arm curl test and a chair stand test. The results were used in a subsequent motivational interview conducted by one of the GPs. Patients were encouraged to engage in lifestyle exercise and simple home-based self-managed exercise programmes. Data were analysed with mixed models.

Results: At end of study, 102 (80.3%) participants remained in the intervention. Over 18 months, VO2max increased 2.5% (p = 0.032) while increases of 33.2% (p < 0.001) and 34.1% (p < 0.001) were registered for the arm curl test and chair stand test, respectively. HDL-cholesterol increased 8.6% (p < 0.001), but HbA1c remained unchanged (p = 0.57) on a low level (6.8%). Patients without cardiovascular disease or pain from function limitation increased their VO2max by 5.2% (p < 0.0001) and 7.9% (p = 0.0008), respectively.

Conclusions: In this 18-month study, participants who had repeated fitness consultations, including physical testing and motivational interviewing to improve physical activity, improved VO2max, muscle strength, and lipid profile. Our results indicate that physical testing combined with motivational interviewing is feasible in a primary health care setting. Here, a fitness consultation tailored to the individual patient, his/her comorbidities and conditions in the local area can be incorporated into the diabetes programme to improve patients' muscle strength and cardio-respiratory fitness.

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Related in: MedlinePlus

Changes over 18 months in arm curl test (A), chair stand test (B), and VO2max (C).
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Figure 2: Changes over 18 months in arm curl test (A), chair stand test (B), and VO2max (C).

Mentions: Differences between study subjects and excluded patients were investigated by χ2 tests or Kruskal-Wallis tests. The development of each outcome variable was described in a mixed model with a separate fixed effect for each examination, and a random patient intercept [29]. The concatenation of fixed effects was interpreted as the average development of the outcome, and was superimposed on the cross-sectional distributions of the outcome (shown as box-plots) in Figure 2. Whether the outcome remains the same over time was tested by a Wald test for the hypothesis that all parameters of the fixed effects were the same. A heuristic measure of increase was Δ: the difference between the modelled baseline outcome and the modelled outcome at the seventh examination. A power calculation shows that the study has a power of 80% to detect a difference in change in VO2max from 0 (no change) to 1.3 ml O2 kg-1 min-1 during 18 months when n = 127.


Fitness consultations in routine care of patients with type 2 diabetes in general practice: an 18-month non-randomised intervention study.

Lohmann H, Siersma V, Olivarius NF - BMC Fam Pract (2010)

Changes over 18 months in arm curl test (A), chair stand test (B), and VO2max (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2984455&req=5

Figure 2: Changes over 18 months in arm curl test (A), chair stand test (B), and VO2max (C).
Mentions: Differences between study subjects and excluded patients were investigated by χ2 tests or Kruskal-Wallis tests. The development of each outcome variable was described in a mixed model with a separate fixed effect for each examination, and a random patient intercept [29]. The concatenation of fixed effects was interpreted as the average development of the outcome, and was superimposed on the cross-sectional distributions of the outcome (shown as box-plots) in Figure 2. Whether the outcome remains the same over time was tested by a Wald test for the hypothesis that all parameters of the fixed effects were the same. A heuristic measure of increase was Δ: the difference between the modelled baseline outcome and the modelled outcome at the seventh examination. A power calculation shows that the study has a power of 80% to detect a difference in change in VO2max from 0 (no change) to 1.3 ml O2 kg-1 min-1 during 18 months when n = 127.

Bottom Line: The results were used in a subsequent motivational interview conducted by one of the GPs.In this 18-month study, participants who had repeated fitness consultations, including physical testing and motivational interviewing to improve physical activity, improved VO2max, muscle strength, and lipid profile.Our results indicate that physical testing combined with motivational interviewing is feasible in a primary health care setting.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Lohmann@dadlnet.dk

ABSTRACT

Background: Increasing physical activity is a cornerstone in the treatment of type 2 diabetes and in general practice it is a challenge to achieve long-term adherence to this life style change. The aim of this study was to investigate in a non-randomised design whether the introduction of motivational interviewing combined with fitness tests in the type 2 diabetes care programme was followed by a change in cardio-respiratory fitness expressed by VO2max, muscle strength of upper and lower extremities, haemoglobin A1c (HbA1c) and HDL-cholesterol.

Methods: Uncontrolled 18-month intervention study with follow-up and effect assessment every 3 months in a primary care unit in Denmark with six general practitioners (GPs). Of 354 eligible patients with type 2 diabetes, 127 (35.9%) were included. Maximum work capacity was tested on a cycle ergometer and converted to VO2max. Muscle strength was measured with an arm curl test and a chair stand test. The results were used in a subsequent motivational interview conducted by one of the GPs. Patients were encouraged to engage in lifestyle exercise and simple home-based self-managed exercise programmes. Data were analysed with mixed models.

Results: At end of study, 102 (80.3%) participants remained in the intervention. Over 18 months, VO2max increased 2.5% (p = 0.032) while increases of 33.2% (p < 0.001) and 34.1% (p < 0.001) were registered for the arm curl test and chair stand test, respectively. HDL-cholesterol increased 8.6% (p < 0.001), but HbA1c remained unchanged (p = 0.57) on a low level (6.8%). Patients without cardiovascular disease or pain from function limitation increased their VO2max by 5.2% (p < 0.0001) and 7.9% (p = 0.0008), respectively.

Conclusions: In this 18-month study, participants who had repeated fitness consultations, including physical testing and motivational interviewing to improve physical activity, improved VO2max, muscle strength, and lipid profile. Our results indicate that physical testing combined with motivational interviewing is feasible in a primary health care setting. Here, a fitness consultation tailored to the individual patient, his/her comorbidities and conditions in the local area can be incorporated into the diabetes programme to improve patients' muscle strength and cardio-respiratory fitness.

Show MeSH
Related in: MedlinePlus