Improving physical activity within diabetes care: Preliminary effects and feasibility of a national low-intensity group-based walking intervention among people with type 2 diabetes mellitus

Introduction

Despite the positive outcomes of physical activity (PA) interventions on health and PA behavior in people with type 2 diabetes mellitus (T2DM), it proves rather difficult to structurally implement such interventions in daily diabetes care. The National Diabetes Challenge (NDC) was designed as a low-intensity and low-cost annual walking intervention for people with T2DM, with the aim to overcome potential barriers in intervention delivery. The aim of the present study was to explore the feasibility and preliminary efficacy of this approach.

Methods

This feasibility study had a pre/posttest design. First, we assessed acceptability and feasibility by means of posttest process evaluations among participants and healthcare providers. Second, to examine preliminary efficacy we studied emotional well-being and patient activation among 822 participants with T2DM, and number of daily steps and somatic health outcomes in a subgroup of 189 participants with T2DM. These data were analyzed using paired-samples t-tests.

Results

The intervention was generally well-received by both the participants and healthcare providers, people reporting satisfaction and perceived benefits. The results show improved glycemic control in participants with above target baseline HbA1c, improved patient activation in participants with lower activation at baseline, and decrease of body weight and improved emotional well-being in all participants. Furthermore, the number of daily steps taken increased during the intervention.

Conclusions

This feasibility study did show acceptability and generally good feasibility with regard to implementation, and provides initial evidence for the effectiveness of a group-based walking intervention with weekly group supervision, with improved behavioral, somatic and psychological outcomes in people with T2DM. Our findings highlight the potential of a low-intensity group-based walking intervention in increasing PA behavior in people with T2DM, while also taking into account common barriers regarding structural implementation in diabetes care. The study provides support for a more rigorous testing of the NDC program.