Long-term Effects Of Interwalk-based Interval Walking On Physical Activity Levels Among Patients With Type 2 Diabetes

Background:Lifestyle modification such as physical activity(PA)and healthy nutrition is considered as a cornerstone in the prevention and management of type 2diabetes(T2D).However,the adaptation and long-term maintenance of PA is critical.Currently,smartphone-based lifestyle self-management programs are widely used in the management of T2D.Among these practices,the significant benefits of Interval Walking Exercise(IWE)have been well documented.However,the long-term effects of smartphone-based IWE(InterWalk APP)to improve the level/duration of PA among patients with T2D are unknown.Furthermore,it is unknown whether motivational support could enhance individual's behavioral change.Hypothesis and objective:We hypothesized that structured intervention of smartphone APP-delivered IWE will increase the T2D patients'daily moderate-to-vigorous PA(MVPA)after 12-week intervention and be manitained during 40-week follow-up(totally 52 weeks),compared to the standard care rehabilitation.To test our hypothesis,we conducted a randomized controlled trial aiming at increasing the MVPA(primary outcome)of patients with T2D.The study also attempt to assess individual motivation change for PA.Methods:This study is a parallel-group,open-labelled,randomised controlled trial with 12-week IWE intervention and 40-week's long-term follow-up including 213patients with T2D.Measures were performed at baseline,after 12-week,and after 52-week.The patients were allocated as an IWE intervention group(total n=140;n=71 or69 for with or without motivation support;repeated cycles of 3 min of fast and 3 min of slow walking at 70-85%and 40-55%of VO2max,respectively;30 min per day;four times per week)and a control group(n=73;Light PA of 45%VO2max with standard care).The changes of PA levels and sedentary behavior(SED)were objectively measured with the Axivity(AX3,Newcastle,UK).Individual's motivation for PA was measured with the Behavioural Regulation of Exercise Questionnaire(BREQ-2).The patient's HRQoL was measured by the Short-Form Health Survey(SF-12).All analyses were conducted according to the Intention-To-Treat(ITT)principle,perfomed by descriptive statistics and repeated-measures linear mixed effects models using R program(RStudio).Results:213 patients with T2D(age 59.58±10.54 years,BMI 34.02±5.77 kg/m~2,duration of diagnosed for T2D 5.54±6.52 years)were included in this study.The PA intersity in IWE group was significantly higher than control group due to the IWE intervention.After 12-week intervention,there were significant improvements of the daily duration of MVPA in both IWE and control groups(p=0.01).However,the IWE group(23.4±25.2 min)had shorter duration of MVPA than the control group(30.1±27.3 min).Dispite of short MVPA duration,the IWE group significantly improved their behavior change for PA(+2.19,95%CI 0.72,3.43,p=0.02),which resulted in health benefits such as SED(-5.8 min,95%CI-22.9,11.3,p=0.57),waist circumference(-2.69cm,95%CI-3.62,-1.76,p=0.10),weight(-1.19 kg,95%CI-3.30,0.93,p=0.36),BMI(-0.38 kg/m~2,95%CI-1.21,0.44,p=0.81),physical health composite scores(PCS,(+4.10,95%CI 2.63,5.56,p=0.01),and mental health composite scores(MCS,+2.55,95%CI0.59,4.52,p=0.31).During the 40-week follow up after intervention,the daily duration of MVPA was maintained in both IWE(21.2±31.3 min;30.8±33.8 min)and control(29.0±46.2 min,p<0.001)groups.Meanwhile,in the IWE group,the motivation for PA behavior change was maintained(+2.52,95%CI 1.17,3.86,p=0.04)and resulted in health benefits,including SED(+2.9 min,95%CI-13.6,19.3,p=0.61),PCS(+4.27,95%CI2.64,5.90,p=0.04),MCS(+1.70,95%CI-0.15,3.56,p<0.001),waist circumference(-3.11 cm,p=0.02),weight(-1.54 kg,p=0.76),and BMI(-0.59 kg/m~2,p=0.08).Conclusion:The InterWalk-based IWE intervention helped patients with T2D to establish their healthy behavior due to motivation of behavior change related to physical activity.The long-term health benefits for the patients of T2D by using InterWalk-based IWE mainly derived from high intensity physical activity compared to standard care.This study emphasized the importance of intensity of physical activity.In the clinical practice of T2D management,more systematic encouragement for patients to maintain their long-term,short duration,and high intensity interval exercise is needed.