Physical activity for patients

Background: People with diabetes are at high risk for macrovascular and microvascular complications. However, the impact of physical inactivity on this pressing global health problem is unknown. Methods: We analyzed data from 238,323 middle-aged and older adults from 11 population-based cohort studies. Physical inactivity was defined as not reaching the recommended physical activity (PA) level (i.e., 150 minutes of moderate-to-vigorous PA per week). Diabetes-related complications included macrovascular (i.e., cardiovascular diseases, stroke, coronary heart disease (CHD), heart failure) and microvascular (i.e., retinopathy) complications. We calculated the risk of developing these complications in people with diabetes associated with physical inactivity in longitudinal cohorts. Then, the population attributable fraction (PAF) of physical inactivity for each complication was calculated using the relative risks from a previous meta-analysis and the latest prevalence of physical inactivity in countries and territories worldwide. Results: We estimated that one in ten cases of diabetes-related macro and microvascular complications is attributable to physical inactivity worldwide. The highest PAF was observed for stroke (11%), retinopathy (10%), and cardiovascular diseases (8.9%). Latin America and the Caribbean and the Eastern Mediterranean showed the largest PAF to physical inactivity for macrovascular and microvascular complications. Kuwait showed the highest PAF (25.8% for stroke) whereas the lowest was observed in Uganda (1.5% for CHD). Conclusions: The burden of physical inactivity in people with diabetes is elevated worldwide. Promoting PA in this population may reduce the impact of diabetes-related complications on patients’ health. Practical implications: Our findings underscore the urgent need for targeted strategies to promote physical activity among individuals with diabetes. Healthcare providers and policymakers should prioritize the integration of regular physical activity promotion programs into diabetes management protocols. Finally, we highlighted the importance of tailoring intervention efforts to address region-specific challenges. Funding: None.

Background: Existing evidence suggests that physical activity (PA) improves the quality of life in patients with inflammatory bowel disease (IBD).

Purpose: We aimed to i) assess levels of PA, ii) identify factors associated with levels of PA, and iii) assess the impact of PA on
physical and mental health in patients with IBD compared to the background non-IBD population.

Methods: Information on PA was collected in the Danish Capital Region Health Surveys from 2007 to 2021. We used data from 207,959 participants, of whom 2341 were diagnosed with IBD. Sociodemographic information was obtained from nationwide registers. Self-rated physical and mental health was measured with SF-12. Data were analysed by multiple regression analyses weighted for survey design.

Results: The proportion that adopted the recommended level of PA was lower among participants with IBD (82%) than the background population (86%), corresponding to an adjusted OR of 0.83 (95% CI 0.82-0.85). Lower proportions of physically active were seen in participants living alone, having children, smokers and having an unhealthy diet. Among participants with IBD, women were more physically active than men; the opposite was observed in the background population. Among participants with IBD, sedentary behaviour was associated with a lower mean self-rated physical health (p<0.001). The highest mental quality of life score was among participants with moderate PA compared to high or low PA (p<0.001).

Conclusion: In this population-based cohort, we found that participants with IBD have lower levels of PA and more sedentary behaviour compared to non-IBD individuals. Moderate PA is associated with the highest mental quality of life score in individuals with IBD.

Practical implications: These results can guide clinicians when IBD patients ask for advice on PA and be used in the development of an evidence-based intervention for the promotion of PA in patients with IBD.

Funding: Health Insurance Denmark

Background: Twenty-five percent of the population worldwide will experience a severe mental illness (SMI) during their lifetime. Replacing daily sedentary behaviour (SB) with physical activity (PA) can be fundamental to promote the well-being, mental health, and quality of life of adults with SMI. However, effective interventions aiming to reduce SB in adults with SMI are scarce. Purpose: To assess the impact of a “sit less, move more” intervention on the depression symptoms, SB, and PA of adults with SMI as part of their rehabilitation. Methods: Randomized Clinical Trial. Adults with SMI (39.8 years) were allocated to a control (n=29; 74,2% males, usual care) or intervention group (n=31; 48.3% males; Sit less, Move more). The intervention (n=16 weeks) organized “groups of friends” to meet up for regular city walks combined with social activities and individual home-based exercises. The Hamilton Depression Rating Scale (HAM-D) assessed depressive symptoms. ActivPALs™ assessed daily total sitting time, sitting time spent on bouts of different lengths, total time spent in light and moderate-to vigorous PA (MVPA). Mann-Whitney U Tests assessed group differences between baseline and at 3-months follow-up. Results: 29 adults with SMI (93%) completed the intervention (75% adherence to the “sit less, move more” activities). Compared to the control group, scores for depressive symptoms were reduced from 13 to 6.5 (p = 0.003) from baseline to follow up, while time spent in MVPA (+11.3 min/day; 95% CI 3.7 – 18.9; size effect 0.64) and sedentary time spent in short bouts (<20') were significantly increased (+40.9 min/day; 95% CI 19.5 – 72.3; effect size 0.78). Conclusions: Reducing SB throughout the day can reduce the severity of depressive symptoms of adults with SMI. Practical implications: Mental Health Care Centres would benefit from adding “sit less, move more” interventions in their rehabilitation services. Funding: AGAUR 2015 DI 024.

Background: Strategies for increasing opportunities for exercise engagement among female cancer survivors are needed. Community-based exercise programs have been shown to improve psychosocial wellbeing and health-related quality of life. However, few opportunities are designed with dissemination in mind and do not partner with community organizations. This research is a community-academic partnership between 2Unstoppable (2U), a nonprofit organization that promotes wellness among women diagnosed with cancer, and the University of Michigan. 2U Strong is a 10-week, remote delivered, and group-based exercise program developed for female cancer survivors. The program was supervised by a coach with a certification in cancer and exercise. The primary aim was to assess the feasibility (acceptance rate of ≥ 65%) and acceptability (satisfaction at Mscore is ≥ 4 out of 5) of 2U Strong. The secondary aim was to evaluate the preliminary efficacy of 2U Strong on perceived social support, self-reported physical activity, and health-related quality of life. Methods: Female cancer survivors (N=44; Mage=53.9 years, SD=8.5; 81.4% White and 14.0% Black; 58.1% married, 88.4% diagnosed with breast cancer; 37.2% Stage IV or metastatic cancer) enrolled in 2U Strong and consented to completing questionnaires at baseline (~1-2 weeks prior to 2U Strong) and post-program. Analyses included descriptive statistics and repeated measures ANOVA. Results: A total of 5 exercise groups completed the 2U Strong program from 2022 to 2023. Out of 63 total program participants, 44 enrolled in the research (70.0% acceptance rate). Research participants were very satisfied with 2U Strong (Mscore=4.7 out of 5, SD=0.6). Only perceived social support significant increased from baseline to post-program (F(2,35)=13.4, Mdifference=+1.5, p<.001). Conclusion: 2U Strong was rated as feasible and acceptable and had a positive effect on perceived social support among female cancer survivors. Practical Implications: 2U Strong may promote broader dissemination into difficult-to-reach communities including rural areas. Funding: Rutgers Mission Support.

Context : Practicing physical activity helps combat the effects of the disease and treatments (Wurz et al., 2021). To continue the action in Adapted Physical Activity (APA) initiated at the Bordeaux University Hospital, the Parentraide Cancer Association, the GE APA Santé Nutrition and the pediatric oncology department have designed an APA project at home, for elderly children and adolescents from 3 to 18 years old affected by cancer, with the aim of getting deconditioned patients following cancer back into movement and physical and psychological condition and enabling them to integrate regular physical activity. Components of program or policy delivery: At the end of intensive treatments, the APA Teacher (APAT) of the pediatric oncology department offers this support to patients and their parents. After their agreement, the link is made with the GE APA Santé Nutrition so that an APAT from this association can start APA support at home with the child. Each patient benefited from 13 individual APA sessions at home. Fun activities and games were offered as well as balance exercises, muscle strengthening, coordination exercises, flexibility, skill and endurance exercises. Assessment: The initial assessment of quality of life was carried out by the Child Health Questionnaire (CHQ-CF87). Since 2017, 131 children have been referred by the CHU, 105 of whom were supported (80%). 63% of the children completed the 13 sessions. The project is proposed all over the New Aquitaine. Conclusions: Families expressed great satisfaction with this support. They integrated physical activity into their daily lives, the patients regained confidence. Practical implications: This program could be reproduced in other hospital services and supports the relevance and place of EAPA in the support of children in pediatric oncology, whether during hospitalization or afterwards. Funding: The project is financed thanks to donations collected by the association each year.

Background: Lifestyle programs enhance type 2 diabetes (T2D) management; however, short-term barriers and enablers to maintaining changes are unclear. Purpose: To explore barriers and enablers to maintaining lifestyle changes in adults with T2D who had completed an 8-week lifestyle program, then to map them to the Capability, Opportunity, Motivation – Behaviour (COM-B) model. Methods: Focus groups were conducted with participants (n=28) at the end-of-program (n=8 groups) and one-month after (n=6 groups) to explore anticipated and experienced barriers and enablers, respectively. Following thematic inductive coding, themes were deductively grouped according to COM-B. Results: Nine barriers emerged (two anticipated only, one experienced only, six both). Key barriers related to capability (physical health), opportunity (difficulty accessing/using resources; unwillingness to invest in social networks) and motivation (lack of internal drive). Eleven enablers emerged: all across both times. Key enablers related to capability (knowledge), opportunity (access and use of program resources; sense of belonging/safety in the program) and motivation (beliefs/awareness around perceived risk; monitoring of progress; committed to change). Conclusions: Anticipated and experienced barriers and enablers were mostly aligned, and spanned aspects related to capability, opportunity and motivation. Practical Implications : Findings suggest T2D management programs should enable ongoing access to resources to build on positive habits and sense of belonging. Investing in mechanisms to scaffold participants into suitable community-based activities may also be beneficial. Funding: GNH is funded by Australian MRFF Emerging Leadership Fellowship. SRG is partly funded by the HWCRI, which is co-funded by UQ and Health and Wellbeing Queensland.

Abstract Background: Individuals living with chronic diseases like type 2 diabetes may find it challenging to engage in physical activity when the weather is unfavorable. However, research on how the season affects their physical activity levels is lacking. Aim: This study examines the influence of season and months of the year on self-monitored step counts in individuals with prediabetes and type 2 diabetes. Methods: This study is a secondary analysis of Sophia Step Study. In eight rounds, participants were recruited through primary care centers. The study measured physical activity using step counters (Yamax Digiwalker), and the participants wore step counters and reported daily steps on a website. Daily step patterns were examined seasonally (summer, fall, winter, and spring) and monthly. Two linear mixed models analyzed the association between independent variables (seasons and months) and dependent variables (steps). The model was adjusted for sex, age, and body mass index, and a random intercept by subject was employed. Result: The step counts were significantly higher during summer (7824, 95% CI [7762, 7889]) and spring (7805, 95% CI [7757, 7852]) when compared to winter (7097, 95% CI [7052, 7145]) and fall (7422, 95% CI [7349, 7490]). The analysis also indicated that the highest number of step counts was registered in May (7992, 95% CI [7904, 8070]), followed by June (7967, 95% CI [7895,8062]). The lowest step counts were registered in January (6943, 95% CI 68855, 7033) and November with step counts of (7208, 95% CI [7112,7289]). Conclusion: This study revealed a noticeable variation in self-reported daily steps self-monitored by people with prediabetes and type 2 diabetes over two years, along with seasonal and monthly weather patterns. The study also indicated that specific weather conditions during certain months, such as May, June, and July, may be more favorable for physical activity.