Kirk, Alison Fiona (2003) Promoting and maintaining physical activity in people with type 2 ...

202 Pages·2010·18.1 MB·English

Kirk, Alison Fiona (2003) Promoting and maintaining physical activity in
people with type 2 diabetes. PhD thesis.

http://theses.gla.ac.uk/1994/

Copyright and moral rights for this thesis are retained by the author

A copy can be downloaded for personal non-commercial research or
study, without prior permission or charge

This thesis cannot be reproduced or quoted extensively from without first
obtaining permission in writing from the Author

The content must not be changed in any way or sold commercially in any
format or medium without the formal permission of the Author

When referring to this work, full bibliographic details including the
author, title, awarding institution and date of the thesis must be given

Glasgow Theses Service
http://theses.gla.ac.uk/
[email protected]
PROMOTING AND MAINTAINING PHYSICAL ACTIVITY IN
PEOPLE WITH TYPE 2 DIABETES
by
Alison Fiona Kirk (BSc)
A Doctoral Thesis
Submitted in fulfilment for degree
the the
partial of requirements of
Doctor Philosophy
of
University Glasgow
of
Department Medicine Therapeutics
of and
2003
ABSTRACT
The benefits
frequent
for
of regular, physical activity and exercise the management of
Type 2 diabetes
documented.
Current American College Sports Medicine
are well
of
(ACSM)
for
guidelines physical activity recommend that people should aim to
least
accumulate 30 intensity 5 days
at minutes of moderate physical activity a week or
20 60
to high intensity 3 5 days
continuous minutes of moderate to exercise, to a week.
Around 80
Type 2 diabetes do To
percent of people with not achieve these guidelines.
date,
research that addresses the promotion of physical activity in people with Type 2
diabetes has been limited.
The
the
successful results of a pilot study evaluating
in Type 2
effectiveness of exercise consultation to promote physical activity people with
diabetes
5 led development PhD. This builds
over weeks to the of this thesis on the
foundations
intervention 12
the the this
of pilot study and evaluates effectiveness of over
in Type 2 diabetes.
months people with
Accurate habitual is key importance
to this to
assessment of physical activity of research
Accelerometers
the true the
examine effect of exercise consultation on physical activity.
have become for Studies
a popular objective method physical activity measurement.
investigating have been
the to
validity of accelerometers restricted children and young
Prior PhD further investigate
to the to
adults. main research a pilot study was conducted
Computer Science Applications (CSA)
the the to
accuracy of and uniaxial accelerometer
in Type 2 diabetes. 13 Type 2 diabetes
measure physical activity people with people with
(8M 5F, 54.2±6.5yrs, BMI 33.4±4.1) Participants
mean age were recruited. walked at a
brisk daily living (e.
slow, normal and pace and performed other activities g. stair
hoovering, loaded bags loaded
climbing, carrying shopping and pushing a shopping
During
trolley at the normal walking pace). each activity steady state oxygen uptake
breath by breath (Cosmed K4b2)
(Vo2ml/kg/min)
was measured using a portable system
CSA
the
and activity counts/min were recorded using accelerometers worn at waist,
ankle and wrist.
demonstrated
The this
results of study oxygen uptake and activity counts at all
increase increased (p<0.05).
placements significantly as walking speed
accelerometer
bags loaded
for
Oxygen the the trolley
carrying and pushing shopping were
uptake
higher (p<O. 01). Compared
than to
normal walking normal
and significantly
similar,
bags higher
the
activity counts when carrying were significantly and activity
walking,
counts when pushing the cart were significantly lower (p<0.05). Results
were similar at
Ankle
all accelerometer higher
placements. counts were consistently than
wrist and waist
for
counts all activities except vacuuming when wrist counts were highest. No significant
differences
found between
for
were wrist and waist counts all activities except
It from
in
vacuuming. was concluded the results of this study that changes oxygen
during daily living
by in
uptake
activities are not always reflected changes activity counts.
To in Type 2 diabetes
accurately assess physical activity people with several methods
be
should used.
The
the to the
primary aim of main study was evaluate effectiveness of exercise
for
12 in
consultation promoting and maintaining physical activity over months people
Type 2 diabetes. Secondary investigate from baseline
to 6
with aims were changes to and
12 in biochemical life
70
months a number of physiological, and quality of variables.
inactive Type 2 diabetes (35M 35F, 57.6±7.9yrs, BMI 34.6±6.8)
people with mean age
information
to
were given standard exercise and randomised receive an exercise
intervention (experimental (control
consultation group n=35) or not group n=35).
Exercise based
the transtheoretical theory
consultation, on model, combines motivational
behavioural into individualised intervention
to
and cognitive strategies an promote and
Exercise delivered baseline 6
maintain physical activity. consultations were at and months
1 3
and support phone calls were given and months after each exercise consultation.
Changes from baseline 6 12 in (7-day
to
and months were assessed a) physical activity
behaviour
recall) accelerometer, stage and processes of exercise change and
fitness), b) (body index blood
cardiorespiratory physiological mass and pressure), c)
biochemical (glycaemic lipid fibrinogen d)
control, profile, and microalbuminuria) and
life (Short form-36 Well-being
quality of and questionnaire).
illustrated between differences in
Results
recorded group minutes of moderate activity
6 12 (p<O. 01). The
and total accelerometer counts per week at and months experimental
from
increased
total
group minutes of moderate activity and accelerometer counts
baseline 6 (P<0.01), decrease from 6 to 12
to months with no significant months
(P>0.05). From baseline 12 increase in the
to
months a significant was recorded
for (p<O. 01), but
total
experimental group minutes of moderate activity not
decrease in
(p=0.7). The
accelerometer counts per week control group recorded a
from baseline 12 (p=0.03).
to
months
accelerometer counts per week
At 6 12 to
controls,
and months significantly more experimental participants, compared
11
ACSM
(6M
were meeting physical activity guidelines
x2=22.0, p<0.01,12M X2=15.2.
P<0.01)
being in
and a greater proportion reported (action
an active stage or
behaviour
(6M
maintenance) of exercise
change X2=26.4, p<0.01,12M
X2=19.9,
01). Significant between
differences
p<O. for frequency
group were recorded the
of using
behaviour
change processes self-liberation, counter conditioning &
reinforcement
(p<0.05)
6 (p<0.01),
management dramatic &
at months and all processes
except relief
12 Experimental
increased
stimulus control at months. participants significantly their
use
the &
of processes self-liberation, counter conditioning reinforcement management
(p<O. 01) from baseline
6
to the
months and processes self-liberation, counter
& helping (p<0.01) from baseline
conditioning, reinforcement management relationships
to 12 The in frequency
months. control group recorded no significant changes the of
behaviour
using any processes of exercise change.
Analyses in illustrated increase in
of change exercise testing variables an total exercise
duration from baseline 6 (p<O. 01) in
and peak gradient to months the experimental
decrease from 6 12 (p>0.05). The
to
group, with no significant months control group
decrease in from baseline 6 12
recorded a significant oxygen uptake to and months
(p<0.05). Significant between differences for in
the
group were recorded change systolic
blood HbAI, fibrinogen from baseline 6 (p<0.05) in
to total
pressure, and months and
from baseline 12 (p=0.03 ). In both life
to
cholesterol months quality of questionnaires on
the to
most sub-scales experimental group recorded small moderate positive effect size
from baseline 6 12 In
to the
scores and months. comparison control group recorded
from baseline 6 12 A
to to
small moderate negative effect size scores and months.
between difference from baseline 12 in
the to the
significant group of change months
functioning SF-36 (p<O. 01). At 6
the
physical score on was recorded months a greater
improvement in health by
the
number of experimental participants reported an recorded
Short form-36 (p=0.04).
questionnaire
improvements in in
The the
greater all physical activity outcomes experimental group,
demonstrated intervention
to that the
compared controls, exercise consultation was more
information for
than
effective standard exercise promoting and maintaining physical
behaviour 12 in Type 2 diabetes. Participants
change over months people with
activity
intervention improvements in
receiving the exercise consultation also experienced
factors. Exercise
glycaemic control and a number of cardiovascular risk consultation
be by
training the
requires minimal resources and with could conducted any member of
111
diabetes This base for
team. the
multidisciplinary research provides evidence an
innovative diabetes
to
addition current management.
Iv
PUBLICATIONS
FROM RESEARCH
PAPERS
1. Kirk AF, Fisher BM, Mutrie N, Maclntyre PD. Promoting
in
physical activity people
Type 2 diabetes.
Journal
with Diabetes Cardiovascular
of and Disease 2002,2: 211
-
213.
2. Kirk AF, Mutrie N, Maclntyre PD Fisher BM. Increasing in
physical activity people
Type 2 diabetes. Diabetes Care
with 2003; 26: 1186-1192
BOOKS
1. Kirk AF, Maclntyre PD. Physical Activity Exercise. In B. M. Fisher,
and
editors.
Heart Disease Diabetes. Glasgow: Martin Dunitz Publishers, 2002.
and
POLICY DOCUMENTS/TRAINING
RESOURCES
1. Kirk AF. 2000. Regional Guidelines for Care Elderly People Diabetes in
the
of with
Nursing Homes. "Exercise for diabetes".
prescription elderly people with
2. Kirk AF 2001. Physical for Greater Glasgow Health
training the
activity resource
board. "Exercise Diabetes" "Exercise in
and and weight management"
3. Mutrie N, Kirk AF 2001. Scottish Intercollegiate Guidelines Network (SIGN).
Management Diabetes Lifestyle Edinburgh SIGN (SIGN
of management.
-
55)
publication no.
ABSTRACTS
1. Kirk AF, Higgins LA, Hughes AR, Fisher BM, Mutrie N, McLean J, Maclntyre PD.
in
The
effectiveness of exercise consultation on promotion of physical activity a
Type 2 diabetics: A Presented American College Sports
group of pilot study. at of
Medicine Annual Conference 2000 (Indianapolis, USA). Med Sci Sports & Exerc
2000; 32: P 177.
2. Kirk AF, Hughes AR, Fisher BM, Mutrie N, Hillis WS, Maclntyre PD.
in Presented Diabetes UK
Measurement
of physical activity clinical populations. at
Conference 2001 (Glasgow, UK) Diabe Med 2001; 18: P99.
Annual Professional
3. Kirk AF, Higgins LA, Hughes AR, Fisher BM, Mutrie N, Maclntyre PD. Promotion
in Type 2 diabetes. Presented 16th International
at
of physical activity people with
Puijo Symposium 2001 (Kupio, Finland).
V
4. Kirk AF, Hughes AR, Fisher BM, Mutrie N, Hillis WS, Maclntyre PD. Accuracy
of
CSA
the
accelerometer to in
measure Presented
physical activity clinical populations.
16`x' International
at Puijo Symposium 2001 (Kupio, Finland).
5. Kirk AF, McKay M, Hughes AR, Fisher BM, Mutrie N, Hillis WS, Maclntyre PD.
Physical
behaviour
low
activity levels in
and correlates of physical activity
people
Type 2 diabetes.
Presented
with The European Association for Study
at the
of
Diabetes Annual Conference
2001 (Glasgow, UK) Diabetologia
2001; 44: P255.
6. Kirk AF, Hughes AR, Fisher BM, Mutrie N, Maclnytre PD. Exercise
consultation
improves
behaviour in
physical activity Type 2 diabetes. Presented
people with
at
American College Sports Medicine Annual Conference 2002 (St Louis, USA).
of
Med Sci Sports & Exerc 2002; 34: P97.
7. Kirk AF, Hughes AR, Fisher BM, Mutrie N, Maclnytre PD. Exercise in
consultation
Type 2 diabetes: Physiological, biochemical life
people with
and quality of effects.
Presented the Diabetes UK Annual Professional Conference 2002 (Birmingham,
at
UK) Diabe Med 2002; 19: P97.
8. Kirk AF, Mutrie N, Maclntyre PD, Fisher BM. Promoting in
physical activity people
Type 2 diabetes. Presented the Diabetes in Scotland Conference 2002
with at
(Glasgow, UK). Published Diabetes in Scotland Available from
the
on website.
http: //www.
show. scot. nhs. uk
9. Kirk A, Fisher B. Mutrie N. Maclnytre P. Promoting
and maintaining physical
in Type 2 Presented Diabetes UK Annual Professional
activity people with at
Conference 2003 (Glasgow, UK) Diabe Med 2003; 20: 25-26.
10. Kirk A, Fisher B, Mutrie N, Maclnytre P. Promoting
and maintaining physical
behaviour in Type 2 diabetes in Scotland. Presented
activity change people with at
American College Sports Medicine Annual Conference 2003, (San Francisco,
of
USA) Med Sci Sports Exerc 2003; 35: P233.
Awarded American Collge Sports Medicine International Student for this
the
of
abstract presentation
in
11. Kirk AF, Mutrie N. Maclntyre PD, Fisher BM. Promotig
physical activity people
biochemical Presented
Type 2 diabetes: the
physiological and effects. at
with
International Diabetes Federation Congress 2003, (Paris, France) Diabetologia 2003
(In Press).
VI
ACKNOWLEDGEMENTS
A
number important
of people provided A big
an to this
contribution thankyou
research.
to:
My 3
supervisors. Paul Maclntyre. The initiator indecisive
in 2
an moment resulted
-
PhD
Thank for
students. the Nanette Mutrie. Thank for
you pulling strings.
you
continued perfect supervision and encouragement. Miles Fisher. Thank for
you
introducing
to the diabetes for
me world of and your continued motivation,
financial
encouragement
and support.
To friend fellow
PhD Adrienne Hughes. We
my and student. the
climbed peaks and
troughs together had laugh. I don't I have
and still a think to this
would got stage
without you.
To Without have been
the the them this thesis
all participants of study. would not
possible.
To diabetes Royal Alexandra Hospital for
the team the the training
at all and education
I
to the this
you gave me support running of research. am now an expert phlebotomist!
To Chief Cardiac Scientific Officers (CCSO) the Royal Alexandra Hospital
the
at
all
in 230
tests.
who assisted me conducting exercise
To family (mum, dad Debbie). I to
and promise move out soon.
my
To Paul Gartland. For
changing my priorities.
funded by diabetes funds the Royal
This the cardiac and research at
research was
by TENOVUS Scotland (project 30967).
Alexandra Hospital
number
and
N-11
DECLARATION
I declare
I
that
composed the work submitted in this thesis that data
and all were
by
collected and analysed myself Neither the thesis the
nor original work contained
has been
therein
submitted to this institution for higher degree.
or any other
a
'tom
V........
Signed
^2sO.... Date
........ ..... .
... .............
ALISON F KIRK
"The belongs United
this thesis to the the terms the
copyright of author, under of
Kingdom by University Glasgow Due
the
copyright act, as qualified of regulations.
be in,
the
acknowledgement must always made of use of any material contained or
delivered from,
this thesis"
vi"