Objective This study examined the impact of a multicomponent intervention to increase physical activity (PA) in adults with type 2 diabetes (T2D) in Oman. Research design and methods This is a cluster randomized controlled trial in eight primary health centers. Participants were physically inactive, aged ≥18 years, and with no contraindication to PA. Patients attending intervention health centers (n=4) received the ‘MOVEdiabetes’ intervention, which consisted of personalized, individual face-to-face consultations by dietitians. Pedometers and monthly telephone WhatsApp messages were also used. Patients attending comparison health centers received usual care. The primary outcome was change in PA [Metabolic Equivalent(MET).min/week] after 12 months assessed by the Global Physical Activity Questionnaire. The secondary outcomes were changes in daily step counts, sitting time, weight, body mass index, glycated hemoglobin, blood pressure and lipids. Results Of the 232 participants (59.1% female, mean (SD) age 44.2 (8.1) years), 75% completed the study. At 12 months, the mean change in MET.min/week was +631.3 (95% CI 369.4 to 893.2) in the intervention group (IG) vs +183.2 (95% CI 83.3 to 283.0) in the comparison group, with a significant between-group difference of +447.4 (95% CI 150.7 to 744.1). The odds of meeting PA recommendations were 1.9 times higher in the IG (95% CI 1.2 to 3.3). Significant between-group differences in favor of IG were detected for mean steps/day (+757, 95% CI 18 to 1531) and sitting time hours/ per day (−1.5, 95% CI −2.4 to −0.7). Clinical measures of systolic and diastolic blood pressure and triglycerides also showed significant intervention effects. Conclusions ‘MOVEdiabetes’ was effective in increasing PA, the likelihood of meeting PA recommendations, and providing cardioprotective benefits in adults with T2D attending primary care.

/pdf/movediabetes-a-cluster-randomized-controlled-trial-to-3os19m36pn.pdf

'MOVEdiabetes': A cluster randomized controlled trial to increase physical activity in adults with type 2 diabetes in primary health in Oman

Physical fitness measures indicate health status and could be used to improve management of overall health.

Purpose
To describe the development of a Self-Reported Fitness (SRFit) survey intended to estimate fitness in adults aged ≥40 years across four domains; 1) muscular strength and endurance, 2) cardiovascular fitness, 3) flexibility, and 4) body composition.

/pdf/developing-a-self-reported-physical-fitness-survey-5fcaomdprl.pdf

Developing a self-reported physical fitness survey.

Objectives To identify how primary care physicians (PCPs) prescribe physical activity for patients with chronic disease, and to determine characteristics of physical activity interventions with improved clinical outcomes of chronic disease. Design A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews 2018 was completed. Data sources Four bibliographic databases (Medline, EMBASE, SPORTDiscus, CINAHL) and four grey literature/unpublished databases (Proquest, National Institute for Health and Care Excellence, Canadian Health Research Collections, Clinical Trials) were searched from inception to 7 March 2022. Eligibility criteria for selecting studies Studies involving PCP-delivered physical activity prescriptions or counselling for participants with a chronic disease or mental health condition, which reported clinical outcomes were included. Opinion papers, news and magazine articles and case reports were excluded, as were studies in which a physical activity intervention was provided for primary prevention of chronic disease, prescribed by healthcare providers or researchers other than PCPs, or for healthy participants without chronic disease. Results An initial search identified 4992 records. Fifteen studies met inclusion criteria. Characteristics of physical activity prescriptions that improved clinical outcomes included: personalised advice; brief intervention; behavioural supports (handouts and/or referrals) and physician follow-up. Reported adverse events were rare. Research gaps include optimal timing and length of follow-up, and the long-term and cost-effectiveness of interventions. Summary/Conclusion Several characteristics of physical activity counselling by PCPs for patients with chronic disease may improve clinical outcomes, although research gaps remain. Studies exploring the effectiveness of physical activity prescription for individuals with chronic conditions are urgently needed.

/pdf/the-miracle-cure-how-do-primary-care-physicians-prescribe-2moz2bk0.pdf

The ‘miracle cure’: how do primary care physicians prescribe physical activity with the aim of improving clinical outcomes of chronic disease? A scoping review

Introduction: as part of the treatment of diabetes mellitus, many people choose to do alternative exercises including mind-body activities used in the Chinese traditional medicine. Objective: to describe some alternative forms of exercising used by Chinese traditional medicine as a choice to be considered in the treatment of diabetes mellitus people. Development: similar effects to those reported with the use of conventional physical activity in diabetic persons were found; it seems that they may be reached with the Chinese traditional medicine exercising as is the case of practicing Tai chi chuan, Qigong and Wai tan kung. These are well-structured programs of useful exercises that have been practiced during thousand of years and that, together with the conventional therapy for diabetes mellitus, could facilitate good progress and higher quality of life in this people. They provide positive effects in terms of metabolic control, bone density, general physical function and particularly, cardiopulmonary function, psychological status and immunological condition of the patient. Conclusions: the favorable impact from the practice of alternative forms of physical exercises in Chinese traditional medicine by diabetes mellitus patients makes practice a choice to be considered in treating this important entity.

/pdf/algunas-formas-alternativas-de-ejercicio-una-opcion-a-48adoa5fku.pdf

Algunas formas alternativas de ejercicio, una opción a considerar en el tratamiento de personas con diabetes mellitus

Objectives
To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory.
Design
Realist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome (CMO) statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation.
Results 
A taxonomy was produced, including thirteen categories of physical activity interventions for people with long-term conditions.
Abridged realist programme theory:
Routinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources with better coordination will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions is helpful in affecting positive patient behaviour change. Training can improve the knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy.
These statements informed the co-design of a prototype intervention to improve physical literacy amongst practice staff, describe/develop the role of a physical activity advisor who can encourage people to use local opportunities to be more active, and materials to support this behaviour change. 
Conclusions 
Previous physical activity interventions in primary care have had limited effect, perhaps because they only partially address factors emerging in our programme theory. Our prototype intervention addresses all the elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including COVID-19 restrictions), and testing in a future study. The integration of realist and co-design methods strengthened this study.

https://bmjopen.bmj.com/content/bmjopen/11/7/e046751.full.pdf

'Function First': how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods.

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. 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. 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. 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.

/pdf/fitness-consultations-in-routine-care-of-patients-with-type-2xra09d2rl.pdf

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

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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