A pragmatic randomised controlled trial referring to a Personalised Self-management SUPport Programme (P-SUP) for persons enrolled in a disease management programme for type 2 diabetes mellitus and/or for coronary heart disease.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) are two chronic diseases that cause a tremendous burden. To reduce this burden, several programmes for optimising the care for these diseases have been developed. In Germany, so-called disease management programmes (DMPs), which combine components of Disease Management and the Chronic Care Model, are applied. These DMPs have proven effective. Nevertheless, there are opportunities for improvement. Current DMPs rarely address self-management of the disease, make no use of peer support, and provide no special assistance for persons with low health literacy and/or low patient activation. The study protocol presented here is for the evaluation of a programme that addresses these possible shortcomings and can be combined with current German DMPs for T2DM and CHD. This programme consists of four components: 1) Meetings of peer support groups 2) Personalised telephone-based health coaching for patients with low literacy and/or low patient activation 3) Personalised patient feedback 4) A browser-based web portal METHODS: Study participants will be adults enrolled in a DMP for T2DM and/or CHD and living in North Rhine-Westphalia, a state of the Federal Republic of Germany. Study participants will be recruited with the assistance of their general practitioners by the end of June 2021. Evaluation will be performed as a pragmatic randomised controlled trial with one intervention group and one waiting control group. The intervention group will receive the intervention for 18 months. During this time, the waiting control group will continue with usual care and the usual measures of their DMPs. After 18 months, the waiting control group will also receive a shortened intervention. The primary outcome is number of hospital days. In addition, the effects on self-reported health-state, physical activity, nutrition, and eight different psychological variables will be investigated. Differences between values at month 18 and at the beginning will be compared to judge the effectiveness of the intervention. DISCUSSION: If the intervention proves effective, it may be included into the DMPs for T2DM and CHD. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) in early 2019 under the number 00020592. This registry has been affiliated with the WHO Clinical Trials Network ( https://www.drks.de/drks_web/setLocale_EN.do ) since 2008. It is based on the WHO template, but contains some additional categories for which information has to be given ( https://www.drks.de/drks_web/navigate.do?navigationId=entryfields&messageDE=Beschreibung%20der%20Eingabefelder&messageEN=Description%20of%20entry%20fields ). A release and subsequent number assignment only take place when information for all categories has been given.

Cohesion and adherence in exercise groups of patients with chronic heart diseases - a prospective study.

Objective: In cardiac rehabilitation, long-term adherence to exercise prescription is an important prerequisite to reduce mortality and the risk of recurrent cardiac events. Cohesion seems to be an important predictor of adherence when exercise is conducted in prevention settings, but in clinical settings, this relationship is currently unknown. To address this gap, the goal of this study was to determine the relationship between group cohesion and adherence in cardiac rehabilitation programs considering the duration of membership as a moderator.Design: The study was conducted with 474 participants (21.7% women), in three rehabilitation centres in North Rhine Westphalia, Germany, assessing cohesion, adherence and group membership in outpatient cardiac exercise groups.Main Outcome Measures: Cohesion was assessed using the KIT-FG and adherence was operationalized as the total number of sessions attended over a 7-week period.Results: Moderated hierarchical stepwise regression analyses revealed that perceptions of the social dimension of group cohesion significantly predicted adherence behaviour only for members with a rather long duration of membership.Conclusion: Our findings suggest that cohesion might have a differential effect on an individual's decision to regularly participate in exercise, depending on the duration of membership in the group.

Becoming active post-hospitalisation discharge - an exploration of motivational profiles during exercise change in obese patients.

Despite the urgent need to prevent weight regain in the long-term, it remains questionable whether inpatient multicomponent behavioural obesity treatments positively impact their patients, leaving them with favourable (i.e. autonomous) motivational profiles towards exercising. Based on Organismic Integration Theory, a sub-theory of Self-Determination Theory, this study retrospectively examined how exercise motivational profiles relate to exercise behaviour outcomes of a behavioural obesity treatment. Obese patients for whom outpatient treatment was deemed ineffective (N = 262; 34.2% female, body mass index >30 kg/m2) were administered to a 3-week inpatient obesity treatment. The study design incorporates both longitudinal and retrospective cross-sectional aspects. Patients completed questionnaires concerning exercise behaviour (pre-hospitalisation/6 months post-discharge) and behavioural regulations (6 months post-discharge). Exercise motivational profiles were generated based on the six behavioural regulations using K-means non-hierarchical cluster analysis. The self-reported dependent variable represents a change in patients' exercise status (i.e. remaining inactive, becoming active). Chi-square tests related motivational profiles to exercise behaviour. Three profiles emerged: a moderate-controlled cluster (n = 80), a moderate-autonomous cluster (n = 78) and a high-autonomous cluster (n = 104). Of the patients who became active over time, the majority belonged to the high-autonomous cluster. No significant differences were found between patients who became active or remained inactive and whether they belonged to the moderate-controlled or moderate-autonomous cluster. Although the moderate-controlled and moderate-autonomous clusters differ greatly in their motivational quality, moderately controlled motivation does not seem detrimental regarding exercise change, as both clusters result in similar exercise behaviour outcomes.