Exercise and Lifestyle Education program for Brazilians living with prediabetes and diabetes: A pilot randomized trial.

AIMS: To test the Diabetes College Brazil Study feasibility, the acceptability of study interventions and their preliminary effectiveness, and describe the study protocol modifications due to the COVID-19 pandemic. METHODS: Single-center, double-blinded pilot randomized trial with two parallel groups, Exercise and Lifestyle Education (ExLE; 12-week exercise and educational interventions) and Exercise (Ex; 12-week exercise intervention only) involving patients with prediabetes or diabetes. Feasibility (eligibility, recruitment, retention, completeness of variables measures and participation rates), acceptability (satisfaction), and preliminary effectiveness of interventions (variables: functional capacity, physical activity (PA), exercise self-efficacy, diabetes knowledge, health literacy, adherence to Mediterranean food pattern, glycated hemoglobin (HbA1c), anthropometric measures, cardiac autonomic control, depression, and quality of life (QofL)). RESULTS: Eligibility, recruitment, retention, participation in exercise sessions, and education classes rates were 17%, 93%,82%, 76%, and 71%, respectively. Missing data in the post-intervention assessment (PA, HbA1c, cardiac autonomic control, anthropometric measures, depression, and QofL) were mainly related to research procedure modifications. The interventions were highly acceptable, and most variables improved farther in the ExLE, with moderate effect sizes for PA, diabetes knowledge, health literacy, cardiac autonomic control, and QofL. CONCLUSIONS: The Diabetes College Brazil Study is feasible, and the ExLE may benefit Brazilians living with prediabetes and diabetes.

Maintenance of Physical Activity Behavior by Individuals with Prediabetes and Diabetes during the COVID-19 Pandemic after Completing an Exercise Intervention in Brazil.

This cross-sectional study evaluated the perception of individuals with prediabetes/diabetes about their living conditions during the COVID-19 pandemic to identify the facilitators, barriers, and reasons to remain physically active at home and adhere to recommended exercise. It included individuals with prediabetes/diabetes who had completed an exercise intervention, which started on-site and moved to a remote home-based regime due to the COVID-19 pandemic and were advised to keep exercising at home. The outcomes were assessed by a bespoke questionnaire that was developed by the research team, the Brazilian Portuguese adapted version of the Exercise Adherence Rating scale, and the Motives for Physical Activity Measure-Revised scale. Of 15 participants (8 female, 58 ± 11 years), most reported positive perceptions about their living conditions and few difficulties maintaining some physical activity at home. However, only 53.8% of them adhered to the recommended exercise. Time flexibility, no need for commuting, and a sense of autonomy were the main facilitators of home exercise, while a lack of adequate space was the main barrier. The descending order of median scores that were obtained in each reason for physical activity was fitness, enjoyment, competence, social, and appearance. Individuals with prediabetes/diabetes maintained some physical activity during the pandemic, mainly motivated by health concerns.

Behavior change interventions in patients with type 2 diabetes: a systematic review of the effects on self-management and A1c.

PURPOSE: This study aimed to identify the characteristics of interventions employed to promote behavior change in people with type 2 diabetes mellitus (T2DM) and their impact on disease self-management and glycated hemoglobin (A1c). METHODS: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to guide the protocol development for this systematic review. Randomized controlled clinical trials which compared behavior change interventions to controls in adults with T2DM and investigated disease self-management and glycated hemoglobin (A1c) measured by validated methods were eligible for this study. The risk of bias and quality of evidence was assessed respectively by Cochrane's tool and grading of recommendations, assessment, development, and evaluation (GRADE). RESULTS: A total of 27 studies were included involving 4464 participants. Behavior change was mainly promoted by education sessions on diabetes care delivered face-to-face, monthly, or every other month, lasting more than 60 min, involving blood glucose monitoring, healthy eating, exercise, and medication. Four studies showed significant improvement in both disease self-management and A1c. The risk of bias was classified as high in most studies. A meta-analysis could not be performed for A1c and self-management due to the high differences in intervention parameters (delivery mode, number, duration, and frequency) and self-management assessments. CONCLUSION: Low evidence of improvement in disease self-management and A1c considering only validated assessment methods were found for behavior change interventions, mainly promoted by education sessions on diabetes care. The quality of studies and probably the differences in intervention protocols contributed to this finding. PROSPERO NUMBER: CRD42020161162.