This behavioral intervention study aims to assess physical activity levels and sedentary behavior among individuals with diabetes. It will compare the effectiveness of standard interventions against informational sessions on the benefits of physical activity for achieving changes in behavior and improving quality of life while reducing reliance on healthcare services. Participants will be divided into 3 groups: one receiving standard care from the diabetology service; one attending three theoretical motor counseling sessions; another engaging in three theoretical motor counseling sessions plus practical counseling supervised by kinesiologist. The primary objective is to evaluate physical activity levels at 6 and 12 months post-intervention. Secondary objectives include assessing sedentary time, health status, anthropometric measurements, blood pressure, barriers to engaging in physical activity, motivation levels, dietary habits, readiness for lifestyle changes, perceived quality of life, and functional capacities.
A total of 123 participants, all voluntary and at no cost, will be recruited from the Diabetology clinics of the Complex Structure of Endocrinology and Metabolic Diseases in Perugia. The recruitment process will employ a randomized, non-blinded methodology, enabling the formation of three distinct groups for comparison. Group 1 will consist of 41 people who have been diagnosed with diabetes mellitus for a minimum of three months. This cohort will receive standard medical care, which encompasses routine monitoring and management of their condition. Alongside this, participants will complete questionnaires designed to assess their health status and lifestyle, as well as undergo evaluations of their functional abilities, which may include tests of strength, mobility, and overall physical capacity. Importantly, members of this group will not receive specific recommendations for engaging in daily physical activity from healthcare providers or kinesiologists. Instead, the guidance provided will be solely theoretical, with no practical motor counseling offered to enhance their physical activity levels. Group 2 will similarly include 41 people meeting the same three-month diagnostic criteria for diabetes mellitus. These participants will also benefit from standard care, complete questionnaires, and undergo assessments of their functional abilities. However, a key distinction for Group 2 is the provision of recommendations for daily physical activity from both healthcare professionals and kinesiologists. While this group will receive theoretical guidance on the importance of physical activity, they will not receive practical motor counseling to help them implement these recommendations in their daily lives. Group 3 will feature another set of 41 people, again fulfilling the condition of having a diabetes mellitus diagnosis for no less than three months. In addition to receiving the same standard care, questionnaire administration, and assessments of functional capabilities, participants in this group will also receive recommendations for daily physical activity from their healthcare and kinesiology teams. What sets Group 3 apart is the inclusion of 24 biweekly sessions focused on practical motor counseling, where individuals will engage in structured physical activity programs. This component is designed to provide hands-on, practical guidance that enables participants to actively incorporate physical exercise into their routines, aiming to enhance their overall health and functional abilities. Through this detailed approach, the study aims to explore the impact of differing levels of prescribed physical activity and support on the functional outcomes of individuals living with diabetes mellitus, contributing valuable insights to the management practices in diabetic care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
123
Participant wil be involved in: * Routine assessments: Anthropometric (weight, height, waist circumference) and hematobiochemical parameters (e.g., glycemic and lipid profiles), and systolic and diastolic blood pressure. * General information + administration of the IPAQ, PACE, Barriers, Mediterranean Diet, and Quality of Life questionnaires. * Body Composition Assessment: BMI, fat mass (FM), fat free mass (FFM), muscle mass, total body water (TBW) and basal metabolism rate (BMR). * Non-diagnostic assessment of functional abilities: submaximal tests of strength, muscular endurance, and flexibility. * Only 3 sessions (1 per month) of TCPA: the Kinesiologist will inform the patient about the guidelines and the various types of PA, as well as their dose-dependent effects.
Participant wil be involved in: * Routine assessments: Anthropometric (weight, height, waist circumference) and hematobiochemical parameters (e.g., glycemic and lipid profiles), and systolic and diastolic blood pressure. * General information + administration of the IPAQ, PACE, Barriers, Mediterranean Diet, and Quality of Life questionnaires. * Body Composition Assessment: BMI, fat mass (FM), fat free mass (FFM), muscle mass, total body water (TBW) and basal metabolism rate (BMR). * Non-diagnostic assessment of functional abilities: submaximal tests of strength, muscular endurance, and flexibility. * Only 3 sessions (1 per month) of TCPA: the Kinesiologist will inform the patient about the guidelines and the various types of PA, as well as their dose-dependent effects. * PCPA: supervised mixed physical activity program (cardiovascular + resistance) lasting 3 months, with 2 sessions per week.
Diabetes Center of the Section of Endocrinology and Metabolism, University Hospital of Perugia
Perugia, PG, Italy
RECRUITINGTotal weekly physical activity time
Total physical activity (PA) time in a week, expressed in min/week. It result from the sum of time spent in moderate-intensity PA + time spent in vigorous-intensity PA + time spent in walking. This measure will be assessed using the International Physical Activity Questionnaire and Actigraphy.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Total weekly walking physical activity time
Total physical activity (PA) time in a week, expressed in min/week, spent in walking. This measure will be assessed using the International Physical Activity Questionnaire and Actigraphy.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Total weekly moderate physical activity time
Total physical activity (PA) time in a week, expressed in min/week, spent in moderate-intensity PA. This measure will be assessed using the International Physical Activity Questionnaire and Actigraphy.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Total weekly vigorous physical activity time
Total physical activity (PA) time in a week, expressed in min/week, spent in vigorous-intensity PA. This measure will be assessed using the International Physical Activity Questionnaire and Actigraphy.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Sedentary time
Daily time spent in sedentary activities (defined as activities with a energy expenditure \<1.5 Metabolic Equivalent of Task-hours). This measure will be assessed using the International Physical Activity Questionnaire and Actigraphy.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Age
Number of years of patients
Time frame: At the time of enrollment.
Body weight
Weight (kg) assessed using a calibrate medical scale
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Height
Height (m) assessed using a medical stadiometer.
Time frame: At the enrollment, and during follow up (6 and 12 months)
Waist circumference
Waist circumference (cm) will be measured using a medical tape
Time frame: At the enrollment, and during follow up (6 and 12 months)
Body mass index (BMI)
Body mass index (kg/m2) will be calculated as weight (kg) divided by the square of height (meters).
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Fasting glucose
Blood glucose value expressed in mg/dl
Time frame: At the enrollment, and during follow up (6 and 12 months)
Glycated hemoglobin (HbA1c)
Mean of blood glucose in the last three months, expressed in percentage
Time frame: At the enrollment, and during follow up (6 and 12 months)
Total blood cholesterol value
Total cholesterol value in blood, expressed in mg/dL
Time frame: At the enrollment, and during follow up (6 and 12 months)
Serum Glutamic-Oxaloacetic Transaminase (SGOT) and Serum Glutamic-Pyruvic Transaminase (SGPT)
SGOT and SGPT blood values
Time frame: At the enrollment, and during follow up (6 and 12 months)
Creatinine
creatinine blood values, expresseg in mg/dL
Time frame: At the enrollment, and during follow up (6 and 12 months)
Blood pressure
Systolic and diastolic blood pressure (mmHg) values will be measured with a digital column sphygmomanometer for professional blood pressure measurement.
Time frame: At the enrollment, and during follow up (6 and 12 months)
Stages of Change
Stages of Change will be studied using an eight point item questionnaire specifically used for exercise, developed as part of the PACE (Patient-centered Assessment and Counseling for Activity) project. It is based on the Transthetic Model of Prochaska and Di Clemente and helps understand where a person is with respect to physical activity.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Barriers to physical activity
This is a 32-item instrument used to identify specific barriers to adherence and maintenance physical activity. Items are grouped into key categories that influence behavior: personal barriers (e.g., laziness, lack of motivation, tiredness, feelings of shame); physical/health barriers (e.g., pain, fear of injury, feeling too fat); environmental/external barriers (e.g., weather conditions, lack of safe places, traffic); social/economic barriers (lack of family support, excessive costs). The list of barriers comes from integrating the "PACE" protocol adapted for diabetic or obese people .
Time frame: At time of enrollment and follow up (6 and 12 months).
Adherence to the Mediterranean diet
Eating habits and adherence to the principles of the Mediterranean diet will be assessed by administering the 14-Item Mediterranean Diet Assessment Tool questionnaire.
Time frame: At time of enrollment and follow up (6 and 12 months).
Measures of patient's health-related quality of life
The 36-Item Short Form Survey (SF-36) evaluates eight health domains (physical functioning, role limitations due to physical health, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health), providing scores for both physical and mental health functioning. Each item is scored on a 0 to 100 range: a lower score indicates higher impairment and a higher score indicates better health.
Time frame: At time of enrollment and follow up (6 and 12 months).
Self-Care, Usual Activities quality of life, and health status
Movement Ability, Personal Care, usual Activities (i.e. Work, Study, Home), Pain or Discomfort, and Anxiety or Depression will be assessed using the EuroQol-5Dimensions-3levels questionnaire. For each dimensions, participants will choose between 3 levels of severity (indicated by numbers 1= No problems; 2=Some / Moderate problems; 3=Extreme problems / Inability to perform the action). Finally, the EQ-VAS will be used to ask participants about health status over the past year. This questionnaire is usually accompanied by a Visual Analog Scale (VAS), a sort of "thermometer" graduated from 0 to 100 on which the patient is asked to mark how they rate their health today.
Time frame: At time of enrollment and follow up (6 and 12 months).
Hand Grip Strength
The Hand Grip Strength will be measured with DynX ® dynamometer.
Time frame: At time of enrollment and follow up (6 and 12 months).
Dynamic muscle strength
Dynamic muscle strength will be assessed by estimating one repetition maximum by submaximal upper and lower limb strength tests, performed at natural load or with the aid of isotonic machines, using Brzycki's 1-RM prediction equation.
Time frame: At time of enrollment and follow up (6 and 12 months).
Aerobic capacity
Aerobic capacity will be estimated using the 6 Minutes Walking Test.
Time frame: At the time of enrolment and at 6 and 12 months
Total High-Density Lipoprotein (HDL) values
Total HDL values in blood, expressed in mg/dL
Time frame: At the enrollment, and during follow up (6 and 12 months)
Total Low-Density Lipoprotein (LDL) values
Total LDL values in blood, expressed in mg/dL
Time frame: At the enrollment, and during follow up (6 and 12 months)
Triglycerides values
Triglycerides value in blood, expressed as mg/dL
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Fat mass value
Body fat mass, expressed in kg, assessed using an impedance platform (Tanita Body Composition Analyzer BC-420MA; Tokyo, Japan).
Time frame: At time of enrollment and follow up (6 and 12 months).
Fat free mass value
Body fat free mass, expressed in kg, assessed using an impedance platform (Tanita Body Composition Analyzer BC-420MA; Tokyo, Japan).
Time frame: At time of enrollment and follow up (6 and 12 months).
Muscle mass value
Muscle mass, expressed in kg, assessed using an impedance platform (Tanita Body Composition Analyzer BC-420MA; Tokyo, Japan).
Time frame: At time of enrollment and follow up (6 and 12 months).
Total body water value
Total body water, expressed in percentage, assessed using an impedance platform (Tanita Body Composition Analyzer BC-420MA; Tokyo, Japan).
Time frame: At time of enrollment and follow up (6 and 12 months).
Basal metabolism value
Basal metabolism rate, expressed in kcal, assessed using an impedance platform (Tanita Body Composition Analyzer BC-420MA; Tokyo, Japan).
Time frame: At time of enrollment and follow up (6 and 12 months).
Fat mass percentage
Fat mass percentage assessed using an air plethysmograph (BOD POD® Composition System; COSMED, Albano Laziale, Italy).
Time frame: At time of enrollment and follow up (6 and 12 months).
Fat free mass percentage
Fat free mass percentage assessed using an air plethysmograph (BOD POD® Composition System; COSMED, Albano Laziale, Italy).
Time frame: At time of enrollment and follow up (6 and 12 months).
Total Sleep Time
Total Sleep Time, expressed in minutes, measured with the help of portable accelerometers of the ActiGraph Wearable Devices - wGT3X-BT type.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Sleep Efficiency percentage
Sleep Efficiency is a a ratio, expressed as a percentage, representing the proportion of time spent asleep relative to the total time spent in bed. It is calculated as (Total Sleep Time / Time in Bed) × 100. Higher values indicate more consolidated and restorative sleep. It will be measured with the help of portable accelerometers of the ActiGraph Wearable Devices - wGT3X-BT type.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Wake After Sleep Onset
Wake After Sleep Onset is the total amount of time spent awake after initially falling asleep, until the final awakening. It reflects the degree of sleep fragmentation during the night. It will be measured with the help of portable accelerometers of the ActiGraph Wearable Devices - wGT3X-BT type.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Sleep Onset Latency time
Sleep Onset Latency, expressed in minutes, is the time it takes to transition from full wakefulness to sleep after lying down. Longer latency may indicate difficulty initiating sleep. It will be measured with the help of portable accelerometers of the ActiGraph Wearable Devices - wGT3X-BT type.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
Sleep Fragmentation Index
Sleep Fragmentation Index is an index that measures the frequency of sleep-wake transitions, expressed as a percentage. It will be measured with the help of portable accelerometers of the ActiGraph Wearable Devices - wGT3X-BT type.
Time frame: At the time of enrollment and follow-up (6 and 12 months).
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