The Effect of Tele-Monitoring on Exercise Training Adherence Functional Capacity Quality of Life and Glycemic Control in Patients With Type II Diabetes

摘要

We used tele-monitoring to attempt to improve exercise adherence (number of hours of exercise completed), peak VO2, HbA1c% and quality of life in an unsupervised, home based exercise program in people with type II diabetes, a cost analysis was also conducted. Thirty-nine patients with type II diabetes were randomized to tele-monitoring (TELE) or control (CON) groups. All patients were asked to complete 6 months exercise training and complete an exercise activity diary. The TELE group was instructed to record their exercise heart rates using a monitor and received weekly telephone calls from an exercise physiologist. Six TELE patients and seven CON patients did not complete the 6 month testing. TELE patients completed a mean weekly volume of 138 minutes, moderate intensity exercise, while CON patients completed 58 minutes weekly (p < 0.02). Neither group achieved the American Heart Association statement guideline for weekly exercise volume of 150 minutes. TELE patients improved peak VO2 (5.5 %), but neither group improved HbA1c% or quality of life. The CON group showed a 4.9% reduction in peak VO2. While tele-monitored patients completed more hours of exercise and demonstrated improved peak VO2 compared to controls, the exercise volume completed was insufficient to improve glycemic control. There is the potential via tele-monitoring to enable people with diabetes to meet exercise training guidelines.Key points class="unordered" style="list-style-type:disc">Weekly telephone calls from a health professional providing encouragement, increases the amount of exercise completed by people with diabetesWeekly telephone calls will result in improved fitnessAt least 150 minutes weekly exercise is required to improve diabetes controlThe cost of home exercise with telephone monitoring is cheaper (and more convenient for the patient) than delivering an exercise program at the hospitalLonger term research is needed to examine whether telephone supervised exercise will prevent serious events such as heart attack, strokes and death class="kwd-title">Keywords: Diabetes mellitus, telemedicine, exercise therapy, outpatient, cost analysis. class="head no_bottom_margin" id="sec1-1title">IntroductionExercise training has become an important adjunct therapy for both the prevention and management of type II diabetes mellitus. Meta-analyses of regular, supervised exercise training in type II diabetes mellitus patients concluded that statistically and clinically significant improvements in blood glucose, HbA1c (8-9%), lipid profile and peak VO2 (12%) are likely, independent of body mass changes (Boule et al., ; Yoo and Lee, ). Furthermore exercise capacity is a strong predictor of all-cause mortality in type II diabetes (Kokkinos et al., ).It is unfortunate that supervised exercise programs for people with diabetes are often delivered via an outpatient program with a finite duration (Thomas et al., ) as outpatient programs of longer duration are cost-prohibitive for most health service providers. Long-term adherence to exercise is required for ongoing effective diabetes management, but the Cochrane systematic review of exercise training studies reports only one included study with a training duration greater than six months (Thomas et al., ) and some short duration studies have reported adherence rates insufficient to promote or retain health benefits (Harrison et al., ).Unsupervised exercise training provides a cost-effective alternative to an outpatient program, but is also likely to have poor adherence unless strategies are implemented to keep patients motivated (King et al., ). Our group has previously utilised tele-monitoring to maintain exercise training adherence for 12 months in heart failure patients (ACSM, ). The provision of telephone-based physical activity counselling has been shown to be effective in increasing physical activity over 12 months in previously low-active older adults (Kolt et al., ) and in improving glycemic control in patients with type I diabetes (Gomez et al., ), but tele-monitoring of long-term (>3 months) exercise training in patients with type II diabetes is a novel approach (Smart et al., ).The aims of this study were to investigate whether adherence (number of hours of exercise completed and proportion of hours at an appropriate intensity) to a 6 month, unsupervised, home based exercise program would be improved if a tele-monitoring strategy was employed. The secondary aim was to examine if peak VO2, HbA1c% and quality of life were improved with tele- monitoring and whether any changes were related to aggregate exercise time or mean intensity. Finally, we also wished to examine the cost-effectiveness of exercise training compared to pharmacological therapy in people with type II diabetes.