Digital Intervention Promoting Physical Activity Among Obese People (DIPPAO) (DIPPAO)

Digital Intervention Promoting Physical Activity Among Obese People Randomized Controlled Trial: Assessing the Effects of a Digital Intervention to Promote Physical Activity in Patients With Obesity and/or Type 2 Diabetes Mellitus

Overweight and obesity are today considered among the most important health risks facing humanity with more than one in two adults overweight or obese in western countries. In addition, Type 2 diabetes mellitus (T2DM) is a common comorbidity associated with overweight and obesity and counts for 5% of the French population under 65 years of age and 15% in people over 65 years old. Despite the accumulation of scientific evidence supporting the benefits of physical activity, obese and diabetic people remain insufficiently active and current programs struggle to engage and sustain physical activity of patients over long periods of time. It is therefore urgent to develop interventions that can effectively change individuals' behavior. In this context, "e-health" interventions and gamification appear to be a particularly promising avenue to improve physical activity and reduce attrition rates of current programs.

This clinical trial aim to test the effectiveness of a digital intervention based on gamification and teamwork in comparison to a supervised physical activity program. The investigators hypothesized that the intervention will be efficient by the development of a self-determined motivation through the process of gamification on the one hand. On the other hand, through the in-group collaboration with other people who share the same stigmatized criteria that will help participants to overcome weight stigmas, acting generally as physical activity barriers.

Study Overview

• Status: Completed
• Conditions: Obesity; Diabete Type 2
• Intervention / Treatment: Device: Kiplin; Behavioral: face-to-face

Detailed Description

This trial is a randomized, two-arm intervention design that will examine the efficacy of a digital group-based intervention based on gamification and teamwork among obese and T2DM patients. The experimental arm will be compared to an active control group representing the traditional care program (supervised physical activity).

The digital intervention is composed of four components within a smartphone application: a) a gamification of PA, b) a remote adapted physical activity program with telecoaching sessions, c) an interface for exchange and conversation and, d) an activity monitoring tool. Accelerometer data, self-reported PA, body composition, and physical capacities will be assessed before, at the end of the intervention and then at the issue of a 6-month follow up. To advance our understanding of complex interventions like gamified and group-based ones, this study will explore several psychological mediators relative to motivation, enjoyment, in-group identification, or perceived weight stigma. Finally, to assess a potential superior efficiency compared to the current treatment (face-to-face supervised PA), this study will include a cost-utility analysis between the two conditions.

• Study Type: Interventional
• Enrollment (Actual): 56
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Clermont-Ferrand, France, 63000
    • CHU de Clermont-Ferrand

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Subject affected for obesity (BMI ≥30 kg/m² and <45 kg/m²) and/or T2DM.
• Subject treated at the University Hospital of Clermont-Ferrand.
• The participants must have an iOS (at least iOS8 version) or Android (at least version 5) smartphone.
• Subjects must also be able to provide informed consent to participate in the research and be covered by health social security.
• Subjects must be native to any physical activity intervention.
• Sufficient proficiency of French will be required to ensure the understanding of the questionnaires.

Exclusion Criteria:

• Medical or surgical history judged by the investigator to be incompatible with the study.
• Subject with an unstable psychiatric condition.
• Pregnant or breastfeeding women.
• Heavy alcohol consumption (> 2 to 3 drinks per day depending on gender) or drug addiction.
• Disability or contraindication to PA.
• Subject with cardiorespiratory and/or osteoarticular disorders that limit their ability to perform physical tests or moderate PA for 30 minutes.
• Subject with progressive cardiovascular or neoplastic disease.
• Subject who has presented a major infection in the 3 months prior to inclusion.
• Subject with a known neuro-muscular pathology (i.e., myopathy, myasthenia, rhabdomyolysis, paraplegia, hemiplegia).
• Subject with chronic or acute inflammatory pathology within 3 months prior to inclusion.
• Subject diagnosed and/or treated for schizophrenia, bipolar disorder, major depression.
• Subject deprived of their liberty by judicial or administrative decision.
• Subject refusing to sign the written consent to participate.
• Subject participating in another study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Kiplin intervention; Kiplin intervention composed of the access to a mobile app and to telecoaching sessions. The number of teleocaching sessions per week will decrease over 3 months.	Device: Kiplin; The Kiplin intervention will be composed of four components within a smartphone application: a) a gamification of Physical Activity through multiple games called "animations", b) a remote adapted physical activity program with telecoaching sessions, c) an interface for exchange and conversation and, d) an activity monitoring tool.
Active Comparator: face-to-face supervised PA (usual care at the University Hospital of Clermont-Ferrand, France); three-month program of face-to-face adapted physical activity, three sessions a week, for a total of 36 sessions.	Behavioral: face-to-face; three-month program of face-to-face adapted physical activity, three sessions a week, for a total of 36 sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in daily physical activity from baseline to 3 months	The primary outcome will be the change of daily physical activity measured as the daily step count assessed via the Garmin Vivofit 3 (Garmin International Inc., Olathe, KS, USA)	Month 3

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in body composition (BMI) from baseline to 9 months	in kg/m2	Month 9
Change in body composition from baseline to 9 months	evaluated by bioelectrical impedance analysis	Month 9
Change in daily physical activity from baseline to 9 months	measured as the daily step count assessed via the Garmin Vivofit 3 (Garmin International Inc., Olathe, KS, USA)	Month 9
Change in physical activity level from baseline to 9 months	total physical activity (minutes/day) measured using the Garmin Vivofit 3 (Garmin International Inc., Olathe, KS, USA)	Month 9
Change in moderate-to-vigorous physical activity (MVPA) from baseline to 9 months	measured using a tri-axial accelerometer (ActiGraph GT3x; ActiGraph LLC, Pensacola, FL, USA).	Month 9
Change in light physical activity (LPA) from baseline to 9 months	measured using a tri-axial accelerometer (ActiGraph GT3x; ActiGraph LLC, Pensacola, FL, USA).	Month 9
Change in sedentary time from baseline to 9 months	measured using a tri-axial accelerometer (ActiGraph GT3x; ActiGraph LLC, Pensacola, FL, USA).	Month 9
Change in self-reported physical activity from baseline to 9 months	measured using the RPAQ	Month 9
Change in six minute walking distance from baseline to 9 months	measured via the 6-minute walking test	Month 9
Change in muscular strength of the upper limbs from baseline to 9 months	measured via handgrip measurements	Month 9
Change in muscular strength of the lower limbs from baseline to 9 months	measured via isokinetic dynamometer	Month 9
Programme adherence	number of APA sessions attended. Application engagement and utilization for the experimental group only	Month 3
Change in quality of life from baseline to 9 months	measured via the EQ-5D	Month 9
Cost-utility analysis	measured using incremental cost-effectiveness ratio between the average difference in cost and the average difference in effectiveness (QALY) observed between the two arms	Month 9
Perceived enjoyment of physical activity at the end of the intervention	measured using the Physical Activity Enjoyment Scale (PACES)	Month 3
Social identification at the end of the intervention	measured via the In-group identification questionnaire	Month 3
Psychological needs satisfaction at the end of the intervention	measured via the Psychological Need Satisfaction in Exercise Scale (PNSES)	Month 3
Change in motivation toward physical activity from baseline to 9 months	Autonomous and controlled motivation toward physical activity via the EMAPS.	Month 9
Change in weight stigma concerns from baseline to 9 months	measured using the scale developed by Hunger and Major	Month 9
Change in perceived daily discrimination from baseline to 9 months	measured via the everyday discrimination scale	Month 9
Change in weight bias internalisation from baseline to 9 months	measured via the Modified Weight Bias Internalization Scale (WBIS-M)	Month 9

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived vulnerability toward COVID-19	measured using the perceived vulnerability questionnaire	Month 9
Perceived digitalization	measured using a single item	Month 9
Perceived exertion during the APA sessions	measured via the Borg scale	Month 3

Collaborators and Investigators

• Sponsor: University Hospital, Clermont-Ferrand
• Collaborators: SENS laboratory, Univ. Grenoble Alpes; INRAE, UNH, CRNH Auvergne, Clermont Auvergne University; Kiplin; I-SITE Clermont Auvergne Project 20-25
• Investigators: Principal Investigator: Martine DUCLOS, University Hospital, Clermont-Ferrand

Publications and helpful links

General Publications

• Mazeas A, Chalabaev A, Blond M, Pereira B, Duclos M. Digital intervention promoting physical activity among obese people (DIPPAO) randomised controlled trial: study protocol. BMJ Open. 2022 Jun 16;12(6):e058015. doi: 10.1136/bmjopen-2021-058015.

Study record dates

Study Major Dates

• Study Start (Actual): June 10, 2021
• Primary Completion (Actual): October 15, 2023
• Study Completion (Actual): October 15, 2023

Study Registration Dates

• First Submitted: May 3, 2021
• First Submitted That Met QC Criteria: May 10, 2021
• First Posted (Actual): May 14, 2021

Study Record Updates

• Last Update Posted (Actual): April 9, 2024
• Last Update Submitted That Met QC Criteria: April 8, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Physical activity; eHealth; Mobile app; Behavior change; Cost-utility; Gamification; Weight stigma
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus; Overnutrition; Nutrition Disorders; Overweight; Body Weight; Diabetes Mellitus, Type 2; Obesity
• Other Study ID Numbers: RBHP 2020 DUCLOS 2; 2020-A03091-38 (Other Identifier: ANSM)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: We will share de-identified data associated with the collected samples by depositing these data at the Open Science Framework (OSF) repository. The storage will be in Germany (Frankfurt). Data will include demographic, anthropometric, and physical measurements along with data from questionnaires and intervention adherence. We agree that we will identify where the data will be available and how to access the data in any publications and presentations that we author about these data.
• IPD Sharing Time Frame: Data will be available via a public OSF project that will be accessible by everyone. We agree to deposit outcome data into the OSF repository as soon as possible but no later than within two years after the completion of the trial or upon acceptance of the data for publication, or public disclosure of a submitted patent application, whichever is earlier.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No