Effect of ecological momentary assessment, goal-setting and personalized phone-calls on adherence to interval walking training using the InterWalk application among patients with type 2 diabetes-A pilot randomized controlled trial

Laura Staun Valentiner, Ida Kær Thorsen, Malte Bue Kongstad, Cecilie Fau Brinkløv, Rasmus Tolstrup Larsen, Kristian Karstoft, Jens Steen Nielsen, Bente Klarlund Pedersen, Henning Langberg, Mathias Ried-Larsen, Laura Staun Valentiner, Ida Kær Thorsen, Malte Bue Kongstad, Cecilie Fau Brinkløv, Rasmus Tolstrup Larsen, Kristian Karstoft, Jens Steen Nielsen, Bente Klarlund Pedersen, Henning Langberg, Mathias Ried-Larsen

Abstract

Objectives: The objective was to investigate the feasibility and usability of electronic momentary assessment, goal-setting and personalized phone-calls on adherence to a 12-week self-conducted interval walking training (IWT) program, delivered by the InterWalk smartphone among patients with type 2 diabetes (T2D).

Methods: In a two-arm pilot randomized controlled trial (Denmark, March 2014 to February 2015), patients with T2D (18-80 years with a Body Mass Index of 18 and 40 kg/m2) were randomly allocated to 12 weeks of IWT with (experimental) or without additional support (control). The primary outcome was the difference between groups in accumulated time of interval walking training across 12 weeks. All patients were encouraged to use the InterWalk application to perform IWT for ≥90 minute/week. Patients in the experimental group made individual goals regarding lifestyle change. Once a week inquiries about exercise adherence was made using an ecological momentary assessment (EMA). In case of consistent self-reported non-adherence, the patients would receive a phone-call inquiring about the reason for non-adherence. The control group did not receive additional support. Information about training adherence was assessed objectively. Usability of the EMA was assessed based on response rates and self-reported satisfaction after 12-weeks.

Results: Thirty-seven patients with T2D (66 years, 65% female, hemoglobin 1Ac 50.3 mmol/mol) where included (n = 18 and n = 19 in experimental and control group, respectively). The retention rate was 83%. The experimental group accumulated [95%CI] 345 [-7, 698] minutes of IWT more than the control group. The response rate for the text-messages was 83% (68% for males and 90% for females). Forty-one percent of the experimental and 25% of the control group were very satisfied with their participation.

Conclusion: The combination inquiry about adherence using EMA, goal-setting with the possibility of follow-up phone calls are considered feasible interventions to attain training adherence when using the InterWalk app during a 12-week period in patients with T2D. Some uncertainty about the effect size of adherence remains.

Trial registration: Clinicaltrials.gov NCT02089477.

Conflict of interest statement

The authors declare that no competing financial interest exists.

Figures

Fig 1. Flow chart.
Fig 1. Flow chart.
Pilot trial with randomization.
Fig 2. Timeline and overview of the…
Fig 2. Timeline and overview of the interventions in the pilot trial.
*1-week revisit: both the experimental and the control group had a 1-week revisit to ensure that they understood how to use the InterWalk app.
Fig 3. Weekly ecological momentary assessments (EMA’s)…
Fig 3. Weekly ecological momentary assessments (EMA’s) regarding frequency of training during the past week (all text has been translated from Danish to English language).
Fig 4. Prompts send every fourth week…
Fig 4. Prompts send every fourth week regarding the IWFT (the standardized walking test in the InterWalk application) (all text has been translated from Danish to English language).
Fig 5. Accumulated minutes of interval walking…
Fig 5. Accumulated minutes of interval walking training across 12-weeks by group.
Data are means with standard error.
Fig 6. Weekly interval walking training minutes…
Fig 6. Weekly interval walking training minutes during week 1 through 12 of follow-up for the intention-to-treat population.
Closed circles represent the experimental group and open triangles are the control group. Data are means and error bars represent standard error. IWT denotes Interval walking training.

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