Autonomous exercise game use improves metabolic control and quality of life in type 2 diabetes patients - a randomized controlled trial

Abstract

Background: Lifestyle intervention in type 2 diabetes mellitus (T2DM) is effective but needs a special local setting and is costly. Therefore, in a randomized-controlled trial we tested the hypothesis that the autonomous use of the interactive exercise game Wii Fit Plus over a period of 12 weeks improves metabolic control, with HbA1c reduction as the primary outcome, and weight loss, reduction of cardiometabolic risk factors, physical activity and quality of life (secondary outcomes) in T2DM patients.

Methods: Participants (n = 220) were randomized into an intervention and a control group. The intervention group was provided with a Wii console, a balance board and the exercise game Wii Fit Plus for 12 weeks. The control group remained under routine care and received the items 12 weeks later. At baseline and after 12 weeks (and for the control group additionally after 12 weeks of intervention) the participants' health parameters, medication, physical activity and validated questionnaires for quality of life (PAID, SF12, WHO-5, CES-D) were requested and compared in a complete case analysis using the Mann-Whitney test and the Wilcoxon signed rank test.

Results: 80% of participants completed the 12-week study. Patients in the intervention group significantly improved HbA1c (from 7.1 ± 1.3% to 6.8 ± 0.9%; -0.3 ± 1.1%; p = 0.0002) in comparison to the control group (from 6.8 ± 0.9% to 6.7 ± 0.7%; -0.1 ± 0.5%) and also significantly reduced fasting blood glucose (from 135.8 ± 38.9 mg/dl to 126.6 ± 36.6 mg/dl; p = 0.04), weight (from 97.6 ± 19.2 kg to 96.3 ± 18.7 kg; p < 0.001) and body mass index (from 34.1 ± 6.5 kg/m2 to 33.5 ± 6.5 kg/m2; p < 0.001). Daily physical activity increased significantly (p < 0.001). Diabetes-dependent impairment, mental health, subjective wellbeing and quality of life also improved significantly, and the number of patients with depression decreased. Similar improvements were seen in the control group after exercise game intervention.

Conclusions: In this trial a low-threshold intervention with the interactive exercise game Wii Fit Plus was able to motivate T2DM patients to improve physical activity, glucometabolic control and quality of life.

Trial registration: ClinicalTrials.gov NCT01735643.

Figures

Figure 1

Flowchart of study participants.

Figure 2

Significant reduction of HbA1c during the 12-week exercise game intervention. Shown are means ± standard error of means. (A) HbA1c values have been determined at baseline and after 12 weeks in the intervention group (n = 93; white bars) and the control group (n = 83; checked bars) as well as after additional 12 weeks of intervention (n = 54). (B) Differences in HbA1c were defined as values after 12 weeks of intervention or waiting minus baseline values, and additionally for the control group, values after 12 weeks of intervention minus values after 12 weeks of waiting. Differences between groups have been estimated using the Mann–Whitney test and within groups using the Wilcoxon signed rank test; Wilcoxon signed rank test was used to determine if differences were significantly different from 0 (*, p < 0.05; **, p < 0.01; ***, p < 0.001).

Figure 3

Improvement in diabetes-dependent impairment, subjective wellbeing and quality of life during exercise game intervention. Using validated questionnaires we estimated (A) diabetes-dependent impairment (PAID), (B) mental health (SF-12), (C) subjective wellbeing (WHO-5) and (D) quality of life (ADS-L). For details see legend to Figure 1.

Figure 4

Percentage of patients with depression. Depression was self-assessed using the validated questionnaires (A) PAID, (B) WHO-5 and (C) ADS-L. Participants who reached a score >39% (PAID), ≤52% (WHO-5) and ≥40 (ADS-L) were diagnosed as depressed. The percentage of patients with depression is given by the checked part of the bar, the white part of the bar gives the percentage of participants without depression. Fisher’s exact test was used to analyze if the numbers of depressed participants differed between groups or points in time (*, p < 0.05).