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

PLoS One. 2019 Jan 10;14(1):e0208181. doi: 10.1371/journal.pone.0208181. eCollection 2019.

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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cell Phone*
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Ecological Momentary Assessment*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Goals
  • Humans
  • Male
  • Mobile Applications*
  • Patient Compliance*
  • Patient Satisfaction
  • Pilot Projects
  • Text Messaging
  • Treatment Outcome
  • Walking*

Associated data

  • ClinicalTrials.gov/NCT02089477

Grants and funding

Laura Staun Valentiner is supported by a grant from the City of Copenhagen, Denmark (www.international.kk.dk) and The Danish Physiotherapist Foundation (www.fysio.dk). Mathias Ried-Larsen is supported by a post-doctoral grant from the Danish Diabetes Academy (www.danishdiabetesacademy.dk) supported by the Novo Nordisk Foundation (www.novonordiskfonden.dk/en). CIM/CFAS is a member of DD2 - the Danish Centre for Strategic Research in Type 2 Diabetes (www.dd2.nu) (the Danish Council for Strategic Research, grant no. 09-067009 and 09-075724). Henning Langberg is supported by a professor grant from the City of Copenhagen, Denmark. The trial was supported by grants from Fonden for laegevidenskabens fremme (www.apmollerfonde.dk) and Viggo og Krista Pedersens fond (www.kv-fonden.dk). Centre for Physical Activity Research is supported by a grant from TrygFonden (www.trygfonden.dk/english). MR-L has received fees for teaching from Novo Nordisk A/S.