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Title: Facilitating Access and Adherence to Exercise in People with Type 2 Diabetes
Author: Armstrong, Marni
Advisor: Sigal, Ronald
Keywords: Health Sciences
Issue Date: 3-Feb-2015
Abstract: Exercise is a key component in the management of type 2 diabetes. It improves blood glucose control and quality of life, and reduces cardiovascular events and mortality. Despite the strong evidence demonstrating protective effects of exercise in type 2 diabetes, much of this population remains inactive, and many of those who begin an exercise program do not continue long-term. Finding strategies to support the adoption and long-term adherence to exercise is a valuable endeavor. The aim of this thesis was to examine the effectiveness of motivational interviewing, a potential facilitator to behaviour change and maintenance, together with an examination of pre-exercise stress testing which has been identified as a plausible barrier to supervised exercise programs. This was accomplished through a variety of methods within three distinct studies. These included a systematic review and meta-analysis of motivational interviewing in weight loss interventions, a randomized controlled trial on the effectiveness of motivational interviewing-based counselling to promote maintenance of exercise after the completion of a supervised exercise program, and finally a data linkage study examining the utility of pre-exercise stress testing within a retrospective cohort from a real-world supervised exercise program. The results of the first two studies gave support to use of motivational interviewing as a strategy to improve the effectiveness of weight loss interventions and as an approach to help promote the maintenance of physical activity after a supervised exercise program. In the examination of the use of pre-exercise stress testing, we discovered that the rate of cardiovascular outcomes was low, and that in the few cases where referral for pre-exercise stress testing resulted in a change in care, the patients had multiple cardiac risk factors. These results suggest that improved pre-exercise risk stratification might help identify the small subset of patients with type 2 diabetes likely to benefit from pre-exercise stress testing, thereby streamlining the process prior to the initiation of a supervised exercise program. Within supervised exercise programs, implementing strategies that employ effective facilitators, as well as reduce barriers such as unnecessary testing, may help improve participation and long-term adherence to exercise in people with type 2 diabetes.
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