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Published in: Trials 1/2019

Open Access 01-12-2019 | Prediabetes | Research

Social cognitive theory-based intervention to promote physical activity among prediabetic rural people: a cluster randomized controlled trial

Authors: Tahereh Shamizadeh, Leila Jahangiry, Parvin Sarbakhsh, Koen Ponnet

Published in: Trials | Issue 1/2019

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Abstract

Background

The present randomized controlled trial (RCT) evaluated the effectiveness of a theory-based physical activity (PA) intervention for rural patients with prediabetes. It was hypothesized that a PA intervention program based on the social cognitive theory (SCT) will modify fasting blood sugar (FBS) among rural people with prediabetes, which in turn will result in a decrease in diabetes incidence in the rural area.

Methods

A cluster RCT on prediabetic people was conducted in Ahar, East Azerbaijan Province, Iran. A PA intervention in prediabetes was performed over 16 weeks of follow-ups in 12 villages (six per arm). Residents (n = 272; n = 136 per arm) were invited to participate in the study through rural health care centers during screening for eligibility. Participants in the intervention and control groups were informed of their prediabetic conditions and encouraged to make appropriate changes to their lifestyles to modify their prediabetes. The intervention was an educational program delivered over 16 weeks and involved behavioral change techniques. Through the education program, the intervention group received one session per week lasting about 90 min (a total of 16 sessions). The importance of risk control with PA, the duration of hill climbing, as well as exercise and safety tips were explained in a brochure that was given to the participants. Anthropometric measures, glycemic status, and PA were evaluated at the beginning of the program and after 16 weeks of follow-up.

Results

The PA program showed a reduction in FBS mg/dl at 16 weeks (large-effect-size Cohen’s d = −0.63, p = 0.001) compared to the control condition. PA intervention led to a large effect size on diastolic blood pressure (BP, − 1.01) and a medium effect size for systolic BP (− 0.57), body mass index (BMI, − 0.33), and weight (− 0.35). Based on generalized linear mixed model analysis, significant reductions in FBS (mg/dl), BMI, weight, and diastolic BP were found in the intervention group compared to the control group.

Conclusion

Our results support the effectiveness of an SCT-based PA intervention to reduce the risk of prediabetes developing into diabetes among rural patients with prediabetes. Findings suggest that implementation of SCT-based PA intervention for a rural population at risk of diabetes has potential benefits.

Trial registration

Iranian Registry of Clinical Trials, IRCT201607198132​N4. Registered on 1 September 2017. Prospectively registered.
Literature
1.
go back to reference Herman WH, Rothberg AE. Prevalence of diabetes in the United States: a glimmer of hope? JAMA. 2015;314:1005–7.CrossRef Herman WH, Rothberg AE. Prevalence of diabetes in the United States: a glimmer of hope? JAMA. 2015;314:1005–7.CrossRef
2.
go back to reference Esteghamati A, Etemad K, Koohpayehzadeh J, Abbasi M, Meysamie A, Noshad S, Asgari F, Mousavizadeh M, Rafei A, Khajeh E, et al. Trends in the prevalence of diabetes and impaired fasting glucose in association with obesity in Iran: 2005–2011. Diabetes Res Clin Pract. 2014;103:319–27.CrossRef Esteghamati A, Etemad K, Koohpayehzadeh J, Abbasi M, Meysamie A, Noshad S, Asgari F, Mousavizadeh M, Rafei A, Khajeh E, et al. Trends in the prevalence of diabetes and impaired fasting glucose in association with obesity in Iran: 2005–2011. Diabetes Res Clin Pract. 2014;103:319–27.CrossRef
3.
go back to reference Esteghamati A, Gouya MM, Abbasi M, Delavari A, Alikhani S, Alaedini F, Safaie A, Forouzanfar M, Gregg EW. Prevalence of diabetes and impaired fasting glucose in the adult population of Iran. National Survey of Risk Factors for Non-Communicable Diseases of Iran. Diabetes Care. 2008;31:96–8.CrossRef Esteghamati A, Gouya MM, Abbasi M, Delavari A, Alikhani S, Alaedini F, Safaie A, Forouzanfar M, Gregg EW. Prevalence of diabetes and impaired fasting glucose in the adult population of Iran. National Survey of Risk Factors for Non-Communicable Diseases of Iran. Diabetes Care. 2008;31:96–8.CrossRef
4.
go back to reference Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metrics. 2010;8:29.CrossRef Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metrics. 2010;8:29.CrossRef
5.
go back to reference Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for developing diabetes. Lancet. 2012;379:2279–90.CrossRef Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for developing diabetes. Lancet. 2012;379:2279–90.CrossRef
6.
go back to reference Tuso P. Prediabetes and lifestyle modification: time to prevent a preventable disease. Perm J. 2014;18:88–93.CrossRef Tuso P. Prediabetes and lifestyle modification: time to prevent a preventable disease. Perm J. 2014;18:88–93.CrossRef
7.
go back to reference Alfaqeeh G, Cook EJ, Randhawa G, Ali N. Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia. BMC Health Serv Res. 2017;17:106.CrossRef Alfaqeeh G, Cook EJ, Randhawa G, Ali N. Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia. BMC Health Serv Res. 2017;17:106.CrossRef
8.
go back to reference Portero McLellan KC, Wyne K, Villagomez ET, Hsueh WA. Therapeutic interventions to reduce the risk of progression from prediabetes to type 2 diabetes mellitus. Ther Clin Risk Manag. 2014;10:173–88.PubMedPubMedCentral Portero McLellan KC, Wyne K, Villagomez ET, Hsueh WA. Therapeutic interventions to reduce the risk of progression from prediabetes to type 2 diabetes mellitus. Ther Clin Risk Manag. 2014;10:173–88.PubMedPubMedCentral
9.
go back to reference Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. Physical activity and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis. Eur J Epidemiol. 2015;30:529–42.CrossRef Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. Physical activity and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis. Eur J Epidemiol. 2015;30:529–42.CrossRef
10.
go back to reference Jadhav RA, Hazari A, Monterio A, Kumar S, Maiya AG. Effect of physical activity intervention in prediabetes: a systematic review with meta-analysis. J Phys Act Health. 2017;14:745–55.CrossRef Jadhav RA, Hazari A, Monterio A, Kumar S, Maiya AG. Effect of physical activity intervention in prediabetes: a systematic review with meta-analysis. J Phys Act Health. 2017;14:745–55.CrossRef
11.
go back to reference Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52:1–26.CrossRef Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52:1–26.CrossRef
12.
go back to reference Bandura A. Social cognitive theory of self-regulation. Organ Behav Hum Decis Process. 1991;50:248–87.CrossRef Bandura A. Social cognitive theory of self-regulation. Organ Behav Hum Decis Process. 1991;50:248–87.CrossRef
13.
go back to reference Young MD, Plotnikoff RC, Collins CE, Callister R, Morgan PJ. Social cognitive theory and physical activity: a systematic review and meta-analysis. Obes Rev. 2014;15:983–95.CrossRef Young MD, Plotnikoff RC, Collins CE, Callister R, Morgan PJ. Social cognitive theory and physical activity: a systematic review and meta-analysis. Obes Rev. 2014;15:983–95.CrossRef
14.
go back to reference Gram B, Christensen R, Christiansen C, Gram J. Effects of Nordic walking and exercise in type 2 diabetes mellitus: a randomized controlled trial. Clin J Sport Med. 2010;20:355–61.PubMed Gram B, Christensen R, Christiansen C, Gram J. Effects of Nordic walking and exercise in type 2 diabetes mellitus: a randomized controlled trial. Clin J Sport Med. 2010;20:355–61.PubMed
15.
go back to reference Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95.CrossRef Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95.CrossRef
17.
go back to reference American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37:S81–90.CrossRef American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37:S81–90.CrossRef
18.
go back to reference Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign: Human Kinetics Books; 1988. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign: Human Kinetics Books; 1988.
19.
go back to reference Vasheghani-Farahani A, Tahmasbi M, Asheri H, Ashraf H, Nedjat S, Kordi R. The Persian, last 7-day, long form of the International Physical Activity Questionnaire: translation and validation study. Asian J Sports Med. 2011;2:106–16.CrossRef Vasheghani-Farahani A, Tahmasbi M, Asheri H, Ashraf H, Nedjat S, Kordi R. The Persian, last 7-day, long form of the International Physical Activity Questionnaire: translation and validation study. Asian J Sports Med. 2011;2:106–16.CrossRef
21.
go back to reference Rodgers WM, Wilson PM, Hall CR, Fraser SN, Murray TC. Evidence for a multidimensional self-efficacy for exercise scale. Res Q Exerc Sport. 2008;79:222–34.CrossRef Rodgers WM, Wilson PM, Hall CR, Fraser SN, Murray TC. Evidence for a multidimensional self-efficacy for exercise scale. Res Q Exerc Sport. 2008;79:222–34.CrossRef
22.
go back to reference Taylor LM, Raine KD, Plotnikoff RC, Vallance JK, Sharma AM, Spence JC. Understanding physical activity in individuals with prediabetes: an application of social cognitive theory. Psychol Health Med. 2016;21:254–60.CrossRef Taylor LM, Raine KD, Plotnikoff RC, Vallance JK, Sharma AM, Spence JC. Understanding physical activity in individuals with prediabetes: an application of social cognitive theory. Psychol Health Med. 2016;21:254–60.CrossRef
23.
go back to reference Waltz CF, Bausell BR. Nursing research: design statistics and computer analysis. Philadelphia: F.A. Davis; 1981. Waltz CF, Bausell BR. Nursing research: design statistics and computer analysis. Philadelphia: F.A. Davis; 1981.
24.
go back to reference Waltz CF, Strickland OL, Lenz ER. Measurement in nursing and health research. New York: Springer; 2010. Waltz CF, Strickland OL, Lenz ER. Measurement in nursing and health research. New York: Springer; 2010.
25.
go back to reference Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28:563–75.CrossRef Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28:563–75.CrossRef
26.
go back to reference Nilsen V, Bakke PS, Gallefoss F. Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial. BMC Public Health. 2011;11:893.CrossRef Nilsen V, Bakke PS, Gallefoss F. Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial. BMC Public Health. 2011;11:893.CrossRef
27.
go back to reference Fergusson D, Aaron SD, Guyatt G, Hébert P. Post-randomisation exclusions: the intention to treat principle and excluding patients from analysis. BMJ. 2002;325:652–4.CrossRef Fergusson D, Aaron SD, Guyatt G, Hébert P. Post-randomisation exclusions: the intention to treat principle and excluding patients from analysis. BMJ. 2002;325:652–4.CrossRef
28.
go back to reference Rice ME, Harris GT. Comparing effect sizes in follow-up studies: ROC Area, Cohen’s d, and r. Law Hum Behav. 2005;29:615.CrossRef Rice ME, Harris GT. Comparing effect sizes in follow-up studies: ROC Area, Cohen’s d, and r. Law Hum Behav. 2005;29:615.CrossRef
29.
go back to reference Church TS, Blair SN, Cocreham S, Johannsen N, Johnson W, Kramer K, Mikus CR, Myers V, Nauta M, Rodarte RQ, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010;304:2253–62.CrossRef Church TS, Blair SN, Cocreham S, Johannsen N, Johnson W, Kramer K, Mikus CR, Myers V, Nauta M, Rodarte RQ, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010;304:2253–62.CrossRef
30.
go back to reference Diabetes Prevention Program Research G. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.CrossRef Diabetes Prevention Program Research G. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.CrossRef
31.
go back to reference Riddell MC, Burr J. Evidence-based risk assessment and recommendations for physical activity clearance: diabetes mellitus and related comorbidities. Appl Physiol Nutr Metab. 2011;36:S154–89.CrossRef Riddell MC, Burr J. Evidence-based risk assessment and recommendations for physical activity clearance: diabetes mellitus and related comorbidities. Appl Physiol Nutr Metab. 2011;36:S154–89.CrossRef
32.
go back to reference Chen MF, Hung SL, Chen SL. Empowerment program for people with prediabetes: a randomized controlled trial. J Nurs Res. 2017;25:99–111.CrossRef Chen MF, Hung SL, Chen SL. Empowerment program for people with prediabetes: a randomized controlled trial. J Nurs Res. 2017;25:99–111.CrossRef
33.
go back to reference Anderson ES, Wojcik JR, Winett RA, Williams DM. Social-cognitive determinants of physical activity: the influence of social support, self-efficacy, outcome expectations, and self-regulation among participants in a church-based health promotion study. Health Psychol. 2006;25:510.CrossRef Anderson ES, Wojcik JR, Winett RA, Williams DM. Social-cognitive determinants of physical activity: the influence of social support, self-efficacy, outcome expectations, and self-regulation among participants in a church-based health promotion study. Health Psychol. 2006;25:510.CrossRef
34.
go back to reference McAuley E, Szabo A, Gothe N, Olson EA. Self-efficacy: implications for physical activity, function, and functional limitations in older adults. Am J Lifestyle Med. 2011;5(4):10.CrossRef McAuley E, Szabo A, Gothe N, Olson EA. Self-efficacy: implications for physical activity, function, and functional limitations in older adults. Am J Lifestyle Med. 2011;5(4):10.CrossRef
35.
go back to reference Sakane N, Sato J, Tsushita K, Tsujii S, Kotani K, Tsuzaki K, Tominaga M, Kawazu S, Sato Y, Usui T, Kamae I. Prevention of type 2 diabetes in a primary healthcare setting: three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance. BMC Public Health. 2011;11:40.CrossRef Sakane N, Sato J, Tsushita K, Tsujii S, Kotani K, Tsuzaki K, Tominaga M, Kawazu S, Sato Y, Usui T, Kamae I. Prevention of type 2 diabetes in a primary healthcare setting: three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance. BMC Public Health. 2011;11:40.CrossRef
36.
go back to reference Saaristo T, Moilanen L, Korpi-Hyövälti E, Vanhala M, Saltevo J, Niskanen L, Jokelainen J, Peltonen M, Oksa H, Tuomilehto J, Uusitupa M. Lifestyle intervention for prevention of type 2 diabetes in primary health care: one-year follow-up of the Finnish National Diabetes Prevention Program (FIN-D2D). Diabetes Care. 2010;33:2146–51.CrossRef Saaristo T, Moilanen L, Korpi-Hyövälti E, Vanhala M, Saltevo J, Niskanen L, Jokelainen J, Peltonen M, Oksa H, Tuomilehto J, Uusitupa M. Lifestyle intervention for prevention of type 2 diabetes in primary health care: one-year follow-up of the Finnish National Diabetes Prevention Program (FIN-D2D). Diabetes Care. 2010;33:2146–51.CrossRef
37.
go back to reference Vermunt PW, Milder IE, Wielaard F, De Vries JH, Van Oers HA, Westert GP. Lifestyle counseling for type 2 diabetes risk reduction in Dutch primary care: results of the APHRODITE study after 0.5 and 1.5 years. Diabetes Care. 2011;34:1919–25.CrossRef Vermunt PW, Milder IE, Wielaard F, De Vries JH, Van Oers HA, Westert GP. Lifestyle counseling for type 2 diabetes risk reduction in Dutch primary care: results of the APHRODITE study after 0.5 and 1.5 years. Diabetes Care. 2011;34:1919–25.CrossRef
38.
go back to reference Mensink M, Blaak EE, Corpeleijn E, Saris WH, De Bruin TW, Feskens EJ. Lifestyle intervention according to general recommendations improves glucose tolerance. Obes Res. 2003;11:1588–96.CrossRef Mensink M, Blaak EE, Corpeleijn E, Saris WH, De Bruin TW, Feskens EJ. Lifestyle intervention according to general recommendations improves glucose tolerance. Obes Res. 2003;11:1588–96.CrossRef
39.
go back to reference Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, Uusitupa M, Tuomilehto J. The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26:3230–6.CrossRef Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, Uusitupa M, Tuomilehto J. The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26:3230–6.CrossRef
40.
go back to reference McPhee JS, French DP, Jackson D, Nazroo J, Pendleton N, Degens H. Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology. 2016;17:567–80.CrossRef McPhee JS, French DP, Jackson D, Nazroo J, Pendleton N, Degens H. Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology. 2016;17:567–80.CrossRef
41.
go back to reference Sweet SN, Fortier MS. Improving physical activity and dietary behaviours with single or multiple health behaviour interventions? A synthesis of meta-analyses and reviews. Int J Environ Res Public Health. 2009;6:1–25. Sweet SN, Fortier MS. Improving physical activity and dietary behaviours with single or multiple health behaviour interventions? A synthesis of meta-analyses and reviews. Int J Environ Res Public Health. 2009;6:1–25.
42.
go back to reference Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour—and are they the same? Health Educ Res. 2011;26:308–22.CrossRef Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour—and are they the same? Health Educ Res. 2011;26:308–22.CrossRef
43.
go back to reference Hu Z, Qin L, Xu H. One-year results of a synthetic intervention model for the primary prevention of T2D among elderly individuals with prediabetes in rural China. Int J Environ Res Public Health. 2017;14:417.CrossRef Hu Z, Qin L, Xu H. One-year results of a synthetic intervention model for the primary prevention of T2D among elderly individuals with prediabetes in rural China. Int J Environ Res Public Health. 2017;14:417.CrossRef
44.
go back to reference Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, Lancet Physical Activity Series Working Group. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380:247–57.CrossRef Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, Lancet Physical Activity Series Working Group. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380:247–57.CrossRef
45.
go back to reference Tremblay MS, Warburton DE, Janssen I, Paterson DH, Latimer AE, Rhodes RE, Kho ME, Hicks A, LeBlanc AG, Zehr L. New Canadian physical activity guidelines. Appl Physiol Nutr Metab. 2011;36:36–46.CrossRef Tremblay MS, Warburton DE, Janssen I, Paterson DH, Latimer AE, Rhodes RE, Kho ME, Hicks A, LeBlanc AG, Zehr L. New Canadian physical activity guidelines. Appl Physiol Nutr Metab. 2011;36:36–46.CrossRef
46.
go back to reference Bean MK, Miller S, Mazzeo SE, Fries EA. Social cognitive factors associated with physical activity in elementary school girls. Am J Health Behav. 2012;36:265–74.CrossRef Bean MK, Miller S, Mazzeo SE, Fries EA. Social cognitive factors associated with physical activity in elementary school girls. Am J Health Behav. 2012;36:265–74.CrossRef
47.
go back to reference Plotnikoff RC, Lippke S, Courneya KS, Birkett N, Sigal RJ. Physical activity and social cognitive theory: a test in a population sample of adults with type 1 or type 2 diabetes. Appl Psychol. 2008;57:628–43.CrossRef Plotnikoff RC, Lippke S, Courneya KS, Birkett N, Sigal RJ. Physical activity and social cognitive theory: a test in a population sample of adults with type 1 or type 2 diabetes. Appl Psychol. 2008;57:628–43.CrossRef
48.
go back to reference Shahgholian N, KarimiFard O, Shahidi S. Effects of aerobic exercise on blood glucose in continuous ambulatory peritoneal dialysis patients. Iran J Nurs Midwifery Res. 2015;20:165–70.PubMedPubMedCentral Shahgholian N, KarimiFard O, Shahidi S. Effects of aerobic exercise on blood glucose in continuous ambulatory peritoneal dialysis patients. Iran J Nurs Midwifery Res. 2015;20:165–70.PubMedPubMedCentral
Metadata
Title
Social cognitive theory-based intervention to promote physical activity among prediabetic rural people: a cluster randomized controlled trial
Authors
Tahereh Shamizadeh
Leila Jahangiry
Parvin Sarbakhsh
Koen Ponnet
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Prediabetes
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3220-z

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