Effect of ‘activity monitor-based’ counseling on physical activity and health-related outcomes in patients with chronic diseases: A systematic review and meta-analysis

Figures & data

Figure 1. Study flow diagram.

Figure 2. Funnel plot comparing interventions reporting steps/day as physical activity outcome.

Table I. Methodological quality studies.

Study	Population	1. Eligibility criteria	2. Random allocation	3. Concealed allocation	4. Similarity at baseline	5. Blinding patients	6. Blinding therapists	7. Blinding assessors	8. Outcome—85% patients	9. Treatment as allocated or intention to treat	10. Between-group comparisons	11. Point measures and measures of variability	Quality (PEDro score)
Allen (36), 2008	DMII	yes	yes	yes	yes	no	no	no	yes	yes	yes	yes	8
Araiza (31), 2006	DMII	yes	yes	no	yes	no	no	no	yes	yes	yes	yes	7
Bjorgaas (37), 2008	DMII	yes	yes	no	yes	no	no	no	no	yes	yes	yes	6
De Greef (39), 2010	DMII	yes	no	yes	yes	no	no	no	yes	yes	yes	yes	7
De Greef (32), 2011	DMII	yes	yes	yes	yes	no	no	yes	yes	yes	yes	yes	9
De Greef (40), 2011	DMII	yes	yes	no	yes	no	no	no	yes	yes	yes	yes	7
Diedrich (28), 2010	DMII	no	yes	no	yes	no	no	no	no	yes	yes	yes	5
Dyson (41), 2010	DMII	yes	yes	yes	yes	no	no	no	yes	yes	yes	no	7
Engel (42), 2006	DMII	yes	yes	no	yes	no	no	no	yes	yes	yes	yes	7
Furber (43), 2008	DMII	yes	no	no	yes	no	no	no	yes	yes	yes	yes	6
Kempny (45), 2008	DMII	yes	yes	no	yes	no	no	no	yes	yes	no	yes	6
Keyserling (33), 2002	DMII	yes	yes	yes	yes	no	no	no	no	yes	yes	yes	7
Kirk (35), 2001	DMII	no	yes	yes	yes	no	no	no	yes	yes	yes	yes	7
Kirk (34), 2004	DMII	yes	yes	yes	yes	no	no	no	yes	yes	yes	yes	8
Kirk (46), 2009	DMII	yes	yes	yes	yes	no	no	yes	yes	yes	yes	yes	9
Mitsui (51), 2008	DMII	yes	no	no	yes	no	no	no	yes	yes	yes	yes	6
Paschali (47), 2005	DMII	yes	yes	no	yes	no	no	no	yes	yes	yes	yes	7
Piette (48), 2011	DMII	yes	yes	yes	yes	no	no	no	yes	yes	yes	yes	8
Tudor-Locke (49), 2004	DMII	yes	yes	no	yes	no	no	no	no	yes	yes	yes	6
Vincent (30), 2009	DMII	yes	yes	no	no	no	no	no	yes	yes	no	no	4
Weinstock (50), 2011	DMII	yes	yes	no	yes	no	no	no	no	yes	yes	yes	6
De Blok (38), 2006	COPD	yes	yes	no	yes	no	no	yes	no	yes	yes	yes	7
Hospes (44), 2009	COPD	yes	yes	no	yes	no	no	no	yes	yes	yes	yes	7
Steele (29), 2008	COPD	yes	yes	no	no	no	no	no	no	yes	yes	yes	5

Table II. Characteristics studies including patients with DMII.

Study	Population	Drop out rate (%)	Intervention	Instrument	Outcome parameters
Allen (36), 2008	DMII Total (n = 52): 57.0 (13.5) yrs; 48% male	12	8 weeks	ActiGraph 7 days at baseline and 7 days at week 7	PA: - PA level (frequency, intensity) - PA self-efficacy Health-related outcomes: - HbA1c - BMI - Blood pressure
	I (n = 27): 57 (14.6) yrs; 44% male	22	I: activity monitor and Continuous Glucose Monitoring System; 90 min of individualized education including topics of the control intervention and Continuous Glucose Monitoring System counseling; recommended to walk 30 min most days of the week
	C (n = 25): 57 (12.5) yrs; 52% male	0	C: 90 min of individualized education on diabetes, diet strategies, glucose testing, risk reduction, foot care, and a brief review of a PA brochure
Araiza (31), 2006	DMII Total (n = 30)	0	6 weeks	Yamax DigiWalker SW 701 No information on pedometer use	PA: - Steps/day Health-related outcomes: - BMI - Blood pressure
	I (n = 15): 49 (11.0) yrs	0	I: instructed to walk 10,000 steps on 5 or more days of the week
	C (n = 15): 51 (10.0) yrs	0	C: instructed to maintain normal activity habits
Bjorgaas (37), 2008	DMII Total (n = 48)	31	6 months; 4 visits	Yamax DigiWalker ML AW-320 No information on pedometer use	PA: - Steps/day Health-related outcomes: - HbA1c - BMI - Blood pressure
	I (n = 23): 56.4 (11.0) yrs; 61% male	34	I: pedometer 3 weekdays twice per month; log-book was kept of all major PAs; encouraged to increase their daily step count from one visit to the next
	C (n = 25): 61.2 (9.7) yrs; 68% male	29	C: encouraged to increase daily time spent walking guided by the log-book with PAs
De Greef (39), 2010	DMII Total (n = 41): 68% male	10	12 weeks	Yamax DigiWalker SW-200 Actigraph 7164 5 consecutive days (during waking hours), including at least one weekend day, before and after intervention	PA: - Steps/day - Intensity Health-related outcomes: - HbA1c - BMI - Blood pressure
	I (n = 20): 61.3 yrs; 65% male	10	I: cognitive-behavioral group program (5 sessions) combined with pedometer; at each session PA progress was reviewed and new goals were set
	C (n = 21): 61.3 yrs; 71% male	10	C: usual care and one single group education on the effects of PA on diabetes care
De Greef (32), 2011	DMII Total (n = 92): 62 (9.0) yrs; 69% male	4	24 weeks	Yamax DigiWalker SW-200 7 consecutive days (during waking hours) before and after intervention	PA: - Steps/day - Intensity
	I (n = 60)	3	I: face-to-face session; pedometer and diary; 24-week telephone support (7 follow-ups); encourage to increase PA
	C (n = 32)		C: usual care
De Greef (40), 2011	DMII Total (n = 67); 70.1% male	6	12 weeks	Yamax DigiWalker SW-200 7 consecutive days (during waking hours) before and after intervention	PA: - Steps/day - Intensity Health-related outcomes: - HbA1c - BMI
	I1 (n = 22): 66.6 (9.5) yrs	5	I1: pedometer and diary to be used as motivational tools in PA goal setting; 3 × 90 min group counseling sessions with a behavioral expert to increase knowledge on PA and change PA behavior
	I2 (n = 21): 70.0 (6.3) yrs	5	I2: pedometer and diary to be used as motivational tools in PA goal-setting; 3 × 15 min face-to-face consultations with a general practitioner on pedometer use, goal-setting, and relapse prevention
	C (n = 24): 66.0 (11.0) yrs	5	C: usual care from general practitioner
Diedrich (28), 2010	DMII Total (n = 33)	4	3 months	Yamax DigiWalker SW-200 No information on pedometer use	PA: - Steps/day Health-related outcomes: - HbA1c - Weight, body fat - Blood pressure
	I (n = 16): 56.7 (13.6) yrs	38	I: Diabetes Self-Management Education Program; Manpo-Kei book; asked to measure walking activity and record pedometer readings according to instructions in book; encouraged to increase PA
	C (n = 17): 54.9 (9.8) yrs	41	C: Diabetes Self-Management Education Program
Dyson (41), 2010	DMII Total (n = 42): 60.8 (9.6) yrs; 43% male	35	6 months	Omron No information on pedometer use	PA: - Steps/day Health-related outcomes: - HbA1c - BMI - Blood pressure - Quality of life (WHO-5)
	I (n = 21): 62.9 (9.5) yrs; 38% male	7	I: usual medical care from primary care physician; education about lifestyle management; pedometer; 3 lifestyle videos
	C (n = 21): 58.6 (9.2) yrs; 48% male	0	C: usual care; education from nurse
Engel (42), 2006	DMII Total (n = 54)	14	6 months	Yamax DigiWalker 700 No information on pedometer use	PA: - Time spent walking Health-related outcomes: - HbA1c - BMI - Blood pressure
	I (n = 24): 60.5 (7.34) yrs; 54% male	12	I: pedometer; 6 coaching sessions including diabetes-related education, behavior-change strategies, and psychosocial support; goals based on steps per day (between 3500 and 5500 steps per day)
	C (n = 30): 64 (6.76) yrs; 50% male	NR	C: coaching only; goals based on time spent walking per day
Furber (43), 2008	DMII Total (n = 226)	NR	20 weeks	Yamax DigiWalker No information on pedometer use	PA: - Time spent walking - Intensity
	I (n = 121): 58.3 (12.6) yrs; 54% male	12	I: pedometer and step diary; education on PA; encouraged to set PA goals (increase recorded steps per day or a time-based target)
	C (n = 105): 61.6 (12.3) yrs; 51% male	NR	C: education on PA; encouraged to undertake at least 30 min of moderate-intensity activity on all or most days of the week
Kempny (45), 2008	DMII Total (n = 30)	NR	5 weeks	Omron HJ113 No information on pedometer use	PA: - MET*min/week Health-related outcomes: - BMI - Blood pressure
	I (n = 16): 57.7 (4.8) yrs; 44% male	6	I: oral advice to increase PA; pedometer; instructed to achieve 10,000 steps per day
	C (n = 14): 56.4 (4.9); 36% male	NR	C: oral advice to increase PA; encouraged to enhance PA level, informed to increase time spent walking
Keyserling (33), 2002	DMII Total (n = 200): 59.0 yrs	NR	12 months	Caltrac 1 week (during waking hours) before and after intervention	PA: - Energy expenditure Health-related outcomes: - HbA1c - Weight - Quality of life (Mental and Social Well-Being Scale)
	I1 (n = 67): 58.5 yrs	15	I1: clinic- and community-based intervention on PA, dietary and diabetes care; increase moderate-intensity PA to a cumulative of 30 min a day
	I2 (n = 66): 59.8 yrs	19	I2: clinic-based intervention on PA, dietary and diabetes care; increase moderate-intensity PA to a cumulative of 30 min a day
	C (n = 67): 59.2 yrs	11	C: diabetes education via the post
Kirk (35), 2001	DMII Total (n = 23): 48.6 (8.5) yrs	13	5 weeks	CSA monitor 7 days (during waking hours) before and after intervention	PA: - Counts - Steps/day Health-related outcomes: - Quality of life (SF-36)
	I (n = 11)	8	I: exercise consultation; standard exercise information; encouraged to accumulate 30 min of moderate-intensity PA most days of the week or to build in 30 min of vigorous exercise 3 or more days a week
	C (n = 12)	8	C: standard exercise information
Kirk (34), 2004	DMII Total (n = 70): 57.6 (7.9) yrs; 50% male	8	12 months	CSA monitor 7 days (during waking hours) before and after intervention	PA: - Counts Health-related outcomes: - HbA1c
	I (n = 35)	15	I: counseling on improving PA and preventing relapse; standard exercise leaflet; encouraged to accumulate 30 min of moderate-intensity PA on most days of the week or to build in 30 min of vigorous exercise 3 or more days a week
	C (n = 35)	14	C: standard exercise leaflet
Kirk (46), 2009	DMII Total (n = 134)	17	12 months	ActiGraph 7 days (during waking hours) before and after intervention	PA: - Counts - Steps/day Health-related outcomes: - HbA1c - BMI - Blood pressure
	I1 (n = 47): 60.9 (9.6) yrs; 53.2% male	13	I1: physical activity pack in written form; 30 min consultation with a trained researcher; encouraged to make a PA plan, which was discussed during follow-up phone calls after 1 and 3 months and 6 months visit
	I2 (n = 52): 63.2 (10.6) yrs; 42.3% male	11	I2: physical activity pack given in written form; encouraged to make a PA plan, which was discussed during follow-up phone calls after 1 and 3 months and 6 months visit
	C (n = 35): 59.2 (10.4) yrs; 51.4% male	17	C: usual care
Mitsui (51), 2008	DMII Total (n = 23)	11	12 weeks	EM-180 No information on pedometer use	PA: - Steps/day Health-related outcomes: - HbA1c - BMI - Blood pressure
	I (n = 13): 64.4 (7.7) yrs; 23% male	9	I: pedometer program; goal to walk at least 30 min, 5 days/week for 12 weeks
	C (n = 10): 61.8 (8.3) yrs; 20% male	15	C: usual care
Paschali (47), 2005	DMII Total (n = 26)	0	3 months	BioTrainer No information on pedometer use	PA: - Activity units
	I (n = 13): 48.8 (6.1) yrs; 47% male	13	I: accelerometer with feedback; individual counseling sessions; instructed to formulate and improve goals each month based on accelerometer data
	C (n = 13): 47.0 (7.2) yrs; 47% male	13	C: accelerometer with no feedback; counseling based on self-report diaries
Piette (48), 2011	DMII Total (n = 291): 56.0 (10.1) yrs; 48.5% male	13	12 months	Omron-HJ-720ITC 7 consecutive days (during waking hours) before and after intervention	PA: - Steps/day Health-related outcomes: - HbA1c - Blood pressure - Quality of life (SF-12)
	I (n = 145); 55.1 (9.4) yrs; 49% male	14	I: 12 month telephone-delivered cognitive behavioral therapy program; pedometer-based walking program; monitor progress toward step-count goals
	C (n = 146): 56.0 (10.9) yrs; 50% male	16	C: copy of the Feeling Good Handbook—a self-help book based on cognitive behavioral therapy for depression
Tudor-Locke (49), 2004	DMII Total (n = 38): 52.7 (5.2) yrs; 63% male	13	16 weeks	Yamax SW-200 3 consecutive days (during waking hours), including one weekend day, before and after intervention	PA: - Steps/day Health-related outcomes: - HbA1c - Weight - Blood pressure
	I (n = 16): 52.8 (5.7) yrs; 50% male	22	I: 16 week behavior modification program; pedometer; Weeks 1–4: program manual containing goal-setting and problem-solving exercises, calendars, weekly group meetings; Weeks 5–16: independently continue pedometers use and calendars
	C (n = 22): 52.5 (4.8) yrs; 61% male	23	C: usual care
Vincent (30), 2009	DMII Total (n = 17): 56 (9.3) yrs; 29% male	20	8 weeks	Colorado on the Move, Accusplit No information on pedometer use	PA: - Steps/day Health-related outcomes: - HbA1c - BMI
	I (n = 9): 56.7 (10.6) yrs; 11% male	15	I: 8 weekly 2-hour group sessions including education on diabetes and exercise; record number of steps each day
	C (n = 8): 55.3 (8.2) yrs; 50% male	10	C: usual care and education given at the clinic
Weinstock (50), 2011	DMII Total (n = 1650)	20	5 years	NR No information on pedometer use	PA: - Days/week following exercise program) Health-related outcomes: - HbA1c - BMI - Blood pressure - Quality of life (SF-12)
	I (n = 837): 70.8 (6.5) yrs; 36.4% male	NR	I: telemedicine and pedometer; home video visits with a diabetes educator every 4–6 weeks; encourage to increase PA (common goal: to increase steps per day by 10%, or to maintain number of steps)
	C (n = 813): 70.9 (6.8) yrs; 37.9% male	NR	C: usual care; pedometer

I = intervention; C = control; yrs = years; min = minutes; PA = physical activity; NR = not reported.

Table III. Characteristics studies including patients with COPD.

Study	Population	Drop out rate (%)	Intervention	Instrument	Outcome parameters
De Blok (38), 2006	COPD Total (n = 21): 43% male	24	10 weeks	Yamax DigiWalker SW-200 1 week prior to rehabilitation and 1 week during week 9 (during waking hours)	PA: - Steps/day Health-related outcomes: - Quality of life (SGRQ)
	I (n = 10): 65.7 (10.4) yrs; 50% male; FEV1 43 (13) %pred	20	I: regular pulmonary rehabilitation program; lifestyle PA counseling program (4 sessions); stimulated to increase PA using pedometer as motivational and feedback tool
	C (n = 11): 62.5 (12.3) yrs; 36% male; FEV1 52 (22) %pred	27	C: regular pulmonary rehabilitation program
Hospes (44), 2009	COPD Total (n = 35)	10	12 weeks	DigiWalker SW-200 2 weeks at baseline and after intervention	PA: - Steps/day Health-related outcomes: - Quality of life (SGRQ, CCQ, SF-36)
	I (n = 18): 63.1 (8.3); 56% male; FEV1 67.4 (17.5) %pred	10	I: customized exercise counseling program (5 sessions) to enhance daily PA and to develop a more physically active lifestyle; feedback of pedometer
	C (n = 17): 61.2 (9.1) yrs; 65% male; FEV1 61.8 (14.4) %pred	11	C: usual care
Steele (29), 2008	COPD Total (n = 89)	20	12 weeks All patients participated in a 8-week pulmonary rehabilitation program that included exercise and education before intervention	RT3 6 days before and after intervention	PA: - Accelerometer activity - Exercise capacity (6-min walking distance) Health-related outcomes: - Quality of life (SF-36)
	I (n = 42)	22	I: weeks 1–4: home- and community-based exercise program with emphasis on walking; weeks 5–12: implementing a regular program of exercise, at least 20 min, 4 days/week; weekly phone calls and 1 home visit over 3 months; self-monitoring PA using pedometer
	C (n = 47)	18	C: no information

I = intervention; C = control; yrs = years; min = minutes; PA = physical activity; FEV1 = forced expiratory volume in 1 second.

Figure 3. Effects of activity monitor-based counseling on physical activity and generic and disease-specific health-related outcomes in adults with DMII. A: Effect of activity monitor-based interventions versus control on physical activity (steps/day) in patients with DMII; B: Effect of activity monitor-based interventions versus control on HbA1c in patients with DMII; C: Effect of activity monitor-based interventions versus control on BMI in patients with DMII; D: Effect of activity monitor-based interventions versus control on systolic blood pressure in patients with DMII; E: Effect of activity monitor-based interventions versus control on diastolic blood pressure in patients with DMII.

Allen NA, Fain JA, Braun B, Chipkin SR. Continuous glucose monitoring counseling improves physical activity behaviors of individuals with type 2 diabetes: a randomized clinical trial. Diabetes Res Clin Pract. 2008;80:371–9.

 PubMed Web of Science ®Google Scholar

Araiza P, Hewes H, Gashetewa C, Vella CA, Burge MR. Efficacy of a pedometer-based physical activity program on parameters of diabetes control in type 2 diabetes mellitus. Metabolism. 2006; 55:1382–7.

 PubMedGoogle Scholar

Bjorgaas MR, Vik JT, Stolen T, Lydersen S, Grill V. Regular use of pedometer does not enhance beneficial outcomes in a physical activity intervention study in type 2 diabetes mellitus. Metabolism. 2008;57:605–11.

 PubMed Web of Science ®Google Scholar

De Greef K, Deforche B, Tudor-Locke C, De Bourdeaudhuij I. A cognitive-behavioural pedometer-based group intervention on physical activity and sedentary behaviour in individuals with type 2 diabetes. Health Educ Res. 2010;25:724–36.

 PubMed Web of Science ®Google Scholar

De Greef KP, Deforche BI, Ruige JB, Bouckaert JJ, Tudor-Locke CE, Kaufman JM, et al. The effects of a pedometer-based behavioral modification program with telephone support on physical activity and sedentary behavior in type 2 diabetes patients. Patient Educ Couns. 2011;84:275–9.

 PubMedGoogle Scholar

De Greef K, Deforche B, Tudor-Locke C, De Bourdeaudhuij I. Increasing physical activity in Belgian type 2 diabetes patients: a three-arm randomized controlled trial. Int J Behav Med. 2011;18:188–98.

 PubMedGoogle Scholar

Diedrich A, Munroe DJ, Romano M. Promoting physical activity for persons with diabetes. Diabetes Educ. 2010;36:132–40.

 PubMedGoogle Scholar

Dyson PA, Beatty S, Matthews DR. An assessment of lifestyle video education for people newly diagnosed with type 2 diabetes. J Hum Nutr Diet. 2010;23:353–9.

 PubMed Web of Science ®Google Scholar

Engel L, Lindner H. Impact of using a pedometer on time spent walking in older adults with type 2 diabetes. Diabetes Educ. 2006;32: 98–107.

 PubMedGoogle Scholar

Furber S, Monger C, Franco L, Mayne D, Jones LA, Laws R, et al. The effectiveness of a brief intervention using a pedometer and step-recording diary in promoting physical activity in people diagnosed with type 2 diabetes or impaired glucose tolerance. Health Promot J Austr. 2008;19:189–95.

 PubMedGoogle Scholar

Kempny A, Moczulski D, Kempny A. [Pedometer improves doctor's advice to enhance physical activity in type 2 diabetes]. Diabetologia Doswiadczalna i Klinicza. 2008;8:33–7.

 Google Scholar

Keyserling TC, Samuel-Hodge CD, Ammerman AS, Ainsworth BE, Henriquez-Roldan CF, Elasy TA, et al. A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity. Diabetes Care. 2002;25:1576–83.

 PubMed Web of Science ®Google Scholar

Kirk AF, Higgins LA, Hughes AR, Fisher BM, Mutrie N, Hillis S, et al. A randomized, controlled trial to study the effect of exercise consultation on the promotion of physical activity in people with type 2 diabetes: a pilot study. Diabet Med. 2001;18:877–82.

 PubMedGoogle Scholar

Kirk A, Mutrie N, MacIntyre P, Fisher M. Effects of a 12-month physical activity counselling intervention on glycaemic control and on the status of cardiovascular risk factors in people with type 2 diabetes. Diabetologia. 2004;47:821–32.

 PubMed Web of Science ®Google Scholar

Kirk A, Barnett J, Leese G, Mutrie N. A randomized trial investigating the 12-month changes in physical activity and health outcomes following a physical activity consultation delivered by a person or in written form in Type 2 diabetes: Time2Act. Diabet Med. 2009;26:293–301.

 PubMed Web of Science ®Google Scholar

Mitsui T, Shimaoka K, Kobayashi T.. [Examining a 30-minute walking program using a pedometer in the management of type 2 diabetes]. Gazzetta Medica Italiana Archivio per le Scienze Mediche. 2008; 167:293–8.

 Google Scholar

Paschali AA, Goodrick GK, Kalantzi-Azizi A, Papadatou D, Balasubramanyam A. Accelerometer feedback to promote physical activity in adults with type 2 diabetes: a pilot study. Percept Mot Skills. 2005;100:61–8.

 PubMedGoogle Scholar

Piette JD, Richardson C, Himle J, Duffy S, Torres T, Vogel M, et al. A randomized trial of telephonic counseling plus walking for depressed diabetes patients. Med Care. 2011;49:641–8.

 PubMed Web of Science ®Google Scholar

Tudor-Locke C, Bell RC, Myers AM, Harris SB, Ecclestone NA, Lauzon N, et al. Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes. Int J Obes Relat Metab Disord. 2004;28:113–9.

 PubMed Web of Science ®Google Scholar

Vincent D. Culturally tailored education to promote lifestyle change in Mexican Americans with type 2 diabetes. J Am Acad Nurse Pract. 2009;21:520–7.

 PubMed Web of Science ®Google Scholar

Weinstock RS, Brooks G, Palmas W, Morin PC, Teresi JA, Eimicke JP, et al. Lessened decline in physical activity and impairment of older adults with diabetes with telemedicine and pedometer use: results from the IDEATel study. Age Ageing. 2011;40:98–105.

 PubMedGoogle Scholar

de Blok BM, de Greef MH, ten Hacken NH, Sprenger SR, Postema K, Wempe JB. The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study. Patient Educ Couns. 2006;61: 48–55.

 PubMed Web of Science ®Google Scholar

Hospes G, Bossenbroek L, Ten Hacken NH, van Hengel P, de Greef MH. Enhancement of daily physical activity increases physical fitness of outclinic COPD patients: results of an exercise counseling program. Patient Educ Couns. 2009;75:274–8.

 PubMed Web of Science ®Google Scholar

Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J, et al. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease. Arch Phys Med Rehabil. 2008;89:404–12.

 PubMed Web of Science ®Google Scholar

Oerkild B, Frederiksen M, Hansen JF, Prescott E. Self-reported physical inactivity predicts survival after hospitalization for heart disease. Eur J Cardiovasc Prev Rehabil. 2011;18:475–80.

 PubMedGoogle Scholar

Eckert K. Impact of physical activity and bodyweight on health-related quality of life in people with type 2 diabetes. Diabetes Metab Syndr Obes. 2012;5:303–11.

 PubMedGoogle Scholar