Health outcomes of the Dunedin Community Exercise Programme for people with type 2 diabetes and prediabetes: a single-group study

Background

Type 2 diabetes (T2D) is a concerning and increasing health problem: 257,700 people are estimated to have T2D in New Zealand (NZ); and in 2014 alone, this number grew by nearly 40 people/day [1]. A chronic, progressive disease, T2D requires ongoing healthcare management and significant resource utilisation. T2D is highly prevalent among Māori and Pacific people, and people living in low socioeconomic areas in NZ and people who find accessing appropriate, quality health care extremely challenging [2]. Multimorbidity commonly occurs alongside T2D, which can exacerbate the complexity of management and interventions [3]. Exercise combined with health education and lifestyle change is effective for successful T2D/prediabetes management. Physiotherapists are uniquely positioned in the healthcare team to provide safe and effective interventions for adults with T2D/prediabetes.

To improve access to care and positively influence health outcomes among those with T2D/prediabetes, freely available, tailored, community-based interventions are needed. The Dunedin Community Exercise Programme (DCEP) was designed with these goals in mind. DCEP is an interprofessional, evidence-based, patient-centred, whānau (family) -supported package of care specifically developed to target Māori and Pacific people and those living in low socioeconomic areas [4]. This single-group cohort study explores the health outcomes of participants enrolled in DCEP, a physiotherapist and nurse-led exercise and health education programme.

Purpose

The primary aim of this study was to assess the health-related physical fitness changes (i.e. six-minute walk distance and waist circumference) following completion of a 12-week comprehensive, community-based exercise and education programme for people with T2D/prediabetes. Secondary aims include attrition rate and adverse advents to determine the feasibility of this programme.

Methods

Participants were recruited from the community via physician referrals, word of mouth, coordination with local indigenous healthcare providers and advertisements. The 12-week DCEP included biweekly exercise and education sessions led by the physiotherapist, physiotherapy students and a nurse. Each participant was assessed at baseline by the physiotherapist and nurse to identify individual goals, preferences and physiological profile for safe, individually prescribed exercise parameters (e.g. cardiovascular fitness, muscle strength and flexibility). Participants attended two, 90-minute sessions per week. Sessions comprised of 45 min of exercise, followed by 45 min of education on health-related topics. Each exercise session included a warm-up, an aerobic and resistance exercise circuit, with a focus on the major muscle groups, and flexibility exercises. The degree of difficulty and intensity level of the exercise was prescribed on an individual basis, where comorbidities and exercise prescription protocols were considered for decision-making. Education sessions focussed on different topics to promote self-management of diabetes, such as ‘portion sizes’, ‘foot health’, ‘medication management’, ‘managing blood sugar levels’ and ‘benefits of exercise’. The sessions were created and delivered by various healthcare professionals (e.g. dietician, podiatrist, pharmacist, diabetes nurse specialist and physiotherapist). Primary outcomes included were six-minute walk distance and waist circumference at baseline and programme completion; secondary outcomes were attrition rate and adverse events.

Results

From June 2015 to May 2016, 52 participants (age 63 SD 14 years; 42% males; BMI 36 SD 8.3) with T2D and prediabetes and associated multimorbidity were enrolled. The programme successfully recruited participants from high-risk populations in and around Dunedin, New Zealand: indigenous peoples (33%) and individuals from areas of high socioeconomic deprivation (mean deprivation index 6.4, with 10 representing area of highest deprivation). Results demonstrated a significant change in six-minute walk distance (84 m (95%CI: 46–121); p = .00) and a nonsignificant change in waist circumference (p = .54). The attrition rate was 30%, but there were no adverse medical events related to the programme. Reasons for attrition included sourcing daytime employment (DCEP was held during morning working hours), family leaving the city, wound infection and transport difficulties.

Conclusions

DCEP successfully recruited people with T2D and prediabetes, in particular the populations most in need, and delivered a clinically meaningful health programme. The attrition rate was largely due to reasons unrelated to the programme. This study demonstrated that DCEP, a physiotherapist-designed, and interprofessional team led programme for adults with T2D and prediabetes, is safe, culturally accepted and feasible.

Implications

This community-based, interprofessional T2D/prediabetes programme has the potential to be replicated and implemented in other communities for adults with similar long-term conditions. Further research into the programme’s long-term health efficacy, translatability and cost-effectiveness has now commenced. Within interprofessional healthcare teams, physiotherapists have a key role to play in complex T2D and prediabetes management by providing tailored, safe and effective exercise interventions and health education to promote positive lifestyle changes.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was funded by WellSouth Primary Health Network, Dunedin, New Zealand (Funded 3 × 12-week Programmes per year for 2015 and 2016).