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Background Physical activity (PA) is a key behaviour for patients with type 2 diabetes (T2DM). However, healthcare professionals’ (HCP) recommendations (walking advice), which are short-term and individually focused, did not reduce the PA drop-out ratio in the long run. Using a socio-ecological model approach may contribute to reducing patient dropout and improving adherence to PA. The aim of this study is threefold: first, to evaluate the effectiveness of a theory-driven Nordic walking intervention using a socio-ecological approach with T2DM patients in Spain; second, to explore the feasibility on the PA adherence process in T2DM patients while participating in the SENWI programme; and third, to understand the HCPs’ opinion regarding its applicability within the Spanish healthcare system. Methods A three-arm randomized control trial (n = 48 each group) will assess the efficacy of two primary care-based PA interventions (Nordic walking vs. Nordic walking plus socio-ecological approach; two sessions per week for twelve weeks) compared to a control group (usual HCPs’ walking advice on PA). Inclusion criteria will include physically inactive patients with T2DM, older than 40 years and without health contraindications to do PA. PA levels and drop-out ratio, quality of life and metabolic and health outcomes will be assessed at baseline, post-intervention and at 9- and 21-month follow-ups. The effect of the different interventions will be assessed by a two-factor analysis of variance: treatment group vs time. Also, a two-factor ANOVA test will be performed with linear mixed models for repeated measures. A qualitative analysis using focus groups will explore the reasons for the (in)effectiveness of the new PA interventions. Qualitative outcomes will be assessed at post-intervention using thematic analysis. Discussion Compared with the general PA walking advice and Nordic walking prescriptions, integrating a socio-ecological approach into Spanish primary care visits could be an effective way to reduce the PA drop-out ratio and increase PA levels in patients with T2DM. Such interventions are necessary to understand the role that multiple socio-complex process in day-to-day PA behaviour has in patients with T2DM in the Spanish context. Trial registration ClinicalTrials.gov NCT05159089. Physical Activity Drop-out Ratio in Patients’ Living with Type 2 Diabetes. Prospectively registered on 15 December 2021.

Planning healthier cities is essential for public health. However, there is a gap between the insights from public health research and applications to planning practice. Based on a scoping review and in cooperation with urban planners and public health professionals, this study developed evidence-based tools and a comprehensive approach to help urban planners integrate health into the urban master plan (2017–2020) of a medium-sized city named Vic (Barcelona). The scoping review included a systematic review of the literature (PubMed, PRISMA protocol) and an advanced Google search for gray literature (2015–2017). The systematic review identified significant associations between urban planning attributes (n = 16) and health outcomes (n = 21). After critical appraisal with stakeholders, an urban and health association matrix was developed to help urban planners understand the connection between urban planning and health. The advanced Google search identified urban planning actions (n = 117) that had an impact on health outcomes. After critical appraisal with stakeholders, a healthy urban planning actions checklist (n = 68) was developed to help urban planners’ decision-making on the inclusion of locally tailored health-enhancing urban planning actions into the urban master plan. From the reviewed evidence and tools, a comprehensive approach delineated a series of steps that successfully led urban planners to incorporate health-enhancing urban actions (n = 112) into the urban master plan. This translational research developed a comprehensive approach to include health in local urban planning. This might scale up to other European medium-sized cities to maximise the effectiveness of built environment interventions and monitor their health impact.

Background Although physical activity (PA) is a key behaviour for preventing and controlling diabetes (T2DM), low adoption-adherence continues to impair patient progress. Importantly, for many patients, intentional PA may have never been central to their wider cultural context. Therefore, progress in behaviour change may be more about collective than individual processes. The aim of this study was to identify barriers to undertake and maintain PA overtime and describe the relationship and the influence between these barriers in T2D patients’ real-life. Methods Twenty-two T2D patients contributed either to focus groups (n = 5) or to semi-structured interviews (n = 4). We explored adoption-adherence using an established behaviour change model (Transtheoretical) and an anthropological research method (Cultural Materialism) throughout a qualitative analysis. Results Findings suggested patients responded to PA promoted through medicalised services, using two basic, yet inter-related, social processes. To consider adopting PA a Basic Social Psychological Process was used. In contrast, patients willing to sustain PA focused on prominent ‘infrastructural’ barriers, using a Basic Social Structural Process. Conclusion This interpretation simplifies in two processes the change of behaviour related to PA. At the same time, defines the barriers’ relationship between the different levels and the influence that each level has in patients’ real-life. These insights support using phased, ecological frameworks to design and promote PA to patients with T2D, so they maintain changes over time.