Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension

Abstract

AimsThere are few proven strategies to enhance physical activity and cardiometabolic profiles in patients with type 2 diabetes and hypertension. We examined the effects of physician‐delivered step count prescriptions and monitoring.MethodsParticipants randomized to the active arm were provided with pedometers and they recorded step counts. Over a 1‐year period, their physicians reviewed their records and provided a written step count prescription at each clinic visit. The overall goal was a 3000 steps/day increase over 1 year (individualized rate of increase). Control arm participants were advised to engage in physical activity 30 to 60 min/day. We evaluated effects on step counts, carotid femoral pulse wave velocity (cfPWV, primary) and other cardiometabolic indicators including haemoglobin A1c in diabetes (henceforth abbreviated as A1c) and Homeostasis Model Assessment‐Insulin Resistance (HOMA‐IR) in participants not receiving insulin therapy.ResultsA total of 79% completed final evaluations (275/347; mean age, 60 years; SD, 11). Over 66% of participants had type 2 diabetes and over 90% had hypertension. There was a net 20% increase in steps/day in active vs control arm participants (1190; 95% CI, 550‐1840). Changes in cfPWV were inconclusive; active vs control arm participants with type 2 diabetes experienced a decrease in A1c (−0.38%; 95% CI, −0.69 to −0.06). HOMA‐IR also declined in the active arm vs the control arm (ie, assessed in all participants not treated with insulin; −0.96; 95% CI, −1.72 to −0.21).ConclusionsA simple physician‐delivered step count prescription strategy incorporated into routine clinical practice led to a net 20% increase in step counts; however, this was below the 3000 steps/day targeted increment. While conclusive effects on cfPWV were not observed, there were improvements in both A1c and insulin sensitivity. Future studies will evaluate an amplified intervention to increase impact.

Process Evaluation of the Sophia Step Study-A Primary Care Based Three-Armed Randomized Controlled Trial Using Self-Monitoring of Steps With and Without Counseling in Prediabetes and Type 2 Diabetes

“…A majority of the participants were recruited from urban centers, a fact that reduces the external validity of the feasibility. Many of the participants in this study were rather active at baseline (mean steps 6566 steps/day) which is in congruence with previous studies in type 2 diabetes (28)(29)(30) and pointing to the fact that that behavioral interventions reach individuals with high disease engagement or already healthy lifestyles, rather than those in most need.…”

“…This study demonstrates that self-monitoring of steps both with and without counseling are feasible methods to implement in the primary care setting to increase and maintain daily steps in individuals with prediabetes and type 2 diabetes. The response rate (49%) is comparable to similar interventions and is probably a realistic number to reach with a behavior change program (27)(28)(29). Both genders were equally represented in this study, and every other participant had university education, which is in line with the Swedish general population.…”

Physical Activity and Diabetes

“…In a randomized controlled trial examining the effect of a pedometer-based prescription in people with type 2 diabetes, the change in A1C at the end of the 1-year step count prescription intervention was 0.38% lower in the active arm compared to the control arm (140). Active arm participants reviewed step count logs with their physicians at each clinic visit over a 1-year period, set step targets and received a written step count prescription.…”

Adding Team-Based Financial Incentives to the Carrot Rewards App Increases Daily Step Count on a Population Scale: A 24-Week Matched Pairs Study

“…lower A1C) in individuals living with type 2 diabetes. 15,48 Higher step counts in general are also associated with improved mood and overall health ratings, and are inversely related to systolic blood pressure. 15,49 From a public health perspective, a 1% reduction in the number of Canadians classi ed as "physically inactive" (fewer than 5,000 daily steps) would yield annual healthcare savings of $2.1 billion CAD.…”