Embed Size (px)
Citation preview
Using an adaptive coaching system to improve outcomes during a free living training programme in T2DM
Insight student conference October 2015
Hugh Byrne BSc., MSc.UCD
2
Content
• My background• What is T2DM?• Exercise in T2DM• Rationale behind the use of a step training programme• Rationale behind the use of an adaptive coaching system• Outline of a proposed intervention study
Background
• 1st year PhD student in Insight Centre for data analytics, UCD• Physiotherapist
– Interested in improving health related outcomes and the day to day quality of life of patients
• Research is initially aimed at improving adherence to exercise in T2DM in a free-living setting (independently)
4
5
Type 2 Diabetes Mellitus
• T1DM & T2DM- 171 million adults worldwide - estimated to rise to 366 million by 2030.
• Part of a group of metabolic disorders characterised by increased levels of glucose (sugar) in the bloodstream caused by failings in insulin secretion, insulin action or both.
• T2DM has traditionally been associated with obesity and low levels of physical activity. – Increase in sedentary lifestyles and poor dietary habits has
seen rates increase dramatically in recent times– Exercise along with dietary and pharmacological
interventions are fundamental for successful management. – Aim to prevent or slow the progression of the disease and
the complications associated with it.
6
Exercise in T2DM
• Adherence to exercise has been traditionally poor in the population – lifestyle related disease.
• Majority of exercise related research to date - conducted in a laboratory or hospital setting. – useful in identifying the exact effects of exercise in the
condition at a cellular level, but not reflective of daily habits and drain health care resources.
• Patients should be able to manage condition including their exercise regimen in a free living setting – minimal regular contact between patients and
practitioners and requires the patients to alter their lifestyles and manage the disease independently.
7
Is Free Living Exercise in T2DM effective?
• Beneficial for measures of metabolism, body composition and functional capacity
• Improves lifestyle (habitual behaviours away from the exercise sessions) and quality of life of participants when adhered to – Byrne et al., Systematic review- waiting publication
• Adherence to exercise still remains low away from research in the population – Further motivation needed to increase and maintain
adherence– Patients should make concrete plans and identify
strategies to overcome barriers.
8
Step training programmes
• An inexpensive exercise that can be carried out independently by patients, in various locations throughout the day
• Only equipment required is a step – a bottom step of a stairs could be used if required
• Previously been shown to improve functional, cardiorespiratory, and body composition outcomes in non-diabetics.
• Efficacy in type 2 diabetics not assessed to date.
9
Previous step training programmes conducted in UCD
10
Proposed exercise programme
• Initially similar to the above programme - an average of 21 minutes high intensity step training per week over 4 weeks.
• Then progress gradually to 3 longer bouts of 10 minutes maintaining a high intensity
• 3x10 minutes/day of home based cycling previously yielded a 98% completion rate of prescribed sessions over 4-5 weeks in a research setting– 3 shorter bouts also appear to be more beneficial for
measures of metabolism than 1 longer bout of equal aggregate length - ↑ EPOC
• However, adherence may drop over the course of time due to the costs associated with it and its inaccessibility – step training more accessible and cheaper.
11
12
The adaptive coaching system
• Adaptive coaching systems have improved adherence to exercise and meditation programmes in other populations.
• Provide motivation to participants based on theories of behavioural change including goal-setting theory and self efficacy theory – “best of both worlds”.
13
The adaptive coaching system
• The smart-phone app will set goals that will gradually progress in difficulty & will vary depending on the success of the participant in completing the previous exercise sessions prescribed in order to increase and maintain adherence.– The adaptive sweet spot - not too easy and not too difficult
• If the participant does not succeed in completing a session, the app will prescribe an easier next exercise session and vice versa until they reach the 3x10 minute target.
• The app will remotely monitor the participants’ adherence to exercise and provide motivational prompts to the patient that will differ depending on the successful completion of prescribed exercise
14
The planned trial• A 16 week RCT comparing the effects of the step training
programme, the step training programme combined with the adaptive coaching system and a control group.
• Participants: previously sedentary & confirmed diagnosis of T2DM and no co-morbidities or contra-indications to exercise.
• Adherence to the exercise programmes and intensity of the exercise during sessions will be assessed
• Diabetes related outcome measures including HbA1C and metabolic outcomes, body composition, functional and cardiorespiratory fitness, quality of life and changes made to habitual behaviour will be assessed.
• A long term follow up will also be conducted to identify if behavioural and lifestyle changes and their associated healthcare benefits persist longer than the duration of the study.
15
Hypotheses
• Both intervention groups will display improvements in health related outcomes compared to baseline and compared to the control group
• Due to the fact that step training is both an aerobic and resistance type exercise, the participants will experience the benefits associated both.
• It is also hypothesized that the exercise and adaptive coaching system group will have a greater adherence to the programme compared to the exercise alone group and so, will display greater health related benefits following the trial.
16
Current progress
• Systematic review completed and awaiting publishing– It is from this the exercise intervention has been described
• Currently in preliminary stages of designing the app– Testing and validating the activity tracker/step counter to
ensure the app does not require human input• Finalising exact progressions of each intervention setting and
testing protocols– To begin participant recruitment after Christmas
17
References
• Konrad, A., Bellotti, V., Crenshaw, N., Tucker, S., Nelson, L., Du, H., ... & Whittaker, S. (2015, April). Finding the Adaptive Sweet Spot: Balancing Compliance and Achievement in Automated Stress Reduction. In Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems (pp. 3829-3838). ACM.
• Mair, J. L., Boreham, C. A., Ditroilo, M., McKeown, D., M Lowery, M., Caulfield, B., & Vito, G. (2014). Benefits of a worksite or home‐based bench stepping intervention for sedentary middle‐aged adults–a pilot study. Clinical physiology and functional imaging, 34(1), 10-17.
• Doheny, E. P., McGrath, D., Ditroilo, M., Mair, J. L., Greene, B. R., Caulfield, B., ... & Lowery, M. M. (2013). Effects of a Low-Volume, Vigorous Intensity Step Exercise Program on Functional Mobility in Middle-Aged Adults. Annals of biomedical engineering, 41(8), 1748-1757.
• Eriksen, L., Dahl-Petersen, I., Haugaard, S. B., & Dela, F. (2007). Comparison of the effect of multiple short-duration with single long-duration exercise sessions on glucose homeostasis in type 2 diabetes mellitus. Diabetologia, 50(11), 2245-2253.
18
Acknowledgements
• App production:– David Coyle– Stephen Gallagher
• Supervisors:– Prof. Brian Caulfield – Dr. Denise McGrath – Prof. Madeleine Lowery – Prof. Giusseppe De Vito
