Mobile Health Biometrics to Enhance Exercise and Physical Activity Adherence in Type 2 Diabetes

Why is this project important?
Being physically active and exercising is very important in the treatment of type 2 diabetes, with it helping to control blood sugar and prevent complications. Nevertheless, lots of people with type 2 diabetes find it hard to be physically active and/or stick to an exercise programme, even when doctors and diabetes nurses have told them to exercise as part of their treatment. Research is needed to identify more effective methods to help people with type 2 diabetes increase their everyday physical activity levels, start exercising regularly and stick too the right amount of exercise to benefit their type 2 diabetes management, particularly in the early stages after diagnosis.

What is the purpose of the project?
In this project we want to see if mobile health technology (i.e. the use of smartphones, wearable technology and apps to support the delivery of interventions) when added into exercise advice makes it easier for people with type 2 diabetes to begin and maintain a physically active lifestyle, which includes exercising regularly.

How will we run the project?
We will run a study for people who have recently been diagnosed with type 2 diabetes in the UK and Canada. 120 people will be recruited (UK n=60, Canada n=60) and randomly put into two groups. One group will receive standard support to help them become and then remain more active. The second group, in addition to this support will be provide with a wrist watch that can monitor everyday activity and their heart rate, a smartphone app and access to a website. Monitoring of everyday activities will help to encourage the participants to be more active throughout the day. Heart rate monitoring will help them to exercise at home by providing details of what needs to be done in each exercise session, and providing real time feedback on how hard they are working during the exercise sessions. The smartphone app will allow patients to track progress towards personalised physical activity and exercise goals, contact their health care professional, and share experiences with other people with type 2 diabetes on the programme. Finally, the website will allow health care professionals to track patient's daily physical activity and exercise adherence, using the data to provide personalised feedback to patients throughout the programme.

What is unique about this project?
Usually, soon after diagnosis people with type 2 diabetes attend education sessions. As part of this education they are advised to increase physical activity and exercise regularly. However, many patients with type 2 diabetes do not follow this advice, because they are unsure how to increase their activity, they get little support from health care professionals and they have no-one with Type 2 diabetes to talk with about exercise. The mobile health technology in this project will provide patients with advice on how to increase their exercise, in a similar way to how a personal trainer would. This technology will also enable health care professionals to keep in close contact with patients, and will enable patients to contact other people with type 2 diabetes also trying to become more active. We believe this technology will help educate and motivate patients to increase daily physical activity, and stick to an exercise plan, helping to manage their diabetes.

How will the outcomes improve the health of people with diabetes?
Findings from this study will help us design a larger study to test whether this mobile health technology would work throughout the UK and Canada. If so it would be cheap to roll out as technology is becoming cheaper and the majority of people already have smart phones.

T2D is one of the top 10 global causes of death. Worldwide cases are forecast to rise, and healthcare costs directed to the management and treatment are increasing faster than gross domestic product. Exercise and PA are central components of initial T2D management, and are recommended by international consensus. Yet, many people with T2D do not perform enough PA to elicit clinical benefit and help manage the disease, despite patients recognising that regular PA is important. Therefore, the development of scalable and cost effective interventions to support exercise and PA as part of T2D management is a major priority.

Current strategies; (i) prescription of supervised exercise or (ii) PA counselling, are either clinically effective but unsuitable in routine practice (supervised exercise), or suitable in routine practice but clinically ineffective (counselling). Mobile health technologies, providing biometric data to patients and health professionals, may bridge the gap between intensive supervised and PA counselling, enabling patients to engage in long-term physically active lifestyles, which include regular exercise.

We propose a dual country randomised controlled pilot study to test whether a translational solution of exercise and PA counselling using mHealth technology and biometric data can improve activity levels over and above standard advice. We will implement a theoretical model whereby mHealth technology is utilised to programme a personalised home-based exercise and PA plan, where exercise session intensity and daily PA, through heart rate and step count, respectively, are visible to patients and monitored remotely by health professionals to improve feedback and motivational support. This model will specifically inform the NHS RightCare Pathway in the UK and Diabetes 360 in Canada. Moreover, the intervention will assist in reaching remote communities, a recognised health inequality in Canada.

Following successful completion of our aim to evaluate a theoretical model where mHealth technology, allowing biometric informed feedback and coaching, is incorporated into a structured home-based exercise and physical activity (PA) intervention in newly diagnosed T2D patients. We will have an evidence-based exercise and PA intervention, which is embed in primary care in the UK and Canada, ready to evaluate in a future RCT. Therefore, this work will produce a number of major impacts on human healthcare and have practical importance within both academia and industry:

1. Impact for Patients: This research will provide direct patient benefits through: promotion of healthy living & active involvement of patients, providing personalised care, evidence based services & improving educational standards. Ultimately, this research will form the basis of a new PA and exercise intervention model that will empower patients to implement PA and exercise into their daily lifestyle long-term.

2. Impact for the Academic community: The results will help academics understand the effectiveness of mHealth biometrics in upregulating PA and exercise in newly diagnosed T2D patients, and importantly the dose-response relationship between levels of PA and clinical outcomes (e.g. HbA1c). Understanding the potential exercise adherence and clinical outcomes from PA and exercise interventions in real life environments will aid the development of future exercise interventions, and ensures that when embedded into routine clinical care they are are successful.

3. Impact for the Clinical community: The work proposed has the potential to have a major impact on local healthcare, and will aid the development of large scale RCTs in the UK and Canada. Primary care in both countries currently focuses on education of T2D patients early after diagnosis, but without an effective and supportive exercise and PA intervention. The findings from this study will provide primary care clinicians and stakeholders with an alternative option to the current simple exercise promotion and advice from health care professionals. The findings of this study are key to providing evidence that mHealth technology is successful in T2D patients, which will allow discussion and planning of how such technology could be integrated into current or new clinical care pathways for T2DM.

4. Impact for mHealth technology companies: The proposed study will provide technology companies with user information directly from a patient group, and provide a greater understanding of how their technology can be used to promote exercise and PA in individuals with T2D. This information will assist technology companies adapt technology that was initially designed for athletes and coaches, and fine tune applications and devices for implementation in patient groups.

A clear, planned route of how the findings can have specific impacts are outlined in the pathway to impact section.