Behavioral intervention to increase physical activity led to lasting results at 3 years

At three outpatient diabetes clinics in Rome, Italy, participants who received specialized behavioral counseling sessions had greater increases in physical activity and decreases in sedentary time than those who received general physician recommendations.


A behavioral intervention led to a sustained increase in physical activity and decrease in sedentary time in a group of sedentary and physically inactive individuals with type 2 diabetes, a randomized trial found.

Conducted at three outpatient diabetes clinics in Rome, Italy, the Italian Diabetes and Exercise Study 2 was funded by the Metabolic Fitness Association and randomized 300 participants (mean age, 61.6 years; 38.7% women) to receive either a behavioral intervention or standard care for three years. The intervention, derived from the original Italian Diabetes and Exercise Study protocol, promoted decreasing sedentary time by substituting it with various light-intensity physical activities and gradually increasing purposeful moderate- to vigorous-intensity physical activity.

One hundred fifty patients in the behavioral intervention group received one individual theoretical counseling session (conducted by a diabetologist) and eight individual biweekly theoretical and practical counseling sessions (conducted by a certified exercise specialist) each year, whereas 150 patients in the standard care group received only general physician recommendations. All participants' physical activity and sedentary time were measured by an accelerometer. Results were published online on March 5 by JAMA.

Overall, 267 participants completed the study (133 in the intervention group and 134 in the standard care group) for a median follow-up of 3.0 years. Participants in the intervention group accumulated 13.8 metabolic equivalent hours of physical activity volume per week, compared to 10.5 in the standard care group (difference, 3.3 [95% CI, 2.2 to 4.4]; P<0.001). They also had longer respective durations of moderate- to vigorous-intensity physical activity (18.9 vs. 12.5 min/d; difference, 6.4; P<0.001) and light-intensity physical activity (4.6 vs. 3.8 h/d; difference, 0.8; P<0.001), as well as shorter respective durations of sedentary time (10.9 vs. 11.7 h/d; difference, −0.8; P<0.001).

While between-group differences were apparent throughout the study period for all endpoints, the difference in moderate- to vigorous-intensity physical activity diminished during the third year, “suggesting that moderate- to vigorous-intensity physical activity is more difficult to maintain with time and increasing age,” the study authors wrote.

There were 41 adverse events in the intervention group and 59 in the standard care group outside of the sessions. Those in the intervention group had 30 adverse events during the sessions, most commonly musculoskeletal injury or discomfort and mild hypoglycemia.

The study authors noted that the findings may not be generalizable to all settings and that the intervention must be validated in different cohorts or settings. In addition, study-provided accelerometers may have encouraged activity in the control group and did not provide time-stamped data; therefore, it was not possible to discern patterns of sedentary time.