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Agborsangaya C.B.,University of Alberta | Gee M.E.,Public Health Agency of Canada | Johnson S.T.,Athabasca University | Dunbar P.,Diabetes Care Program of Nova Scotia | And 4 more authors.
BMC Public Health | Year: 2013

Background: Lifestyle behavior modification is an essential component of self-management of type 2 diabetes. We evaluated the prevalence of engagement in lifestyle behaviors for management of the disease, as well as the impact of healthcare professional support on these behaviors. Methods. Self-reported data were available from 2682 adult respondents, age 20 years or older, to the 2011 Survey on Living with Chronic Diseases in Canada's diabetes component. Associations with never engaging in and not sustaining self-management behaviors (of dietary change, weight control, exercise, and smoking cessation) were evaluated using binomial regression models. Results: The prevalence of reported dietary change, weight control/loss, increased exercise and smoking cessation (among those who smoked since being diagnosed) were 89.7%, 72.1%, 69.5%, and 30.6%, respectively. Those who reported not receiving health professional advice in the previous 12 months were more likely to report never engaging in dietary change (RR = 2.7, 95% CI 1.8 - 4.2), exercise (RR = 1.7, 95% CI 1.3 - 2.1), or weight control/loss (RR = 2.2, 95% CI 1.3 - 3.6), but not smoking cessation (RR = 1.0; 95% CI: 0.7 - 1.5). Also, living with diabetes for more than six years was associated with not sustaining dietary change, weight loss and smoking cessation. Conclusion: Health professional advice for lifestyle behaviors for type 2 diabetes self-management may support individual actions. Patients living with the disease for more than 6 years may require additional support in sustaining recommended behaviors. © 2013 Agborsangaya et al.; licensee BioMed Central Ltd. Source


Fowles J.R.,Acadia University | Shields C.,Acadia University | Barron B.,Acadia University | McQuaid S.,Acadia University | Dunbar P.,Diabetes Care Program of Nova Scotia
Canadian Journal of Diabetes | Year: 2014

Objective: The purpose of this study was to determine the effectiveness of toolkit-based physical activity counselling on physical activity and exercise participation of type 2 diabetes patients attending diabetes centres in Atlantic Canada. Methods: Patients with type 2 diabetes (n=198) were recruited to a quasiexperimental study comparing the effectiveness of counselling by persons trained to use a physical activity and exercise resource manual (i.e. toolkit) vs. a standard of care counselling situation. Effectiveness was assessed through questionnaires completed by patients, and clinical data were extracted from patient charts before and 6months after a single appointment with a diabetes educator. Primary outcome measures were patient self-reported physical activity and exercise levels, efficacy perceptions and mean glycated hemoglobin. Results: There were no significant differences in primary outcomes over time. Subanalyses of the toolkit-counselled patients revealed a significant interaction for moderate-to-vigorous physical activity (MVPA [p<0.0001]), whereby patients who were not meeting Canadian Diabetes Association guidelines for physical activity at baseline (i.e. <150 MVPA a week; n=44) increased physical activity (from 20±23 to 120±30 minutes) and patients who were active at baseline (i.e. >150 MVPA a week; n=22) decreased physical activity (from 444±32 to 161±41 minutes) at 6 months. Conclusions: A single counselling appointment using the toolkit did not elicit significant changes in physical activity or clinical outcomes measured 6 months later when compared with standard care condition; however, increased physical activity was observed for patients who were inactive at baseline. Repeated counselling or more intensive strategies may be required to increase patient physical activity levels and produce clinical outcomes. © 2014 Canadian Diabetes Association. Source


Fowles J.R.,Acadia University | Shields C.,Acadia University | d'Entremont L.,Acadia University | McQuaid S.,Acadia University | And 2 more authors.
Canadian Journal of Diabetes | Year: 2014

Objective: The purpose of this study was to determine the effectiveness of enhancing support for physical activity counselling and exercise participation at diabetes centres in Nova Scotia on physical activity and exercise behaviours and clinical outcomes in patients with type 2 diabetes mellitus. Methods: In all, 180 patients at 8 diabetes centres participated in this observational study. A range of enhanced supports for exercise were offered at these centres. A kinesiologist was added to the diabetes care team to primarily provide extra physical activity counselling and exercise classes. Patient physical activity and exercise levels, efficacy perceptions and mean glycated hemoglobin (A1C) were evaluated at baseline and 6months. We compared changes in these variables for patients who participated in the enhanced supports versus patients who did not. Results: Participants who attended exercise classes (n=46), increased moderate physical activity by 27% and doubled resistance exercise participation (1.0±1.8 to 2.0±2.1days per week) whereas those who did not attend exercise classes (n=49) reduced moderate physical activity by 26% and did not change resistance exercise participation (interactions, p=0.04 and p=0.07, respectively). Patients who received resistance band instruction (n=15) from a kinesiologist had reductions in A1C (from 7.5±1.4 to 7.1±1.2; p=0.04), whereas other subgroups did not have significant changes in A1C. Conclusions: Offering enhanced support for exercise at diabetes centres produced improvements in physical activity and exercise in type 2 diabetes patients. Resistance band instruction from a kinesiologist combined with participating in a walking and resistance training program improved glycemic control, which underscores the importance of including exercise professionals in diabetes management. © 2014 Canadian Diabetes Association. Source


Shields C.A.,Acadia University | Fowles J.R.,Acadia University | Dunbar P.,Diabetes Care Program of Nova Scotia | Barron B.,Acadia University | And 2 more authors.
Canadian Journal of Diabetes | Year: 2013

Objective: The objective of this action research was to examine the effectiveness of a comprehensive intervention (the toolkit) in improving diabetes educators' (DEs') perceptions of their abilities and their patients' abilities related to physical activity as part of regular diabetes self-management. Methods: Two separate studies were conducted. Participants completed measures assessing confidence, attitudes and perceived difficulty. In study 1, a quasi-experimental design was used to examine the impact of the training intervention at 6 months. Cross-sectional sampling at baseline and 12 months then was used to assess the longer-term impact of the intervention. In study 2, a pre-post design was used to test the impact of the intervention at 12-months in a separate sample. Results: The primary finding was a consistent increase in DEs' confidence in their ability to provide physical activity and exercise counselling with increases of up to 20% after the training intervention. Furthermore, DEs reported greater knowledge about physical activity (p<0.03) yet perceived physical activity counselling to be more difficult after receiving the training (p<0.05). In study 2, the DEs reported increases in perceived patient knowledge and confidence in their patients (p<0.03) after the intervention. Secondary analyses showed that frequently referring to the toolkit was associated with higher counselling efficacy and lower perceived difficulty (p<0.03). Conclusions: These findings suggest that the toolkit is an effective resource to improve DEs' confidence in the area of physical activity counselling. As a result of this work, the toolkit has been adopted as standard diabetes care across Nova Scotia and as a foundational resource for DEs across Canada. © 2013 Canadian Diabetes Association. Source


Dillman C.J.,Acadia University | Shields C.A.,Acadia University | Fowles J.R.,Acadia University | Perry A.,Acadia University | And 2 more authors.
Canadian Journal of Diabetes | Year: 2010

Objective: The purpose of this study was to examine diabetes educators' perceptions of (a) their abilities, attitudes and difficulties/challenges related to physical activity and exercise counselling; and (b) their patients' abilities and attitudes related to performing physical activity and exercise in managing their diabetes. Method: Using a cross-sectional, observational design, diabetes educators (N=119) recruited from 3 provinces completed survey measures of counselling, referral and other efficacies; attitudes; perceived difficulty; barriers; and training practices related to physical activity and exercise. Results: Analyses revealed that diabetes educators lacked confidence in their own ability to counsel patients about, prescribe and make referrals for physical activity and exercise; they also lacked confidence in the ability of their patients to perform physical activity and exercise. While diabetes educators had positive attitudes about physical activity and exercise, they perceived their typical patient's attitudes to be much less positive. Diabetes educators perceived that including more in-depth physical activity and exercise counselling in their practice would be only somewhat difficult, but they indicated that they experienced multiple barriers in this area. Diabetes educators' perceptions were also shown to be associated with their counselling practices related to physical activity and exercise. Conclusion: These findings provide novel insight into diabetes educators' perceptions of their own abilities, as well as those of their patients, and further underscore the need to provide diabetes educators with greater training in physical activity and exercise counselling. Source

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