Avaliação de uma intervenção de exercício físico associada à educação para promoção de mudança de comportamento e melhores condições de saúde em pessoas com prédiabetes ou diabetes

Abstract

Exercise and patient education are critical components of diabetes care. However, although the benefits of physical exercise for diabetes control are widely known, adopting and maintaining an active lifestyle is still challenging. Additionally, several studies have verified patient education's effectiveness in promoting favorable behavior changes. However, educational interventions aimed at people living with diabetes and prediabetes are still poorly investigated and implemented in low-and middle-income countries, such as Brazil. The Diabetes College Brazil Study is a randomized clinical trial (RCT) that aims to mitigate this gap by investigating the effectiveness of exercise intervention (Ex) associated with an educational intervention (ExEd) in Brazilians living with diabetes or prediabetes on the following outcomes: functional capacity, disease-related knowledge, health behaviors, cardiometabolic health parameters and quality of life. The educational curriculum to be used in the RCT was developed based on educational needs and national guidelines. Before the RCT development, the feasibility and acceptability of the interventions proposed, and their preliminary effectiveness were evaluated. During the conduct of this pilot study, modifications were necessary for its experimental protocol due to the COVID-19 pandemic, and this experience contributed to the research team envisioning the possibility of adding another form of delivery of RCT interventions (remote with or without the internet), in addition to the planned in-person delivery initially. Therefore, upon completion of the pilot study, a feasibility study was conducted to test the feasibility of remote delivery of RCT interventions. The pilot study revealed that the interventions proposed in the Diabetes College Brazil Study are feasible (eligibility, recruitment, retention, and participation rates in exercise sessions and education classes were 17%, 93%, 82%, 76%, and 71%, respectively) and widely accepted by the participants. The preliminary results indicated the potential benefit of the ExEd intervention compared to Ex for promoting health behavior change, improving cardiometabolic health parameters and quality of life, and increasing diabetes knowledge. The feasibility study results showed that data collection procedures, weekly remote monitoring, access to study websites, educational tools use, and implementation costs are feasible, and participants reported satisfaction with remote interventions. Additionally, remote delivery of interventions via the internet appeared to have positive effects on most RCT outcomes. It was impossible to conclude the feasibility of delivering the interventions without the use of the internet due to the small number of participants allocated to this delivery form. Therefore, the experimental protocol of the RCT should be modified to add remotely delivery of the interventions (via the internet) or in person, depending on the access and/or familiarity of the participants with the internet, totaling four groups: Ex internet, ExEd internet, Ex in person and ExEd in person.