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Abstract Background While strong and consistent evidence supports the role of lifestyle modification in the prevention and management of type 2 diabetes (T2DM), the best strategies for program implementation to support lifestyle modification within primary care remain to be determined. The objective of the study is to evaluate the implementation of an evidence-based self- management program for patients with T2DM within a newly established primary care network (PCN) environment. Method Using a non-randomized design, participants (total N = 110 per group) will be consecutively allocated in bi-monthly blocks to either a 6-month self-management program lead by an Exercise Specialist or to usual care. Our primary outcome is self-reported physical activity and pedometer steps. Discussion The present study will assess whether a diabetes self-management program lead by an Exercise Specialist provided within a newly emerging model of primary care and linked to available community-based resources, can lead to positive changes in self-management behaviours for adults with T2DM. Ultimately, our work will serve as a platform upon which an emerging model of primary care can incorporate effective and efficient chronic disease management practices that are sustainable through partnerships with local community partners. Clinical Trials Registration ClinicalTrials.gov identifier: NCT00991380

Objective: To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care. Methods: Eligible participants from 4 primary care networks in Alberta, Canada were assigned to either a lifestyle program or a control group. The program targeted increased daily walking through individualized daily pedometer step goals for the first 3 months and brisk walking speed, along with substitution of low-relative to high-glycemic index foods over the next 3 months. The outcomes were daily steps, diet, and clinical markers, and were compared using random effects models. Results: 198 participants were enrolled (102 in the intervention and 96 in the control). For all participants, (51% were women), mean age 59.5 (SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.6 kg/m2 (SD 6.5), systolic BP 125.6 mmHg (SD 16.2), glycemic index 51.7 (4.6), daily steps 5879 (SD 3130). Daily steps increased for the intervention compared with the control at 3-months (1292 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted P = .002). No significant differences were observed for diet or clinical outcomes. Conclusions: A 6-month lifestyle program delivered in primary care by an exercise specialist can be effective for increasing daily walking among adults with recently diagnosed type 2 diabetes. This short-term increase in daily steps requires longer follow-up to estimate the potential impact on health outcomes. [ABSTRACT FROM AUTHOR]

Background: Arthritis is highly prevalent among older adults with type 2 diabetes mellitus (T2DM) and presents a barrier to participating in regular land-based physical activity. Aim: To examine the effects of a 12-week community-based aquatic exercise program for overweight older adults (≥55 years of age) with T2DM and lower body arthritis. Methods: For this quasi-experimental study, participants completed an exercise specialist-led program consisting of 60-min, twice/week, of aquatic activities at intensities that increased at 4-week increments from 40% to 65% of heart rate reserve for a total of 12 weeks. Clinical and functional measures were completed at baseline and after 12 weeks. Results: Thirty participants completed baseline measures. Overall, half were female, mean (standard deviation = SD) age 67.7 (7.0) years, A1c = 6.7 (1.3)%, BMI = 35.9 (8.6) kg/m2, average daily steps = 4207 (5504). Actual mean heart rate responses during aquatic exercise sessions were at 85%, 90%, and 85% of what was prescribed at weeks 4, 8, and 12, respectively. After 12 weeks, improvements were found for 6-min walking distance (+16.6, SD 43.4 m; p = .05), sit-to-stand repetitions (+1.0, SD 2.0; p = .01), and BMI (−0.2, SD 0.6 kg/m2; p = .04) Conclusion: This pilot study showed that an aquatic program produced functional improvements among overweight older adults with T2DM and arthritis. [ABSTRACT FROM AUTHOR]