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. 2016 Jun 8:8:201-9.
doi: 10.2147/CLEP.S97303. eCollection 2016.

Implementation of interval walking training in patients with type 2 diabetes in Denmark: rationale, design, and baseline characteristics

Mathias Ried-Larsen  1 , Reimar W Thomsen  2 , Klara Berencsi  3 , Cecilie F Brinkløv  4 , Charlotte Brøns  4 , Laura S Valentiner  5 , Kristian Karstoft  6 , Henning Langberg  5 , Allan A Vaag  7 , Bente K Pedersen  6 , Jens S Nielsen  8
Affiliations

Implementation of interval walking training in patients with type 2 diabetes in Denmark: rationale, design, and baseline characteristics

Mathias Ried-Larsen et al. Clin Epidemiol. .

Abstract

Promoting physical activity is a first-line choice of treatment for patients with type 2 diabetes (T2D). However, there is a need for more effective tools and technologies to facilitate structured lifestyle interventions and to ensure a better compliance, sustainability, and health benefits of exercise training in patients with T2D. The InterWalk initiative and its innovative application (app) for smartphones described in this study were developed by the Danish Centre for Strategic Research in T2D aiming at implementing, testing, and validating interval walking in patients with T2D in Denmark. The interval walking training approach consists of repetitive 3-minute cycles of slow and fast walking with simultaneous intensity guiding, based on the exercise capacity of the user. The individual intensity during slow and fast walking is determined by a short initial self-conducted and audio-guided fitness test, which combined with automated audio instructions strives to motivate the individual to adjust the intensity to the predetermined individualized walking intensities. The InterWalk app data are collected prospectively from all users and will be linked to the unique Danish nationwide databases and administrative registries, allowing extensive epidemiological studies of exercise in patients with T2D, such as the level of adherence to InterWalk training and long-term effectiveness surveys of important health outcomes, including cardiovascular morbidity and mortality. Currently, the InterWalk app has been downloaded by >30,000 persons, and the achieved epidemiological data quality is encouraging. Of the 9,466 persons providing personal information, 80% of the men and 62% women were overweight or obese (body mass index ≥25). The InterWalk project represents a contemporary technology-driven public health approach to monitor real-life exercise adherence and to propagate improved health through exercise intervention in T2D and in the general population.

Keywords: cell phones; exercise; telemedicine.

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Figures

Figure 1
Figure 1
Degree of motivation to continue the training intervention among participants at the end of a 4-month clinical trial assessing the efficacy of interval walking training. Notes: Participants were randomized to continuous walking training (CWT) or interval walking training (IWT). The participants were asked to rate the degree of motivation.
Figure 2
Figure 2
Level of agreement with statements regarding what would motivate the participants to continue to perform walking training at the end of a 4-month clinical trial assessing the efficacy of interval walking training. Notes: Participants were randomized to continuous walking training (CWT) or interval walking training (IWT).
Figure 3
Figure 3
Degree of motivation to continue the training intervention among participants at 1-year follow-up following the 4-month clinical trial assessing the efficacy of interval walking training. Notes: Participants were randomized to continuous walking training (CWT) or interval walking training (IWT). The participants were asked to rate the degree of motivation.
Figure 4
Figure 4
Development process of the InterWalk app after a 4-month clinical trial (*) assessing the efficacy of interval walking training. Abbreviations: IWT, interval walking training; T2D, type 2 diabetes.
Figure 5
Figure 5
Layout of the InterWalk app (translated from Danish). Notes: (A) The front page and the InterWalk app logo, (B) the protocol for the fitness test, (C) the start page including the user progression (smileys) across the current and previous weeks, (D) the immediate feedback after an InterWalk session, and (E) the historical InterWalk user data.
Figure 6
Figure 6
Interpretation of the smiley feedback system. Abbreviation: IWT, interval walking training.
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