title: Implementation of resources to support patient physical activity through diabetes centres in Atlantic Canada: the effectiveness of toolkit-based physical activity counselling.
abstract: 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 6 months 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.
authors: Acadia University, Wolfville, Nova Scotia, Canada. Electronic address: jonathon.fowles@acadiau.ca.
authors: Jonathon R
authors: JR
authors: Fowles
authors: Acadia University, Wolfville, Nova Scotia, Canada.
authors: Chris
authors: C
authors: Shields
authors: Acadia University, Wolfville, Nova Scotia, Canada.
authors: Brittany
authors: B
authors: Barron
authors: Acadia University, Wolfville, Nova Scotia, Canada.
authors: Stephanie
authors: S
authors: McQuaid
authors: Diabetes Care Program of Nova Scotia, Halifax, Nova Scotia, Canada.
authors: Peggy
authors: P
authors: Dunbar
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003376:Counseling / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D015444:Exercise; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D010809:Physical Fitness / Q000523:psychology
keywords: A1C; A1c; Diabetes Centre; Nouvelle-É cosse; Nova Scotia; Toolkit; activité physique; boîte à outils; centre du diabète; diabetes educator; diabète de type 2; exercice; exercise; implementation; mise en œuvre; physical activity; type 2 diabetes; éducateur spécialisé en diabète