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Talk: The InterWalk Project: Implementing interval walking training (IWT) in type 2 diabetes treatment at the national level

Please join us for a presentation from visiting researchers on the use of mobile technology to promote physical activity. Open to the public.

Monday 10-11 June 2
West Village H Room 366

The InterWalk Project: Implementing interval walking training (IWT) in type 2 diabetes treatment at the national level

Mathias Ried-Larsen & Henning Langberg
Centre for Physical Activity Research, Rigshospitalet, Denmark
CopenRehab, University of Copenhagen, Denmark

Physical activity is included in the first line treatment in Type 2 Diabetes (T2D). However, evidence supports supervised exercise and little evidence indicates that current un-supervised physical activity regimens are effective in TD2 rehabilitation. As the numbers of T2D patients increase and supervised exercise regimens labor intensive and expensive, novel effective unsupervised exercise are pivotal in prevention of morbidities and treatment of T2D. We have shown that the novel exercise mode, interval walking training (cycle of three minutes of slow walking followed by three minutes of fast walking) delivered by a small training computer (JD mate), is more efficient in improving physical fitness and glycemic control and reduce central fatness compared to continuous walking in T2D patients independent of the overall volume during walking. However, delivering interval walking on a large scale still remains a challenge as the training computer was expensive and frequently malfunctioning. New approaches are needed in order to ensure an effective implementation.

Information technology (IT) has shown promising results in T2D self-management. Therefore, we developed an application (app) for smartphones to promote interval walking in the T2D population – the InterWalk app. The app serves as a personal trainer and provides feedback on the quality of interval walking by engaging the onboard sensors in the smartphone. Uniquely, we can combine exercise data from the app with the large Danish health and disease registers allowing us to evaluate the effect on a large scale. Although several applications to promote physical activity and exercise exist, none have been developed especially for T2D patients with a focus on individualized exercise and been systematically investigated effectiveness in T2D rehabilitation.

The project consists of several sub-projects including testing of the effectiveness of the app in increasing physical activity compared to standard municipal setting in a large scale randomized controlled trial and evaluating the effect of nation-wide release of the app on glycemic control, morbidities, medication usage and contact to the treatment system in T2D patients. The latter is obtained by linking data from the app to the Danish registers. It is of utmost importance that we understand and are able implement and evaluate a feasible concept which is readily available for clinic and long-term therapy. Therefore, special attention is paid to develop novel tools for motivating the users to increase their habitual physical activity level. At the same time we intend develop feasible support frames for the municipalities to use directly in their prevention programs. The results from this project will potentially provide evidence to support implementation of a high quality intervention tool for use in the general public and specifically for rehabilitation of T2D patients at low cost, thus hopefully increase quality of life, decrease contact with the public care system and reduction of medication usage in the patient group.

Since the release of the first version in November 2013, the app has been downloaded more than 10,000 times from app-store. Therefore, I expect that the results and experiences from this project will provide evidence that exercise can be effectively implemented at low costs on a large scale. Furthermore, I expect that this tele-medical approach is more effective compared to the municipal standard care implemented currently, thus will impact the way rehabilitation is implemented. Overall this project could potentially form ground for new approaches of rehabilitation, nationally as well as internationally, at reduced personal and societal costs.