Using an adaptive coaching system to improve outcomes during a free living training programme in T2DM Insight student conference October 2015 Hugh Byrne.

Using an adaptive coaching system to improve outcomes during a free living training programme in T2DM

Insight student conference October 2015

Hugh Byrne BSc., MSc.UCD

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Content

• My background• What is T2DM?• Exercise in T2DM• Rationale behind the use of a step training programme• Rationale behind the use of an adaptive coaching system• Outline of a proposed intervention study

Background

• 1st year PhD student in Insight Centre for data analytics, UCD• Physiotherapist

– Interested in improving health related outcomes and the day to day quality of life of patients

• Research is initially aimed at improving adherence to exercise in T2DM in a free-living setting (independently)

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Type 2 Diabetes Mellitus

• T1DM & T2DM- 171 million adults worldwide - estimated to rise to 366 million by 2030.

• Part of a group of metabolic disorders characterised by increased levels of glucose (sugar) in the bloodstream caused by failings in insulin secretion, insulin action or both.

• T2DM has traditionally been associated with obesity and low levels of physical activity. – Increase in sedentary lifestyles and poor dietary habits has

seen rates increase dramatically in recent times– Exercise along with dietary and pharmacological

interventions are fundamental for successful management. – Aim to prevent or slow the progression of the disease and

the complications associated with it.

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Exercise in T2DM

• Adherence to exercise has been traditionally poor in the population – lifestyle related disease.

• Majority of exercise related research to date - conducted in a laboratory or hospital setting. – useful in identifying the exact effects of exercise in the

condition at a cellular level, but not reflective of daily habits and drain health care resources.

• Patients should be able to manage condition including their exercise regimen in a free living setting – minimal regular contact between patients and

practitioners and requires the patients to alter their lifestyles and manage the disease independently.

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Is Free Living Exercise in T2DM effective?

• Beneficial for measures of metabolism, body composition and functional capacity

• Improves lifestyle (habitual behaviours away from the exercise sessions) and quality of life of participants when adhered to – Byrne et al., Systematic review- waiting publication

• Adherence to exercise still remains low away from research in the population – Further motivation needed to increase and maintain

adherence– Patients should make concrete plans and identify

strategies to overcome barriers.

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Step training programmes

• An inexpensive exercise that can be carried out independently by patients, in various locations throughout the day

• Only equipment required is a step – a bottom step of a stairs could be used if required

• Previously been shown to improve functional, cardiorespiratory, and body composition outcomes in non-diabetics.

• Efficacy in type 2 diabetics not assessed to date.

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Previous step training programmes conducted in UCD

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Proposed exercise programme

• Initially similar to the above programme - an average of 21 minutes high intensity step training per week over 4 weeks.

• Then progress gradually to 3 longer bouts of 10 minutes maintaining a high intensity

• 3x10 minutes/day of home based cycling previously yielded a 98% completion rate of prescribed sessions over 4-5 weeks in a research setting– 3 shorter bouts also appear to be more beneficial for

measures of metabolism than 1 longer bout of equal aggregate length - ↑ EPOC

• However, adherence may drop over the course of time due to the costs associated with it and its inaccessibility – step training more accessible and cheaper.

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The adaptive coaching system

• Adaptive coaching systems have improved adherence to exercise and meditation programmes in other populations.

• Provide motivation to participants based on theories of behavioural change including goal-setting theory and self efficacy theory – “best of both worlds”.

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The adaptive coaching system

• The smart-phone app will set goals that will gradually progress in difficulty & will vary depending on the success of the participant in completing the previous exercise sessions prescribed in order to increase and maintain adherence.– The adaptive sweet spot - not too easy and not too difficult

• If the participant does not succeed in completing a session, the app will prescribe an easier next exercise session and vice versa until they reach the 3x10 minute target.

• The app will remotely monitor the participants’ adherence to exercise and provide motivational prompts to the patient that will differ depending on the successful completion of prescribed exercise

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The planned trial• A 16 week RCT comparing the effects of the step training

programme, the step training programme combined with the adaptive coaching system and a control group.

• Participants: previously sedentary & confirmed diagnosis of T2DM and no co-morbidities or contra-indications to exercise.

• Adherence to the exercise programmes and intensity of the exercise during sessions will be assessed

• Diabetes related outcome measures including HbA1C and metabolic outcomes, body composition, functional and cardiorespiratory fitness, quality of life and changes made to habitual behaviour will be assessed.

• A long term follow up will also be conducted to identify if behavioural and lifestyle changes and their associated healthcare benefits persist longer than the duration of the study.

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Hypotheses

• Both intervention groups will display improvements in health related outcomes compared to baseline and compared to the control group

• Due to the fact that step training is both an aerobic and resistance type exercise, the participants will experience the benefits associated both.

• It is also hypothesized that the exercise and adaptive coaching system group will have a greater adherence to the programme compared to the exercise alone group and so, will display greater health related benefits following the trial.

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Current progress

• Systematic review completed and awaiting publishing– It is from this the exercise intervention has been described

• Currently in preliminary stages of designing the app– Testing and validating the activity tracker/step counter to

ensure the app does not require human input• Finalising exact progressions of each intervention setting and

testing protocols– To begin participant recruitment after Christmas

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References

• Konrad, A., Bellotti, V., Crenshaw, N., Tucker, S., Nelson, L., Du, H., ... & Whittaker, S. (2015, April). Finding the Adaptive Sweet Spot: Balancing Compliance and Achievement in Automated Stress Reduction. In Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems (pp. 3829-3838). ACM.

• Mair, J. L., Boreham, C. A., Ditroilo, M., McKeown, D., M Lowery, M., Caulfield, B., & Vito, G. (2014). Benefits of a worksite or home‐based bench stepping intervention for sedentary middle‐aged adults–a pilot study. Clinical physiology and functional imaging, 34(1), 10-17.

• Doheny, E. P., McGrath, D., Ditroilo, M., Mair, J. L., Greene, B. R., Caulfield, B., ... & Lowery, M. M. (2013). Effects of a Low-Volume, Vigorous Intensity Step Exercise Program on Functional Mobility in Middle-Aged Adults. Annals of biomedical engineering, 41(8), 1748-1757.

• Eriksen, L., Dahl-Petersen, I., Haugaard, S. B., & Dela, F. (2007). Comparison of the effect of multiple short-duration with single long-duration exercise sessions on glucose homeostasis in type 2 diabetes mellitus. Diabetologia, 50(11), 2245-2253.

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Acknowledgements

• App production:– David Coyle– Stephen Gallagher

• Supervisors:– Prof. Brian Caulfield – Dr. Denise McGrath – Prof. Madeleine Lowery – Prof. Giusseppe De Vito

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Thank you for listening!

• [email protected]