Abstract

A patient’s adherence to self-management therapies in diabetes strongly influences health outcomes, health care utilization, and ultimately health care costs. Engaging in regular exercise therapy reduces risk factors associated with type 2 diabetes. The purpose of this randomized prospective study was to determine if a client-centered approach (CCA) toward diabetes education, verses a traditional-directive approach (TDA), would improve exercise participation, perceived control, intention to exercise, and glycemic control in patients with type 2 diabetes.

Fifty-nine type 2 patients were randomized into two groups: CCA and TDA. Diabetes education in the CCA group provided empowerment toward acquiring knowledge, skills, and responsibility to effect change by exercise adherence. Education in the TDA group was designed to influence the knowledge, attitudes, and behavior of patients to increase compliance with treatment recommendations. Both study groups received diabetes education, handouts, and three phone interviews encouraging exercise through the designated education method. Body weight, body mass index (BMI), HbA1c, blood glucose level, blood pressure, resting heart rate, self-reported exercise habits and psychosocial measures were assessed at baseline and a 2-month follow-up. Data were collected from six different classes, all having an eight week study period for both the CCA and TDA groups.

Compared to baseline values, both groups showed significant reductions in body weight (p < .0001), BMI (p = .001), HbA1c (p < .0001), blood pressure (p < .0001), resting heart rate (p < .0001), as well as an increase in exercise frequency and duration (p < .0001), at the 2 month follow-up. CCA participants spent more time exercising per session than the TDA participants, 35 minutes versus 18 minutes, respectively (approximately 17 minutes/session difference). This contributed to significantly greater glycemic control, with HbA1c (p < .0001) decreasing by 3.2% for CCA participants versus 1.1% decrease for TDA participants. Perceived control also increased in both groups at 2-month follow-up (p < .001), but was greater in the CCA participants compared to TDA (13.4 vs. 7.64 total score changes, respectively).

Exercise therapy may be under-estimated by diabetes educators and patients. This study demonstrates that a client-centered educational approach to encourage exercise among individuals with type 2 diabetes may significantly improve participation in exercise activity and subsequently glycemic control, which may reduce morbidity and mortality in this population.

School

School of Public Health

First Advisor

Glen G. Blix

Second Advisor

Helen Hopp Marshak

Third Advisor

Anthony Firek

Degree Name

Doctor of Public Health (DrPH)

Degree Level

Ph.D.

Year Degree Awarded

2000

Date (Title Page)

2000

Language

English

Library of Congress/MESH Subject Headings

Patient- Centered Care; Patient Education; Exercise Therapy; Power (Psychology); Models, Psychological; Diabetes, Mellitus, Non-Insulin-Dependent

Type

Dissertation

Page Count

xii; 132

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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