An m-health intervention to increase activity among patients at risk for type 2 diabetes

Saturday, October 01, 2016

 

Philip Polgreen, MD, MPH 
Associate Professor of Internal Medicine – Infectious Diseases

In 2013, Dr. Polgreen was the recipient of a FOEDRC Pilot Grant for his research entitled, “To evaluate a novel tool using text messages as a mechanism to promote sustained weight loss in patients with obesity and insulin resistance.” This cutting edge science was recently recognized and awarded additional funding by the National Institutes of Health (NIH).

Exercise and weight loss have many health benefits. In fact, increasing activity levels and subsequent weight loss can induce remission of type II diabetes. However it is incredibly difficult for patients to consistently exercise enough to lose weight. Most guidelines recommend that diabetics increase activity, but there are currently few ways for a physician to determine if indeed patients are following such advice after clinic visits. Furthermore, exactly how to effectively encourage activity and weight loss in a cost effective manner is not clear. However, what is clear is that a sedentary lifestyle is not only a risk factor for type two diabetes (T2D), but it can also exacerbate the disease. Recommending increased physical activity is therefore a cornerstone of T2D prevention and management. Historically, increasing activity was synonymous with exercise; however, even much more modest activity levels (e.g. simply walking) or merely decreasing the proportion of sedentary time may be sufficient to improve health outcomes. Some interventions designed to increase activity have shown promise; others have been less successful. The availability of inexpensive pedometers, and more recently, low-cost triaxial accelerometers, has now made it much easier to monitor activity levels and provide feedback to users. These devices are ideal for capturing activity associated with walking, the most popular and acceptable form of exercise for patients with T2D, but only if patients actually wear them. Thus, there is a need to develop pragmatic approaches that encourage patients to not only wear these monitoring devices, but also to motivate them to increase their activity. Because it has been difficult to generalize and maintain exercise programs for people with pre-diabetes or T2D, Dr. Polgreen’s interdisciplinary research group created MapTrek, a mobile-phone-based walking game that allows people to take a virtual walk in any number of interesting locations around the world and track their progress against the progress of other people like themselves on an interactive map. Steps are counted using a commercially-available triaxial accelerometer (e.g., a Fitbit), and patients see their own updated progress overlaid on Google Maps, with all the usual Google Maps features (e.g., zooming, street view, etc.) available. The objective is to alert patients at risk for or diagnosed with T2D of their activity levels in the innovative game-based environment, thereby encouraging them, first to walk more every day and, second, to maintain these new increased levels of physical activity. Dr. Polgreen’s game will also focus on motivating patients to increase their walking pace and reduce their sedentary time. This R21 grant from the NIH, will fund a pilot clinical trial to test the effectiveness of their game against the effectiveness of Fitbits alone. Congratulations to Dr. Polgreen’s team on this award to enable our patients to have fun while losing weight and preventing diabetes!