Interactive exercise therapy at home:
a web based solution to improve long-term adherence, self-management and clinical efficacy of a life-style intervention program for patients with Type 2 Diabetes

Physical exercise training is an important tool for improving glucose
homeostasis in type 2 diabetic patients. A combined strength- and endurance
training program appears to improve functional capacity, body composition and
metabolic control in type 2 diabetes patients. However, long-term adherence to
such programs is generally poor. Therefore, alternative strategies are
warranted to reduce attrition rate.

Primary Objectives:
- DirectLifeDirectLifeAre the LiveWorkout® and DirectLife® concept feasible web
based training programs for type 2 diabetes patients ?
- How do type 2 diabetes patients experience web based training intervention
programs ? What can be recommended for future web based training interventions
to increase effectively ?
- What barriers experience patients who are not willing to engage in web based
training intervention programs ?

Secondary Objectives:
- Will online exercise training as compared to a usual care program cause an
improvement in:
- Movement-related everyday activity/energy expenditure and functional capacity
- Muscle strength and resistance to fatigue
- Glycemic control (HbA1c) and fasting plasma glucose levels
- Cardiovascular risk profile
• Is there a difference in adherence between the LiveWorkOut® and DirectLife®
group ?
care improve glycemic control (HbA1c), fasting plasma glucose levels and
cardiovascular risk profile?

A randomized controlled intervention study

Patients will be randomized to follow either a supervised progressive interval
endurance and resistance type of training at the ErasmusMC (13 weeks) combined
with an interactive web based (LiveWorkout®) resistance training at home (26
weeks), or to take part in a webbased activity monitor based lifestyle coaching
program (26 weeks). Both programs are aimed at increasing daily physical
activity levels.

Since all patients will undergo a symptom limited exercise stress test using
ECG-monitoring, the risk for exercise related cardiac ischaemia and/or
arrhythmia during the course of the exercise intervention is rather limited. To
minimize the risk for a hypoglycemic event, capillary blood glucose following
interval endurance training will be measured during the first 2 weeks of the
exercise intervention. The exercise intervention is expected to improve
glycemic control, blood pressure and workload capacity/physical fitness level.
As such, cardiovascular risk profile, general health and well-being is expected
to improve in the experimental group. All patients will be seen 3 times (in
total approximately 3.5 hrs) before and after the intervention. Measurements
that will be done during those visits are: questionnaires (PAR-Q, SF-36,
specifically designed LiveWorkout users questionnaire), body composition, blood
pressure, spiroergometry, muscle strength (upper arm and leg), Sit to
Stand-test, fasting blood sample (3x7 ml). Patients will be asked to wear a
small accelerometry-based Activity Monitor for 7 days and register movement
related activities (7 days) as well as dietary intake (3 days).