Pivoting online during the pandemic: Improving physical fitness and health outcomes in older adults with type 2 diabetes mellitus with an adapted, online Beat It program. (Preprint)

Abstract

The COVID-19 pandemic has necessitated limitations on physical interaction, requiring the rapid virtual adaptation of key health programs and services. A national lockdown to prevent the spread of COVID-19 in Australia was introduced in March 2020. This lockdown included the closure of exercise clinics, fitness centres and other community spaces, which pre-pandemic were used to deliver Beat It, a community-based clinician-led group exercise and education program for adults self-managing diabetes. To continue offering this translational program, Beat It was adapted from a face-to-face to a fully online supervised group exercise program for adults with type 2 diabetes mellitus.

The aim of this study is to assess whether the Beat It Online program was effective in improving physical fitness (muscular strength and power, aerobic endurance, balance, and flexibility) and waist circumference, of adults with type 2 diabetes mellitus, during the height of the COVID-19 pandemic.

Beat It Online is an eight-week program which involves twice-weekly synchronous group exercise and education sessions, delivered via video-conferencing software, by Accredited Exercise Physiologists. Exercise sessions include moderate intensity aerobic, resistance, flexibility and balance-based exercises, and the education sessions focus on different areas of diabetes self-management.

A total of 171 individuals were included in the study. Of this cohort, 54 (31.6%) were male, age ranged from 60 to 89 years with a mean age 71 ± 5.6 years, and 69 (40.4%) of participants resided in lower socioeconomic areas. Participants attended between 5 and 16 exercise sessions, with 70% of the cohort attending at least 14 out of the 16 sessions. For the education sessions, participants attended between 0 and 6 sessions, with 80% of the cohort attending at least 5 out of the 6 education sessions. Significant improvements (P<.001) in waist circumference, aerobic capacity, muscular strength, flexibility, and balance were observed post program in both male and female participants. Significant improvements in diabetes self-efficacy scores were reported post program (3.9 vs 4.3; P<.001), while non-significant improvements in patient activation scores were observed (44.3 vs 45.4; P=0.07).

This study found that the Beat It Online program, an eight-week clinician-led supervised group exercise program, significantly improved physical fitness (aerobic capacity, strength, balance, and flexibility), reduced waist circumference, and improved self-efficacy in older adults with T2DM. This is important because globally it has been reported that during the home confinement of lockdowns and necessary isolation, most individuals decreased their physical activity levels, increased sedentary behaviour, and those with T2DM increased body weight and worsened their glycemic control.