Social Dimensions of Health Research past, current and future

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Social Dimensions of HealthResearch past,
current and future

• Dr Alison Kirk

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PhD Research

• RCT investigating the effectiveness of a physical
  activity counselling intervention, compared to
  standard exercise leaflet over 12 months for
  promoting physical activity in people with Type 2
  diabetes
• Primary outcome measures physical activity
  levels (subjective and objective), stage
  processes of exercise behaviour change (TTM)
• Secondary outcome measures physiological (BP,
  BMI, cardiorespiratory fitness, Biochemical
  (HbA1c, full lipid profile, fibrinogen,
  plasminogen activator inhibitor-1), Quality of
  life.

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Study design
Patients (n70)
Baseline assessments Physical activity (7-day
recall, CSA activity monitor) Glycaemic control
(HbA1c, medication) Cardiovascular risk factors
(Body Mass Index, blood pressure, lipid profile)
Exercise consultation standard exercise leaflet
(n35)
Standard exercise leaflet alone (n35)
6 month assessment Repeat baseline assessments
Exercise consultation standard exercise leaflet
(n32)
Standard exercise leaflet alone (n31)
12 month assessment Repeat baseline assessments
Experimental group (n31)
Control group (n29)
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Results Physical activity guidelines
?222.0 Plt0.001
?215.2 Plt0.001
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Results Glycaemic control
Change from baseline to 12 months
Experimental group
Control group
0.34 increase
0.27 decrease
Change from baseline to 6 months
0.15 increase
0.26 decrease
Non diabetic range 4-6
-0.4
-0.3
-0.2
-0.1
0
0.1
0.2
0.3
0.4
HbA1c ()
Improving
Deteriorating
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Results Cardiovascular risk factors

• Between groups difference for change in systolic
  BP (baseline to 6
• months) change in total cholesterol (baseline
  to 12 months)

• Systolic blood pressure

• Total cholesterol

0.04 mmol/L
Change in blood pressure (mmHg)
Change in cholesterol (mmol/L)
- 0.32 mmol/L
Control group
Experimental group
Experimental group
Control group
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Related publications

• Kirk A, Mutrie N, MacIntyre P Fisher M. 2004.
  Promoting and maintaining physical activity in
  people with type 2 diabetes. American Journal of
  Preventive Medicine 27 289-296
• Kirk A, Mutrie N, MacIntyre P Fisher M. 2004.
  Effects of a 12-month physical activity
  counselling intervention on glyceamic control and
  on the status of cardiovascular risk factors in
  people with Type 2 diabetes Diabetologia
  47821-832.
• Kirk A, Mutrie N, MacIntyre P Fisher M. 2003.
  Increasing Physical Activity in People With Type
  2 Diabetes Diabetes Care 261186-1192.

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• Current future developments
• Funding from Diabetes UK to develop evaluate a
  supervised exercise education programme for
  people with Type 2 diabetes (current)
• Comparison of effectiveness and cost
  effectiveness of 2 physical activity
  interventions for people with Type 2 diabetes
  (future)
• Interested in process of behaviour change and
  development of innovative methods to influence
  lifestyle

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Measurement of physical activity

• Previous research has looked at validity of
• Computer Science and Applications
  accelerometer during walking and house hold
  activities
• Validity of using pedometers in people with Type
  2 diabetes and people classified as obese.
  (future research)
• Placement site
• Development of pedometer based physical activity
  interventions for clinical populations. (future
  research)

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• Cardiac rehabilitation diabetes
• Currently investigating adherence to phase IV
  cardiac rehabilitation exercise programme over
  last 6 years, in particular determinants of
  adherence
• Interested in future research investigating
  referral of process and determinants of adherence
  in cardiac rehabilitation
• Kirk A, Mutrie N, MacIntyre P Fisher M. 2004
  Diabetes and survival after myocardial
  infarction is cardiac rehabilitation an
  effective secondary prevention measure? Practical
  Diabetes International 21 267-275