A series of studies analyzing exercise behavior and exploring the effects of interventions among pre-diabetes, type 1, and type 2 diabetes

In 21st century, the most rapidly-increased morbidity and mortality rate in chronic diseases lies in diabetes mellitus. Promoting early screening of pre-diabetes and education of diabetes play a major role in preventing and managing diabetes, as evidence has shown that 85% of pre-diabetes patients who fail to change life style, have 70% chance to contribute to diabetes and 10-20% of them reveal pathological changes in micro-vessels. Similarly, diabetes patients who fail to perform an active life style, are at high risks of complications resulted from blood sugar disorder. Although most of them did realize the importance of regular exercise, they did not achieve the target recommendation. Performing and maintaining regular exercise depend on the knowledge and attitude. Hence, the purpose of this study is to investigate the exercise behavior model, including the stages of exercise, balance exercise decision-making and self-efficacy, among pre-diabetes, type 1 and type 2 diabetes, and further to explore the effectiveness of “Cognitive-Behavioral Education Courses” and “Exercise Program” on exercise behavior model, anthropometric, metabolism of lipid and carbohydrate in a group of pre-diabetes, type 1, and type 2 diabetes. This study is composed of two stages in three years period. Participants will be recruited from outpatient department of a medical center in northern Taiwan. The first stage included two phases. In phase I, a cross-sectional survey will be conducted to explore the stages of exercise among participants. In phase II, a quasi-experimental design will be used to determine the effects of a four-week education courses on changes of exercise behavior among subjects who meet the exercise stage of “pre-contemplation” and “contemplation”. The second stage of this study, subjects who are in the later stage of exercise behavior, such as "preparation " and "action" stage will be recruited and randomly divided into three groups, self-monitoring steps group (SSG), structured aerobic exercise group (SAG) and control group (CG). After twelve weeks exercise prescription intervention, outcome indicators including exercise behavior, anthropometrics, biological marker of lipid and carbohydrate will be collected before intervention and on the 12th, 24th and 48th week after intervention. SPSS for Window 17.0 software will be used in statistical analysis. The details of demographic variables will be expressed as mean, standard deviation, number and percentage of descriptions. In inferences analysis, chi-square test, Pearson correlation coefficient, paired t-test, one-way ANOVA and post hoc comparison (scheffe) test will be used to examine the variance among groups. Multiple regressions will be performed in the second stage to establish the model of β-cell function. Description data will be expressed as mean, standard deviation, number and percentage of performance to analyze the trend of outcome indicators. Finally, GEE mode will be used to test the effectiveness of exercise intervention in different timing period.