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BackgroundComorbid anxiety and depression can add to the complexity of managing treatment for people living with chronic obstructive pulmonary disease (COPD). Monitoring mood has the potential to identify individuals who might benefit from additional support and treatment. ObjectiveWe used data from the sElf-management anD support proGrammE (EDGE) trial to examine: (1) the extent to which the mood-monitoring components of a mobile health system for patients with COPD were used by participants; (2) the levels of anxiety and depression symptoms among study participants; (3) the extent to which videos providing advice about coping with low mood were viewed; and (4) the characteristics of participants with differing levels of mood and utilization of mood monitoring. MethodsA total of 107 men and women with a clinical diagnosis of COPD, aged ≥40 years old, were recruited to the intervention arm of the EDGE trial. Participants were invited to complete the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 test every four weeks using a tablet computer. Mood disturbance based on these measures was defined as a score ≥5 on either scale. Participants reporting a mood disturbance were automatically directed (signposted) to a stress or mood management video. Study outcomes included measures of health status, respiratory quality of life, and symptoms of anxiety and depression. ResultsOverall, 94 (87.9%) participants completed the 12-month study. A total of 80 participants entered at least one response each month for at least ten months. On average, 16 participants (range 8-38 participants) entered ≥2 responses each month. Of all the participants, 47 (50%) gave responses indicating a mood disturbance. Participants with a mood disturbance score for both scales (n=47) compared with those without (n=20) had lower health status (P=.008), lower quality of life (P=.009), and greater anxiety (P

BackgroundSelf-monitoring of behavior (namely, diet and physical activity) and physiology (namely, glucose) has been shown to be effective in type 2 diabetes (T2D) and prediabetes prevention. By combining self-monitoring technologies, the acute physiological consequences of behaviors could be shown, prompting greater consideration to physical activity levels today, which impact the risk of developing diabetes years or decades later. However, until recently, commercially available technologies have not been able to show individuals the health benefits of being physically active. ObjectiveThe objective of this study was to examine the usage, feasibility, and acceptability of behavioral and physiological self-monitoring technologies in individuals at risk of developing T2D. MethodsA total of 45 adults aged ≥40 years and at moderate to high risk of T2D were recruited to take part in a 3-arm feasibility trial. Each participant was provided with a behavioral (Fitbit Charge 2) and physiological (FreeStyle Libre flash glucose monitor) monitor for 6 weeks, masked according to group allocation. Participants were allocated to glucose feedback (4 weeks) followed by glucose and physical activity (biobehavioral) feedback (2 weeks; group 1), physical activity feedback (4 weeks) followed by biobehavioral feedback (2 weeks; group 2), or biobehavioral feedback (6 weeks; group 3). Participant usage (including time spent on the apps and number of glucose scans) was the primary outcome. Secondary outcomes were the feasibility (including recruitment and number of sensor displacements) and acceptability (including monitor wear time) of the intervention. Semistructured qualitative interviews were conducted at the 6-week follow-up appointment. ResultsFor usage, time spent on the Fitbit and FreeStyle Libre apps declined over the 6 weeks for all groups. Of the FreeStyle Libre sensor scans conducted by participants, 17% (1798/10,582) recorded rising or falling trends in glucose, and 24% (13/45) of participants changed ≥1 of the physical activity goals. For feasibility, 49% (22/45) of participants completed the study using the minimum number of FreeStyle Libre sensors, and a total of 41 sensors were declared faulty or displaced. For acceptability, participants wore the Fitbit for 40.1 (SD 3.2) days, and 20% (9/45) of participants and 53% (24/45) of participants were prompted by email to charge or sync the Fitbit, respectively. Interviews unearthed participant perceptions on the study design by suggesting refinements to the eligibility criteria and highlighting important issues about the usability, wearability, and features of the technologies. ConclusionsIndividuals at risk of developing T2D engaged with wearable digital health technologies providing behavioral and physiological feedback. Modifications are required to both the study and to commercially available technologies to maximize the chances of sustained usage and behavior change. The study and intervention were feasible to conduct and acceptable to most participants. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 17545949; isrctn.com/ISRCTN17545949

BackgroundAcute reductions in postprandial glucose excursions because of movement behaviors have been demonstrated in experimental studies but less so in free-living settings. ObjectiveThe objective of this study was to explore the nature of the acute stimulus-response model between accelerometer-assessed physical activity, sedentary time, and glucose variability over 13 days in nondiabetic adults. MethodsThis study measured physical activity, sedentary time, and interstitial glucose continuously over 13 days in 29 participants (mean age in years: 44.9 [SD 9.1]; female: 59%, 17/29; white: 90%, 26/29; mean body mass index: 25.3 [SD 4.1]) as part of the Sensing Interstitial Glucose to Nudge Active Lifestyles (SIGNAL) research program. Daily minutes spent sedentary, in light activity, and moderate to vigorous physical activity were associated with daily mean glucose, SD of glucose, and mean amplitude of glycemic excursions (MAGE) using generalized estimating equations. ResultsAfter adjustment for covariates, sedentary time in minutes was positively associated with a higher daily mean glucose (mmol/L; beta=0.0007; 95% CI 0.00030-0.00103; P

Introduction: Health care professionals are well-positioned to encourage physical activity. The Clinical Champions Physical Activity Training Program (CCTP) aimed to increase population-level physical activity across England. This study aimed to (1) evaluate CCTP uptake and utilization; (2) explore CCTP fidelity, barriers, facilitators, and satisfaction; and (3) provide recommendations for program improvement. Methods: Physical Activity Clinical Champions were recruited and trained to deliver training to other health care professionals about physical activity. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to conduct a process evaluation using data collected from CCTP training sessions delivered (often at hospitals and General Practitioner surgeries) between February and December 2018. Results: About 509 training sessions were delivered, with 89% of sessions delivered by doctor/physician and nurse Clinical Champions; 8917 health care professionals attended a training session. Sessions lasted on average 1 hour 28 minutes and core slide sets were used in 65% of sessions. Barriers related to arranging the sessions and time available to deliver sessions. Conclusion: The process evaluation demonstrated a national peer-led training program can reach all geographical regions of England; however, barriers need to be addressed. Recommendations include providing more administrative support to the Clinical Champions, improving communication and advertising to raise awareness of the CCTP, and standardizing training session duration and content. [ABSTRACT FROM AUTHOR]

Background: The benefits of physical activity for preventing and managing long-term health conditions are well established and health care professionals could promote physical activity to patients. The current study aims to evaluate the impact of the Clinical Champions Physical Activity Training Program. Methods: Health care professionals attend a one-off in-person training session delivered by a trained Clinical Champion. Attendees at the Clinical Champions Physical Activity Training Program were asked to complete a baseline survey prior to the training session and follow-up surveys 4 and 12 weeks posttraining. Results: A total of 5945 training attendees completed the baseline survey. A total of 1859 and 754 participants completed 4- and 12-week follow-up (31.3% and 12.7% response rate, respectively). Significant increases in confidence to deliver brief physical activity advice and knowledge of physical activity guidelines were reported at 12 weeks (P <.001). The perceived frequency of physical activity discussions with patients significantly increased (P <.001). Twelve weeks after training, fewer barriers in promoting physical activity were reported. Conclusions: The evaluation of the Clinical Champions Physical Activity Training Program demonstrated an increase in knowledge of physical activity guidelines, levels of confidence, and frequency of delivery of brief physical activity advice to patients. Further research is required to determine if this impact translates into changes to patients' physical activity behavior. [ABSTRACT FROM AUTHOR]

Introduction Increasing physical activity (PA) reduces the risk of developing diabetes, highlighting the role of preventive medicine approaches. Changing lifestyle behaviours is difficult and is often predicated on the assumption that individuals are willing to change their lifestyles today to reduce the risk of developing disease years or even decades later. The self-monitoring technologies tested in this study will present PA feedback in real time, parallel with acute physiological data. Presenting the immediate health benefits of being more physically active may help enact change by observing the immediate consequences of that behaviour. The present study aims to assess user engagement with the selfmonitoring technologies in individuals at moderate-to-high risk of developing type 2 diabetes. Methods and analysis 45 individuals with a moderateto-high risk, aged =40 years old and using a compatible smartphone, will be invited to take part in a 7-week protocol. Following 1 week of baseline measurements, participants will be randomised into one of three groups: group 1-- glucose feedback followed by biobehavioural feedback (glucose plus PA); group 2--PA feedback followed by biobehavioural feedback; group 3--biobehavioural feedback. A PA monitor and a flash glucose monitor will be deployed during the intervention. Participants will wear both devices throughout the intervention but blinded to feedback depending on group allocation. The primary outcome is the level of participant engagement and will be assessed by device use and smartphone usage. Feasibility will be assessed by the practicality of the technology and screening for diabetes risk. Semistructured interviews will be conducted to explore participant experiences using the technologies. [ABSTRACT FROM AUTHOR]

Background: Continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) are widely used in diabetes management and increasingly being considered for type 2 diabetes mellitus (T2DM) prevention. This scoping review aims to summarize the literature published to date on CGM and FGM use in adults at risk of T2DM., Methods: A systematic search of four databases (CINAHL, PsycINFO, MEDLINE, Cochrane Library) was conducted, covering studies from 1985 to 2024. Eligible studies used CGM or FGM in interventional settings targeting adults at risk of T2DM. Rayyan software facilitated article screening, and the Johns Hopkins Evidence-Based Practice tool assessed study quality., Results: From 13 644 articles, 12 studies were included, reporting on 1144 participants (353 at-risk, mean age 47 ± 12.8 years) across eight countries. Ten studies employed FGM, focusing on health-related behaviors (diet, physical activity, or both). Significant improvements in glucose control and anthropometrics were reported in 75% and 50% of the studies, respectively, along with reductions in glycated hemoglobin, fasting glucose, and insulin resistance. Seven studies used qualitative methods, with recurrent themes including perceived benefits and motivators for behavior change and acceptability and feasibility of device use. Three studies were rated as "high" level and scored a "B" for evidence quality, while the remaining studies were lower for both level and evidence quality., Conclusions: Existing published studies deploying glucose monitoring technologies show promise in supporting interventions aimed at preventing T2DM in at-risk adults. Further robust studies are required to confirm the long-term acceptability and efficacy of these technologies., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.