SMART Health Teachers’ Study – A community-based physical activity study for teachers with Type 2 diabetes (T2D) or 'at risk' of developing T2D.

The aim of this randomised controlled trial is to evaluate the preliminary efficacy and feasibility of referral to an Exercise Specialist and Psychologists and supplementary physical activity behaviour change strategies for school teachers ‘at risk' of type 2 diabetes or with type 2 diabetes. Teachers with type 2 diabetes or at ‘intermediate/high risk’ of developing type 2 diabetes will be randomised to one of 3 groups: Group 1 - Standard Care group (n=30) = Wait-list control group. At study completion (9 months), participants will receive three face-to-face sessions with a qualified Exercise Specialist sessions and two sessions with a qualified Psychologist, or two qualified exercise specialist sessions and three sessions with a qualified Psychologist (based on individual participant choice), and a behaviour change support package. Group 2 - Qualified Exercise Specialist sessions / Psychologist group (n=30). Participants will receive three face-to-face sessions with a qualified Exercise Specialist and two sessions with a qualified Psychologist OR two qualified Exercise Specialist sessions and three sessions with a qualified Psychologist (based on individual participant choice) over three months. At study completion (9-months), Group 2 participants will also be offered the behaviour change support package. Group 3 - Qualified Exercise Specialist sessions / Psychologist + Support Package group (n=30) = Participants will receive three face-to-face sessions with a qualified Exercise Specialist and two sessions with a qualified Psychologist OR two qualified Exercise Specialist sessions and three sessions with a qualified Psychologist (based on individual participant choice), over three months, followed by a behaviour change support package (e-health, m-health and help-line) (additional six months). The support package will include e-health (website access, with options to download print materials) and m-health (iPhone/android app) strategies and/or the option of receiving print-based materials by post. The sessions with the Exercise Specialist and Psychologist will be held fortnightly at the University of Newcastle (or Muswellbrook Hospital for rural participants). The first session will be 45 minutes in duration and subsequent appointments will be 30 minutes in duration. The Exercise Specialist will be assessing participants' current level of fitness and capacity for participating in physical activity using behaviour change techniques to encourage participants to increase physical activity. The psychologist will be using behaviour change techniques to encourage participants to increase their level of physical activity. The content of these sessions is further described in a protocol booklet. The Exercise Specialist and Psychologist will keep a written log detailing the frequency, duration and content of their face to face sessions with the participants. The following is a summary of the material covered with participants in the sessions with the Exercise Specialist and Psychologist: Session 1 (Psychologist): Introduce the participant to the session flow and cognitive-behaviour techniques (purpose and rationale), educate participants about the influence of thoughts and emotions on physical activity behaviour, discuss motivational techniques and types of automatic thoughts, address the importance of tracking and changing automatic thoughts, acknowledge the importance of behavioural tasks in the program. Session 2: (Exercise Specialist): Assess restrictions to activity/previous injury, participants’ ability to safely perform physical activity, level of confidence to change behaviour, historical enablers for reaching physical activity goals. Discuss the importance of physical activity, benefits of increasing physical activity, having good time management. Set physical activity goals and assist participants to complete weekly planner. Using weekly planner, ascertain time available to exercise, equipment available for exercise, people to exercise with. Determine which exercises cannot be performed, provide exercise demonstration, develop a physical activity plan with participants’ input. Address questions/concerns from participant. Session 3 (Psychologist): Define unhelpful thinking styles and apply potential solutions for these. Review tasks from session 1 and check if participant had difficulties or noticed/learned anything Session 4 (Exercise Specialist): Assess restrictions to activity/previous injury since previous session and participants’ ability to safely perform physical activity. Re-iterate the importance of physical activity and benefits of increasing physical activity. Assess whether participants’ level of confidence to change behaviour has changed. Re-assess physical activity goals and participants' progress towards achieving these. Assess physical activity enablers and barriers since last session – assess participants’ ability to overcome barriers. Assess whether participant has been completing their weekly programme and whether attitude towards physical activity is changing. Discuss any health improvements participants' may have noticed. Re-assess programme plan if necessary. Session 5 (Psychologist): Discuss self-awareness task and behaviour maintenance strategy. Implement self-awareness and behaviour maintenance strategy. Summarise previous sessions Session 5 (Exercise Specialist) Same flow as session 4. Extend on next steps (Adoption, Implementation, Maintenance; SMART Goals; time management, progression of exercises, variation) The e-health website and m-health app contain information to assist participants in achieving the physical activity recommendations for Australian adults. This includes information and education to support the behaviour change techniques being used in the face to face sessions with the psychologist and exercise specialist, photos demonstrating various muscle strengthening exercises and links to websites that contain evidence based information about physical activity, diabetes, mental health and nutrition. Participants will be encouraged to access the website and the app as often as they would like. There will be tracking and process measures in place to assess participants' use of the website. The support package will also include access to a physical activity behaviour ‘helpline’. The helpline counselling will be delivered by a qualified Exercise Specialist and Psychologist (who are appropriately trained in operationalising social cognitive constructs and trained in counselling). The helpline will be open for 4 hours/week for participants to be able to call the Exercise Specialist and 4 hours/week for participants to be able to call the Psychologist. These times will be outlined to participants and participants may have a phone consultation with the Exercise Specialist and/or the Psychologist for up to 15 minutes/week.