Diabetes Clinic: Exercise Physiology group service for older people with type 2 diabetes

The Diabetes Clinic project aims to examine the feasibility, acceptability and preliminary efficacy of an Accredited Exercise Physiologist (AEP) delivered type 2 diabetes (T2D) group service for older adults. The Diabetes Clinic will be delivered within the UNSW Medicine Lifestyle Clinic, as part of usual clinical service, with the aim of improving diabetes management through increased participation in healthy lifestyle behaviours including exercise. Participants may choose to participate in Part A and/or Part B. Furthermore, those who are not involved in Part A are still eligible to participate in Part B. The project will have an initial focus group (PART A) conducted 1 month prior to the start of the Diabetes Clinic intervention (PART B). A full qualitative analysis of the information collected in PART A will not be undertaken. Instead, it aims to inform on key logistical aspects of the protocol (e.g. morning vs afternoon sessions, frequency per week, duration of sessions, patient goals, exercise preference, enablers and barriers to attending). Any feedback that is deemed by the research team to warrant a modification of the intended protocol, as is presented in this submission, will be implemented, but only following ethical approval after the modification has been submitted and reviewed. This will be done prior to the commencement of PART B data collection. Part B Focus group will then be conducted at the completion on the group intervention, using quantitative analysis to examine feasibility, acceptability, and impact on health outcomes. Both Part A and Part B Focus groups will go for 45-60 minutes each. The focus groups will be facilitated by two researchers, at least one of whom is an AEP with a minimum of 5 years experience. The focus groups will be conducted online via Microsoft Teams, at a place and time convenient for the participant (e.g. their home). If the participant does not have online access, they may be invited to attend the focus group from an available space within the UNSW Medicine Lifestyle Clinic. If participants do need to attend face-to-face, all necessary social distancing requirements will be adhered to. PART B: The Diabetes Clinic will be delivered face to face within the UNSW Medicine Lifestyle Clinic (UNSW Sydney Australia) by AEPs with a minimum 5 years experience, as part of usual clinical service, with the aim of improving diabetes management through increased participation in healthy lifestyle behaviours including exercise. The group will have a minimum of 2 and maximum of 12 participants. If there are more than 12 participants enrolled at any one time, a second group will be created to accommodate numbers. The group services will be delivered as a rolling program, with a group session being delivered once a week to facilitate participant adherence. Following initial assessment (90-120 minutes including health interview, physical assessment and questionnaire completion), each participant will receive 8 sessions at a frequency of once per week. Each session will run between 60-90 minutes to include both and educational (approximately 30 minutes) and exercise (approximately 60 minutes) component. The educational component will be delivered in Sessions 1-8, ensuring each participant has exposure to all topics irrespective of when they commence the group services. The below topics will be discussed across the 8 sessions with the use of educational material developed by Diabetes Australia, Heart foundation Australia and the Australian Government department of health. Session 1: Understanding Type 2 Diabetes (fact sheet understanding type2 diabetes) Session 2: Managing Diabetes as you age (booklet managing diabetes as you age guide for people over 65) Session 3: Health Care team guide for people over 65 (booklet your health care team guide for people over 65) Session 4: Physical Activity for diabetes (fact sheet physical activity, physical activity action plan) Session 5: Diabetes related complications; Strategies for optimal heart health (fact sheet diabetes related complications) Session 6: Healthy eating guide for people over 65 (booklet healthy eating guide for people over 65, Health weight action plan) Session 7: Adjusting to life with diabetes (fact sheet adjusting to life with diabetes, Psychological and social health action plan) Session 8: Physical activity tips and ideas (Choose health brochure, Aus Gov PA tips and ideas older adults) The exercise component will be evidence based and delivered utilising the variety of exercise equipment available within the UNSW Medicine Lifestyle Clinic. A combination of aerobic, resistance, balance and flexibility exercises will be prescribed as is suitable and relevant to the participant within the group setting. The below exercise prescription guidelines as per American College of Sports Medicine (ACSM) will be followed: Exercise: AEROBIC EXERCISE Frequency 1xwk Intensity Light-Vigorous (Light: 40-55% HRmax, RPE 8-10; Moderate 55-70%HRmax, RPE 11-13; Vigorous 70-90%HRmax, RPE 14-16) Time 20-30 minutes Type Major muscle groups: Cycling (upright/recumbent); Walking (treadmill), rowing, stepping Volume Aerobic exercise: Frequency x intensity x time Pattern One continuous bout or multiple bouts (e.g. 30 minutes or 3 x 10 min) Progression Commence first exercise session in wk 1 at low-moderate intensity (50-60%HRmax, RPE 9-13) and progress gradually as tolerated by the individual RESISTANCE EXERCISE Frequency 1xwk Intensity Light-Vigorous (Light: 30-49%1RM, RPE 9-11; Moderate 50-69%1RM, RPE: 12-13; Vigorous: 70-84%1RM, RPE 14-17) Time 20-30 minutes Type Pin-loaded weight plate machined (e.g. Leg Press, Leg Extension, Leg Curl, Seated row, Chest Press, Lat Pulldown) body weight, free weights, therabands. Sets 1-3 Repetitions 8-12 Volume sets x reps x days Pattern 2 second concentric, 3 second eccentric. 1-2 minute rest between sets Progression Commence first exercise session in wk 1 at low-moderate intensity (50-69%1RM, RPE 9-13) and progress gradually as tolerated by the individual Balance and flexibility exercises will be prescribed and delivered as determined to be suitable to the individuals attending the group. Participants attendance and physical activity enjoyment will be recorded each session. All prescriptive elements of all exercises performed will be recorded on pre-prepared program training sheets by the supervising AEP and supporting 4th year Exercise Physiology undergraduate students each session to ensure all necessary detail is captured. The final assessment will be completed on the week following the completion of their eighth group session. To account for a real-world setting, the final assessment may be conducted up to 2 weeks after attending their eighth and final group session. The total time commitment for attending the assessments and group sessions is 16 hours over approximately 10 weeks. The 6 month follow up would include another 90-120 minute assessment. PART B Focus groups will be conducted within 1 month of participants completing their final assessment and with a minimum of 2 participants (no maximum).