Examining the effectiveness of a Meta-Health Clinic: Exercise, diet and lifestyle education to manage cardiometabolic health, quality of life and pain in people with type 2 diabetes and osteoarthritis

Meta-Health Clinic This project is a community based, wait-list controlled randomised trial. The program will be delivered and overseen by Accredited Exercise Physiologists (AEPs) and Accredited Practicing Dietitians (APDs), utilising the Medicare service item numbers, detailed in the below list: Participant Group: Meta-Health Clinic Group Intervention Initial Assessment (Week 9 - final assessment follow control period) 8 group face-to-face sessions Frequency: Once a week (week 10 – 17) Duration: 60 minutes Session structure: exercise (approximately 40 minutes) and educational (approximately 20 minutes) components. Final Assessment (Week 18) Focus group (Week 19-20) Medicare item numbers: • 81110 x1 (AEP Exercise Physiology Service – Assessment for Group Services). Week 9 • 81115 x6 (Exercise Physiology Service – Group service item number). Weeks 10, 11, 13, 14, 15, 17 • 81112 x2 (APD Dietetics Service – Group Service). Weeks 12, 16) Participant Group: Meta-Health Clinic Individual Telehealth Intervention Initial Assessment (Week 9 - final assessment follow control period) 4 individual telehealth sessions Frequency: Once every 2-3 weeks. (weeks 10, 12, 14, 17). Duration: 60 minutes Session structure: exercise (approximately 40 minutes) and educational (approximately 20 minutes) components. Final Assessment (Week 9-10) Focus group (Week 10-14) Medicare item numbers: • 10953 x1 (Exercise Physiology Services item number face to face). Week 0 • 93000 x4 (Allied Health Telehealth items). 2xAEP (Weeks 10, 14), 2xAPD (Weeks 12, 17) Health outcomes for people living with T2D and OA will be compared between intervention/control and baseline/follow-up. The Meta-Health Clinic (Assessments and Group services) will be delivered by an AEP and APD within the UNSW Medicine & Health Lifestyle Clinic. As the clinic operates as a learning and teaching facility, patients are advised that Exercise Physiology undergraduate students complete their clinical placement and work alongside the AEPs to deliver clinical services. As per industry guidelines, an AEP may supervise up to five students at a time. Therefore, up to five 4th year undergraduate exercise physiology students may support the AEP in the delivery of the service as is current practice within the UNSW Medicine Lifestyle Clinic. All students involved in the project will have undergone an induction to the Lifestyle Clinic, be trained by the research team and be added to the ethics application prior to being involved in the project. Two groups (6 participants per group) of The Meta-Health Clinic will take place over approximately 6 months (February 2024 - July 2024). GROUP SESSIONS Following initial assessment, each participant randomised to the group intervention will receive 8 group sessions at a frequency of once per week. Each session will run for 60 minutes and will include exercise (approximately 40 minutes) and educational (approximately 20 minutes) components. The exercise component will be evidence based. The Meta-Health Clinic – Group intervention will be delivered face-to-face utilising the variety of exercise equipment available within the UNSW Medicine & Health Lifestyle Clinic. The Meta-Health Clinic – Individual Telehealth intervention will be delivered online utilising any home-based exercise equipment available to the participant or equipment free options. Nutritional information will be modified for each individual, with no one diet approach to be prescribed. Exercises will be modified for each individual based on ability and fitness. A combination of aerobic, resistance, balance and flexibility exercises will be prescribed as is suitable and relevant to the participant. The below exercise prescription guidelines as per ACSM will be followed: 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: 10-20 minutes Type: Major muscle groups: cycling (upright/recumbent); elliptical (upright/recumbent), walking (treadmill, on the spot/corridor), rowing, stepping, boxing 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 week 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: 10-20 minutes Type: Pin-loaded weight plate machines (e.g. Leg Press, Leg Extension, Leg Curl, Seated row, Chest Press, Lat Pulldown), body weight, free weights, exercise bands. 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 week 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. The prescriptive elements of all exercises performed will be recorded in program training sheets each session to ensure all necessary detail is captured. The below topics will be discussed across the educational sessions (including physical activity, nutrition, and lifestyle self-management) with the use of educational material developed by organisations including the National Diabetes Services Scheme, Arthritis NSW, the Australian Government Department of Health. Session 1: Understanding diabetes Session 2: Understanding Osteoarthritis Session 3: Nutrition and healthy eating for type 2 diabetes and osteoarthritis - Part 1 Session 4: Exercise and type 2 diabetes Session 5: Exercise and Osteoarthritis Session 6: Adjusting to life with diabetes and osteoarthritis Session 7: Nutrition and healthy eating for type 2 diabetes and osteoarthritis - Part 2 Session 8: Bringing everything together