Integrating smartphone technology, social support and the outdoor physical environment to improve fitness among adults at risk of, or diagnosed with, Type 2 Diabetes: findings from the 'eCoFit' randomized controlled trial

The risk and prevalence of Type 2 Diabetes (T2D) has dramatically increased over the past decade. The aim of this study was to develop, implement and evaluate a physical activity intervention to improve aerobic and muscular fitness among adults at risk of, or diagnosed with T2D. A 20-week, assessor blinded, parallel-group randomized controlled trial (RCT) was conducted at the University of Newcastle (June–December 2015). Adults were randomized to the intervention (n = 42) or wait-list control group (n = 42). The theory-based intervention included: Phase 1 (weeks 1–10) integrated group sessions (outdoor physical activity and cognitive mentoring), and the eCoFit smartphone application (app). Phase 2 (weeks 11–20) only included the eCoFit app. Participants were assessed at baseline, 10 weeks and 20 weeks. Linear mixed models (intention-to-treat) were used to determine group-by-time interactions at 10 weeks (primary time-point) and 20 weeks for the primary outcomes. Several secondary outcomes were also assessed. After 10 weeks, significant group-by-time effects were observed for aerobic fitness (4.5 mL/kg/min; 95% CI [1.3, 7.7], d = 0.68) and muscular fitness (lower body) (3.4 reps, 95% CI [2.7, 4.2], d = 1.45). Intervention effects for secondary outcomes included significant increased physical activity (1330 steps/week), improved upper body muscular fitness (5 reps; arm-curl test), improved functionality (− 1.8 s; timed-up and go test) reduced waist circumference (2.8 cm) and systolic blood pressure (− 10.4 mm Hg). After 20 weeks, significant effects were observed for lower body muscular fitness and health outcomes. eCoFit is an innovative lifestyle intervention which integrates smartphone technology, social support, and the outdoor environment to improve aerobic and muscular fitness.