Building Competency and Capacity for Promotion of Effective Physical Activity in Diabetes Care in Canada
In Canada, individuals with diabetes are recommended to participate in at least 150 minutes of moderate- to vigorous-intensity aerobic exercise and do resistance training 2 to 3 times a week. Despite these recommendations, a small percent of individuals with diabetes currently meet these physical activity (PA) guidelines. To better support the efforts of diabetes practitioners in the field, the Canadian Diabetes Association developed a resource manual called Building Competency in Diabetes Education: Physical Activity and Exercise. The manual takes into account the specific challenges of providing PA counseling in the context of diabetes care. Initial testing of the manual resulted in increased in PA counseling efficacy and an overall reduction in PA counseling barriers.
To increase the dissemination of information provided in the manual, a series of regional workshops were held across Canada between 2014 and 2016. A total of 462 practitioners attended the workshops with a majority of the participants being registered nurses (44 percent) or dietitians (35 percent) working in diabetes care. Workshop attendees completed a series of evaluations prior to, at the end of, and 8-12 months after their respective workshop. Practitioners were asked their likelihood of using the resources they were provided within their practice, how the information and training that they received would affect their future practice, changes in their confidence in providing PA counseling in diabetes care, and the extent to which they ended up changing their PA counseling practices.
At the end of the workshops, 93 percent of the attendees reported being ‘likely’ or ‘very likely’ to implement skills from the workshop in their practices by increasing the priority they placed on PA promotion (e.g. discussing PA more frequently), employing tools provided in the toolkit, greater promotion of resistance training, and engaging patients in novel ways in promoting PA. Of the 132 diabetes practitioners that completed the long-term follow up 8-12 months later, 66 percent (an increase of 8 percent) reported including PA content in more than half of their sessions, while only 18 percent addressed PA in less than 25 percent of their sessions (a decrease of 11 percent). The majority of the respondents reported increased confidence in providing information and advice regarding the benefits of PA, providing instruction regarding resistance training, and customizing PA programs that accommodated patients’ individual needs or limitations. Most practitioners (80 percent) reported that they most often used the resources when working with patients who were inactive, but were ready for or preparing for physical activity. The most popular resource, used by 58 percent of the practitioners, was the resistance training brochures.
Overall, workshop attendees found that the resources presented to them were helpful and they used these materials in counseling patients who were inactive, but ready to begin regular PA. Although time and patient resistance to change were common barriers, practitioners reported discussing PA more frequently and confidently with patients after the workshop. Attendees desired continued support and direction regarding PA and resource implementation, more resources and training on how to perform exercises, more training regarding health behavior change techniques, and greater involvement of exercise specialists in diabetes care. These findings illustrate the positive impact of a national training initiative on promoting PA in diabetes care, while also providing evidence of the additional work that is needed to improve diabetes care across Canada.
Gray E, Shields C, and Fowles, JR. Building Competency and Capacity for Promotion of Effective Physical Activity in Diabetes Care in Canada. Can J Diabetes. 2017 Apr. S1499-2671(16): 30522-6.