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Title: Effects of a 10,000 steps per day and a social ecology intervention in health parameters in overweight men
Author: Alduhishy, Anas Mohmmad
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 2012
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Diabetes mellitus (DM) is a very common chronic disease, as well as being a major public health issue internationally. Hyperglycaemia is the most important clinical manifestation of diabetes. It develops through a multifactorial aetiology which includes genetic, environmental, and behavioural factors. It is estimated that 171 million people in the world currently have diabetes mellitus. This figure is expected to increase to 366 million by the year 2030. The distribution of DM varies around the world. The country with the greatest number of people with DM is India, with 31.7 million in 2000 and estimated to increase to 79.4 by 2030, though this is a low prevalence rate of 3% of the population. The USA has 18.8 million cases in 2011, representing 8% of the population, and this figure is estimated to rise to 30.3 million cases by 2030. The UK has 2.8 million cases in 2010, representing 4.2% of the population, and estimated to reach 4 million cases by 2025. The prevalence of DM has reached epidemic status in Saudi Arabia, where it affected 8.3 million people, or 23.7% of the population, in 2007. It is clear from these figures that there is variance in rates of diabetes prevalence in different countries. Moreover, researchers reported that this high rate of diabetes occur at lower average adiposity levels in some ethnic groups, such as South Asians, than in European populations, suggesting that South Asians are more susceptible to the effects of obesity. Several studies have investigated these differences in specific ethnic populations, but other populations, such as Saudi Arabs, have received less attention in these studies. The impending global pandemic of obesity, type 2 diabetes and vascular disease suggests an urgent need for both prevention strategies and effective treatment, which need to account for these ethnic differences. Physical activity has been shown to improve glucose metabolism and insulin sensitivity in men and women of all ages and ethnicities. Diabetes UK and the American College of Sport Medicine (ACSM) recommend that adults take at least 30 minutes of moderately intense physical activity on most days. They also recommend walking 10,000 steps most days. This is supported by the work of Tudor-Locke, Bassett, Le Massurier et al. (2007). These recommendations are aimed at European and American populations. However, to date there has been no study of the benefits of accumulation of 10,000 steps daily on glycaemic control or insulin sensitivity. Despite the benefits of physical activity being well-known, previous findings have reported that more than 43% of Saudis do not take any moderately intense physical activity. Moreover, the current evidence emphasises the importance of creating a programme to increase physical activity, encompassing multiple levels of the social environment. The aims of this thesis are to investigate if a walking programme can be conducted successfully among Saudi Arabian and, if so, whether it can deliver improved glycaemic control. In addition, the second study evaluated the efficacy of a social ecological intervention to increase walking among sedentary Saudi men. First Study: The first study was a 12-week randomised controlled trial. It recruited 39 overweight men with a family history of type 2 diabetes. After two weeks of baseline activity, participants were randomised into two groups: control and active. The control group (n = 17, 45±9 yr) was instructed to continue with their baseline activity for 12 weeks. The active group (n = 22, 47±7 yr) was instructed to walk at least 10,000 steps per day, 5 or more days per week, for 12 weeks. Steps were measured using a Yamax SW-200 pedometer. All subjects participated in a pre-test and a post-test. Each session consisted of a metabolic and anthropometric test. The baseline physical activity was not significantly different in the active and control groups (3781 ± 344 and 3298± 516 steps/day; P = 0.57). Subjects in both groups significantly increased physical activity during the intervention phase of the study. The active group increased to 9199 ± 1084 steps per day (P = 0.002) and the control group increased to 4863 ± 787 (P = 0.03). In the active group, glucose concentration reduced from 6.33 ± 0.4 at pre-test to 5.73 ± 0.3 at post-test (P = 0.008), which was a significant decrease. Fasting insulin reduced from 14.0 ± 2.5 to 13.4 ± 2.3 (P =0.046). Body mass also significantly decreased in the active group (P = 0.01). There was no significant change in these figures in the control group. Second Study In the second study, overweight male volunteers were recruited. They were randomised into two groups: a social ecology group (SE) of 35 volunteers and a self-monitoring group (SM) of 28 volunteers completed the study. Both groups monitored their steps/day during a one-week control period and over the 10-week study. In addition, the men in the active group attended four weekly sessions designed to target intrapersonal (self-efficacy, and self-regulation), and interpersonal (social support functions: attachment, social integration, reassurance of worth, reliable alliance, guidance and opportunity of nurturance) levels of the social environment. During the study period, data was collected at three time points: pre-test (baseline), post-test (at 4 weeks), and follow-up (at 11 weeks). Steps were measured using a Yamax SW-200 pedometer. Both groups significantly increased their steps/day at each time point (P < 0.001). This increase was significantly greater in the SE group (baseline 3321 ± 950 to post-test 7294 ± 338 to follow-up 5514 ± 394) compared to the SM comparison (baseline 3305 ± 720 to post-test 4865 ± 263 to follow-up 3540 ± 217). The intervention had a significant impact on self-regulatory self-efficacy, task self efficacy, self regulation for walking and some of the social support functions (attachment, reassurance of worth and reliable alliance) in SE participants only. In conclusion, the results presented in this thesis are the first to show that it is feasible to conduct a 10,000 step/day walking programme for overweight men. In addition, this programme was effective in producing statistically significant improvements in glycaemic control. The thesis also describes the first social ecology study to be conducted with overweight men. Such comparatively simple methods as social support and advice also significantly increased physical activity. In this pilot project, the use of pedometers has proved to be an effective tool for promoting healthy lifestyle changes that include daily physical activity and self-monitoring of therapeutic goals.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RZ Other systems of medicine ; QP Physiology