Title:
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The effects of a free-living walking intervention on glycaemic control and cardiovascular disease risk in overweight and obese individuals with intermediate hyperglycaemia
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The prevalence of obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD)
continues to rise. Physical activity (PA) guidelines for health are often prescribed in an effort to reduce
physical inactivity and improve health in overweight adults at risk of T2DM and CVD. However, freeliving
individuals struggle to regulate PA intensity. Primarily this research aims to examine the effects
of walking on T2DM and CVD risk in overweight adults with intermediate hyperglycaemia (IHG). A pilot
study (Appendix 1) was undertaken to investigate the usefulness of 13C stable isotope as a method of
assessing glucose disposal in this population; as results did not support this methodology it was not
explored further within the thesis. The systematic review (Study 1; Chapter Four) highlights that
aerobic exercise, particularly walking, is an effective method of reducing T2DM and CVD risk in
overweight adults. Study 2 (Chapter Five) uses objective accelerometer data to identify ambulatory
activity habits of a cohort of overweight IHG adults from Northern Ireland. Study 2 highlights this
population spend the majority of time in sedentary-to-light-intensity activity, do not meet current PA
guidelines and concluded that time spent in sedentary activity is significantly correlated with two-hour
glucose concentration. Study 3 (Chapter Six) assessed the ability of overweight IHG adults to regulate
their walking intensity to self-selected music with a predetermined tempo. Results proved this is a
useful method to help this population regulate their walking intensity. This study also found that using
music with a predetermined beat helps adults to attain at least moderate intensity walking. Study 4
(Chapter Seven) concluded that a novel walking intervention (music with a predetermined beat using
a mobile application) with behaviour change support was not more effective than usual care for
improving glycaemic control in overweight IHG adults. This nine month study found significant
improvements in perceived quality of life and flow mediated dilation (FMD), however this latter result
should be cautiously accepted. Future research incorporating greater sample sizes should investigate
if this novel intervention achieves statistical significance in various parameters as primary outcome
measures.
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