scholarly journals Motivating Diabetic and Hypertensive Patients to Increase Physical Activity: The Use of Photos and Group Dynamics

2018 ◽  
Author(s):  
Angela Yee Man Leung ◽  
Pui Hing Chau ◽  
Isaac Leung ◽  
Michael Tse ◽  
Perick Lai Choi Wong ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Lower Limb ◽  
Intervention Group ◽  
Mean Difference ◽  
Regular Physical Activity ◽  
Activity Level ◽  
Control Group ◽  
Body Strength ◽  
Group Meetings

Aims: Photovoice is a strategy to allow people to express their views and concerns about health. This project aimed to promote physical activity (PA) among patients with chronic illness, identify facilitators and barriers for PA, enhance walking within the neighbourhood, and build up efficacy in doing exercise. Design: A quasi-experimental study with waitlisted control and pre-and-post measures. Setting: Community elderly centres. Participants: A total of 204 older adults with diabetes and/or hypertension were recruited. They were assigned to either intervention group (IG) or waitlisted control group (CG). Intervention: Under the supervision of a nurse, six weekly group meetings were arranged in community elderly centres in which the participants freely exchanged their views about the barriers and facilitators of regular physical activity. Participants were encourage to take photos in their neighbourhood or at homes, and brought these photos for sharing in the group meetings. The photos showed the barriers and the facilitators to PA. In the last meeting, each participant worked out a plan to perform PA in the coming four weeks. Measures: PA referred to the number of steps taken per day and it was measured by Garmin Accelerometer at baseline, at Week 6 and Week 10. Other measures include the 9-item Self-efficacy Scale for Exercise - Chinese version (SEE-C), the 23-item Chinese Barriers to Exercise Scale and Senior Fitness Tests. General linear mixed model was used to compare the outcomes between IG and CG after the intervention. Results: After the 6-week intervention, the average number of steps taken by the IG participants increased. At Week 10, there was a significant higher proportion of the IG participants who had increased at least 1,200 steps than that of the CG (Estimate=0.151, SE=0.066, p<0.05). The lower body strength of the IG participants was significantly higher than that of the CG (mean difference = 0.94, t=1.957, p<0.05) and the lower limb flexibility of the IG participants was also significantly higher than that of the CG (mean difference = 2.04, t=2.397, p<0.05) at Week 10. Conclusion: Understanding older adults’ views and thoughts about barriers to PA through photos and group discussion seemed to be a good strategy to motivate older adults with chronic illnesses to commit to regular physical activity. This photovoice intervention improved the participants’ physical activity level and physical fitness, particularly in lower limb flexibility and body strength.

scholarly journals Motivating Diabetic and Hypertensive Patients to Engage in Regular Physical Activity: A Multi-Component Intervention Derived from the Concept of Photovoice

2019 ◽  
Author(s):  
Angela Y. M. Leung ◽  
Pui Hing Chau ◽  
Isaac S. H. Leung ◽  
Michael Tse ◽  
Perick Lai Choi Wong ◽  
...  
Keyword(s):  
Physical Activity ◽  
Confidence Interval ◽  
Lower Limb ◽  
The Elderly ◽  
Mean Difference ◽  
Regular Physical Activity ◽  
Activity Level ◽  
Body Strength ◽  
Barriers To Exercise ◽  
Group Meetings

Aims: A community-based multi-component intervention (increasing awareness of the importance of physical activity in chronic illness management through reading comic books, training regarding warm-up stretching exercises, identifying facilitators and barriers to exercise through photosharing, supporting self-reflection and development of action plans) was developed to promote physical activity (PA) among patients with diabetes and hypertension. This study aimed to evaluate the efficacy of this intervention on health behaviour (walking) and health outcomes. Design: A non-randomized controlled trial with waitlisted control and pre- and post-measures. Setting: Community centres for the elderly. Participants: A total of 204 older adults with diabetes and/or hypertension were recruited. They were assigned to either the intervention group (IG) or waitlisted to the control group (CG). Intervention: Under the supervision of a nurse, six weekly group meetings were arranged in community centres for the elderly in which the participants freely exchanged their views regarding the barriers and facilitators of regular physical activity. Participants were encouraged to take photos in their neighbourhood or at home and brought these photos to share at the group meetings. The photos showed both the barriers and the facilitators to PA. In the last meeting, each participant worked out a plan to perform PA in the coming four weeks. Measures: PA referred to the number of steps taken per day and it was measured by a Garmin Accelerometer at baseline, Week 6 and Week 10. Other measures included the nine-item Self-Efficacy Scale for Exercise - Chinese version (SEE-C), the 23-item Chinese Barriers to Exercise Scale and Senior Fitness Tests. Generalised Estimating Equations (GEE) models compared the outcomes over time between IG and CG. Results: A statistically significant difference in the changes in the average number of steps taken daily between the two groups at Week 10 (mean difference = 965.4; 95% confidence interval: 92.2, 1838.6, p = 0.030) was observed, although the difference at Week 6 was non-significant (mean difference = 777.6; 95% confidence interval: −35.3, 1590.5, p = 0.061). IG participants also showed significant improvements in lower body strength (mean difference = 0.967; 95% confidence interval: 0.029, 1.904, p = 0.043) and lower limb flexibility (mean difference = 2.068; 95% confidence interval: 0.404, 3.731, p = 0.015) at Week 10 compared to CG participants. Conclusion: This multi-component intervention improved the participants’ physical activity level and physical fitness, particularly in lower limb flexibility and body strength.

scholarly journals Motivating Diabetic and Hypertensive Patients to Engage in Regular Physical Activity: A Multi-Component Intervention Derived from the Concept of Photovoice

2019 ◽  
Vol 16 (7) ◽  
pp. 1219 ◽  
Author(s):  
Angela Leung ◽  
Pui Chau ◽  
Isaac Leung ◽  
Michael Tse ◽  
Perick Wong ◽  
...  
Keyword(s):  
Physical Activity ◽  
Confidence Interval ◽  
Lower Limb ◽  
The Elderly ◽  
Mean Difference ◽  
Regular Physical Activity ◽  
Activity Level ◽  
Body Strength ◽  
Barriers To Exercise ◽  
Group Meetings

Aims: A community-based multi-component intervention (increasing awareness of the importance of physical activity in chronic illness management through reading comic books, training regarding warm-up stretching exercises, identifying facilitators and barriers to exercise through photosharing, supporting self-reflection and development of action plans) was developed to promote physical activity (PA) among patients with diabetes and hypertension. This study aimed to evaluate the efficacy of this intervention on health behaviour (walking) and health outcomes. Design: A non-randomized controlled trial with waitlisted control and pre- and post-measures. Setting: Community centres for the elderly. Participants: A total of 204 older adults with diabetes and/or hypertension were recruited. They were assigned to either the intervention group (IG) or waitlisted to the control group (CG). Intervention: Under the supervision of a nurse, six weekly group meetings were arranged in community centres for the elderly in which the participants freely exchanged their views regarding the barriers and facilitators of regular physical activity. Participants were encouraged to take photos in their neighbourhood or at home and brought these photos to share at the group meetings. The photos showed both the barriers and the facilitators to PA. In the last meeting, each participant worked out a plan to perform PA in the coming four weeks. Measures: PA referred to the number of steps taken per day and it was measured by a Garmin Accelerometer at baseline, Week 6 and Week 10. Other measures included the nine-item Self-Efficacy Scale for Exercise–Chinese version (SEE-C), and the 23-item Chinese Barriers to Exercise Scale and Senior Fitness Tests. Generalised estimating equations (GEE) models compared the outcomes over time between IG and CG. Results: A statistically significant difference in the changes in the average number of steps taken daily between the two groups at Week 10 (mean difference = 965.4; 95% confidence interval: 92.2, 1838.6, p = 0.030) was observed, although the difference at Week 6 was non-significant (mean difference = 777.6; 95% confidence interval: −35.3, 1590.5, p = 0.061). IG participants also showed significant improvements in lower body strength (mean difference = 0.967; 95% confidence interval: 0.029, 1.904, p = 0.043) and lower limb flexibility (mean difference = 2.068; 95% confidence interval: 0.404, 3.731, p = 0.015) at Week 10 compared to CG participants. Conclusion: This multi-component intervention improved the participants’ physical activity level and physical fitness, particularly in lower limb flexibility and body strength.

scholarly journals Physical Activity Level Following Resistance Training in Community-Dwelling Older Adults Receiving Home Care: Results from a Cluster-Randomized Controlled Trial

2021 ◽  
Vol 18 (13) ◽  
pp. 6682
Author(s):  
Hilde Bremseth Bårdstu ◽  
Vidar Andersen ◽  
Marius Steiro Fimland ◽  
Lene Aasdahl ◽  
Hilde Lohne-Seiler ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Resistance Training ◽  
Home Care ◽  
Community Dwelling ◽  
Activity Level ◽  
Group Differences ◽  
Control Group ◽  
Cluster Randomized ◽  
Community Dwelling Older Adults

Older adults’ physical activity (PA) is low. We examined whether eight months of resistance training increased PA level in community-dwelling older adults receiving home care. A two-armed cluster-randomized trial using parallel groups was conducted. The included participants were >70 years and received home care. The resistance training group performed resistance training using body weight, elastic bands, and water canes twice per week for eight months. The control group was informed about the national PA guidelines and received motivational talks. The ActiGraph GT3X+ accelerometer was used to estimate PA. Outcomes included total PA (counts per minute), sedentary behavior (min/day), light PA (min/day), moderate-to-vigorous PA (min/day), and steps (mean/day). Between-group differences were analyzed using multilevel linear mixed models. Twelve clusters were randomized to either resistance training (7 clusters, 60 participants) or the control group (5 clusters, 44 participants). A total of 101 participants (median age 86.0 (interquartile range 80–90) years) had valid accelerometer data and were included in the analysis. There were no statistically significant between-group differences for any of the PA outcomes after four or eight months. This study offers no evidence of increased PA level following resistance training in older adults with home care.

scholarly journals AN MHEALTH BEHAVIORAL INTERVENTION FOR PROMOTING PHYSICAL ACTIVITY AND SLEEP IN COMMUNITY-DWELLING OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S169-S169
Author(s):  
Junxin Li ◽  
Sarah Szanton ◽  
Minhui Liu ◽  
Nada Lukkahatai ◽  
Junxin Li ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Sleep Quality ◽  
Behavioral Intervention ◽  
Intervention Group ◽  
Community Dwelling ◽  
Control Group ◽  
Post Intervention ◽  
Tnf Α ◽  
Community Dwelling Older Adults

Abstract Evidence suggests physical activity (PA) improves sleep in older adults. This study examined the preliminary effect of a personalized mHealth behavioral intervention on PA and sleep in older adults. We conducted a randomized controlled pilot trial in 21 community-dwelling older adults with sleep complaints. The 24-week mHealth behavioral intervention included a 2-hour in person training session, personalized exercise prescription, real time PA self-monitoring, interactive prompts, phone consultation, and weekly financial incentives. PA and sleep were measured objectively using Actiwatch 2.0 and subjectively using questionnaires. Peripheral blood was drawn for measuring Plasma inflammatory biomarkers [interleukin 1β, 6, 8, Tumor Necrosis Factor- alpha (TNF-α), and c-reactive protein (CRP)]. Data were collected at baseline, 8-week, 16-week, and post intervention. Repeated measures ANOVA (time*group) was used to examine differences of PA and sleep across times between the two groups. Majority of participants are women (71.4%) with mean age of 73.7 (SD = 6.9). Repeated measure ANOVA showed significant (p <0.05) improvement of objective and subjective PA, objective nocturnal sleep duration, self-report sleep quality (measured by Pittsburg Sleep Quality Index and Insomnia Severity Index) and decreasing of sedentary time over times in the intervention group (n=11), compared to the control group. The intervention group showed significant reduction of plasma TNF-α and CRP levels at 16-week and post intervention. Interventions combining personalized PA and mHealth strategies may positively affect physical activity and sleep in older adults. A larger study is needed to test the efficacy of this intervention and the mechanisms associated with it.

Efficacy of an E-Mail Intervention for the Promotion of Physical Activity and Nutrition Behavior in the Workplace Context

2005 ◽  
Vol 19 (6) ◽  
pp. 422-429 ◽  
Author(s):  
Ronald C. Plotnikoff ◽  
Linda J. McCargar ◽  
Philip M. Wilson ◽  
Constantinos A. Loucaides
Keyword(s):  
Physical Activity ◽  
Mode Of Delivery ◽  
Intervention Group ◽  
Activity Level ◽  
Self Report ◽  
Control Group ◽  
Nutrition Behavior ◽  
Nutrition Messages ◽  
Mail Address ◽  
E Mail

Purpose. The purpose of this study was to evaluate a 12-week workplace e-mail intervention designed to promote physical activity and nutrition behavior. Design. A pre- and post-test design was conducted to compare the effects of e-mail messages between intervention and control groups. Setting. Five large workplaces in Alberta, Canada. Subjects. Employees with access to a personal e-mail address (N = 2121) were randomly assigned to an intervention (n = 1566) or a control group (n = 555). Intervention. Physical activity and nutrition messages were based on social-cognitive theories. The intervention group received one physical activity and one parallel nutrition message per week for 12 weeks. The control group received no weekly messages. Measures. Each participant completed self-report measures of physical activity and nutrition related to knowledge, attitudes, and behaviors 1 week before (time 1) and 1 week after (time 2) the intervention. Results. The intervention group was more efficacious at time 2 on measures of self-efficacy, pros, cons, intentions, and behavior related to physical activity. This group also reported more favorable changes in practicing healthy eating, balancing food intake with activity level, cooking meals with techniques to reduce fat, and avoiding eating high-fat foods. Effect sizes for all significant differences were small. Conclusion. E-mail is a promising mode of delivery for promoting physical activity and nutrition in the workplace. Further theoretically driven studies are needed.

An mHealth-Facilitated Personalized Intervention for Physical Activity and Sleep in Community-Dwelling Older Adults

2021 ◽  
pp. 1-10
Author(s):  
Junxin Li ◽  
Sarah L. Szanton ◽  
Miranda V. McPhillips ◽  
Nada Lukkahatai ◽  
Grace W. Pien ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Financial Incentives ◽  
Pilot Trial ◽  
Intervention Group ◽  
Community Dwelling ◽  
Control Group ◽  
Subjective Sleep Quality ◽  
Community Dwelling Older Adults ◽  
Personalized Intervention

This randomized controlled pilot trial tested the preliminary effect of a 24-week mHealth-facilitated, personalized intervention on physical activity (PA) and sleep in 21 community-dwelling older adults. The intervention included a personalized exercise prescription, training, goal setting, and financial incentives. mHealth strategies, including self-monitoring, motivational messages, activity reminders, and phone coaching, were used to facilitate PA participation. PA and sleep were measured using actigraphy and questionnaires at baseline and 8-, 16-, and 24-week visits. Participants in the intervention group had lower objective PA levels at 24 weeks than at 8 and 16 weeks, although levels of PA remained higher than at baseline. Compared with the control group, the intervention increased PA at 8, 16, and 24 weeks; improved subjective sleep quality at 16 and 24 weeks; and increased actigraphy-measured sleep duration and sleep efficiency at 24 weeks. mHealth PA interventions may benefit PA and sleep in older adults. Strategies for maintaining long-term PA behavioral changes are needed.

Abstract P200: Effects Of A 2-year Randomized Controlled Trial Physical Activity Intervention On Accelerometer-measured Sleep Characteristics Among Older Adults In Senior Center Communities

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Kelsie M Full ◽  
Katie Crist ◽  
Marta Jankowska ◽  
Pamela L Lutsey ◽  
Loki Natarajan
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Sleep Duration ◽  
Low Income ◽  
Controlled Trial ◽  
Intervention Group ◽  
Sleep Efficiency ◽  
Control Group ◽  
Senior Center ◽  
Intervention Effect

Background: Targeting daily increases in physical activity (PA) is a common lifestyle strategy for cardiovascular disease (CVD) risk reduction. While less targeted in lifestyle interventions, poor sleep is also consistently linked to CVD. Emerging evidence connects changes in daily PA to beneficial changes in sleep; however, little is known about the impact of community-based PA interventions on habitual sleep among older adults. We leveraged accelerometer data from the Peer Empowerment Program for Physical Activity in Low Income & Minority Seniors (PEP4PA) randomized controlled trial to examine the effect of a PA intervention on accelerometer-measured sleep characteristics among older adults in low income and diverse senior center communities. Methods: PEP4PA participants (N=476; mean age=71.0 ± 9 years, 75% female, 60% low income, 36% non-white) were recruited from senior centers and randomized to a healthy control condition(n=209) or a peer-lead walking intervention (N=267). The peer-led PA intervention included self-monitoring techniques, health coach counseling, group walks, and community advocacy to improve walking conditions. Participants wore Actigraph GT3X+ accelerometers on the wrist at baseline, 6, 12, and 24 months. Data were processed for sleep characteristics including weekly average sleep duration and sleep efficiency. Mixed effects regression models provided estimates of the intervention effect on sleep characteristics at each time point. Models were adjusted for age, sex, and race. Three way interaction terms (time*treatment*sleep duration status) were used to assess differential intervention effects by short (<7) and long (>8 hours) sleep duration status at baseline. Results: At baseline, the average sleep duration of participants was 7 hours (SD: 1.07 hours) and the average sleep efficiency was 87.0% (SD: 6.2%). Compared to participants in the control group, participants in the intervention group had shorter sleep durations (7.1 hours vs 7.0 hours; p value: 0.08) and poorer sleep efficiency 86.0% vs 88.2%; p<0.001) at baseline. At 12 or 24-months, there was no intervention effect on participants’ average sleep duration or efficiency. Although not significant, at 6 months, long sleepers in the intervention group experienced an average 6-minute reduction in sleep duration (-B: 6.25, p=0.45) compared to those in the control group. Conclusions: Over the 2-year period, the PA intervention did not appear to have an impact on participants’ average sleep duration or quality. More investigation is needed into the temporal and daily relations of PA and sleep among older adults in interventions to understand if increases in daily PA are associated with better sleep characteristics at night.

Impact of Walking Cadence Prescription to Reach the Global Physical Activity Recommendations in Older Adults

2017 ◽  
Vol 25 (4) ◽  
pp. 604-611 ◽  
Author(s):  
Jana Slaght ◽  
Martin Sénéchal ◽  
Danielle R. Bouchard
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Intervention Group ◽  
Moderate Intensity ◽  
Control Group ◽  
Monitoring Strategy ◽  
Physical Activity Recommendations ◽  
Activity Recommendations

Walking cadence is a new monitoring strategy used to increase bouts of time at moderate intensity. Inactive older adults were instructed to walk 150 min per week at no specified intensity during phase one. In phase two, the intervention group (N = 23) received instructions on how to reach moderate intensity, using a pedometer and an individualized walking cadence, while the control group (N = 22) did not. The main outcomes were time at moderate intensity and moderate intensity in 10-min bouts. During phase two only the intervention group increased time at moderate intensity and moderate intensity in 10-min bouts compared with phase one and compared with the control group (p ≤ .01). Older adults can increase time walked at moderate intensity in 10-min bouts weekly by using individually prescribed walking cadence, a pedometer to track intensity, and practicing walking at this cadence.

scholarly journals Effect of a Tailored Activity Pacing Intervention on Fatigue and Physical Activity Behaviours in Adults with Multiple Sclerosis

2020 ◽  
Vol 18 (1) ◽  
pp. 17
Author(s):  
Ulric S. Abonie ◽  
Florentina J. Hettinga
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Mean Difference ◽  
Activity Level ◽  
Self Report ◽  
Control Group ◽  
Activity Levels ◽  
Average Activity ◽  
And Gender

Tailored activity pacing could help manage fatigue and improve physical activity. However, little is known about how to tailor activity pacing for people with multiple sclerosis. This study aims to evaluate the effect of a tailored activity pacing intervention on fatigue and physical activity behaviours in adults with multiple sclerosis. Twenty-one adults with multiple sclerosis, stratified by age and gender, are randomly allocated to either a tailored pacing or control group. Participants wear an accelerometer for seven days that measures physical activity behaviours, and self-report fatigue at the baseline and four-week follow-up. Physical activity behaviours are assessed by examining activity level (seven-day average activity counts per minute) and activity variability (seven-day average highest activity counts each day divided by activity counts on that day). The intervention improves activity levels (Mean difference = 40.91; 95% Confidence Interval [CI] (3.84–77.96); p = 0.03) and lessens activity variability (Mean difference = −0.63; 95% CI (−1.25–0.02); p = 0.04). No significant effect is found for fatigue (Mean difference = −0.36; 95% CI (−1.02–0.30); p = 0.27). This investigation shows that tailoring activity pacing based on physical activity behaviours and fatigue is effective in improving physical activity levels, without exacerbating fatigue symptoms.

scholarly journals A Wearable Technology Delivering a Web-Based Diabetes Prevention Program to People at High Risk of Type 2 Diabetes: Randomized Controlled Trial

10.2196/15448 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e15448
Author(s):  
Emily Staite ◽  
Adam Bayley ◽  
Ebaa Al-Ozairi ◽  
Kurtis Stewart ◽  
David Hopkins ◽  
...  
Keyword(s):  
Physical Activity ◽  
Controlled Trial ◽  
Intervention Group ◽  
Diabetes Prevention Program ◽  
Mean Difference ◽  
Control Group ◽  
Web Based ◽  
The Mean

Background Intensive lifestyle interventions are effective in reducing the risk of type 2 diabetes, but the implementation of learnings from landmark studies is expensive and time consuming. The availability of digital lifestyle interventions is increasing, but evidence of their effectiveness is limited. Objective This randomized controlled trial (RCT) aimed to test the feasibility of a web-based diabetes prevention program (DPP) with step-dependent feedback messages versus a standard web-based DPP in people with prediabetes. Methods We employed a two-arm, parallel, single-blind RCT for people at high risk of developing diabetes. Patients with a hemoglobin A1c (HbA1c) level of 39-47 mmol/mol were recruited from 21 general practices in London. The intervention integrated a smartphone app delivering a web-based DPP course with SMS texts incorporating motivational interviewing techniques and step-dependent feedback messages delivered via a wearable device over 12 months. The control group received the wearable technology and access to the web-based DDP but not the SMS texts. As this was a feasibility study, the primary aim was to estimate potential sample size at different stages of the study, including the size of the target study population and the proportion of participants who consented, were randomized, and completed follow-up. We also measured the main outcomes for a full-scale RCT, namely, change in weight and physical activity at 6- and 12-month follow-ups, and secondary outcomes, including changes in the HbA1c level, blood pressure, waist circumference, waist-to-hip ratio, and lipid levels. Results We enrolled 200 participants: 98 were randomized to the intervention and 102 were randomized to the control group. The follow-up rate was higher in the control group (87/102, 85.3%) than in the intervention group (69/98, 70%) at 12 months. There was no treatment effect on weight at 6 months (mean difference 0.15; 95% CI −0.93 to 1.23) or 12 months (mean difference 0.07 kg; 95% CI −1.29 to 1.44) or for physical activity levels at 6 months (mean difference −382.90 steps; 95% CI −860.65 to 94.85) or 12 months (mean difference 92.64 steps; 95% CI −380.92 to 566.20). We did not observe a treatment effect on the secondary outcomes measured at the 6-month or 12-month follow-up. For the intervention group, the mean weight was 92.33 (SD 15.67) kg at baseline, 91.34 (SD 16.04) kg at 6 months, and 89.41 (SD 14.93) kg at 12 months. For the control group, the mean weight was 92.59 (SD 17.43) kg at baseline, 91.71 (SD 16.48) kg at 6 months, and 91.10 (SD 15.82) kg at 12 months. In the intervention group, the mean physical activity was 7308.40 (SD 4911.93) steps at baseline, 5008.76 (SD 2733.22) steps at 6 months, and 4814.66 (SD 3419.65) steps at 12 months. In the control group, the mean physical activity was 7599.28 (SD 3881.04) steps at baseline, 6148.83 (SD 3433.77) steps at 6 months, and 5006.30 (SD 3681.1) steps at 12 months. Conclusions This study demonstrates that it is feasible to successfully recruit and retain patients in an RCT of a web-based DPP. Trial Registration ClinicalTrials.gov NCT02919397; http://clinicaltrials.gov/ct2/show/NCT02919397

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