Maintaining changes in physical activity among type 2 diabetics - A systematic review of rehabilitation interventions

The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide, and physical activity (PA) is a suitable way of preventing and managing the disease. However, improving long-term levels of PA in people with T2DM is a challenge and the best approach to rehabilitation in this regard is unknown. With the aim of outlining the existing knowledge regarding the maintenance of active lifestyles among people with T2DM after rehabilitation programs and gaining knowledge about options and challenges for their long-term engagement in PA, a systematic review of original research articles assessing PA after rehabilitation programs was conducted. Two thousand two hundred and forty-one articles were identified through PubMed or secondary sources and subjected to various inclusion criteria. Only articles published between the 1st of January 2000 and the 30th of June 2020 were considered. Additionally, the minimum time frame from intervention start to last PA assessment was 6 months and only articles based on interventions performed in Europe were included. The review was based on eighteen randomized controlled trials, four randomized trials without control, and four case studies. The 26 articles described 30 interventions that were categorized as personalized counseling, generalized teaching, supervised exercise, or a combination of personalized and generalized interventions. Statistical and narrative syntheses revealed no clear pattern regarding the effectiveness in eliciting maintained changes in PA. However, across categories, individual involvement, goal setting, social support, and the formation of habits are argued to be important components in sustaining PA and relieving challenges associated with the transition out of rehabilitation programs.