Sigal, RonaldArmstrong, Marni2015-02-032015-02-032015Armstrong, M. (2015). Facilitating Access and Adherence to Exercise in People with Type 2 Diabetes (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/26142http://hdl.handle.net/11023/2066Exercise is a key component in the management of type 2 diabetes. It improves blood glucose control and quality of life, and reduces cardiovascular events and mortality. Despite the strong evidence demonstrating protective effects of exercise in type 2 diabetes, much of this population remains inactive, and many of those who begin an exercise program do not continue long-term. Finding strategies to support the adoption and long-term adherence to exercise is a valuable endeavor. The aim of this thesis was to examine the effectiveness of motivational interviewing, a potential facilitator to behaviour change and maintenance, together with an examination of pre-exercise stress testing which has been identified as a plausible barrier to supervised exercise programs. This was accomplished through a variety of methods within three distinct studies. These included a systematic review and meta-analysis of motivational interviewing in weight loss interventions, a randomized controlled trial on the effectiveness of motivational interviewing-based counselling to promote maintenance of exercise after the completion of a supervised exercise program, and finally a data linkage study examining the utility of pre-exercise stress testing within a retrospective cohort from a real-world supervised exercise program. The results of the first two studies gave support to use of motivational interviewing as a strategy to improve the effectiveness of weight loss interventions and as an approach to help promote the maintenance of physical activity after a supervised exercise program. In the examination of the use of pre-exercise stress testing, we discovered that the rate of cardiovascular outcomes was low, and that in the few cases where referral for pre-exercise stress testing resulted in a change in care, the patients had multiple cardiac risk factors. These results suggest that improved pre-exercise risk stratification might help identify the small subset of patients with type 2 diabetes likely to benefit from pre-exercise stress testing, thereby streamlining the process prior to the initiation of a supervised exercise program. Within supervised exercise programs, implementing strategies that employ effective facilitators, as well as reduce barriers such as unnecessary testing, may help improve participation and long-term adherence to exercise in people with type 2 diabetes.engUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.Health SciencesType 2 diabetesExercisebehavioural interventionsPhysical Activitydoctoral thesishttp://dx.doi.org/10.11575/PRISM/26142