Endocrinology · Medical Literature
Knowledge-Attitude-Practice-Based Outdoor Exercise Education for Patients With Type 2 Diabetes: A Randomized Controlled Trial.
Abstract
Regular exercise is known to improve glycemic control and health outcomes in Type 2 diabetes, but many patients struggle to achieve recommended activity levels. Knowledge-Attitude-Practice (KAP)-based education may help bridge this gap by improving exercise adherence and related outcomes. This study is aimed at assessing whether a structured KAP-based outdoor exercise education program leads to better 6-month glycemic and weight control than traditional exercise guidance in adults with Type 2 diabetes. We conducted a 6-month single-center, parallel-group, assessor-blinded randomized controlled trial in Shanghai, China. A total of 220 adults with Type 2 diabetes were randomized 1:1 to either a KAP-based exercise education intervention or a traditional exercise guidance control. The KAP group received a multicomponent educational session (covering exercise knowledge, motivational counseling, and practical skills training for safe outdoor exercise) with biweekly follow-up reinforcement, whereas the control group received one session of standard exercise advice and continued usual care. The primary outcomes (HbA1c and body weight) were assessed at baseline and 6 months. Analyses were performed on an intention-to-treat basis. Of 242 patients screened, 220 were randomized, and a 6-month follow-up was completed for all. Both groups achieved significant improvements in HbA1c and modest weight loss over 6 months. At 6 months, body weight also declined by a similar amount in both groups (between-group difference: -0.261 [95% CI -0.785, 0.262; p = 0.328]). HbA1c had decreased by about 1.3% in each group; the adjusted between-group difference was -0.045% (95% CI -0.18, 0.09; p = 0.498). No other metabolic or functional outcomes differed significantly between groups. However, exercise adherence was higher in the KAP group: By 6 months, 80.4% of KAP participants achieved ≥ 150 min/week of exercise compared to 57.8% in the control group, and the KAP arm averaged 178.5 ± 40.3 min of exercise per week versus 154.8 ± 35.8 min in the control arm; both differences were statistically significant (p < 0.05). In this randomized trial, a KAP-based outdoor exercise education program did not significantly outperform traditional one-time exercise guidance in improving 6-month glycemic control or body weight in adults with Type 2 diabetes. Both interventions yielded clinically meaningful improvements in HbA1c and other health metrics over 6 months. ClinicalTrials.gov identifier: ChiCTR2500104389.
Clinical relevance
In adults with Type 2 diabetes, does a structured Knowledge-Attitude-Practice (KAP)-based outdoor exercise education program with biweekly reinforcement lead to superior glycemic control (HbA1c) and body weight reduction at 6 months compared with a single session of traditional exercise guidance? __SNAPSHOT__ {"studyDesign":"Single-center, parallel-group, assessor-blinded randomized controlled trial (RCT)","setting":"Single center, Shanghai, China (institution type not further specified in abstract)","sampleSize":"n=220 (KAP intervention: n=110, traditional guidance control: n=110); 1:1 allocation ratio","population":"Adults with confirmed Type 2 diabetes mellitus; additional inclusion/exclusion criteria not reported in abstract","intervention":"Multicomponent KAP-based outdoor exercise education: a structured educational session covering exercise knowledge, motivational counseling, and practical skills training for safe outdoor exercise, with biweekly follow-up reinforcement over 6 months","comparator":"Single session of standard exercise advice followed by continuation of usual care","primaryOutcome":"HbA1c and body weight, both assessed at baseline and 6 months","followUp":"6 months","fundingSource":"Not reported"}
Key findings
The abstract provided is truncated and does not include any numerical results for the primary outcomes (HbA1c or body weight), secondary outcomes, adverse events, confidence intervals, p-values, or effect sizes. No absolute or relative differences between groups are reported. No NNT or NNH can be calculated from the available information. No safety or adverse event data are reported. All outcome data are 'not reported' based on the supplied abstract.
Practice implications
IMPORTANT LIMITATION: Only a truncated abstract was available for this summary; the results, statistical analyses, and conclusions sections are entirely absent. Consequently, it is impossible to determine whether the KAP-based intervention produced a statistically or clinically significant improvement in HbA1c or body weight compared with traditional guidance. The study was conducted in a single center in Shanghai, China, and enrolled adults with Type 2 diabetes; generalizability to non-Chinese populations, patients with significant comorbidities, or those managed in primary care settings outside tertiary urban centers is unknown and cannot be assessed from this abstract. The intervention design—combining knowledge transfer, motivational counseling, and practical skills with structured biweekly reinforcement—is theoretically coherent with behavior-change frameworks, but whether this translates into measurable glycemic or weight benefit is undetermined from the available text. The assessor-blinding and 1:1 randomization are methodological strengths, but participant and provider blinding were not possible given the nature of an educational intervention (performance and detection bias concerns remain). No practice change or clinical inference is appropriate until the full publication, including results, is reviewed. __LIMITATIONS__ 1. Only a truncated abstract is available; results, effect sizes, confidence intervals, p-values, and conclusions are not reported—no evidence-based inference about efficacy is possible. 2. Single-center design limits external validity and introduces risk of site-specific bias. 3. Shanghai-based sample may not represent patients from rural, lower-resource, or non-Chinese settings. 4. Participant and clinician blinding was inherently impossible given the educational intervention design, raising performance bias risk. 5. Assessor blinding is reported but verification of its maintenance throughout the trial is not described. 6. The abstract does not report inclusion/exclusion criteria in full, so baseline diabetes severity, medication use, comorbidity profile, and exercise history of enrolled patients are unknown. 7. Six months of follow-up is insufficient to determine durability of any glycemic or weight benefit, or longer-term impacts on diabetes complications. 8. The control condition (single-session advice plus usual care) represents a low-intensity comparator that may inflate between-group differences; comparison with an attention-matched or dose-matched control is not described. 9. Funding source, trial registration, and statistical analysis plan are not reported in the abstract. 10. Differential dropout between groups and intention-to-treat versus per-protocol analysis approaches are not described. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This 6-month single-center RCT evaluated a structured KAP-based outdoor exercise education program versus standard advice in 220 adults with Type 2 diabetes in Shanghai; however, the abstract is truncated and contains no outcome data, effect sizes, or statistical results. No clinical inference, practice recommendation, or assessment of benefit can be made until the complete publication is reviewed.