Trial reportJournal of diabetes research2026
Knowledge-Attitude-Practice-Based Outdoor Exercise Education for Patients With Type 2 Diabetes: A Randomized Controlled Trial.
Trial report in Journal of diabetes research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRegular 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.
objectiveThis 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.
methodsWe 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.
resultsOf 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).
conclusionsIn 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.
trial registrationClinicalTrials.gov identifier: ChiCTR2500104389.
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