Knowledge-Attitude-Practice-Based Outdoor Exercise Education for Patients With Type 2 Diabetes: A Randomized Controlled Trial.

Authors

Liwen Tu, Qiang Liu, Yun Shen, Shengdi Lu, Lihua Huang, Lintao Liu

Published in

Journal of diabetes research. Volume 2026. Issue 1. Pages e4523789.

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.

PMID:
42370628
Bibliographic data and abstract were imported from PubMed on 29 Jun 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.