Momentary Biobehavioral Effects on Physical Activity in Adults with Type 2 Diabetes Abstract The candidate for this Pathway to Independence award is Cynthia Fritschi, PhD, RN, who recently completed her doctoral studies at the University of Illinois at Chicago College of Nursing (UIC CON). Dr. Fritschi will be mentored by Eileen Collins, PhD, RN, a tenured Associate Professor at the UIC CON and a Research Career Scientist in Rehabilitation Research and Development at the Edward Hines Jr. Department of Veterans Affairs Hospital. The goal of this application is to assist Dr. Fritschi to build an independent program of research in physical activity for people with type 2 diabetes. The independent research proposed herein will expand our knowledge of multilevel biological, psychological, and social factors that impede or foster physical activity behavior. The long-term goal is to assist sedentary adults with type 2 diabetes to maintain optimal health and functioning by helping them to increase physical activity behaviors. This will be accomplished through use of novel, real-time interventions in the natural environment. The candidate's short-term career goal is to acquire the skills and experience necessary to develop a program of research related to this very important topic. In her study, "Fatigue Exercise, and Diabetes" (F31 NR009751) as a predoctoral fellow, Dr. Fritschi developed extensive experience in cross-sectional biological and self-report data collection methods and multivariate regression analyses. She explored an important patient-reported outcome (fatigue) and its correlates and impact on women with type 2 diabetes. However, findings from these studies were limited by use of a cross-sectional design in combination with recall data collection methods. Now, novel, real-time data collection methods, including continuous glucose monitoring (CGM) and activity monitors (actigraphy) in combination with ecological momentary assessment methods have made it possible to effectively study the complex multilevel relationships between biobehavioral factors and physical activity. In her proposed K99 mentored research, Dr. Fritschi will evaluate the feasibility of using real-time technology continuously over 6 days to measure physical activity (wrist actigraphy), fatigue (self-report), blood glucose levels (CGM), and related self-care behaviors (nightly diary), alongside retrospective measures of other factors associated with physical activity in adults with type 2 diabetes. Feasibility includes: (1) acceptability to participants;(2) ease of use;(3) invasiveness into daily activities;and (4) data quality. Findings from the feasibility study will guide revision of the independent research and enhance candidate learning of the analytical methods necessary to achieve her short- and long-term career goals. The primary aim of the independent phase (R00) is to use state-of-the-science ecological momentary assessment methods to examine the influence of selected baseline characteristics (health/physical status, general fatigue, body composition, depression, and demographic factors) and real-time biobehavioral factors (fatigue and blood glucose levels) on PA in 110 adults with type 2 diabetes. Through ecological momentary assessment of physical activity in relation to glucose levels and fatigue episodes, Dr. Fritschi and her team will be able to examine real-time covariation and temporal associations in the natural environment. To date, no other study has examined these relationships in real time among people with type 2 diabetes. By discovering how their physical activity levels relate to fatigue and other biobehavioral determinants of physical activity, findings from this study will guide development of tailored interventions targeted at increasing physical activity and thus reducing the risks for disability in sedentary adults with type 2 diabetes. The goal of the K99 training phase is to strengthen Dr. Fritschi's ability to excel as an independent clinical nurse researcher. The first and primary goal of the training plan is to increase Dr. Fritschi's knowledge in field and laboratory tests of exercise capacity, real-time physical activity monitoring, and exercise behavior. She will also be mentored in longitudinal and intervention research design and analysis. The second training goal is to advance her knowledge and skills in the use of ecological momentary assessment data collection methods and analysis, especially related to physical activity and related health behaviors.
Physical activity is an essential component of therapy for adults with type 2 diabetes and vital in reducing the risks for the devastating long-term complications and disability associated with type 2 diabetes. Physical activity is a relatively simple self-management activity that has been shown to be able to ameliorate some of the many well-known deleterious effects of diabetes. Despite their heightened risk for heart disease, disability, and shorter life span, most adults with type 2 diabetes are physically inactive and report lower levels of PA than their non-diabetic counterparts. Improvement in physical activity levels of people with type 2 diabetes could result in immense gains in their quality of life and lessen the burdens on their family, society, and the medical system.