• Christoph Höchsmann, Olivia Müller, Muriel Ambühl, Christopher Klenk, Karsten Königstein, Denis Infanger, Steffen P Walz, and Arno Schmidt-Trucksäss.
• Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland; Pennington Biomedical Research Center, Baton Rouge, Louisiana.
• Am J Prev Med. 2019 Jul 1; 57 (1): 415041-50.

IntroductionMany type 2 diabetes patients show insufficient levels of physical activity and are often unmotivated to change physical activity behaviors. This study investigated whether a newly developed smartphone game delivering individualized exercise and physical activity promotion through an elaborate storyline can generate sustained improvements in daily physical activity (steps/day).Study DesignThirty-six participants were enrolled in this 24-week RCT between August 2016 and April 2018. After baseline assessment, participants were randomized in equal numbers to the intervention or control condition. Data analysis was performed in May-June 2018.Setting/ParticipantsInactive, overweight type 2 diabetes patients, aged 45-70 years, were recruited through advertising and from hospitals and diabetes care centers in the Basel, Switzerland, metropolitan area.InterventionParticipants were instructed to play the innovative smartphone game (intervention group) or to implement the recommendations from the baseline lifestyle counseling (control group) autonomously during the 24-week intervention period.Main Outcome MeasuresPrimary outcomes were changes in daily physical activity (steps/day); changes in aerobic capacity, measured as oxygen uptake at the first ventilatory threshold; and changes in glycemic control, measured as HbA1c.ResultsDaily physical activity increased by an average of 3,998 (SD=1,293) steps/day in the intervention group and by an average of 939 (SD=1,156) steps/day in the control group. The adjusted difference between the two groups was 3,128 steps/day (95% CI=2,313, 3,943, p<0.001). The increase in daily physical activity was accompanied by an improved aerobic capacity (adjusted difference of oxygen uptake at the first ventilatory threshold of 1.9 mL/(kg·min), 95% CI=0.9, 2.9, p<0.001). Glycemic control (HbA1c) did not change over the course of the intervention.ConclusionsA novel, self-developed smartphone game, delivering multidimensional home-based exercise and physical activity promotion, significantly increases daily physical activity (steps/day) and aerobic capacity in inactive type 2 diabetes patients after 24 weeks. The ability of the game to elicit a sustained physical activity motivation may be relevant for other inactive target groups with chronic diseases.Trial RegistrationThis study is registered at www.clinicaltrials.gov NCT02657018.Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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