Novel Strategies to Improve Cardiometabolic Status and Adherence to Exercise Regimens in Patients at High Risk for Cardiovascular Disease
Novel Strategies to Improve Cardiometabolic Status and Adherence to Exercise Regimens in Patients at High Risk for Cardiovascular Disease
This is a 2x2 study examining the impacts of a novel exercise regimen and daily text message
 reminders in patients at high risk for cardiovascular disease. Patients participating in
 cardiac rehabilitation will be randomized to either moderate intensity continuous training
 (MICT) or a novel exercise regimen consisting of three periods of high intensity exercise,
 called BURST exercise. Additionally, half of the patients in each exercise group will be
 randomized to receive daily text message reminders to improve adherence to the prescribed
 exercise regimen.
Numerous studies have demonstrated the important cardiometabolic impacts of high intensity
 exercise in patients at high risk for cardiovascular disease. It is also known that adherence
 to exercise regimens is poor within these populations. This study compares the impacts of the
 current standard of care, moderate intensity continuous training (MICT) to a novel exercise
 regimen called BURST exercise within a population of patients at high risk for cardiovascular
 disease. BURST exercise consists of three periods of high intensity physical activity spread
 throughout the day. Additionally, as mobile technologies continue to be used more to improve
 adherence to exercise regimens, this study also seeks to compare the impacts of text message
 reminders in patients prescribed each of the exercise regimens examined in this study. Thus,
 patients were also randomized to either receive daily text message reminders, or to receive
 no text message reminders.

 Recruitment will be conducted at Cambridge Cardiac Rehab in Ontario, Canada. Potential study
 subjects are evaluated for inclusion and exclusion criteria, give written informed consent,
 and are randomized, in a 1:1 ratio, to either MICT or BURST exercise. Additionally, patients
 are then randomized in a 1:1 ratio to either receive text message reminders or not receive
 text message reminders.

 Patients prescribed the MICT regimen will be asked to exercise for 30 minutes per day at
 moderate intensity, at least five days per week. Patients prescribed the BURST exercise
 regimen will be asked to exercise for 10 minutes per session, three times a day at high
 intensity, at least five days per week. Patients randomized to receive text message reminders
 will be sent four daily text message reminders reading: "Please remember to exercise for 30
 minutes today."

 Adherence to exercise regimens will be measured by daily logbooks. Patients are asked to log
 the times they exercised and for what duration. BRUCE protocol stress tests will be conducted
 for all patients at baseline (before beginning the study), after three months and after one
 year. Hemoglobin A1C blood tests, height and weight measurements and lipid profile blood
 tests will also be conducted at baseline (before the beginning of the study), after three
 months and after one year.
Inclusion Criteria:

 -  Newly diagnosed type 2 diabetic patients (within the last 3 months)

 -  Participating in on-site the diabetes rehabilitation program at Cambridge Cardiac
 Rehab

 -  Deemed capable of high-intensity exercise

 Exclusion Criteria:

 -  Known or suspected cardiovascular disease

 -  Diabetic end-organ damage

 -  Cerebrovascular disease

 -  Peripheral vascular disease

 -  Arthritis

 -  Joint disease

 -  Taking anti-glycemic medications

 -  Taking lipid lowering medications

 -  Ischemia, hypoxia, arrhythmia or hemodynamic instability during a stress test