Discussion
type 2 diabetes, diabetes
TYPE 2 DIABETES, DIABETES
This pragmatic randomized trial demonstrated the effectiveness of a real-life nationwide PA group program (DIAfit) in improving aerobic fitness and other physical fitness outcomes such as strength, flexibility, balance and walking speed by 10-29%. Although to a lesser extent, the program also improved body weight, body composition, HbAThis study showed important findings regarding translating evidence from highly specialized research centres into real-life clinical practice. Indeed, all patients enrolled in the clinical DIAfit program were eligible and agreed to participate in the study. The program took mostly place in small regional hospitals, but also in private practices or university hospitals. The DIAfit program was delivered by regular staff with no specific experience. All of which increased the generalizability of our findings. Furthermore, patients in our study were of similar age or older than those in previous studies. They had a mean baseline HbA1c of 7.3% which is representative of the glycaemic control observed in larger community-based cohorts of patients with diabetes in Switzerland (We evaluated a comprehensive range of physical fitness outcomes. The primary outcome, aerobic fitness, improved by 11%. Similar results were reported in a previous meta-analysis that demonstrated an 11.8% increase in VOThe DIAfit program was associated with a reduction of a 0.19% in HbAThe DIAfit program was effective in improving body composition. The observed mean reduction in weight of 0.93 kg and waist circumference of 1.14 cm are similar to results found in some structured PA programs of similar duration without any dietary intervention and demonstrates the effects that can be achieved with this intensity and volume of PA (In this study, we also compared two program variants and found similar results for physical fitness, body composition, and cardiometabolic parameters in both programs although effect sizes of changes were larger in the standard program regarding anthropometric parameters, body fat mass, HbAStrengths of the current study included the pragmatic nature of a nation-wide PA program which demonstrated the benefits and relevance of structured PA for patients with type 2 diabetes in real-world conditions integrated in routine care. The multicentre design in different settings increased the external validity since the results were observed in different clinical settings. Furthermore, we included a broad range of outcome measures including extensive physical fitness measures relevant for various health outcomes such aerobic fitness, muscular strength, flexibility, balance, and walking speed. And lastly, the comparison of different forms of exercise frequency is not only novel, but also pertinent for clinical practice. Some limitations should be noted. The most important one being the lack of a control group for our first aim. However, participating health care providers and cantonal agencies did not approve the idea of a waiting list which would not let benefit all patients at the time when they are motivated or at least agree to participate in a PA program. All providers were told not to adapt the medical treatment during the testing time period, but we did not control for any potential changes in medication intake. In this real-life trial, small differences between centres were observed in several outcomes such as aerobic fitness, walking speed, anthropometry, body composition, and some cardiometabolic parameters, see 