4. Discussion
MetS, T2DM, diabetes
ADVERSE EVENTS, PATHOLOGY, RECRUITMENT, DIABETES
The findings of this study show that the culturally appropriate 12-week PA program designed specifically for Ghanaian adults with T2DM improved three MetS markers (FBG, SBP, and WC). This is likely to have contributed to the reclassification of 48.8% of participants in the IG as no longer having MetS after completion of the PA program. Further, there was high engagement in the program. Except for one participant who dropped out of the program, all participants in the IG completed at least 80% of the exercise sessions, with no exercise-related adverse events recorded during the study period.The exercise program trialled in this study involved a combination of aerobic and resistance exercises, with our study results showing a positive impact on MetS severity score among the IG compared to the CG. This finding is consistent with guidelines from the American College of Sports Medicine, suggesting that combined exercise in people with T2DM produced more beneficial outcome compared to aerobics or resistance exercise alone [The overall improvement in MetS severity score following exercise intervention cannot be overemphasised. It is recommended that studies investigating the role of exercise in reducing MetS markers should highlight whether participants still meet the MetS criteria after receiving an intervention [Wewege et al. [Our analysis of changes in QoL following the PA intervention program revealed significant improvement in two dimensions: physical function and vitality. Few studies have examined the effect of PA on QoL in adults with T2DM, and there has been inconsistency in their findings. Using SF-36 to examine the impact of resistance training on the mental health status of Puerto Rico adults with T2DM, Lincoln et al. [Our study had a high participation rate. Previous studies in Ghana have reported low PA participation (21.4%) among the Ghanaian population living with T2DM [A major strength of this study is that there were no significant differences between the two groups at baseline. Moreover, participants received weekly follow-up with a PT. In the first week, all exercise sessions were supervised by a PT at the physiotherapy department to ensure that exercises were performed correctly and within safety limits. Furthermore, the study was conducted in the largest diabetes clinic in Ghana, where patients are from diverse socio-economic and cultural backgrounds.A limitation of this study is the subjective report of participants’ weekly PA, which could possibly lead to under or over reporting. There is some evidence of a fair agreement between self-reported and objectively measured PA, despite evidence that about 59% of patients over-report their PA levels [People who volunteer in PA programs may have high self-motivation; therefore, this might have accounted for the high participation rate. A plausible reason for the successful recruitment and retention of participants may also be related to the tests performed as part of enrolment in this study. (e.g., pathology tests, ECG). The costs for these tests were covered by the funds available for this research, which is self-funded. These expenses pose a financial burden for patients, hence may have contributed to their decision to participate. Lastly, the sample size was small, and it was a single-site study. However, a feasibility study was conducted within the constraints of limited funding and PhD timelines.