Purpose: The Resist Diabetes trial demonstrated that twice-per-week resistance training reduced prediabetes prevalence and improved strength among older adults with prediabetes. Our objective was to determine initial perceptions of patients and care providers in a Veterans Affairs Medical Center (VAMC) regarding Resist Diabetes (RD), and ultimately, inform adaptations to improve uptake of RD in the Veterans Health Administration.
Methods: A mixed-methods approach was utilized. Care providers (n=20) and veterans with prediabetes (n=12) were recruited to gauge perceptions of the RD program and identify barriers and facilitators to the program referral process and program implementation. Care provider perceptions of the acceptability, appropriateness and feasibility were determined using a validated survey. Open-ended questionnaires and interview guides, based upon the Consolidated Framework for Implementation Research, were utilized to determine major and minor themes within the provider and veteran responses. To identify the dissemination potential of RD, the availability of onsite fitness facilities at VAMC facilities nationally (n=159) was assessed.
Results: Providers rated (scaled 1-5; 1=completely disagree, 5=completely agree) the RD program as appealing (4.8+/-0.1), appropriate (4.8+/-0.0), and feasible (4.6+/-0.2). Providers reported that prediabetes/diabetes is a significant problem in the VAMC, and that different prevention programs will appeal to different types of VAMC patients. Patients (n=12; 58% female; aged 65+/-10yrs; BMI 34+/-6 kg/m2; HbA1c 5.7+/-1.8%) expressed interest in an exercise-focused diabetes prevention program and defined key barriers: travel, transportation, and time constraints. Among the responding national VAMC sites, 85% (97/114) reported having an onsite fitness facility.
Conclusion: Salem VAMC care providers and veteran patients demonstrated positive perceptions of the Resist Diabetes program. Program adaptations are needed to address barriers to patient participation including travel, transportation and time constraints.
Keywords: diabetes prevention; exercise; implementation science; prediabetes; resistance training; veterans.