For Those at risk of type 2 diabetes, having a say in exercise type improves long-term outcomes
image: Infographic of the entire study.
Credit: Alexandre Santos, Kaja Falkenhain, Jonathan P. Little, Nikhil R. Patel, Joel Singer, Frank Halperin, Kevin Pistawka and Mary E. Jung.
The team led by Prof. Mary E. Jung and Prof. Jonathan P. Little from University of British Columbia–Okanagan Campus performed a pragmatic randomized controlled trial, known as the CHOICE trial, investigated whether providing a choice between high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) within a community-based diabetes prevention program (Small Steps for Big Changes, SSBC) would yield better psychological, behavioral, and fitness outcomes compared to being prescribed a single exercise modality. This study was published in Translational Exercise Biomedicine (ISSN: 2942-6812), an official partner journal of International Federation of Sports Medicine (FIMS).
Seventy-seven individuals at risk of type 2 diabetes, 61.5 years on average, 75% female, were randomized into three conditions: HIIT-only, MICT-only, or CHOICE (where participants could choose between HIIT and MICT after being introduced to both). The 4-week intervention consisted of one-on-one coaching sessions combining motivational interviewing-based counseling with supervised progressive exercise. The primary outcome was perceived autonomy support measured post-intervention. Secondary outcomes included motivation regulation pre-, post-, and 6-months post-intervention, free-living physical activity via accelerometry, Fitbit and self-report, and cardiorespiratory fitness estimated from treadmill stress tests, all evaluated 6 months after the intervention.
The study found no significant between-group differences in perceived autonomy support or motivation regulation. However, participants in the CHOICE condition showed significant within-group improvements in self-reported physical activity and cardiorespiratory fitness at 6 months. Cardiorespiratory fitness also improved significantly in the MICT condition, but not in the HIIT-only group. While accelerometry and Fitbit data did not show significant within-group changes after correction, indicating a general decline in moderate-to-vigorous physical activity over time, contrasting with improvements in self-reported and fitness outcomes.
Dr. Mary E. Jung, the corresponding author, summarized the study’s implications: “Our findings show that giving individuals at risk of type 2 diabetes a choice between HIIT and MICT is a feasible and potentially effective strategy for improving physical activity and fitness, without negatively impacting their motivation. This pragmatic approach supports the idea that flexible exercise prescriptions can be successfully integrated into community-based diabetes prevention programs.”
The findings suggest that providing a choice between HIIT and MICT within a diabetes prevention program does not significantly enhance perceived autonomy support or motivation regulation compared to imposing a single exercise type. Nevertheless, individuals given a choice demonstrated significant gains in self-reported physical activity and cardiorespiratory fitness. The overall high levels of autonomy support and motivation across all groups suggest that the broader intervention components may be key drivers of psychological and physiological benefits.
This study supports the feasibility of integrating choice into pragmatic, community-based diabetes prevention programs, suggesting that offering flexibility in exercise prescription may be a viable strategy to improve long-term physical activity and fitness outcomes, without compromising motivation or perceived support. The findings also highlight the need for more accurate tools to measure free-living physical activity across different exercise modalities.