Evaluating the Efficacy of a Sedentary Behavior Intervention on Self-Efficacy, Step Count, and frailty in Elderly Patients with Type 2 Diabetes Mellitus of Nursing Home

Evaluating the Efficacy of a Sedentary Behavior Intervention on Self-Efficacy, Step Count, and frailty in Elderly Patients with Type 2 Diabetes Mellitus of Nursing Home | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating the Efficacy of a Sedentary Behavior Intervention on Self-Efficacy, Step Count, and frailty in Elderly Patients with Type 2 Diabetes Mellitus of Nursing Home Xinying Song, Luqing Wu, Huiyue Zhou, Xinxin Li, Ying Chen, Weihong Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6191546/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : This study aimed to explore the effects of interventions on improving self-efficacy, increasing physical activity, and reducing frailty associated with sedentary behavior in older people with type 2 diabetes (OPT2DM). Methods : The convenient sampling method was employed to select OPT2DM from six nursing homes in Zhengzhou City, China, between July 2023 and January 2024. Participants were randomly assigned to control and experimental groups. Prior to the intervention protocol, as well as 8 weeks and 16 weeks post-intervention, the study subjects were assessed using a general data questionnaire, Measure of older sedentary time (MOS), Self-efficacy for diabetes (SED), the Frail-NH Debilitation Scale, step counts, and Body Mass Index (BMI). Results : A total of 92 cases were included in the study, comprising 43 cases in the intervention group and 44 cases in the control group. The scores of SED showed statistically significant improvement after 16 weeks of intervention (P < 0.05). The counts of steps taken exhibited statistically significant differences after both 8 weeks and 16 weeks (P < 0.05). Additionally, frailty demonstrated statistically significant differences at the 16-week mark (P < 0.05). The broad estimation equation analysis indicated that after 16 weeks of intervention, the differences in self-efficacy, step counts, and frailty between the intervention and control groups were statistically significant, highlighting inter-group effects, time effects, and interaction effects (P < 0.05). Conclusion : The 16-week behavior interventions reduced sedentary time among the OPT2DM. These interventions not only enhanced self-efficacy regarding diabetes management but also increased physical activity levels, ultimately improving the overall well-being of these participants. Diabetes Mellitus Older People Sedentary Behavior Psychosocial Intervention Figures Figure 1 Background According to data from the International Diabetes Federation (IDF), there were 537 million individuals with diabetes worldwide, with more than 90–95% of these cases classified as Type 2 Diabetes Mellitus (T2DM) [ 1 – 2 ]. Hyperglycemia associated with T2DM, along with diabetes-related complications, inflammatory cytokines, and endocrine changes, led to a reduction in musculoskeletal mass and muscle weakness, thereby increasing the risk of debilitation [ 3 – 4 ]. Previous study demonstrated that the coexistence of frailty and T2DM elevated the risk of cardiovascular events, hospitalization, disability, and mortality in affected individuals, presenting a formidable challenge in the promotion of healthy aging [ 5 ]. Advanced age was a known risk factor for T2DM and associated debilitation [ 6 ]. In China, there were 297 million individuals aged 60 and above, which constituted 21.1% of the total population [ 7 ]. The rapid progression of population aging was expected to further increased the proportion of OPT2DM. Research indicated that a sedentary lifestyle influenced the deterioration of health in OPT2DM [ 8 ]. Sedentary behavior was defined as any activity that expended 1.5 metabolic equivalent (MET) or less while sitting, reclining, or lying down [ 9 ]. The level of physical activity in individuals was correlated with the secretion of irisin produced by muscle cells, which was also associated with muscle volume. The secretion of metabolic factors by muscle could stimulate the proliferation of pancreatic β cells. Prolonged sitting led to a reduction in irisin secretion from skeletal muscle, thereby increasing insulin resistance [ 10 – 11 ]. Extended periods of sedentary behavior resulted in decreased muscle mass and strength in patients with T2DM, further contributing to diminished muscle endurance, exercise capacity, and balance [ 12 – 13 ], ultimately leading to physical weakness. As an emerging complication of diabetes, weakness reduced peripheral insulin sensitivity [ 14 ], accelerated muscle mass loss, and heightened the risk of adverse health outcomes in diabetic patients, including cardiovascular disease and all-cause mortality [ 15 ]. The interplay of these factors impaired the physical function and quality of life of the elderly [ 16 ]. There were notable differences in activity levels among older people. In comparison to their counterparts in the community, older people residing in nursing homes exhibited the lowest levels of physical activity and the highest propensity for long-term sedentary behavior [ 17 ]. Previous studies indicated that 79% of older people spent prolonged periods sitting during waking hours, with the average sitting time for seniors in nursing homes recorded at 11.6 hours per day (equating to 729 ± 321 steps per day) [ 18 ]. In contrast, those in intermediate or mixed nursing homes had an average sitting time of 9.5 hours per day (or 4556 ± 2624 steps per day). Another study [ 19 ] assessed the physical activity behaviors of older people in nursing homes, revealing that these individuals walked an average of 1007 ± 806 steps per day and sat for more than 9 hours, which accounted for 77.2% of their waking time. Additionally, studies showed that [ 20 ], the proportion of OPT2DM living in nursing homes was high, which complicated the management of T2DM, frailty and blood sugar levels for these patients. Previous studies on interventions targeting sedentary behavior had primarily focused on encouraging individuals to reduce sitting time and increase physical activity through modifications to their environment and behavior [ 21 ]. Chinese researchers had largely concentrated on the sedentary behavior of middle-aged and young adults, as well as the elderly within community settings. However, there had been insufficient attention given to the sedentary behavior of older people residing in nursing homes, particularly those suffering from T2DM. This gap highlighted a lack of targeted intervention strategies for this demographic. Consequently, this study aimed to enhance physical activity levels, mitigate frailty, and improve overall physical function by developing an intervention program tailored specifically for OPT2DM in Chinese nursing homes. This study hypothesized that: 1) OPT2DM combined with frailty living in nursing homes demonstrated a high prevalence of sedentary behavior; and 2) interventions aimed at reducing sedentary behavior in these patients can result in improvements in their activity levels, glycemic control, and overall degree of frailty. Method Setting This study was a quasi-experiment approved by the Ethics Committee of Zhengzhou University (Approval No. ZZUIRB2023-073). It was conducted across six nursing homes in Zhengzhou from July 2023 to January 2024. Each nursing home had maintained a commendable operational record for over two years and was equipped with a minimum of 30 beds. The nursing homes were categorized into three groups based on the principle of having a similar number of residents. From each group, research subjects from one nursing home were randomly selected to be included in the intervention group, while subjects from another nursing home within the same group were designated as the control group. Patient Population The inclusion criteria for participants were as follows: 1) confirmed diagnosis of T2DM, 2) ≥ 60 years old, 3) a minimum of three months of residency in nursing homes [ 22 ], 4) a Frail-NH frailty scale score ≥ 2 points [ 23 ], and 5) provision of informed consent and voluntary participation in this research. The exclusion criteria included 1) individuals with severe mental illness or cognitive impairment, 2) individuals with significant visual, auditory, or mobility impairments, 3) individuals with severe physical or chronic diseases in acute or terminal stages, and 4) individuals currently participating in other research projects. Sample Size Calculations The calculation formula for comparing the mean values of the two samples was utilized to determine the required sample size. In this context, Z1 and Z2 represented the sample sizes needed for the intervention and control groups, respectively. δ denoted the difference between the two population means.σ signified the standard deviation of the two samples. According to the literature[ 24 ], the mean values following the intervention were 8.63 and 7.24, with corresponding standard deviations of 2.041 and 1.869, respectively. Therefor, the mean difference δ was calculated as 1.39, and the standard deviation σ was 1.957. Following these calculations, the sample size required for each group was determined to be 41 cases. Considering a loss-to-follow-up rate of 10%, the final sample size for each group was established at 46 cases, resulting in a total of 92 cases. Interventions The Integrated Theory of Health Behavior Change (ITHBC), proposed by American clinical nursing scholar Polly Ryan, posited that individual health behavior change could be facilitated through the cultivation of knowledge and beliefs, enhancement of self-regulation skills, and provision of social support [ 25 ]. Based on the ITHBC, the construction of intervention programs was divided into several stages: 1) Personalized assessment: Evaluate the current state of participants' sedentary behavior and related risk factors, 2) Guidance and support: Provide assistance based on the assessment results, encompassing knowledge, skills, and confidence, 3) Goal setting and implementation: Develop intervention goals in stages, employing multiple methods to enhance both cognitive and motor abilities in older people, thereby strengthening the intervention effects and enabling older people to experience positive impacts, as well as social facilitation that encourages their engagement in preventive health behaviors. The intervention team comprised a diverse group of professionals: one Doctor of Nursing (responsible for project design, quality control, and team management), one Master of Nursing (focused on project design, implementation of interventions, and research documentation), one Endocrinologist (specializing in disease management), one Rehabilitation Specialist (expert in rehabilitation and sports management), and three nursing staffs from nursing home, each with over three years of experience in implementing interventions. All team members underwent standardized training for the project and achieved consensus on their roles and objectives. The formulation of the intervention plan was grounded in clinical research and a comprehensive literature review. A panel of ten experts, each with 11 to 27 years of experience in geriatrics and diabetes care, was convened to engage in two rounds of correspondence through discussions, telephone calls, and emails. Additionally, pre-experiments were conducted with ten participants, leading to revisions and enhancements based on the findings. The final behavioral intervention plan was subsequently finalized (refer to Table 1 and Table 2 ). Table 1 Control group intervention program Time Objective Intervention content Setting Method Tool Intervener 1st Week Establishing a trusting relationship with participants a) Evaluate the participants' health and disease perception status by analyzing their health records. Office a) One-to-one intervention, b) 1 time/week, 30min/time a) Laptop, b) Electronic recorder, c) Bonus a) Project leaders, b) Institution staff b) Conduct in-person interviews with participants to address any questions or concerns they may have. 2nd Week Popularization of knowledge a) Explain the necessity and significance of interventions such as diabetic exercise, diet, sedentary behavior, and weakness. Activity room a) Both group intervention and One-to-one intervention, b) 1 time/week, 30min/time a) Disease-related health guides and sedentary behavior guides, b) Laptop, pens and paper, c) Bonus a) Project leaders, b) Institution staff b) Conduct specialized knowledge lectures to provide guidance on effective strategies for reducing prolonged sitting behaviors, enhancing physical activity, and managing dietary habits. c) Distribute a comprehensive manual on managing sedentary behavior 3rd Week Improve compliance a) Listen: Actively engage with the needs of participants and address challenging problems. Office a) One-to-one intervention, b) 1 time/week, 30min/time a) Laptop, b) Electronic recorder, c) Bonus a) Project leaders, b) Institution staff b) Encouragement: Provide psychological support and spiritual encouragement to enhance motivation for action. c) Support: Monitor the impact of behavioral improvements and promptly correct any misaligned behaviors. 4th Week Improve intervention compliance and normalization a) Accompany participants in performing rehabilitation exercises systematically according to the established plan to foster positive compliance behaviors. Activity room a) Both group intervention and One-to-one intervention, b) 1 time/week, 30min/time a) Laptop, pens and paper, b) Bonus a) Project leaders, b) Institution staff b) Assist participants in comparing their experiences before and after the intervention, while encouraging them to take an active role in developing management plans. 5th-16th Week Follow-up investigation a) Inquire about the participants' recent health behaviors and needs, and dynamically adjust the content of the sedentary behavior intervention based on the findings. Online a) One-to-one intervention, b) 1 time/week a) telephone Project leaders b) Assess the effectiveness of the intervention. Table 2 Intervention group intervention program Time Phase Objective Intervention content Setting Method Intervener 1st-4th Week Individualized evaluation a) Assess the health status of participants, focusing on disease-related risk factors and their perception of the disease. b) Strengthen the evaluation of the process. a) Measure health risk indicators using participants' health records. Office a) One-to-one intervention, b) 1 time/week, 30min/time a) Project leaders, b) Institution staff b) Provide straightforward health education to participants based on the results of these indicators. c) Conduct interviews with participants to gather information regarding their medical history, sedentary behaviors, dietary habits, psychological state, exercise routines, and other health-related practices. d) Document participants' feedback and analyze the underlying reasons. e) Assess whether the intervention measures require adjustments based on the evaluation outcomes. 5th-8th Week Knowledge guidance and skill guidance a) Enhance participants' sense of self-efficacy. b)Strengthen participants' determination and motivation. c)Improve the consistency of participants' goals regarding the alteration of their long-term sitting habits. 1. Educate elderly patients on effective strategies to reduce prolonged sitting and enhance their physical activity levels. Activity room a) Both group intervention and One-to-one intervention, b) 1 time/week, 30min/time a) Project leaders, b) Institution staff c) Rehabilitation therapist 2. guide them in adopting healthier eating habits and fostering a positive, optimistic outlook on life. 3. Distribute sedentary behavior logs and instruct elderly patients on how to accurately record their activity levels. Improve adherence to these logs by highlighting the significance of behavioral change through the lens of knowledge and health beliefs. 4. einforce the importance of behavior modification by focusing on knowledge and health beliefs, thereby boosting elderly patients' confidence in improving their physical condition and strengthening their commitment to reducing sedentary behaviors. 5. Assess learning outcomes: At this stage, elderly participants will be divided into several groups based on knowledge and skills. This will be achieved by randomly selecting small balls from a box, with participants finding three others who have the same color ball to form a group. Subsequently, groups will engage in cycles of questioning regarding the health knowledge they have acquired, with correct answers rewarded with one health coin. 9th-12th Week The Establishment and Execution of Goals a) Collaboratively establish personalized long-term goals. b) Prevent the decline of enthusiasm and behavioral deterioration. c) Enhance the intention and motivation for behavior change among patients. 1. Elderly individuals with limited knowledge of health risks and who are unable to modify their current behaviors establish clear learning objectives. Office a) One-to-one intervention, b) 1 time/week, 30min/time a) Project leaders, b) Institution staff 2. For elderly individuals who understand the risks associated with sedentary behavior but are reluctant to change, it is important to reinforce education on these risks and set achievable short-term goals. 3. For elderly individuals who are willing to change but lack the necessary skills, it is crucial to provide targeted guidance in both knowledge acquisition and skill development, encouraging them to set progressively more challenging goals. 4. For elderly individuals who have successfully adopted healthy behaviors and possess the requisite knowledge and skills, continued encouragement is essential, along with setting long-term goals for sustained improvement. 13th-16th Week Foster a supportive social environment a) Assist participants in executing the behavior plan. b) Ensure that participants receive adequate social support. a) Enhance participants' confidence and compliance by leveraging peer support, sharing success stories, and improving overall experiences. Activity room a) Both group intervention and One-to-one intervention, b) 1 time/week, 30min/time a) Project leaders, b) Institution staff b) 2. Conduct a dynamic evaluation of changes in behavioral patterns, physical activity levels, and self-efficacy across various stages of the intervention. c) Increase awareness among participants' families and caregivers regarding sedentary behavior, guide them in assisting patients during rehabilitation and daily activities, and reinforce their supervisory role throughout the intervention process. Measures The factors influencing sedentary behavior among OPT2DM were identified through preliminary research, including age, gender, duration of stay in nursing home, educational level, marital status, type of residence, length of diabetes diagnosis, history of falls, smoking habits, alcohol consumption, and the presence of multiple chronic diseases. Building on the foundational work of our team and incorporating relevant sedentary behavior questionnaires from abroad [ 26 – 27 ], a sedentary behavior log was designed specifically for the elderly residing in care institutions. This log comprises two main aspects and eleven entries, aimed at evaluating the sedentary behavior of the elderly over a one-week period. Notably, time spent sleeping or napping in bed is excluded from the assessment, as is repeated sedentary time (e.g., watching TV while eating). Study participants were instructed to record the time and type of sitting each day, with average sedentary time calculated as the sum of daily sedentary time over the week divided by seven. Sedentary time was categorized into increments of 30 minutes, with recorded times including 0, 30, 60 minutes, and so forth. The study defined sedentary behavior as 8 hours per day (h/d) [ 28 ], with ≥ 8 h/d classified as sedentary and < 8 h/d classified as non-sedentary. The Diabetes Self-efficacy Scale (SED), developed by Lorig et al. [ 29 ], was revised and localized into Chinese in 2013 by Wei Jie et al. [ 30 ], tailored to the characteristics of elderly diabetic patients. This scale comprised four dimensions and a total of nine items. Employing a 5-point Likert scoring method, responses were rated from 'completely unconfident' (1 point) to 'completely confident' (5 points). The average score across the items reflected the self-efficacy level of the subjects, with higher scores indicating greater self-efficacy. In this study, the Cronbach's α coefficient was 0.846. The FRAIL-NH Scale was a frailty assessment tool designed for older people in care institutions, developed by Kaehr in 2015 based on the FRAIL scale [ 31 ]. This scale encompassed the core symptoms of both the frailty phenotype and the frailty index, which were widely utilized in current research. It was user-friendly, straightforward, and practical, consisting of seven items: fatigue, transfer, walking, incontinence, weight loss, nutritional intake, and clothing [ 32 ]. Scholar Zhao Meng [ 23 ] localized the scale to create the Chinese version of the FRAIL-NH scale and conducted tests for reliability and validity. The results indicated that the optimal cutoff value for identifying frailty was 2 point, with a Cronbach's α coefficient of 0.84. In this study, the Cronbach's alpha coefficient was 0.782. Steps were measured using a pedometer integrated into a wearable device known as MAMBO, a small bracelet weighing approximately 17 grams, which had a battery life of seven days. Participants wear the device on their wrists or in their clothing pockets. Previous studies [ 33 – 34 ] confirmed the reliability of using a pedometer to measure steps, and it was recommended that measurements be taken over a period of three to four days, with valid data requiring the device to be worn for at least 75% of daytime hours [ 35 ]. Body Mass Index (BMI) was assessed in conjunction with the adult health classification standards applicable in our country. Data collection Data collection occurred at three time points: prior to the implementation of the intervention program, and at 8 and 16 weeks post-intervention. Nursing staff assisted the nursing master in gathering data from the basic information questionnaire, the older sedentary behavior log, the diabetes self-efficacy scale, and other objective measures. During the collection of baseline data, participants were clearly informed about the specific criteria for completing the questionnaire, and the nursing master systematically verified the validity of each questionnaire. Incomplete or erroneous responses were promptly addressed through supplementation, correction, or elimination to minimize the occurrence of invalid questionnaires. If participants were unable to complete the questionnaires independently, they received assistance from either the nursing staff or the nursing master. Data analysis Data entry was conducted using Epidata software, followed by statistical analysis with IBM SPSS Statistics 27.0. (1) Qualitative data are statistically described using frequencies and percentages. For normally distributed measurement data, the mean ± standard deviation is employed for statistical description, while non-normally distributed data are summarized using the median and interquartile range [M (QR)]. (2) To compare the baseline data balance between the two groups, qualitative data were analyzed using the Chi-square test and Fisher's exact test; ordinal data were assessed using the Mann-Whitney U rank sum test. For quantitative data that conform to a normal distribution, the independent samples t-test was applied, whereas the Mann-Whitney U rank sum test was utilized for data that do not meet the normality assumption. (3) Based on the data collected prior to the intervention, as well as at 8 weeks and 16 weeks post-intervention, if the data follow a normal distribution, repeated measures analysis of variance or generalized estimating equations will be used. Results This study enrolled a total of 92 participants, with 87 ultimately completing the entire study—43 in the intervention group and 44 in the control group. The participant recruitment process was detailed in Fig. 1. There was no statistically significant difference in baseline characteristics between the two groups (shown in Table 3 ). Independent sample t-test analysis revealed that the step count before the intervention was 1709.48 ± 299.70 steps in the control group and 1756.93 ± 171.54 steps in the intervention group, with no statistically significant difference in step count between the two groups prior to the intervention (t = -0.904, P = 0.369). The Mann-Whitney U test analysis indicated that before the intervention, the frailty score of the control group was 4.00 (2.0), while that of the intervention group was 4.00 (1.0). There was no statistically significant difference in frailty scores between the two groups before the intervention (Z = -0.523, P = 0.601). Table 3 Demographic and general characteristics of study participants [n = 87(%)] Variables Categories Total Control group Intervention group χ2/F/Z value P- value (n = 87) (n = 44) (n = 43) Age(year) 60–69 33 (38.0) 12 (27.2) 21 (48.9) 5.298 a 0.071 70–79 43 (49.4) 24 (54.6) 19 (44.2) 80–89 11 (12.6) 8 (18.2) 3 (6.9) Gender Female 49 (56.3) 24 (54.5) 25 (58.1) 0.114 b 0.83 Male 38 (43.7) 20 (45.5) 18 (48.9) Duration of residence in nursing home (year) 3 33 (37.9) 19 (43.2) 14 (32.6) Marrage Marriage 22 (25.3) 14 (31.8) 8 (18.6) 2.092 a 0.351 Divorce 5 (5.7) 2 (4.6) 3 (7.0) Widowed 60 (69.0) 28 (63.6) 32 (74.4) Educational level Primary and below 22 (25.3) 13 (29.5) 9 (20.9) 1.478 a 0.687 Junior high school 38 (43.7) 17 (38.6) 21 (48.8) High school 16 (18.4) 9 (20.5) 7 (16.3) College or above 11 (12.6) 5 (11.4) 6 (14.0) Cohabitation status With spouse 21 (24.1) 14 (31.8) 7 (16.3) 4.678 a 0.096 With others 45 (51.8) 23 (52.3) 22 (51.2) Alone 21 (24.1) 7 (15.9) 14 (32.5) Frequency of interaction with families (one time) Every week 37 (42.5) 18 (40.9) 19 (44.2) 0.789 a 0.852 Every month 22 (25.3) 10 (22.7) 12 (27.9) Half of a year 23 (26.5) 13 (29.6) 10 (23.3) No 5 (5.7) 3 (6.8) 2 (4.6) Duration of T2DM 0–5 15 (17.2) 8 (18.2) 7 (16.2) 0.113 a 0.945 6–10 43 (49.4) 21 (47.7) 22 (51.2) >10 29 (33.4) 15 (34.1) 14 (32.6) BMI Underweight 9 (10.3) 5 (11.4) 4 (9.3) 0.596 a 0.897 Normoweight 26 (29.9) 14 (31.8) 12 (27.9) Out of standard 45 (51.7) 21 (47.7) 24 (55.8) Obesity 7 (8.1) 4 (9.1) 3 (7.0) Fall down No 38 (43.7) 20 (45.5) 18 (41.9) 0.114 b 0.83 Yes 49 (56.3) 24 (54.5) 25 (58.1) Smoking Yes 20 (23.0) 11 (25.0) 9 (20.9) 0.644 a 0.725 Never 25 (28.7) 11 (25.0) 14 (32.6) Quiting 42 (48.3) 22 (50.0) 20 (46.5) Alcohol consumption Yes 23 (26.4) 13 (29.5) 10 (23.3) 1.021 a 0.6 Never 12 (13.8) 7 (15.9) 5 (11.6) Quiting 52 (59.8) 24 (54.5) 28 (65.1) Number of concurrent chronic diseases 0–1 26 (29.9) 17 (38.6) 9 (20.9) 3.255 a 0.196 2–3 36 (41.4) 16 (36.4) 20 (46.5) ≥ 4 25 (28.7) 11 (25.0) 14 (32.6) After 8 and 16 weeks of intervention, the differences in total sedentary time, total diabetes self-efficacy scores, and step count scores between the two participant groups were statistically significant (P < 0.05). Furthermore, after 16 weeks of intervention, the differences in the longest continuous sedentary time, sedentary time of 30 minutes or more per session, and frailty scores between the two patient groups were also statistically significant (P < 0.05). (shown in Table 4 ) Table 4 Comparison of Intervention Indicators Between Two Groups [M(QR)] Categories Group T0 T1 T2 Between-group effect Time effect Interaction effect Wald P Wald P Wald P Maximum continuous sedentary time Control group 2.50 (1.0) 2.25 (1.0) 2.25 (1.0) 5.21 <0.001 28.88 <0.001 8.3 0.016 Intervention group 2.50 (1.0) 2.00 (1.0) 2.00 (0.5) Z -0.353 -0.991 -3.832 P 0.724 0.321 <0.001 Sedentary Behaviors ≥ 30min Control group 3.00 (1.0) 3.00 (1.0) 3.00 (1.0) 12.03 <0.001 100.95 <0.001 55.86 <0.001 Intervention group 3.00 (0.0) 3.00 (1.0) 2.00 (1.0) Z -0.321 -0.428 -6.382 P 0.748 0.669 <0.001 Total sedentary time Control group 8.75 (1.5) 8.50 (1.0) 9.00 (1.0) 72.02 <0.001 22.86 <0.001 78.35 <0.001 Intervention group 9.00 (0.5) 8.00 (2.0) 7.00 (1.5) Z -0.065 -2.308 -6.836 P 0.948 0.021 <0.001 Self-efficacy for diabetes scores Control group 2.67 (0.6) 3.14 ± 0.31 3.11 (0.4) 26.76 <0.001 513.19 <0.001 115.7 <0.001 Intervention group 2.67 (0.4) 3.45 ± 0.29 3.89 (0.2) Z/t -0.393 -4.904 -7.673 P 0.694 <0.001 <0.001 Steps Control group 1709.48 ± 299.70 1741.84 ± 222.56 1739.80 ± 227.05 115.63 <0.001 806.51 <0.001 721.53 <0.001 Intervention group 1756.93 ± 171.53 2007.00 ± 222.0 2687.84 ± 165.95 Z/t -0.904 1.225836288 -22.193 P 0.369 < 0.001 < 0.001 Frailty Control group 4.00(2.0) 4.00(1.0) 4.00(1.0) 7.05 <0.001 76.41 <0.001 56.67 <0.001 Intervention group 4.00(1.0) 3.00(1.0) 2.00(1.0) Z/t -0.523 -0.798 -5.21 P 0.601 0.425 < 0.001 Generalized Estimating Equations (GEE) was used to analysis the indicators before and after the intervention in both groups showed that there were statistically significant differences (P < 0.05) in the group effect, time effect, and interaction effect between time and group for continuous sedentary time, sedentary bouts ≥ 30 minutes, total sedentary time, total diabetes self-efficacy score, step count, and frailty score between the both groups. (shown in Table 5 ) Table 5 Intra-group comparison of sedentary behavior levels in the intervention group patients. (n = 43) Catergories Time period Mean Deviation B P 95% CI Maximum continuous sedentary time(h) T1-T0 -0.14 0.047 0.003 -0.23~-0.04 T2-T0 -0.51 0.087 < 0.001 -0.68~-0.34 T2-T1 -0.37 0.887 < 0.001 -0.54~-0.19 Sedentary Behaviors ≥ 30min (time/d) T1-T0 -0.28 0.083 < 0.001 -0.44~-0.12 T2-T0 -1.44 0.111 < 0.001 -1.66~-1.23 T2-T1 -1.16 0.118 < 0.001 -1.39~-0.93 Total sedentary time (h/d) T1-T0 -0.87 0.145 < 0.001 -1.11~-0.54 T2-T0 -1.67 0.174 < 0.001 -2.02~-1.33 T2-T1 -0.85 0.146 < 0.001 -1.14~-0.56 Self-efficacy for diabetes scores T1-T0 0.72 0.048 <0.001 0.63 ~ 0.82 T2-T0 1.13 0.055 <0.001 1.02 ~ 1.24 T2-T1 0.4 0.03 <0.001 0.34 ~ 0.46 Steps (d/step) T1-T0 332.51 20.395 < 0.001 292.54 ~ 372.49 T2-T0 930.91 29.91 < 0.001 872.28 ~ 989.53 T2-T1 598.4 28.219 < 0.001 543.09 ~ 653.70 Frailty (score) T1-T0 -0.3 0.102 < 0.001 -0.50~-0.10 T2-T0 -1.33 0.126 < 0.001 -1.57~-1.08 T2-T1 -1.02 0.096 < 0.001 -1.21~-0.84 Discussion This study was the first to investigate the long-term sedentary behavior in OPT2DM with frailty residing in nursing homes, utilizing the ITHBC. The results confirmed the initial research hypothesis that the levels of sedentary behavior among participants in nursing homes were high. Furthermore, the intervention program had been shown to enhance patients' activity levels, manage blood glucose, and reduce the frailty. This study demonstrated that after 8 weeks of intervention, participants' total sedentary time decreased by 49.8 minutes per day. Following 16 weeks of intervention, the total sedentary time further decreased by 100.8 minutes per day. These findings aligned with the previous researches [ 24 , 36 ]. The formulation of personalized sedentary behavior intervention plans facilitated comprehensive interventions that encompassed knowledge beliefs, skill abilities, and social support. A personalized assessment was integral throughout the intervention process, aiding OPT2DM with frailty in recognizing and identifying the hazards and characteristics of sedentary behavior [ 37 ]. It encouraged participants to change unhealthy lifestyle habits, adopt healthier behaviors, and stimulate their intrinsic motivation, thereby enhancing their confidence in reducing sedentary time. Additionally, goals were established based on the behavioral stage of participants, motivating them to actively manage behaviors related to these goals and increasing their enthusiasm for participation. Notably, after 16 weeks of intervention, the longest continuous sitting time among participants in the intervention group was reduced by 30.6 minutes per day compared to the control group (P < 0.05). The alteration of sitting behavior was contingent upon long-term adherence. The enhancement of participants' understanding of sedentary behavior served as a positive impetus for achieving sustained adherence. Furthermore, goal motivation and social support could bolster participants' positive cognition and behavioral compliance [ 38 ]. Self-efficacy influenced individuals' choices and persistence in behaviors. A high level of self-efficacy helped patients maintain beneficial lifestyle habits [ 39 ]. This study found that after 16 weeks of intervention, the diabetes self-efficacy score of participants in the intervention group increased by an average of 1.22 points compared to baseline, and by an average of 0.78 points compared to measurements taken 8 weeks post-intervention (P < 0.05). The findings were consistent with results of Scott et al [ 40 ]. Cognitive-behavioral interventions enhanced the older people's mastery and understanding of their disease knowledge. Tailored education on relevant knowledge and skills was provided based on patients' actual needs. Older people were organized into various knowledge and skill groups to periodically consolidate and assess their learning achievements. Incentive measures, such as exchanging health coins and incorporating peer education and self-experience sharing, further bolstered patients' confidence in managing diabetes. Generalized estimating equation analysis revealed statistically significant differences (P < 0.05) in the changes of diabetes self-efficacy scores between the two groups before and after the intervention. Pairwise comparison results indicated statistically significant differences in self-efficacy scores at different time points within the intervention group (P < 0.05), while no significant changes were observed in the control group. This suggested that the intervention plan in this research improved diabetes self-efficacy among participants, aligning with expectations. The results corroborated the findings of Zhang Min et al.[ 41 ]. Knowledge tutoring and behavioral guidance could enhance the diabetes self-efficacy of participants [ 42 ]. Support and supervision from multiple parties were conducive to promoting goal achievement. Furthermore, confidence in achieving these goals improved their self-management efficacy. The results of this study indicated that the intervention group increased their daily step count to 2,007.00 (222.0) steps/day after 8 weeks and to 2,687.84 ± 165.95 steps/day after 16 weeks. In contrast, the control group recorded step counts of 1,741.84 ± 222.56 steps/day and 1,739.80 ± 227.05 steps/day, respectively. This were consistent with the research conducted by Masahiro et al. [ 43 ]. An increase in the number of steps reflected a heightened activity level among participants, which correlated with the enhancement of their sports beliefs. Personalized health education, along with supervised exercise, had improved participants' disease management capabilities and self-efficacy, further augmenting their exercise knowledge and step counts [ 44 ]. Phased exercise intervention programs facilitated participants' progression from 'initial adaptation to healthy practices' to 'long-term maintenance of healthy behaviors', thereby fostering a virtuous cycle in physical activity [ 45 ]. By continuously adjusting and setting goals, patients' intentions and motivations for behavior change were reinforced, leading to improved physical activity levels. This research demonstrated that prior to the intervention, the frailty scores for both the intervention group and the control group were 4.00 (1.0) and 4.00 (2.0) points, respectively. After a 16-week intervention, the frailty score of the intervention group decreased to 2.00 (1.0) points (P < 0.05). In contrast, no statistically significant differences were found in the control group's scores before and after the intervention. These findings suggested that improving frailty among participants requires a long-term commitment. Sedentary behavior was associated with an increased risk of frailty, and its potential biological variability might influence frailty development [ 46 ]. This intervention program effectively reduced sedentary time for participants and enhanced their physical activity levels, leading to an improvement in frailty. However, it was noteworthy that after 8 weeks of intervention, participants did not show improvement in frailty status. This indicated that the frailty of participants remained concerning and necessitates urgent attention. Strength and Limitation This study was among the few in China to investigate strategies for reducing prolonged sedentary behavior in OPT2DM with frailty residing in nursing homes. The research protocol effectively managed and analyzed experimental data through both subjective and objective measurement tools, demonstrating simplicity, feasibility, and ease of promotion. Nonetheless, this study had several limitations: 1) a pedometer was utilized to quantify physical activity by measuring step count; however, a causal relationship between step count and sedentary time was not established, necessitating further exploration of this relationship; 2) the intervention was implemented in nursing homes for a duration of only 16 weeks, and the long-term effects of the intervention require further validation; and 3) the intervention measures for sedentary behavior were tested during seasons with favorable temperatures, but their applicability across different seasons or under varying temperature conditions necessitates additional research and verification. Conclusion In nursing homes, OPT2DM with frailty exhibited a significant and pervasive level of sedentary behaviors. Factors such as age, gender, history of falls, type of residence, frequency of family visits, diabetes self-efficacy, and step count served as barriers to patient activity. An intervention program, developed in accordance with the ITHBC, had the potential to reduce sedentary time among the OPT2DM with frailty in nursing homes, enhanced their diabetes self-efficacy, increased their levels of physical activity, and improved their overall frailty status. Abbreviations BMI Body Mass Index OPT2DM Older People with Type 2 Diabetes Mellitus IDF the International Diabetes Federation ITHBC Integrated theory of Health Behavior Change MET Metabolic equivalent MOS Measure of older sedentary time SED Self-efficacy for diabetes T2DM Type 2 Diabetes Mellitus Declarations Acknowledgements We extend our heartfelt gratitude to all the organizers and staffs who contributed to this study. Additionally, we would like to express our sincere wishes to Miss. XS and Mr. HZ, hoping that their relationship will flourish as a result of this study in the future. Author contributions XS and LW designed the study, implemented the intervention, conducted data collection and management, and were responsible for writing the manuscript and creating all tables. HZ and WZ led the study design, supervised the intervention process, performed data analysis, and contributed to the writing and revision of the manuscript. XL and YC participated in the study design, contributed to data analysis, and assisted in drafting the final version. All authors have read and approved the final manuscript. Funding This research was supported by the National Natural Science Foundation of China (Grant No. 72064038), and Scientific and Technological Innovation Team of University in Henan Province (Grant No. 22IRTSTHN027). Data availability Not applicable. Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. It was approved by the Life Sciences Ethics Review Committee of Zhengzhou University (Approval Number: ZZUIRB2023-073). All participants provided written informed consent. They were fully informed about the specific details of the study and voluntarily chose to participate. Furthermore, they retained the right to withdraw from the study at any time without facing any consequences. Consent for publication Not Applicable. Competing interests The authors have no conflicts of interest to declare. Clinical trial number not applicable References Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. https://doi.org/10.1016/j.diabres.2021.109119 . Chung WK, Erion K, Florez JC, Hattersley AT, Hivert MF, Lee CG, et al. Precision Medicine in Diabetes: A Consensus Report From the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43(7):1617–35. https://doi.org/10.2337/dci20-0022 . McCarthy K, Laird E, O'Halloran AM, Fallon P, Ortuño RR, Kenny RA. Association between metabolic syndrome and risk of both prevalent and incident frailty in older adults: Findings from The Irish Longitudinal Study on Ageing (TILDA). Exp Gerontol. 2023;172:112056. https://doi.org/10.1016/j.exger.2022.112056 . Ulley J, Abdelhafiz AH. Frailty predicts adverse outcomes in older people with diabetes. Practitioner. 2017;261(1800):17–20. Kong LN, Lyu Q, Yao HY, Yang L, Chen SZ. The prevalence of frailty among community-dwelling older adults with diabetes: A meta-analysis. Int J Nurs Stud. 2021;119:103952. https://doi.org/10.1016/j.ijnurstu.2021.103952 . Zhang H, Zhou XD, Shapiro MD, Lip GYH, Tilg H, Valenti L, et al. Global burden of metabolic diseases, 1990–2021. Metabolism. 2024;160:155999. https://doi.org/10.1016/j.metabol.2024.155999 . National Bureau of Statistics. Wang Pingping: The total population decreased slightly and the urbanization level continued to improve. Accessed 28. January 2023. http://www.stats.gov.cn/xxgk/jd/sjjd2020/202301/t20230118_1892285.html Zeng X, Jia N, Meng L, Shi J, Li Y, Hu X, et al. A study on the prevalence and related factors of frailty and pre-frailty in the older population with diabetes in China: A national cross-sectional study. Front Public Health. 2022;10:996190. https://doi.org/10.3389/fpubh.2022.996190 . DiPietro L, Al-Ansari SS, Biddle SJH, Borodulin K, Bull FC, Buman MP, et al. Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group. Int J Behav Nutr Phys Act. 2020;17(1):143. https://doi.org/10.1186/s12966-020-01042-2 . Allison MA, Jensky NE, Marshall SJ, Bertoni AG, Cushman M. Sedentary behavior and adiposity-associated inflammation: the Multi-Ethnic Study of Atherosclerosis. Am J Prev Med. 2012;42(1):8–13. https://doi.org/10.1016/j.amepre.2011.09.023 . Howard BJ, Balkau B, Thorp AA, Magliano DJ, Shaw JE, Owen N, et al. Associations of overall sitting time and TV viewing time with fibrinogen and C reactive protein: the AusDiab study. Br J Sports Med. 2015;49(4):255–8. https://doi.org/10.1136/bjsports-2013-093014 . Sanz-Cánovas J, López-Sampalo A, Cobos-Palacios L, Ricci M, Hernández-Negrín H, Mancebo-Sevilla JJ, et al. Management of Type 2 Diabetes Mellitus in Elderly Patients with Frailty and/or Sarcopenia. Int J Environ Res Public Health. 2022;19(14). https://doi.org/10.3390/ijerph19148677 . Yanase T, Yanagita I, Muta K, Nawata H. Frailty in elderly diabetes patients. Endocr J. 2018;65(1):1–11. https://doi.org/10.1507/endocrj.EJ17-0390 . Bourdel-Marchasson I, Maggi S, Abdelhafiz A, Bellary S, Demurtas J, Forbes A, et al. Essential steps in primary care management of older people with Type 2 diabetes: an executive summary on behalf of the European geriatric medicine society (EuGMS) and the European diabetes working party for older people (EDWPOP) collaboration. Aging Clin Exp Res. 2023. https://doi.org/10.1007/s40520-023-02519-3 . He D, Li J, Li Y, Zhu J, Zhou T, Xu Y, et al. Frailty is associated with the progression of prediabetes to diabetes and elevated risks of cardiovascular disease and all-cause mortality in individuals with prediabetes and diabetes: Evidence from two prospective cohorts. Diabetes Res Clin Pract. 2022;194110145. https://doi.org/10.1016/j.diabres.2022.110145 . Bahat G, Ozkok S, Petrovic M. Management of Type 2 Diabetes in Frail Older Adults. Drugs Aging. 2023;40(9):751–61. https://doi.org/10.1007/s40266-023-01049-x . Del Pozo-Cruz J, Irazusta J, Rodriguez-Larrad A, Alfonso-Rosa RM, Álvarez-Barbosa F, Raimundo A, et al. Replacing Sedentary Behavior With Physical Activity of Different Intensities: Implications for Physical Function, Muscle Function, and Disability in Octogenarians Living in Long-Term Care Facilities. J Phys Act Health. 2022;19(5):329–38. https://doi.org/10.1123/jpah.2021-0186 . Leung KW, Sum KR, Yang YJ. Patterns of Sedentary Behavior among Older Adults in Care Facilities: A Scoping Review. Int J Environ Res Public Health. 2021;18(5). https://doi.org/10.3390/ijerph18052710 . Auerswald T, Meyer J, von Holdt K, Voelcker-Rehage C. Application of Activity Trackers among Nursing Home Residents-A Pilot and Feasibility Study on Physical Activity Behavior, Behavior, Acceptance, Usability and Motivational Impact[J]. Int J Environ Res Public Health. 2020;17(18). https://doi.org/10.3390/ijerph17186683 . Wang Shuang Z, Junkun C, Mei P, Qi L, Zhen L, Xiaohong, et al. Clinical expert consensus on standard care of blood glucose for residents in senior care facility in China(2021 edition). Chin J Geriatr. 2021;40(06):683–94. https://doi.org/10.3760/cma.j.issn.0254-9026.2021.06.001 . Gardner B, Smith L, Lorencatto F, Hamer M, Biddle SJ. How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults. Health Psychol Rev. 2016;10(1):89–112. https://doi.org/10.1080/17437199.2015.1082146 . Huimin, Wang. Effects of peer education on the sedentary behavior of the elderly in nursing homes. Shanxi University of Chinese Medicine; 2021. (Chinese). Meng Zhao. Identification and influencing factors of frailty among nursing home residents in China: a longitudinal study. Shandong University,2020. (Chinese). Maher JP, Sliwinski MJ, Conroy DE. Feasibility and preliminary efficacy of an intervention to reduce older adults' sedentary behavior. Transl Behav Med. 2017;7(1):52–61. https://doi.org/10.1007/s13142-016-0394-8 . Ryan P. Integrated Theory of Health Behavior Change: background and intervention development. Clin Nurse Spec. 2009;23(3):161–70. https://doi.org/10.1097/NUR.0b013e3181a42373 . Wijndaele K, DE Bourdeaudhuij I, Godino JG, Lynch BM, Griffin SJ, Westgate K, et al. Reliability and validity of a domain-specific last 7-d sedentary time questionnaire. Med Sci Sports Exerc. 2014;46(6):1248–60. https://doi.org/10.1249/MSS.0000000000000214 . Rosenberg DE, Norman GJ, Wagner N, Patrick K, Calfas KJ, Sallis JF. Reliability and validity of the Sedentary Behavior Questionnaire (SBQ) for adults. J Phys Act Health. 2010;7(6):697–705. https://doi.org/10.1123/jpah.7.6.697 . Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE et al. Does physical activity attenuate,or even eliminate,the detrimental association of sitting time with mortality?A harmonised meta-analysis of data from more than 1 million men and women.Lancet,2016,388(10051):1302–10. https://doi.org/10.1016/S0140-6736(16)30370-1 Lorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37(1):5–14. https://doi.org/10.1097/00005650-199901000-00003 . Jie Wei. Research on Relationship between Diabetes Knowledge, Self-efficacy and Self-management among Rural Elderly Patients. Hangzhou Normal University; 2013. (Chinese). Kaehr E, Visvanathan R, Malmstrom TK, Morley JE. Frailty in nursing homes: the FRAIL-NH Scale. J Am Med Dir Assoc. 2015;16(2):87–9. https://doi.org/10.1016/j.jamda.2014.12.002 . Zhao M, Mou H, Zhu S, Li M, Wang K. Cross-cultural adaptation and validation of the FRAIL-NH scale for Chinese nursing home residents: A methodological and cross-sectional study. Int J Nurs Stud. 2020;105:103556. https://doi.org/10.1016/j.ijnurstu.2020.103556 . Airlie J, Forster A, Birch KM. An investigation into the optimal wear time criteria necessary to reliably estimate physical activity and sedentary behaviour from ActiGraph wGT3X + accelerometer data in older care home residents. BMC Geriatr. 2022;22(1):136. https://doi.org/10.1186/s12877-021-02725-6 . Farrés-Godayol P, Ruiz-Díaz MÁ, Dall P, Skelton DA, Minobes-Molina E, Jerez-Roig J, et al. Determining minimum number of valid days for accurate estimation of sedentary behaviour and awake-time movement behaviours using the ActivPAL3 in nursing home residents. Eur Rev Aging Phys Act. 2023;20(1):19. https://doi.org/10.1186/s11556-023-00329-0 . Chen S, Chen T, Kishimoto H, Yatsugi H, Kumagai S. Associations of Objectively Measured Patterns of Sedentary Behavior and Physical Activity with Frailty Status Screened by The Frail Scale in Japanese Community-Dwelling Older Adults. J Sports Sci Med. 2020;19(1):166–74. Crombie KM, Leitzelar BN, Almassi NE, Mahoney JE, Koltyn KF. The Feasibility and Effectiveness of a Community-Based Intervention to Reduce Sedentary Behavior in Older Adults. J Appl Gerontol. 2022;41(1):92–102. https://doi.org/10.1177/0733464820987919 . von Storch K, Graaf E, Wunderlich M, Rietz C, Polidori MC, Woopen C. Telemedicine-Assisted Self-Management Program for Type 2 Diabetes Patients. Diabetes Technol Ther. 2019;21(9):514–21. https://doi.org/10.1089/dia.2019.0056 . Gardiner PA, Eakin EG, Healy GN, Owen N. Feasibility of reducing older adults' sedentary time. Am J Prev Med. 2011;41(2):174–7. https://doi.org/10.1016/j.amepre.2011.03.020 . Winkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, et al. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess. 2020;24(28):1–232. https://doi.org/10.3310/hta24280 . Rollo S, Prapavessis H. Sedentary Behaviour and Diabetes Information as a Source of Motivation to Reduce Daily Sitting Time in Office Workers: A Pilot Randomised Controlled Trial. Appl Psychol Health Well Being. 2020;12(2):449–70. https://doi.org/10.1111/aphw.12190 . Zhang M. Application of health education based on ITHBC theory in self-management of middle-aged patients with type 2 diabetes. Tianjin University of Traditional Chinese Medicine. Wang X, Tian B, Zhang S, Li J, Yang W, Gu L, et al. Underlying mechanisms of diabetes knowledge influencing diabetes self-management behaviors among patients with type II diabetes in rural China: Based on health belief model. Patient Educ Couns. 2023;117:107986. https://doi.org/10.1016/j.pec.2023.107986 . Kitamura M, Izawa KP, Nagasaki T, Yoshizawa T, Okamura S, Fujioka K, et al. Effects of self-monitoring using an accelerometer on physical activity of older people with long-term care insurance in Japan: a randomized controlled trial[J]. Eur Geriatr Med. 2024;15(2):371–80. https://doi.org/10.1007/s41999-024-00935-w . Gamboa Moreno E, Mateo-Abad M, Ochoa de Retana García L, Vrotsou K, Del Campo Pena E, Sánchez Perez Á, Martínez Carazo C, et al. Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: A randomised controlled trial. Prim Care Diabetes. 2019;13(2):122–33. https://doi.org/10.1016/j.pcd.2018.10.001 . Faroqi L, Wong M, Bonde S, Wong CW, Walai K, West W, et al. Evaluating the clinical implementation of structured exercise: A randomized controlled trial among non-insulin dependent type II diabetics. Contemp Clin Trials. 2018;74:25–31. https://doi.org/10.1016/j.cct.2018.09.003 . Yu L, Guo Z, Long Q, Zhao X, Liu Y, Cao X, et al. Modifiable Lifestyle, Sedentary Behaviors and the Risk of Frailty: A Univariate and Multivariate Mendelian Randomization Study. Adv Biol (Weinh). 2024;e2400052. https://doi.org/10.1002/adbi.202400052 . 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6191546","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":443094212,"identity":"593411d9-ffe9-4146-9e9e-081b77647b49","order_by":0,"name":"Xinying Song","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIie2RsUoEMRCGZ1nINcF6ZE/zCpHAoZX6JgmC26xw5VbiNUlzZ702+hbWWdIGsRS02EoLmwWbLUQMKFht7krh8hVT/R//JAOQSPxbOAAByDpZ4z6ZGLuxkvPeH4od6uXGXWT3RtfqFk94NMbMyr3T+Yu6LsxjQQmWGkHCUN+Pr+Qfzo8a/qr01M8FpXihi4XNlv55XMFqxnvulMZKnlEMytTKPNPjCmuCIn8VRzmWBCWPKvBUie6npWwXjUS5VuHez7KGOxFacugtHujwyW3sLcwsxQf9dHt3Tfk2qK9Lxoxpu6GOLBbOgWGcXgH9O4eN5QN5H8YxwKRbE0wkEolt5RvVt1oGRonW3AAAAABJRU5ErkJggg==","orcid":"","institution":"Zhengzhou University","correspondingAuthor":true,"prefix":"","firstName":"Xinying","middleName":"","lastName":"Song","suffix":""},{"id":443094213,"identity":"a8c47699-bd67-4bb1-86e2-185abdc930de","order_by":1,"name":"Luqing Wu","email":"","orcid":"","institution":"The First Affiliated Hospital of Xiamen University","correspondingAuthor":false,"prefix":"","firstName":"Luqing","middleName":"","lastName":"Wu","suffix":""},{"id":443094214,"identity":"a4b9adda-1565-4387-8e4f-132bf4231084","order_by":2,"name":"Huiyue Zhou","email":"","orcid":"","institution":"NINTH PEOPLE’S HOSPITAL OF ZHENGZHOU","correspondingAuthor":false,"prefix":"","firstName":"Huiyue","middleName":"","lastName":"Zhou","suffix":""},{"id":443094215,"identity":"ec70b05f-1fd3-464a-8bd1-732aacc48f83","order_by":3,"name":"Xinxin Li","email":"","orcid":"","institution":"The First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Xinxin","middleName":"","lastName":"Li","suffix":""},{"id":443094218,"identity":"9bb08377-0e5b-41b7-8402-79a7535026f5","order_by":4,"name":"Ying Chen","email":"","orcid":"","institution":"Luoyang Orthopedic-Traumatological Hospital Of Henan Province (Henan Provincial Orthopedic Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Chen","suffix":""},{"id":443094219,"identity":"3eec3f86-4e06-45f4-8dff-8f3f9a4ad4af","order_by":5,"name":"Weihong Zhang","email":"","orcid":"","institution":"Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Weihong","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-03-10 03:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6191546/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6191546/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80807714,"identity":"7e2d3443-827a-4f13-9844-10f077e1780f","added_by":"auto","created_at":"2025-04-17 09:40:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":103252,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6191546/v1/3c6f53b60b3a7fff6aa1ccc4.png"},{"id":94063948,"identity":"ec0e99bf-c20f-4dcc-a2b0-a254ad744632","added_by":"auto","created_at":"2025-10-22 07:31:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1099279,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6191546/v1/38373315-5df8-45ac-93c9-8502c4740ce6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating the Efficacy of a Sedentary Behavior Intervention on Self-Efficacy, Step Count, and frailty in Elderly Patients with Type 2 Diabetes Mellitus of Nursing Home","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to data from the International Diabetes Federation (IDF), there were 537\u0026nbsp;million individuals with diabetes worldwide, with more than 90\u0026ndash;95% of these cases classified as Type 2 Diabetes Mellitus (T2DM) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Hyperglycemia associated with T2DM, along with diabetes-related complications, inflammatory cytokines, and endocrine changes, led to a reduction in musculoskeletal mass and muscle weakness, thereby increasing the risk of debilitation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Previous study demonstrated that the coexistence of frailty and T2DM elevated the risk of cardiovascular events, hospitalization, disability, and mortality in affected individuals, presenting a formidable challenge in the promotion of healthy aging [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdvanced age was a known risk factor for T2DM and associated debilitation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In China, there were 297\u0026nbsp;million individuals aged 60 and above, which constituted 21.1% of the total population [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The rapid progression of population aging was expected to further increased the proportion of OPT2DM. Research indicated that a sedentary lifestyle influenced the deterioration of health in OPT2DM [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Sedentary behavior was defined as any activity that expended 1.5 metabolic equivalent (MET) or less while sitting, reclining, or lying down [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The level of physical activity in individuals was correlated with the secretion of irisin produced by muscle cells, which was also associated with muscle volume. The secretion of metabolic factors by muscle could stimulate the proliferation of pancreatic β cells. Prolonged sitting led to a reduction in irisin secretion from skeletal muscle, thereby increasing insulin resistance [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Extended periods of sedentary behavior resulted in decreased muscle mass and strength in patients with T2DM, further contributing to diminished muscle endurance, exercise capacity, and balance [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], ultimately leading to physical weakness. As an emerging complication of diabetes, weakness reduced peripheral insulin sensitivity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], accelerated muscle mass loss, and heightened the risk of adverse health outcomes in diabetic patients, including cardiovascular disease and all-cause mortality [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The interplay of these factors impaired the physical function and quality of life of the elderly [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere were notable differences in activity levels among older people. In comparison to their counterparts in the community, older people residing in nursing homes exhibited the lowest levels of physical activity and the highest propensity for long-term sedentary behavior [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Previous studies indicated that 79% of older people spent prolonged periods sitting during waking hours, with the average sitting time for seniors in nursing homes recorded at 11.6 hours per day (equating to 729\u0026thinsp;\u0026plusmn;\u0026thinsp;321 steps per day) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In contrast, those in intermediate or mixed nursing homes had an average sitting time of 9.5 hours per day (or 4556\u0026thinsp;\u0026plusmn;\u0026thinsp;2624 steps per day). Another study [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] assessed the physical activity behaviors of older people in nursing homes, revealing that these individuals walked an average of 1007\u0026thinsp;\u0026plusmn;\u0026thinsp;806 steps per day and sat for more than 9 hours, which accounted for 77.2% of their waking time. Additionally, studies showed that [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], the proportion of OPT2DM living in nursing homes was high, which complicated the management of T2DM, frailty and blood sugar levels for these patients.\u003c/p\u003e \u003cp\u003ePrevious studies on interventions targeting sedentary behavior had primarily focused on encouraging individuals to reduce sitting time and increase physical activity through modifications to their environment and behavior [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Chinese researchers had largely concentrated on the sedentary behavior of middle-aged and young adults, as well as the elderly within community settings. However, there had been insufficient attention given to the sedentary behavior of older people residing in nursing homes, particularly those suffering from T2DM. This gap highlighted a lack of targeted intervention strategies for this demographic. Consequently, this study aimed to enhance physical activity levels, mitigate frailty, and improve overall physical function by developing an intervention program tailored specifically for OPT2DM in Chinese nursing homes.\u003c/p\u003e \u003cp\u003eThis study hypothesized that: 1) OPT2DM combined with frailty living in nursing homes demonstrated a high prevalence of sedentary behavior; and 2) interventions aimed at reducing sedentary behavior in these patients can result in improvements in their activity levels, glycemic control, and overall degree of frailty.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eThis study was a quasi-experiment approved by the Ethics Committee of Zhengzhou University (Approval No. ZZUIRB2023-073). It was conducted across six nursing homes in Zhengzhou from July 2023 to January 2024. Each nursing home had maintained a commendable operational record for over two years and was equipped with a minimum of 30 beds. The nursing homes were categorized into three groups based on the principle of having a similar number of residents. From each group, research subjects from one nursing home were randomly selected to be included in the intervention group, while subjects from another nursing home within the same group were designated as the control group.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatient Population\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria for participants were as follows: 1) confirmed diagnosis of T2DM, 2)\u0026thinsp;\u0026ge;\u0026thinsp;60 years old, 3) a minimum of three months of residency in nursing homes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], 4) a Frail-NH frailty scale score\u0026thinsp;\u0026ge;\u0026thinsp;2 points [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and 5) provision of informed consent and voluntary participation in this research. The exclusion criteria included 1) individuals with severe mental illness or cognitive impairment, 2) individuals with significant visual, auditory, or mobility impairments, 3) individuals with severe physical or chronic diseases in acute or terminal stages, and 4) individuals currently participating in other research projects.\u003c/p\u003e\n\u003ch3\u003eSample Size Calculations\u003c/h3\u003e\n\u003cp\u003eThe calculation formula for comparing the mean values of the two samples was utilized to determine the required sample size. In this context, Z1 and Z2 represented the sample sizes needed for the intervention and control groups, respectively. δ denoted the difference between the two population means.σ signified the standard deviation of the two samples. According to the literature[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], the mean values following the intervention were 8.63 and 7.24, with corresponding standard deviations of 2.041 and 1.869, respectively. Therefor, the mean difference δ was calculated as 1.39, and the standard deviation σ was 1.957. Following these calculations, the sample size required for each group was determined to be 41 cases. Considering a loss-to-follow-up rate of 10%, the final sample size for each group was established at 46 cases, resulting in a total of 92 cases.\u003c/p\u003e\n\u003ch3\u003eInterventions\u003c/h3\u003e\n\u003cp\u003eThe Integrated Theory of Health Behavior Change (ITHBC), proposed by American clinical nursing scholar Polly Ryan, posited that individual health behavior change could be facilitated through the cultivation of knowledge and beliefs, enhancement of self-regulation skills, and provision of social support [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Based on the ITHBC, the construction of intervention programs was divided into several stages: 1) Personalized assessment: Evaluate the current state of participants' sedentary behavior and related risk factors, 2) Guidance and support: Provide assistance based on the assessment results, encompassing knowledge, skills, and confidence, 3) Goal setting and implementation: Develop intervention goals in stages, employing multiple methods to enhance both cognitive and motor abilities in older people, thereby strengthening the intervention effects and enabling older people to experience positive impacts, as well as social facilitation that encourages their engagement in preventive health behaviors.\u003c/p\u003e \u003cp\u003eThe intervention team comprised a diverse group of professionals: one Doctor of Nursing (responsible for project design, quality control, and team management), one Master of Nursing (focused on project design, implementation of interventions, and research documentation), one Endocrinologist (specializing in disease management), one Rehabilitation Specialist (expert in rehabilitation and sports management), and three nursing staffs from nursing home, each with over three years of experience in implementing interventions. All team members underwent standardized training for the project and achieved consensus on their roles and objectives. The formulation of the intervention plan was grounded in clinical research and a comprehensive literature review. A panel of ten experts, each with 11 to 27 years of experience in geriatrics and diabetes care, was convened to engage in two rounds of correspondence through discussions, telephone calls, and emails. Additionally, pre-experiments were conducted with ten participants, leading to revisions and enhancements based on the findings. The final behavioral intervention plan was subsequently finalized (refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eControl group intervention program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObjective\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSetting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMethod\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTool\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIntervener\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1st Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEstablishing a trusting relationship with participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ea) Evaluate the participants' health and disease perception status by analyzing their health records.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOffice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ea) One-to-one intervention,\u003c/p\u003e \u003cp\u003eb) 1 time/week, 30min/time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ea) Laptop,\u003c/p\u003e \u003cp\u003eb) Electronic recorder, \u003c/p\u003e \u003cp\u003ec) Bonus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ea) Project leaders,\u003c/p\u003e \u003cp\u003eb) Institution staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eb) Conduct in-person interviews with participants to address any questions or concerns they may have.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2nd Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePopularization of knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ea) Explain the necessity and significance of interventions such as diabetic exercise, diet, sedentary behavior, and weakness.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eActivity room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) Both group intervention and One-to-one intervention,\u003c/p\u003e \u003cp\u003eb) 1 time/week, 30min/time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) Disease-related health guides and sedentary behavior guides, \u003c/p\u003e \u003cp\u003eb) Laptop, pens and paper, \u003c/p\u003e \u003cp\u003ec) Bonus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) Project leaders,\u003c/p\u003e \u003cp\u003eb) Institution staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eb) Conduct specialized knowledge lectures to provide guidance on effective strategies for reducing prolonged sitting behaviors, enhancing physical activity, and managing dietary habits.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ec) Distribute a comprehensive manual on managing sedentary behavior\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3rd Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eImprove compliance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ea) Listen: Actively engage with the needs of participants and address challenging problems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOffice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) One-to-one intervention,\u003c/p\u003e \u003cp\u003eb) 1 time/week, 30min/time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) Laptop,\u003c/p\u003e \u003cp\u003eb) Electronic recorder, \u003c/p\u003e \u003cp\u003ec) Bonus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) Project leaders,\u003c/p\u003e \u003cp\u003eb) Institution staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eb) Encouragement: Provide psychological support and spiritual encouragement to enhance motivation for action.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ec) Support: Monitor the impact of behavioral improvements and promptly correct any misaligned behaviors.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4th Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eImprove intervention compliance and normalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ea) Accompany participants in performing rehabilitation exercises systematically according to the established plan to foster positive compliance behaviors.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eActivity room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ea) Both group intervention and One-to-one intervention,\u003c/p\u003e \u003cp\u003eb) 1 time/week, 30min/time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ea) Laptop, pens and paper, \u003c/p\u003e \u003cp\u003eb) Bonus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ea) Project leaders,\u003c/p\u003e \u003cp\u003eb) Institution staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eb) Assist participants in comparing their experiences before and after the intervention, while encouraging them to take an active role in developing management plans.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5th-16th Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up investigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ea) Inquire about the participants' recent health behaviors and needs, and dynamically adjust the content of the sedentary behavior intervention based on the findings.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOnline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ea) One-to-one intervention,\u003c/p\u003e \u003cp\u003eb) 1 time/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ea) telephone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProject leaders\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eb) Assess the effectiveness of the intervention.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntervention group intervention program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObjective\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntervention content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSetting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMethod\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIntervener\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e1st-4th Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eIndividualized evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ea) Assess the health status of participants, focusing on disease-related risk factors and their perception of the disease. \u003c/p\u003e \u003cp\u003eb) Strengthen the evaluation of the process.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ea) Measure health risk indicators using participants' health records.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eOffice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ea) One-to-one intervention,\u003c/p\u003e \u003cp\u003eb) 1 time/week, 30min/time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ea) Project leaders,\u003c/p\u003e \u003cp\u003eb) Institution staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb) Provide straightforward health education to participants based on the results of these indicators.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ec) Conduct interviews with participants to gather information regarding their medical history, sedentary behaviors, dietary habits, psychological state, exercise routines, and other health-related practices.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed) Document participants' feedback and analyze the underlying reasons.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee) Assess whether the intervention measures require adjustments based on the evaluation outcomes.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e5th-8th Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eKnowledge guidance and skill guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ea) Enhance participants' sense of self-efficacy. b)Strengthen participants' determination and motivation. c)Improve the consistency of participants' goals regarding the alteration of their long-term sitting habits.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Educate elderly patients on effective strategies to reduce prolonged sitting and enhance their physical activity levels.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eActivity room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ea) Both group intervention and One-to-one intervention,\u003c/p\u003e \u003cp\u003eb) 1 time/week, 30min/time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ea) Project leaders,\u003c/p\u003e \u003cp\u003eb) Institution staff\u003c/p\u003e \u003cp\u003ec) Rehabilitation therapist\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2. guide them in adopting healthier eating habits and fostering a positive, optimistic outlook on life.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3. Distribute sedentary behavior logs and instruct elderly patients on how to accurately record their activity levels. Improve adherence to these logs by highlighting the significance of behavioral change through the lens of knowledge and health beliefs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4. einforce the importance of behavior modification by focusing on knowledge and health beliefs, thereby boosting elderly patients' confidence in improving their physical condition and strengthening their commitment to reducing sedentary behaviors.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5. Assess learning outcomes: At this stage, elderly participants will be divided into several groups based on knowledge and skills. This will be achieved by randomly selecting small balls from a box, with participants finding three others who have the same color ball to form a group. Subsequently, groups will engage in cycles of questioning regarding the health knowledge they have acquired, with correct answers rewarded with one health coin.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e9th-12th Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eThe Establishment and Execution of Goals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ea) Collaboratively establish personalized long-term goals. \u003c/p\u003e \u003cp\u003eb) Prevent the decline of enthusiasm and behavioral deterioration. \u003c/p\u003e \u003cp\u003ec) Enhance the intention and motivation for behavior change among patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Elderly individuals with limited knowledge of health risks and who are unable to modify their current behaviors establish clear learning objectives.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOffice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ea) One-to-one intervention,\u003c/p\u003e \u003cp\u003eb) 1 time/week, 30min/time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ea) Project leaders,\u003c/p\u003e \u003cp\u003eb) Institution staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2. For elderly individuals who understand the risks associated with sedentary behavior but are reluctant to change, it is important to reinforce education on these risks and set achievable short-term goals.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3. For elderly individuals who are willing to change but lack the necessary skills, it is crucial to provide targeted guidance in both knowledge acquisition and skill development, encouraging them to set progressively more challenging goals.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4. For elderly individuals who have successfully adopted healthy behaviors and possess the requisite knowledge and skills, continued encouragement is essential, along with setting long-term goals for sustained improvement.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e13th-16th Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFoster a supportive social environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) Assist participants in executing the behavior plan. \u003c/p\u003e \u003cp\u003eb) Ensure that participants receive adequate social support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ea) Enhance participants' confidence and compliance by leveraging peer support, sharing success stories, and improving overall experiences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eActivity room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) Both group intervention and One-to-one intervention,\u003c/p\u003e \u003cp\u003eb) 1 time/week, 30min/time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) Project leaders, b) Institution staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb) 2. Conduct a dynamic evaluation of changes in behavioral patterns, physical activity levels, and self-efficacy across various stages of the intervention.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ec) Increase awareness among participants' families and caregivers regarding sedentary behavior, guide them in assisting patients during rehabilitation and daily activities, and reinforce their supervisory role throughout the intervention process.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe factors influencing sedentary behavior among OPT2DM were identified through preliminary research, including age, gender, duration of stay in nursing home, educational level, marital status, type of residence, length of diabetes diagnosis, history of falls, smoking habits, alcohol consumption, and the presence of multiple chronic diseases.\u003c/p\u003e \u003cp\u003eBuilding on the foundational work of our team and incorporating relevant sedentary behavior questionnaires from abroad [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], a sedentary behavior log was designed specifically for the elderly residing in care institutions. This log comprises two main aspects and eleven entries, aimed at evaluating the sedentary behavior of the elderly over a one-week period. Notably, time spent sleeping or napping in bed is excluded from the assessment, as is repeated sedentary time (e.g., watching TV while eating). Study participants were instructed to record the time and type of sitting each day, with average sedentary time calculated as the sum of daily sedentary time over the week divided by seven. Sedentary time was categorized into increments of 30 minutes, with recorded times including 0, 30, 60 minutes, and so forth. The study defined sedentary behavior as 8 hours per day (h/d) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], with \u0026ge;\u0026thinsp;8 h/d classified as sedentary and \u0026lt;\u0026thinsp;8 h/d classified as non-sedentary.\u003c/p\u003e \u003cp\u003eThe Diabetes Self-efficacy Scale (SED), developed by Lorig et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], was revised and localized into Chinese in 2013 by Wei Jie et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], tailored to the characteristics of elderly diabetic patients. This scale comprised four dimensions and a total of nine items. Employing a 5-point Likert scoring method, responses were rated from 'completely unconfident' (1 point) to 'completely confident' (5 points). The average score across the items reflected the self-efficacy level of the subjects, with higher scores indicating greater self-efficacy. In this study, the Cronbach's α coefficient was 0.846.\u003c/p\u003e \u003cp\u003eThe FRAIL-NH Scale was a frailty assessment tool designed for older people in care institutions, developed by Kaehr in 2015 based on the FRAIL scale [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This scale encompassed the core symptoms of both the frailty phenotype and the frailty index, which were widely utilized in current research. It was user-friendly, straightforward, and practical, consisting of seven items: fatigue, transfer, walking, incontinence, weight loss, nutritional intake, and clothing [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Scholar Zhao Meng [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] localized the scale to create the Chinese version of the FRAIL-NH scale and conducted tests for reliability and validity. The results indicated that the optimal cutoff value for identifying frailty was 2 point, with a Cronbach's α coefficient of 0.84. In this study, the Cronbach's alpha coefficient was 0.782.\u003c/p\u003e \u003cp\u003eSteps were measured using a pedometer integrated into a wearable device known as MAMBO, a small bracelet weighing approximately 17 grams, which had a battery life of seven days. Participants wear the device on their wrists or in their clothing pockets. Previous studies [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] confirmed the reliability of using a pedometer to measure steps, and it was recommended that measurements be taken over a period of three to four days, with valid data requiring the device to be worn for at least 75% of daytime hours [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Body Mass Index (BMI) was assessed in conjunction with the adult health classification standards applicable in our country.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eData collection occurred at three time points: prior to the implementation of the intervention program, and at 8 and 16 weeks post-intervention. Nursing staff assisted the nursing master in gathering data from the basic information questionnaire, the older sedentary behavior log, the diabetes self-efficacy scale, and other objective measures. During the collection of baseline data, participants were clearly informed about the specific criteria for completing the questionnaire, and the nursing master systematically verified the validity of each questionnaire. Incomplete or erroneous responses were promptly addressed through supplementation, correction, or elimination to minimize the occurrence of invalid questionnaires. If participants were unable to complete the questionnaires independently, they received assistance from either the nursing staff or the nursing master.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003e Data entry was conducted using Epidata software, followed by statistical analysis with IBM SPSS Statistics 27.0. (1) Qualitative data are statistically described using frequencies and percentages. For normally distributed measurement data, the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation is employed for statistical description, while non-normally distributed data are summarized using the median and interquartile range [M (QR)]. (2) To compare the baseline data balance between the two groups, qualitative data were analyzed using the Chi-square test and Fisher's exact test; ordinal data were assessed using the Mann-Whitney U rank sum test. For quantitative data that conform to a normal distribution, the independent samples t-test was applied, whereas the Mann-Whitney U rank sum test was utilized for data that do not meet the normality assumption. (3) Based on the data collected prior to the intervention, as well as at 8 weeks and 16 weeks post-intervention, if the data follow a normal distribution, repeated measures analysis of variance or generalized estimating equations will be used.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study enrolled a total of 92 participants, with 87 ultimately completing the entire study\u0026mdash;43 in the intervention group and 44 in the control group. The participant recruitment process was detailed in Fig.\u0026nbsp;1. There was no statistically significant difference in baseline characteristics between the two groups (shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Independent sample t-test analysis revealed that the step count before the intervention was 1709.48\u0026thinsp;\u0026plusmn;\u0026thinsp;299.70 steps in the control group and 1756.93\u0026thinsp;\u0026plusmn;\u0026thinsp;171.54 steps in the intervention group, with no statistically significant difference in step count between the two groups prior to the intervention (t = -0.904, P\u0026thinsp;=\u0026thinsp;0.369). The Mann-Whitney U test analysis indicated that before the intervention, the frailty score of the control group was 4.00 (2.0), while that of the intervention group was 4.00 (1.0). There was no statistically significant difference in frailty scores between the two groups before the intervention (Z = -0.523, P\u0026thinsp;=\u0026thinsp;0.601).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and general characteristics of study participants [n\u0026thinsp;=\u0026thinsp;87(%)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eχ2/F/Z\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.298\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u0026ndash;89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.114\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDuration of residence in nursing home (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.046\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarrage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.092\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (74.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.478\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (48.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCohabitation status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith spouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.678\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (51.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (51.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eFrequency of interaction with families (one time)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvery week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.789\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.852\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvery month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHalf of a year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDuration of T2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.113\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (51.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.596\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.897\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormoweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOut of standard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFall down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.114\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.644\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAlcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.021\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (59.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (65.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of concurrent chronic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.255\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter 8 and 16 weeks of intervention, the differences in total sedentary time, total diabetes self-efficacy scores, and step count scores between the two participant groups were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, after 16 weeks of intervention, the differences in the longest continuous sedentary time, sedentary time of 30 minutes or more per session, and frailty scores between the two patient groups were also statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Intervention Indicators Between Two Groups [M(QR)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eBetween-group effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eTime effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eInteraction effect\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eWald\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eWald\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003eWald\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMaximum continuous sedentary time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.50 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.25 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.25 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e5.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e28.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.50 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.00 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.00 (0.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.832\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSedentary Behaviors\u0026thinsp;\u0026ge;\u0026thinsp;30min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.00 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.00 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.00 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e12.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e100.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e55.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.00 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.00 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.00 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-6.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal sedentary time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.75 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.50 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.00 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e72.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e22.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e78.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.00 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.00 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.00 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-6.836\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSelf-efficacy for diabetes scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.67 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.11 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e26.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e513.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e115.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.67 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.89 (0.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eZ/t\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-7.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSteps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1709.48\u0026thinsp;\u0026plusmn;\u0026thinsp;299.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1741.84\u0026thinsp;\u0026plusmn;\u0026thinsp;222.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1739.80\u0026thinsp;\u0026plusmn;\u0026thinsp;227.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e115.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e806.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e721.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1756.93\u0026thinsp;\u0026plusmn;\u0026thinsp;171.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2007.00\u0026thinsp;\u0026plusmn;\u0026thinsp;222.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2687.84\u0026thinsp;\u0026plusmn;\u0026thinsp;165.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eZ/t\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.225836288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-22.193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFrailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.00(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.00(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e7.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e76.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e56.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.00(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.00(1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eZ/t\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-5.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGeneralized Estimating Equations (GEE) was used to analysis the indicators before and after the intervention in both groups showed that there were statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the group effect, time effect, and interaction effect between time and group for continuous sedentary time, sedentary bouts\u0026thinsp;\u0026ge;\u0026thinsp;30 minutes, total sedentary time, total diabetes self-efficacy score, step count, and frailty score between the both groups. (shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntra-group comparison of sedentary behavior levels in the intervention group patients. (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatergories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime period\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMaximum continuous sedentary time(h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.23~-0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.68~-0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.54~-0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSedentary Behaviors\u0026thinsp;\u0026ge;\u0026thinsp;30min (time/d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.44~-0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.66~-1.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.39~-0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTotal sedentary time (h/d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.11~-0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.02~-1.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.14~-0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSelf-efficacy for diabetes scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.63\u0026thinsp;~\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.02\u0026thinsp;~\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.34\u0026thinsp;~\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSteps (d/step)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e332.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e292.54\u0026thinsp;~\u0026thinsp;372.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e930.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e872.28\u0026thinsp;~\u0026thinsp;989.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e598.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e543.09\u0026thinsp;~\u0026thinsp;653.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFrailty (score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.50~-0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.57~-1.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2-T1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.21~-0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study was the first to investigate the long-term sedentary behavior in OPT2DM with frailty residing in nursing homes, utilizing the ITHBC. The results confirmed the initial research hypothesis that the levels of sedentary behavior among participants in nursing homes were high. Furthermore, the intervention program had been shown to enhance patients' activity levels, manage blood glucose, and reduce the frailty.\u003c/p\u003e \u003cp\u003eThis study demonstrated that after 8 weeks of intervention, participants' total sedentary time decreased by 49.8 minutes per day. Following 16 weeks of intervention, the total sedentary time further decreased by 100.8 minutes per day. These findings aligned with the previous researches [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The formulation of personalized sedentary behavior intervention plans facilitated comprehensive interventions that encompassed knowledge beliefs, skill abilities, and social support. A personalized assessment was integral throughout the intervention process, aiding OPT2DM with frailty in recognizing and identifying the hazards and characteristics of sedentary behavior [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. It encouraged participants to change unhealthy lifestyle habits, adopt healthier behaviors, and stimulate their intrinsic motivation, thereby enhancing their confidence in reducing sedentary time. Additionally, goals were established based on the behavioral stage of participants, motivating them to actively manage behaviors related to these goals and increasing their enthusiasm for participation. Notably, after 16 weeks of intervention, the longest continuous sitting time among participants in the intervention group was reduced by 30.6 minutes per day compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The alteration of sitting behavior was contingent upon long-term adherence. The enhancement of participants' understanding of sedentary behavior served as a positive impetus for achieving sustained adherence. Furthermore, goal motivation and social support could bolster participants' positive cognition and behavioral compliance [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSelf-efficacy influenced individuals' choices and persistence in behaviors. A high level of self-efficacy helped patients maintain beneficial lifestyle habits [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This study found that after 16 weeks of intervention, the diabetes self-efficacy score of participants in the intervention group increased by an average of 1.22 points compared to baseline, and by an average of 0.78 points compared to measurements taken 8 weeks post-intervention (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The findings were consistent with results of Scott et al [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Cognitive-behavioral interventions enhanced the older people's mastery and understanding of their disease knowledge. Tailored education on relevant knowledge and skills was provided based on patients' actual needs. Older people were organized into various knowledge and skill groups to periodically consolidate and assess their learning achievements. Incentive measures, such as exchanging health coins and incorporating peer education and self-experience sharing, further bolstered patients' confidence in managing diabetes. Generalized estimating equation analysis revealed statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the changes of diabetes self-efficacy scores between the two groups before and after the intervention. Pairwise comparison results indicated statistically significant differences in self-efficacy scores at different time points within the intervention group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while no significant changes were observed in the control group. This suggested that the intervention plan in this research improved diabetes self-efficacy among participants, aligning with expectations. The results corroborated the findings of Zhang Min et al.[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Knowledge tutoring and behavioral guidance could enhance the diabetes self-efficacy of participants [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Support and supervision from multiple parties were conducive to promoting goal achievement. Furthermore, confidence in achieving these goals improved their self-management efficacy.\u003c/p\u003e \u003cp\u003eThe results of this study indicated that the intervention group increased their daily step count to 2,007.00 (222.0) steps/day after 8 weeks and to 2,687.84\u0026thinsp;\u0026plusmn;\u0026thinsp;165.95 steps/day after 16 weeks. In contrast, the control group recorded step counts of 1,741.84\u0026thinsp;\u0026plusmn;\u0026thinsp;222.56 steps/day and 1,739.80\u0026thinsp;\u0026plusmn;\u0026thinsp;227.05 steps/day, respectively. This were consistent with the research conducted by Masahiro et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. An increase in the number of steps reflected a heightened activity level among participants, which correlated with the enhancement of their sports beliefs. Personalized health education, along with supervised exercise, had improved participants' disease management capabilities and self-efficacy, further augmenting their exercise knowledge and step counts [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Phased exercise intervention programs facilitated participants' progression from 'initial adaptation to healthy practices' to 'long-term maintenance of healthy behaviors', thereby fostering a virtuous cycle in physical activity [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. By continuously adjusting and setting goals, patients' intentions and motivations for behavior change were reinforced, leading to improved physical activity levels.\u003c/p\u003e \u003cp\u003eThis research demonstrated that prior to the intervention, the frailty scores for both the intervention group and the control group were 4.00 (1.0) and 4.00 (2.0) points, respectively. After a 16-week intervention, the frailty score of the intervention group decreased to 2.00 (1.0) points (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, no statistically significant differences were found in the control group's scores before and after the intervention. These findings suggested that improving frailty among participants requires a long-term commitment. Sedentary behavior was associated with an increased risk of frailty, and its potential biological variability might influence frailty development [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This intervention program effectively reduced sedentary time for participants and enhanced their physical activity levels, leading to an improvement in frailty. However, it was noteworthy that after 8 weeks of intervention, participants did not show improvement in frailty status. This indicated that the frailty of participants remained concerning and necessitates urgent attention.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStrength and Limitation\u003c/h2\u003e \u003cp\u003eThis study was among the few in China to investigate strategies for reducing prolonged sedentary behavior in OPT2DM with frailty residing in nursing homes. The research protocol effectively managed and analyzed experimental data through both subjective and objective measurement tools, demonstrating simplicity, feasibility, and ease of promotion. Nonetheless, this study had several limitations: 1) a pedometer was utilized to quantify physical activity by measuring step count; however, a causal relationship between step count and sedentary time was not established, necessitating further exploration of this relationship; 2) the intervention was implemented in nursing homes for a duration of only 16 weeks, and the long-term effects of the intervention require further validation; and 3) the intervention measures for sedentary behavior were tested during seasons with favorable temperatures, but their applicability across different seasons or under varying temperature conditions necessitates additional research and verification.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn nursing homes, OPT2DM with frailty exhibited a significant and pervasive level of sedentary behaviors. Factors such as age, gender, history of falls, type of residence, frequency of family visits, diabetes self-efficacy, and step count served as barriers to patient activity. An intervention program, developed in accordance with the ITHBC, had the potential to reduce sedentary time among the OPT2DM with frailty in nursing homes, enhanced their diabetes self-efficacy, increased their levels of physical activity, and improved their overall frailty status.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOPT2DM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOlder People with Type 2 Diabetes Mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIDF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethe International Diabetes Federation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eITHBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntegrated theory of Health Behavior Change\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMET\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMetabolic equivalent\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMeasure of older sedentary time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSelf-efficacy for diabetes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eT2DM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eType 2 Diabetes Mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our heartfelt gratitude to all the organizers and staffs who contributed to this study. Additionally, we would like to express our sincere wishes to Miss. XS and Mr. HZ, hoping that their relationship will flourish as a result of this study in the future.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXS and LW designed the study, implemented the intervention, conducted data collection and management, and were responsible for writing the manuscript and creating all tables. HZ and WZ led the study design, supervised the intervention process, performed data analysis, and contributed to the writing and revision of the manuscript. XL and YC participated in the study design, contributed to data analysis, and assisted in drafting the final version. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the National Natural Science Foundation of China (Grant No. 72064038), and Scientific and Technological Innovation Team of University in Henan Province (Grant No. 22IRTSTHN027).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. It was approved by the Life Sciences Ethics Review Committee of Zhengzhou University (Approval Number: ZZUIRB2023-073). All participants provided written informed consent. They were fully informed about the specific details of the study and voluntarily chose to participate. Furthermore, they retained the right to withdraw from the study at any time without facing any consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.diabres.2021.109119\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2021.109119\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChung WK, Erion K, Florez JC, Hattersley AT, Hivert MF, Lee CG, et al. Precision Medicine in Diabetes: A Consensus Report From the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43(7):1617\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2337/dci20-0022\u003c/span\u003e\u003cspan address=\"10.2337/dci20-0022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCarthy K, Laird E, O'Halloran AM, Fallon P, Ortu\u0026ntilde;o RR, Kenny RA. Association between metabolic syndrome and risk of both prevalent and incident frailty in older adults: Findings from The Irish Longitudinal Study on Ageing (TILDA). Exp Gerontol. 2023;172:112056. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.exger.2022.112056\u003c/span\u003e\u003cspan address=\"10.1016/j.exger.2022.112056\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlley J, Abdelhafiz AH. Frailty predicts adverse outcomes in older people with diabetes. Practitioner. 2017;261(1800):17\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKong LN, Lyu Q, Yao HY, Yang L, Chen SZ. The prevalence of frailty among community-dwelling older adults with diabetes: A meta-analysis. Int J Nurs Stud. 2021;119:103952. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijnurstu.2021.103952\u003c/span\u003e\u003cspan address=\"10.1016/j.ijnurstu.2021.103952\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang H, Zhou XD, Shapiro MD, Lip GYH, Tilg H, Valenti L, et al. Global burden of metabolic diseases, 1990\u0026ndash;2021. Metabolism. 2024;160:155999. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.metabol.2024.155999\u003c/span\u003e\u003cspan address=\"10.1016/j.metabol.2024.155999\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Bureau of Statistics. Wang Pingping: The total population decreased slightly and the urbanization level continued to improve. Accessed 28. January 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.stats.gov.cn/xxgk/jd/sjjd2020/202301/t20230118_1892285.html\u003c/span\u003e\u003cspan address=\"http://www.stats.gov.cn/xxgk/jd/sjjd2020/202301/t20230118_1892285.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeng X, Jia N, Meng L, Shi J, Li Y, Hu X, et al. A study on the prevalence and related factors of frailty and pre-frailty in the older population with diabetes in China: A national cross-sectional study. Front Public Health. 2022;10:996190. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2022.996190\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2022.996190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiPietro L, Al-Ansari SS, Biddle SJH, Borodulin K, Bull FC, Buman MP, et al. Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group. Int J Behav Nutr Phys Act. 2020;17(1):143. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12966-020-01042-2\u003c/span\u003e\u003cspan address=\"10.1186/s12966-020-01042-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllison MA, Jensky NE, Marshall SJ, Bertoni AG, Cushman M. Sedentary behavior and adiposity-associated inflammation: the Multi-Ethnic Study of Atherosclerosis. Am J Prev Med. 2012;42(1):8\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.amepre.2011.09.023\u003c/span\u003e\u003cspan address=\"10.1016/j.amepre.2011.09.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoward BJ, Balkau B, Thorp AA, Magliano DJ, Shaw JE, Owen N, et al. Associations of overall sitting time and TV viewing time with fibrinogen and C reactive protein: the AusDiab study. Br J Sports Med. 2015;49(4):255\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bjsports-2013-093014\u003c/span\u003e\u003cspan address=\"10.1136/bjsports-2013-093014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanz-C\u0026aacute;novas J, L\u0026oacute;pez-Sampalo A, Cobos-Palacios L, Ricci M, Hern\u0026aacute;ndez-Negr\u0026iacute;n H, Mancebo-Sevilla JJ, et al. Management of Type 2 Diabetes Mellitus in Elderly Patients with Frailty and/or Sarcopenia. Int J Environ Res Public Health. 2022;19(14). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph19148677\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19148677\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYanase T, Yanagita I, Muta K, Nawata H. Frailty in elderly diabetes patients. Endocr J. 2018;65(1):1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1507/endocrj.EJ17-0390\u003c/span\u003e\u003cspan address=\"10.1507/endocrj.EJ17-0390\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBourdel-Marchasson I, Maggi S, Abdelhafiz A, Bellary S, Demurtas J, Forbes A, et al. Essential steps in primary care management of older people with Type 2 diabetes: an executive summary on behalf of the European geriatric medicine society (EuGMS) and the European diabetes working party for older people (EDWPOP) collaboration. Aging Clin Exp Res. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40520-023-02519-3\u003c/span\u003e\u003cspan address=\"10.1007/s40520-023-02519-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe D, Li J, Li Y, Zhu J, Zhou T, Xu Y, et al. Frailty is associated with the progression of prediabetes to diabetes and elevated risks of cardiovascular disease and all-cause mortality in individuals with prediabetes and diabetes: Evidence from two prospective cohorts. Diabetes Res Clin Pract. 2022;194110145. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.diabres.2022.110145\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2022.110145\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahat G, Ozkok S, Petrovic M. Management of Type 2 Diabetes in Frail Older Adults. Drugs Aging. 2023;40(9):751\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40266-023-01049-x\u003c/span\u003e\u003cspan address=\"10.1007/s40266-023-01049-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDel Pozo-Cruz J, Irazusta J, Rodriguez-Larrad A, Alfonso-Rosa RM, \u0026Aacute;lvarez-Barbosa F, Raimundo A, et al. Replacing Sedentary Behavior With Physical Activity of Different Intensities: Implications for Physical Function, Muscle Function, and Disability in Octogenarians Living in Long-Term Care Facilities. J Phys Act Health. 2022;19(5):329\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1123/jpah.2021-0186\u003c/span\u003e\u003cspan address=\"10.1123/jpah.2021-0186\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeung KW, Sum KR, Yang YJ. Patterns of Sedentary Behavior among Older Adults in Care Facilities: A Scoping Review. Int J Environ Res Public Health. 2021;18(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph18052710\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18052710\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAuerswald T, Meyer J, von Holdt K, Voelcker-Rehage C. Application of Activity Trackers among Nursing Home Residents-A Pilot and Feasibility Study on Physical Activity Behavior, Behavior, Acceptance, Usability and Motivational Impact[J]. Int J Environ Res Public Health. 2020;17(18). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph17186683\u003c/span\u003e\u003cspan address=\"10.3390/ijerph17186683\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Shuang Z, Junkun C, Mei P, Qi L, Zhen L, Xiaohong, et al. Clinical expert consensus on standard care of blood glucose for residents in senior care facility in China(2021 edition). Chin J Geriatr. 2021;40(06):683\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3760/cma.j.issn.0254-9026.2021.06.001\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.issn.0254-9026.2021.06.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGardner B, Smith L, Lorencatto F, Hamer M, Biddle SJ. How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults. Health Psychol Rev. 2016;10(1):89\u0026ndash;112. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/17437199.2015.1082146\u003c/span\u003e\u003cspan address=\"10.1080/17437199.2015.1082146\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuimin, Wang. Effects of peer education on the sedentary behavior of the elderly in nursing homes. Shanxi University of Chinese Medicine; 2021. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeng Zhao. Identification and influencing factors of frailty among nursing home residents in China: a longitudinal study. Shandong University,2020. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaher JP, Sliwinski MJ, Conroy DE. Feasibility and preliminary efficacy of an intervention to reduce older adults' sedentary behavior. Transl Behav Med. 2017;7(1):52\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s13142-016-0394-8\u003c/span\u003e\u003cspan address=\"10.1007/s13142-016-0394-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyan P. Integrated Theory of Health Behavior Change: background and intervention development. Clin Nurse Spec. 2009;23(3):161\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/NUR.0b013e3181a42373\u003c/span\u003e\u003cspan address=\"10.1097/NUR.0b013e3181a42373\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWijndaele K, DE Bourdeaudhuij I, Godino JG, Lynch BM, Griffin SJ, Westgate K, et al. Reliability and validity of a domain-specific last 7-d sedentary time questionnaire. Med Sci Sports Exerc. 2014;46(6):1248\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1249/MSS.0000000000000214\u003c/span\u003e\u003cspan address=\"10.1249/MSS.0000000000000214\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosenberg DE, Norman GJ, Wagner N, Patrick K, Calfas KJ, Sallis JF. Reliability and validity of the Sedentary Behavior Questionnaire (SBQ) for adults. J Phys Act Health. 2010;7(6):697\u0026ndash;705. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1123/jpah.7.6.697\u003c/span\u003e\u003cspan address=\"10.1123/jpah.7.6.697\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE et al. Does physical activity attenuate,or even eliminate,the detrimental association of sitting time with mortality?A harmonised meta-analysis of data from more than 1 million men and women.Lancet,2016,388(10051):1302\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(16)30370-1\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(16)30370-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37(1):5\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00005650-199901000-00003\u003c/span\u003e\u003cspan address=\"10.1097/00005650-199901000-00003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJie Wei. Research on Relationship between Diabetes Knowledge, Self-efficacy and Self-management among Rural Elderly Patients. Hangzhou Normal University; 2013. (Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaehr E, Visvanathan R, Malmstrom TK, Morley JE. Frailty in nursing homes: the FRAIL-NH Scale. J Am Med Dir Assoc. 2015;16(2):87\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jamda.2014.12.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jamda.2014.12.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao M, Mou H, Zhu S, Li M, Wang K. Cross-cultural adaptation and validation of the FRAIL-NH scale for Chinese nursing home residents: A methodological and cross-sectional study. Int J Nurs Stud. 2020;105:103556. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijnurstu.2020.103556\u003c/span\u003e\u003cspan address=\"10.1016/j.ijnurstu.2020.103556\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAirlie J, Forster A, Birch KM. An investigation into the optimal wear time criteria necessary to reliably estimate physical activity and sedentary behaviour from ActiGraph wGT3X\u0026thinsp;+\u0026thinsp;accelerometer data in older care home residents. BMC Geriatr. 2022;22(1):136. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12877-021-02725-6\u003c/span\u003e\u003cspan address=\"10.1186/s12877-021-02725-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarr\u0026eacute;s-Godayol P, Ruiz-D\u0026iacute;az M\u0026Aacute;, Dall P, Skelton DA, Minobes-Molina E, Jerez-Roig J, et al. Determining minimum number of valid days for accurate estimation of sedentary behaviour and awake-time movement behaviours using the ActivPAL3 in nursing home residents. Eur Rev Aging Phys Act. 2023;20(1):19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s11556-023-00329-0\u003c/span\u003e\u003cspan address=\"10.1186/s11556-023-00329-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen S, Chen T, Kishimoto H, Yatsugi H, Kumagai S. Associations of Objectively Measured Patterns of Sedentary Behavior and Physical Activity with Frailty Status Screened by The Frail Scale in Japanese Community-Dwelling Older Adults. J Sports Sci Med. 2020;19(1):166\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrombie KM, Leitzelar BN, Almassi NE, Mahoney JE, Koltyn KF. The Feasibility and Effectiveness of a Community-Based Intervention to Reduce Sedentary Behavior in Older Adults. J Appl Gerontol. 2022;41(1):92\u0026ndash;102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0733464820987919\u003c/span\u003e\u003cspan address=\"10.1177/0733464820987919\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evon Storch K, Graaf E, Wunderlich M, Rietz C, Polidori MC, Woopen C. Telemedicine-Assisted Self-Management Program for Type 2 Diabetes Patients. Diabetes Technol Ther. 2019;21(9):514\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/dia.2019.0056\u003c/span\u003e\u003cspan address=\"10.1089/dia.2019.0056\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGardiner PA, Eakin EG, Healy GN, Owen N. Feasibility of reducing older adults' sedentary time. Am J Prev Med. 2011;41(2):174\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.amepre.2011.03.020\u003c/span\u003e\u003cspan address=\"10.1016/j.amepre.2011.03.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, et al. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess. 2020;24(28):1\u0026ndash;232. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3310/hta24280\u003c/span\u003e\u003cspan address=\"10.3310/hta24280\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRollo S, Prapavessis H. Sedentary Behaviour and Diabetes Information as a Source of Motivation to Reduce Daily Sitting Time in Office Workers: A Pilot Randomised Controlled Trial. Appl Psychol Health Well Being. 2020;12(2):449\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/aphw.12190\u003c/span\u003e\u003cspan address=\"10.1111/aphw.12190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang M. Application of health education based on ITHBC theory in self-management of middle-aged patients with type 2 diabetes. Tianjin University of Traditional Chinese Medicine.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Tian B, Zhang S, Li J, Yang W, Gu L, et al. Underlying mechanisms of diabetes knowledge influencing diabetes self-management behaviors among patients with type II diabetes in rural China: Based on health belief model. Patient Educ Couns. 2023;117:107986. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pec.2023.107986\u003c/span\u003e\u003cspan address=\"10.1016/j.pec.2023.107986\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitamura M, Izawa KP, Nagasaki T, Yoshizawa T, Okamura S, Fujioka K, et al. Effects of self-monitoring using an accelerometer on physical activity of older people with long-term care insurance in Japan: a randomized controlled trial[J]. Eur Geriatr Med. 2024;15(2):371\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s41999-024-00935-w\u003c/span\u003e\u003cspan address=\"10.1007/s41999-024-00935-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGamboa Moreno E, Mateo-Abad M, Ochoa de Retana Garc\u0026iacute;a L, Vrotsou K, Del Campo Pena E, S\u0026aacute;nchez Perez \u0026Aacute;, Mart\u0026iacute;nez Carazo C, et al. Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: A randomised controlled trial. Prim Care Diabetes. 2019;13(2):122\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pcd.2018.10.001\u003c/span\u003e\u003cspan address=\"10.1016/j.pcd.2018.10.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaroqi L, Wong M, Bonde S, Wong CW, Walai K, West W, et al. Evaluating the clinical implementation of structured exercise: A randomized controlled trial among non-insulin dependent type II diabetics. Contemp Clin Trials. 2018;74:25\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.cct.2018.09.003\u003c/span\u003e\u003cspan address=\"10.1016/j.cct.2018.09.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu L, Guo Z, Long Q, Zhao X, Liu Y, Cao X, et al. Modifiable Lifestyle, Sedentary Behaviors and the Risk of Frailty: A Univariate and Multivariate Mendelian Randomization Study. Adv Biol (Weinh). 2024;e2400052. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/adbi.202400052\u003c/span\u003e\u003cspan address=\"10.1002/adbi.202400052\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diabetes Mellitus, Older People, Sedentary Behavior, Psychosocial Intervention","lastPublishedDoi":"10.21203/rs.3.rs-6191546/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6191546/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eBackground\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThis study aimed to explore the effects of interventions on improving self-efficacy, increasing physical activity, and reducing frailty associated with sedentary behavior in older people with type 2 diabetes (OPT2DM).\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe convenient sampling method was employed to select OPT2DM from six nursing homes in Zhengzhou City, China, between July 2023 and January 2024. Participants were randomly assigned to control and experimental groups. Prior to the intervention protocol, as well as 8 weeks and 16 weeks post-intervention, the study subjects were assessed using a general data questionnaire, Measure of older sedentary time (MOS), Self-efficacy for diabetes (SED), the Frail-NH Debilitation Scale, step counts, and Body Mass Index (BMI).\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eA total of 92 cases were included in the study, comprising 43 cases in the intervention group and 44 cases in the control group. The scores of SED showed statistically significant improvement after 16 weeks of intervention (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The counts of steps taken exhibited statistically significant differences after both 8 weeks and 16 weeks (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, frailty demonstrated statistically significant differences at the 16-week mark (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The broad estimation equation analysis indicated that after 16 weeks of intervention, the differences in self-efficacy, step counts, and frailty between the intervention and control groups were statistically significant, highlighting inter-group effects, time effects, and interaction effects (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe 16-week behavior interventions reduced sedentary time among the OPT2DM. These interventions not only enhanced self-efficacy regarding diabetes management but also increased physical activity levels, ultimately improving the overall well-being of these participants.\u003c/p\u003e","manuscriptTitle":"Evaluating the Efficacy of a Sedentary Behavior Intervention on Self-Efficacy, Step Count, and frailty in Elderly Patients with Type 2 Diabetes Mellitus of Nursing Home","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 09:40:43","doi":"10.21203/rs.3.rs-6191546/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"48b18b05-f568-45f0-a272-8988b34e7f1f","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-22T07:23:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-17 09:40:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6191546","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6191546","identity":"rs-6191546","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}