Consensus-Driven Development of an Exercise Base Manual Programme for Prediabetic Patients: A Delphi Study

Sana Hafeez,1,2 Syed Shakil-Ur-Rehman,1 Saima Riaz,3 Sidra Hafeez,4 Jawad Salman Hafeez,5 Hassan Mumtaz6 1Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, 54000, Pakistan; 2Department of Physical Therapy and Rehabilitation Sciences, University of Management and Technology, Lahore, 54000, Pakistan; 3Ayesha Bakht Institute of Medical Sciences, Lahore, 54000, Pakistan; 4Department of Obstetrics and Gynecology, Services Hospital, Lahore, 54000, Pakistan; 5Department of Medicine, Mayo Hospital, Lahore, 54000, Pakistan; 6BPP University, London, UKCorrespondence: Hassan Mumtaz, BPP University, London, UK, Email [email protected]: Prediabetes is a medical condition characterized by increased levels of glucose in the bloodstream. There are some lifestyle modifications like exercise, dietary patterns and prevention that can reverse prediabetes. Exercise plays an important role in controlling hyperglycemia and insulin sensitivity in prediabetes.Purpose: The objective of the study is to develop a consensus driven exercise base manual programme for the prediabetic population using the Delphi Method.Methods: A three-rounded Delphi study was conducted with 40 panelists either as Patient panelists (n = 20) or expert panelists (n=20). Round 1 included initial items selected from a systemic literature review . Initial recommendations were rated by panalists through a 5-point Likert scale. Additional items were also added by suggestion of Panelists in Round 1. Rounds 2 and 3 included all items from Round 1. All selected items were included in the final set of recommendations in Round 3 and rated as “Important” or “Very important” by at least 70% of all respondents. Descriptive data was analyzed by using SPSS version 25.Results: 36 panellists (patients n = 17, professionals n = 19) completed Round 3. After three rounds of the Delphi process, panelists reached a consensus on the final version of the recommendations. Sixty-two items reached consensus in Round 1. In round 2 and 3 a total of sixty-four and sixty-three items were added, respectively. Fifty-seven of these reached consensuses in round 3.Conclusion: The exercise-based manual programme developed by Modified Delphi study provided disease prevention education, physical activity and dietary recommendations to improve glycemic control in the prediabetic population. The exercise manual programme along with lifestyle modifications contribute to public health by improving prediabetes levels and also addressing the modifiable risk factors. An exercise protocol needs time to mitigate hyperglycemia in prediabetic individuals and to help provide information at community level.Keywords: exercise-based manual, prediabetes, glycemic control, education, physical activity, diet