Changing cognitions to change behaviour change: Reframing biased thinking to improve exercise adherence in individuals with prediabetes

Pre-diabetic individuals exercise less than their non-diabetic counterparts, with less than 15 percent meeting Canada’s physical activity guidelines. Behaviour change techniques (BCTs) such as self-monitoring and provision of goal feedback are key components of interventions for cardiovascular risk factor reduction. However, patients in such programs may not accurately interpret risk information and fail to act in ways that reduce or prevent risk. Individuals at risk for type 2 diabetes (T2D) who exhibit biased thinking (e.g. all-or-nothing thinking; “Going for walks is not going to prevent me from getting T2D”) may not be ready to engage in risk-reducing behaviours. For this reason, reframing biased thoughts may offer a critical pre-intervention (pre-IV) step that prepares them for future attempts at behaviour change.

The purpose of this study is to examine cognitive reframing as a pre-IV strategy for individuals at risk of T2D about to embark on a brief exercise counselling intervention. The main hypothesis is pre-IV cognitive reframing will increase:

• Individuals’ self-regulatory efficacy
• Compliance with brief exercise counselling
• Independent exercise adherence

Cognitive reframing is an evidence-based strategy for reducing biased thinking in health contexts whereby individuals are taught to identify and challenge biased thinking caused by cognitive errors. This study will employ a randomized experimental design (intervention VS control group) to examine the effectiveness of pre-IV reframing for individuals at risk of T2D who experience biased exercise thoughts. The proposed research will be embedded within Dr. Mary Jung’s ongoing randomized control trials examining brief behavioural change IVs for people living with prediabetes in the community.

Results will partly be disseminated by coordinating a community-based prediabetes exercise clinic within Kelowna, and by working directly with Interior Health, the Kelowna Diabetes Program, and the Central Okanagan Division of Family Practitioners.

This novel research program seeks to triage individuals at risk of T2D with biased exercise thoughts. Findings may better prepare individuals with prediabetes struggling with a lifestyle change to be more receptive to receiving BCTs and attempt risk-reducing behaviour.