The effect of physical activity on non-linear gait variability in people with diabetes - exploring interactions between physical activity behaviours, movement characteristics and diabetes.

Introduction: The aim of this thesis is to explore the interactions between diabetes, physical activity behaviours and movement characteristics.

Methods: The methods employed in this thesis include: a qualitative study including surveys and focus groups to explore lived experiences relating to non-medical interventions in people with diabetes; a Delphi study to evaluate consensus in exercise and physical activity advice provided by healthcare professionals and fitness instructors; a systematic review of the use of non-linear analysis to evaluate movement variability in people with diabetes; a scoping review of accelerometer validity and reliability; a pilot study evaluating different devices and body positions in capturing movement data using accelerometers; and an exploratory study exploring interactions between diabetes, physical activity and movement variability using an Android smartphone app.

Results: The analysis of the qualitative survey identified two overarching themes, ‘it’s not my fault’ and ‘getting on with it’ suggesting diversity of experience of non-medical interventions for people with diabetes. The Delphi study found that advice provided by healthcare and fitness professionals lacked consistency of approach which may provide confusion to those people with diabetes seeking to adopt a more active lifestyle. In addition, it has been identified that there is a lack of research considering movement variability in diabetes. Smartphone accelerometers were evaluated as a valid and reliable method to quantify gait, and this method was further validated during pilot testing using non-linear analysis techniques and an ecologically valid environment. Finally, movement variability has been shown to be predicted by physical activity participation in both healthy controls and people with diabetes.

Conclusion: The studies conducted in this thesis have explored interactions between diabetes, physical activity and movement variability and identified new knowledge to develop diabetes and physical activity research further. In particular, foregrounding the voices of patients as well as healthcare and fitness professionals has developed later approaches to quantifying movement variability. This research has further identified the use of smartphone technology as a useful measure of gait stability that could be used to further support physical activity adherence.