Effect of a Pedometer-Guided Physical Activity Intervention on Quality of Life among Type 2 Diabetes Patients with Diabetes-Specific Distress: A Randomized Controlled Trial

Abstract

Type 2 diabetes mellitus (T2DM) frequently coexists with diabetes-specific distress (DSD), an emotional burden distinct from clinical depression that stems from the ongoing demands of glucose self-management rather than from a primary mood disorder. DSD has been linked to weaker treatment adherence, poorer glycemic control and lower quality of life (QoL). This study examined the effect of a 12-week, pedometer-guided physical activity program on QoL among adults with T2DM and DSD attending a tertiary-care hospital in Lahore, Pakistan, reporting the physical-activity arm of a larger four-group randomized controlled trial. One hundred participants were assigned to the physical intervention, which set a target of 150 minutes of moderate-intensity walking per week, monitored with a pedometer and supported by perceived-exertion feedback using the Borg scale. QoL was measured with the WHOQOL-BREF at baseline and immediately after the 12-week program, alongside diabetes-related distress using the Problem Areas in Diabetes (PAID) scale and glycemic control using HbA1c. Because the principal outcome variables departed from a normal distribution, non-parametric statistical tests were applied. Overall QoL rose from a mean WHOQOL-BREF score of 52.84 (SD 4.07) at baseline to 62.91 (SD 4.61) after the intervention (p < .001; Cohen’s d = 2.316), with increases recorded across all four domains: physical health, psychological health, social relationships and environment. HbA1c decreased from 10.25% (SD 1.39) to 8.97% (SD 1.20) (p < .001; d = 0.986), and PAID scores fell from 49.79 (SD 4.24) to 39.53 (SD 5.88) (p < .001; d = 2.002). These results suggest that a low-cost, pedometer-guided walking program can be accompanied by meaningful gains in quality of life together with better glycemic control and reduced diabetes-related distress, even in a resource-constrained clinical setting. Because the intervention required only a simple step-counting device and a defined weekly activity target, it could plausibly be incorporated into routine outpatient diabetes counselling without specialist staffing. In the parent trial, combining physical activity with structured psychological support produced the largest gains across outcomes, suggesting that walking programs may serve as an accessible first step in care, with referral to psychosocial support reserved for patients whose distress remains elevated. Longer follow-up and multicenter replication are needed to confirm the durability of these findings.