Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Health and Rehabilitation Sciences


Dr. Denise Connelly


Obesity and sedentary lifestyle are increasingly prevalent risk factors for type 2 diabetes (T2D), characterized by high blood glucose levels. Adoption and maintenance of healthy eating, physical activity, and exercise is recommended for lowering blood glucose and weight management. Physiotherapists are experts in prescribing safe, effective exercise to optimize health for people with co-morbid health conditions. However, T2D is not a primary condition for referral to physiotherapy services in Canada. The overall question guiding a series of three related studies was, What is the current education and perspectives of Canadian physiotherapists about their role in managing T2D? Study one surveyed and interviewed Canadian physiotherapy educators (n=10) as content experts of academic training of entry-to-practice physiotherapists. Participants held the opinion that physiotherapists are educated to assess for and manage diabetes complications, including peripheral neuropathy, lower limb amputations, and cardiovascular disease. Educators reported T2D is considered as a co-morbid health condition currently in curriculum. Study two detailed the perspectives of physiotherapists (n=21) through interviews. Physiotherapists agreed they would welcome the primary referral of people with T2D. They advocated physiotherapists can provide effective care for people with T2D, as a condition of primary referral, through education, prescription and supervision of exercise, and supporting healthy lifestyle behaviours. Lastly, study three examined the effectiveness of an 8-week supervised group education and exercise program, ‘Get Fit for Active Living with Diabetes’ (GFAL-D), for 12 people with T2D, exploring motivation at one-, six- and 12-month follow ups through interviews. Clinically significant improvements were observed for waist circumference, systolic blood pressure, six-minute walk test (6MWT), timed up-and-go (TUG), 30-second chair stand test (CST) and arm curls. Follow up with a physiotherapy student was a motivator contributing to physical activity adherence within an episodic pattern of adherence throughout the year post-GFAL-D. In conclusion, entry-to-practice physiotherapists are trained to provide direct care employing exercise prescription and monitoring, behaviour change for living healthy lifestyles, and recognition of uncontrolled disease for referral to medical team members. Promotion of physiotherapy as a resource and partnership for referral from primary health care providers is needed to optimize health for people living with T2D.

Summary for Lay Audience

Type 2 diabetes (T2D) is a common disease worldwide where individuals have high blood sugar levels. High blood sugar levels can result in complications including blindness and amputations. However, healthy eating habits and regular physical activity and exercise can help to lower blood sugar levels and prevent complications. This dissertation presents the results of three studies that provide evidence for physiotherapists, exercise specialists, playing a larger role in the management of T2D, which is not currently done in Canada. The first study described what and how T2D is taught in the physiotherapy programs across Canada using an online survey and phone interviews. Ten educators teaching physiotherapy students participated. Participants stated that T2D is taught in case studies and in lecture, however, participants agreed that T2D was not a focus because of lack of classroom time. In study two we explored physiotherapists’ thoughts on T2D and the idea of people with T2D being referred to physiotherapy for their T2D. Twenty-one physiotherapists across Canada participated. Physiotherapists can help people with T2D with healthy lifestyles through exercise, either one-on-one or in a group setting. Our last study included an eight-week education and exercise program called the ‘Get Fit for Active Living with Diabetes’ (GFAL-D). Twelve people with T2D participated in the program and phone interviews one-month, six-months, and 12-months after the program to understand motivation to continue exercise. Physical function, the ability to perform everyday tasks such as walking, stair climbing, and lifting objects, was measured using the following tests: six-minute walk test (6MWT), timed up-and-go (TUG) test, 30-second chair stand test (CST) and arm curls. Physical function improved for all participants along with waist circumference and blood pressure. One year after the program, participants described the motivators (i.e., wanting to improve/maintain health) and barriers (i.e., bad weather, lack of time) to participating in regular exercise.