Table 4 Checklist of the theoretical counseling session

1

Motivation

The benefits of PA/exercise are described as reported by the scientific literature for diabetic patients, stressing those appealing most to the individual patient. Efforts are designed to convince the patient that regular PA is the pre-eminent cure for T2DM as well as to understand what positive expectations the individual patients held from this change in behavior. The importance of reducing SED-time is also stressed.

2

Self-efficacy

Self-efficacy is promoted by patient collaboration in designing an individualized program of PA, based on age and physical state and setting realistic personal goals.

3

Pleasure

Based on the patient’s previous experience of PA/exercise, a choice of several interchangeable indoor and outdoor PAs is proposed to identify those that are more appealing.

4

Support

The supportive presence of a partner/family member/group of peers is preferred, and we offer eight structured indoor PA/exercise sessions in the gym of the Metabolic Fitness Association.

5

Comprehension

Feedback from the patients is elicited to check if they really understand the valuable advantages of the behavioral change. After the exercise program is established, the patient is questioned to establish whether there is a really positive attitude toward the behavioral change. Care is taken to recognize uncertainties and identify perceived impediments to PA.

6

Lack of impediments

Potential obstacles to regular PA/exercise are identified. Instead of simply suggesting a solution, patients are invited to solve the problem and their proposals are supplemented with advice on time management strategies.

7

Diary

The patient are asked to record daily the type and time of PA they perform. On the subsequent visits (every 4 months), the diary is used to record the amount of PA, to encourage patients’ self-efficacy, to increase the time or frequency of PA and to overcome practical problems related to PA/exercise.