Efficacy of device-measured physical activity on cardiometabolic outcomes among individuals with abnormal glucose tolerance in Ghana: A pilot randomized controlled trial

Background: Abnormal glucose tolerance (AGT) is surging rapidly in sub-Saharan Africa, yet evidence on effective interventions remain limited. Physical activity improves glycemic control, but self-reported measures are prone to bias. Device-based monitoring enables objective assessment and may enhance adherence. This pilot randomized controlled trial assessed the preliminary efficacy of a structured, device-measured physical activity intervention on cardiometabolic outcomes among Ghanaian adults with AGT. Methods: An open-label, parallel-group pilot RCT with blinded outcome assessment randomly assigned 28 adults aged ≥25 years with newly diagnosed AGT who owned smartphones to intervention and control groups. The intervention involved a 12-week structured program prescribing ≥150 min of moderate-intensity or ≥ 75 min of vigorous-intensity activity weekly, tracked via smartphone sensors and mobile health applications. Participants received brief training and were instructed to carry their phones during activity. Controls received basic health education materials and kept activity journals. Primary outcomes included glycemic measures and secondary outcomes comprised anthropometric, bioimpedance, and biochemical markers. Generalized estimating equations were used under an intention-to-treat protocol. Results: , 95% CI: -5.2 to -0.1), alkaline phosphatase (β = -24.0 U/L, 95% CI: -47.9 to -0.1), and total protein (β = -12.6 g/L, 95% CI: -23.2 to -2.0). The intervention group was associated with larger within-group changes in HbA1c (-1.2% vs. -0.6%), weight (-4.7 kg vs -0.8 kg), basal metabolic rate (+92.9 vs +66.7 kcal/day), and total body water (+18.5 L vs +16.5 L). Conclusions: Device-based physical activity interventions appear feasible and acceptable among Ghanaian adults with AGT. Preliminary findings suggest potential benefits for body composition and glycemic control, supporting progression to larger trials to confirm efficacy and assess scalability in low-resource settings. Trial registration: This trial is prospectively registered with the Pan African Clinical Trails Registry (PACTR202409492459905).