Research
EXTOD is a research programme. This page holds the trials we are running, the papers that have come out of them, and the evidence each tool on this site is built on.
Trials
Studies in progress
Run across the Universities of Exeter, Birmingham, Liverpool John Moores and partner NHS trusts. Protocols are published open access.
EXTOD-Active
Recruiting
Can four weeks of real-world active breaks improve glycaemic management in sedentary adults with Type 1 diabetes? A randomised controlled trial using CGM outcomes.
Jenkins et al., BMJ Open Sport Exerc Med 2025;11(2):e002594. Protocol ↗
EXTOD-Immune
In progress
Whether a remotely monitored, home-based exercise intervention can reduce immune disease activity in people with Type 1 diabetes.
Quickfall et al., BMJ Open Sport Exerc Med 2024;10(3):e002144. Protocol ↗
EXTOD (pilot RCT)
Complete
Exercise to preserve beta-cell function in recent-onset Type 1 diabetes. The founding EXTOD trial - it established feasibility, retention and the outcome measures the programme still uses.
Narendran et al., Diabet Med 2017;34(11):1521-1531. Protocol ↗
Library
Publications
Papers from EXTOD studies and from studies EXTOD has collaborated on. Newest first.
43 papers
Mixed methods · 2026
Barriers and enablers to physical activity in type 1 diabetes: a mixed-methods study of adults and parent-reported child perspectives in the UK
Cockcroft EJ, Bright C, Nathan H, Farrow D, Russon C, Pulsford RM, Andrews RC.
Diabet Med. 2026;e70378
Comment · 2026
Early-stage type 1 diabetes: is there a role for lifestyle modifications?
Papanikolaou T, Andrews RC, Cockcroft E, Cocks M, Dias RP, Hesketh K, Narendran P, Dayan C.
Lancet Diabetes Endocrinol. 2026;14(7):536-538
Study protocol · 2026
A mixed-methods longitudinal observational study exploring physical activity during pregnancy in women with pre-existing diabetes, support needs and associations with diabetes management: a study protocol
Jones HM, Andrews R, Cockcroft EJ, Doeuk IF, Pulsford RM.
BMJ Open. 2026;16(6):e118879
Trial protocol · 2026
Effect of breaking up sitting with regular active breaks on glucose management and vascular function in adults with type 1 diabetes who use hybrid closed-loop insulin delivery systems: a randomised crossover trial protocol
Jenkins JG, Cocks M, Lucas SJE, Rendeiro C, Peçanha T, Maxwell J, Tennant JH, Philpot G, Narendran P, Andrews R, Scott SN, Hesketh K.
BMJ Open Sport Exerc Med. 2026;12(2):e003240
Prediction tool · 2026
GlucoseGo: a simple tool to predict hypoglycaemia during exercise in type 1 diabetes
Russon CL, Allen MJ, Cockcroft E, Pemberton JS, Frohock AM, Vaughan N, Pulsford RM, Andrews RC.
Diabetologia. 2026;69(6):1468-1481
Audit · 2026
Policy gaps in type 1 diabetes: a UK audit of National Governing Bodies
Abdel-Magid M, Cockcroft EJ, Bright C, Mann RH, Pulsford R, Andrews RC.
Diabet Med. 2026;43(6):e70280
Commentary · 2026
Physical activity (20 min) is a powerful adjunct to insulin for correcting hyperglycaemia in Type 1 diabetes: a paradigm shift
Pemberton JS, Russon CL, Pulsford RM, Metcalf BS, Cockcroft E, Allen MJ, Frohock AM, Andrews RC.
Diabet Med. 2026;43(1):e70163
Case study · 2026
Case study: a cyclist with Type 1 Diabetes prepares for and completes a multiday ultra-endurance self-supported race
Frohock AM.
Int J Sport Nutr Exerc Metab. 2026;36(S1):S1-S15
Qualitative · 2025
Examining the cognitive, practical, and emotional demands of managing physical activity in adolescents with type 1 diabetes: a qualitative study with adolescents, parents, and healthcare professionals
Cockcroft EJ, Smith JR, Lloyd J, Johnson L, Pulsford R, Clarke R, Narendran P, Gardener G, Ngamy T, Dias RP, Andrews RC.
Pediatr Diabetes. 2025;2025:4578096
Observational · 2025
Glucose-lowering effects of physical activity in type 1 diabetes: a causal modelling and matched-pair analysis approach
Pemberton JS, Russon CL, Pulsford RM, Metcalf BS, Cockcroft E, Allen MJ, Frohock AM, Andrews RC.
Diabet Med. 2025;42(12):e70146
Observational · 2025
Quality of life and physical activity in type 1 diabetes
Cockcroft EJ, Chithuranjan D, Narendran P, Andrews RC, Dias RP.
BMC Pediatr. 2025;25(1):345
Mixed methods · 2025
A mixed methods exploration of the experiences of physical activity providers in supporting children and adolescents with type 1 diabetes in the UK
Ngamy T, Statham L, Smith B, Smith JR, Lloyd J, Clarke R, Narendran P, Dias RP, Andrews RC, Cockcroft EJ.
Eur J Pediatr. 2025;184(5):311
Trial protocol · 2025
Can 4 weeks of real-world active breaks improve glycaemic management in sedentary adults with type 1 diabetes? The EXTOD-Active randomised control trial protocol
Jenkins JG, Cocks M, Narendran P, Andrews RC, Shields BM, Scott SN, Lucas SJE, Rendeiro C, Hesketh K.
BMJ Open Sport Exerc Med. 2025;11(2):e002594
Technology · 2025
Impact of recording interval in continuous glucose monitoring on calculating the metrics of glycemic control
Russon CL, Pulsford RM, Allen MJ, Cockcroft E, Vaughan N, Andrews RC.
J Diabetes Sci Technol. 2025;19(2):590-592
Trial · 2025
Mobile health biometrics to enhance exercise and physical activity adherence in type 2 diabetes (MOTIVATE-T2D): a decentralised feasibility randomised controlled trial
Hesketh K, Low J, Andrews R, et al.; MOTIVATE-T2D Team.
BMJ Open. 2025;15(3):e092260
Secondary analysis · 2025
Improved glycemic regulation on exercise compared to non-exercise days in individuals recently diagnosed with type 2 diabetes
Low JL, Hesketh K, Falkenhain K, et al.; MOTIVATE T2D Team.
Diabetes Obes Metab. 2025
Trial protocol · 2024
EXTOD-Immune: a randomised controlled trial to investigate whether a remotely monitored, home-based exercise intervention can reduce disease activity in people with type 1 diabetes
Quickfall M, Cocks M, Long HM, Di Rosa F, Andrews R, Narendran P, Hesketh K, Wadley AJ.
BMJ Open Sport Exerc Med. 2024;10(3):e002144
Narrative review · 2024
Practical considerations for continuous glucose monitoring in elite athletes with type 1 diabetes mellitus: a narrative review
Brar G, Carmody S, Lumb A, Shafik A, Bright C, Andrews RC.
J Physiol. 2024;602(10):2169-2177
Survey · 2024
The need to prioritize education and resources to support exercise in type 1 diabetes: results of an Australian survey of adults with type 1 diabetes and health providers
Glyn T, Fourlanos S, Paldus B, Flint S, Armstrong E, Andrews RC, Narendran P, Wentworth J.
Can J Diabetes. 2024;48(2):105-111.e5
Systematic review · 2024
Effectiveness of educational and psychoeducational self-management interventions in children and adolescents with type 1 diabetes: a systematic review and meta-analysis
Cockcroft EJ, Clarke R, Dias RP, Lloyd J, Mann RH, Narendran P, Reburn C, Smith B, Smith JR, Andrews RC.
Pediatr Diabetes. 2024;2024:2921845
Technology · 2024
A user-friendly web tool for custom analysis of continuous glucose monitoring data
Russon CL, Allen MJ, Pulsford RM, Saunby M, Vaughan N, Cocks M, Hesketh KL, Low J, Andrews RC.
J Diabetes Sci Technol. 2024;18(6):1511-1513
Consensus · 2023
Recommendations from Diabetes UK's 2022 diabetes and physical activity workshop
Morris A, Bright C, Cocks M, et al., Andrews RC, Gill JMR.
Diabet Med. 2023;40(9):e15169
National survey · 2023
Factors affecting the support for physical activity in children and adolescents with type 1 diabetes mellitus: a national survey of health care professionals' perceptions
Cockcroft EJ, Wooding EL, Narendran P, Dias RP, Barker AR, Moudiotis C, Clarke R, Andrews RC.
BMC Pediatr. 2023;23(1):131
Consensus · 2022
Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions
Reid H, Ridout AJ, Tomaz SA, Kelly P, Jones N; Physical Activity Risk Consensus group.
Br J Sports Med. 2022;56(8):427-438
Review · 2020
The benefits of physical exercise for the health of the pancreatic beta-cell: a review of the evidence
Curran M, Drayson MT, Andrews RC, Zoppi C, Barlow JP, Solomon TPJ, Narendran P.
Exp Physiol. 2020;105(4):579-589
Review · 2020
Exercise-induced hypoglycaemia in type 1 diabetes
Cockcroft EJ, Narendran P, Andrews RC.
Exp Physiol. 2020;105(4):590-599
Programme development · 2020
Development of a group structured education programme to support safe exercise in people with Type 1 diabetes: the EXTOD education programme
Narendran P, Greenfield S, Troughton J, Doherty Y, Quann N, Thompson C, Litchfield I, Andrews RC; EXTOD Education Programme Development Team.
Diabet Med. 2020;37(6):945-952
Trial · 2019
A multidisciplinary evaluation of a virtually supervised home-based high-intensity interval training intervention in people with type 1 diabetes
Scott SN, Shepherd SO, Andrews RC, Narendran P, Purewal TS, Kinnafick F, Cuthbertson DJ, Atkinson-Goulding S, Noon T, Wagenmakers AJM, Cocks M.
Diabetes Care. 2019;42(12):2330-2333
Qualitative · 2019
Patient and healthcare professionals perspectives on the delivery of exercise education for patients with type 1 diabetes
Litchfield I, Andrews RC, Narendran P, Greenfield S.
Front Endocrinol. 2019;10:76
Immunology · 2019
Type 1 diabetes impairs the mobilisation of highly-differentiated CD8+ T cells during a single bout of acute exercise
Curran M, Campbell J, Drayson M, Andrews R, Narendran P.
Exerc Immunol Rev. 2019;25:64-82
Trial · 2019
High-intensity interval training improves aerobic capacity without a detrimental decline in blood glucose in people with type 1 diabetes
Scott SN, Cocks M, Andrews RC, Narendran P, Purewal TS, Cuthbertson DJ, Wagenmakers AJM, Shepherd SO.
J Clin Endocrinol Metab. 2019;104(2):604-612
Trial · 2019
Fasted high-intensity interval and moderate-intensity exercise do not lead to detrimental 24-hour blood glucose profiles
Scott SN, Cocks M, Andrews RC, Narendran P, Purewal TS, Cuthbertson DJ, Wagenmakers AJM, Shepherd SO.
J Clin Endocrinol Metab. 2019;104(1):111-117
Case-control · 2019
The type 1 diabetes 'honeymoon' period is five times longer in men who exercise: a case-control study
Chetan MR, Charlton MH, Thompson C, Dias RP, Andrews RC, Narendran P.
Diabet Med. 2019;36(1):127-128
Observational · 2018
Objective measurement of physical activity in adults with newly diagnosed type 1 diabetes and healthy individuals
Matson RIB, Leary SD, Cooper AR, Thompson C, Narendran P, Andrews RC.
Front Public Health. 2018;6:360
Qualitative · 2018
Qualitative study of barriers to clinical trial retention in adults with recently diagnosed type 1 diabetes
Henshall C, Narendran P, Andrews RC, Daley A, Stokes KA, Kennedy A, Greenfield S.
BMJ Open. 2018;8(7):e022353
Qualitative · 2018
Attitudes and barriers to exercise in adults with a recent diagnosis of type 1 diabetes: a qualitative study of participants in the Exercise for Type 1 Diabetes (EXTOD) study
Kennedy A, Narendran P, Andrews RC, Daley A, Greenfield SM; EXTOD Group.
BMJ Open. 2018;8(1):e017813
Pilot RCT · 2017
Exercise to preserve beta-cell function in recent-onset Type 1 diabetes mellitus (EXTOD) - a randomized controlled pilot trial
Narendran P, Jackson N, Daley A, Thompson D, Stokes K, Greenfield S, Charlton M, Curran M, Solomon TPJ, Nouwen A, Lee SI, Cooper AR, Mostazir M, Taylor RS, Kennedy A, Andrews RC.
Diabet Med. 2017;34(11):1521-1531
Position paper · 2015
The time has come to test the beta cell preserving effects of exercise in patients with new onset type 1 diabetes
Narendran P, Solomon TP, Kennedy A, Chimen M, Andrews RC.
Diabetologia. 2015;58(1):10-18
Qualitative · 2014
Attitudes and barriers to exercise in adults with type 1 diabetes (T1DM) and how best to address them: a qualitative study
Lascar N, Kennedy A, Hancock B, Jenkins D, Andrews RC, Greenfield S, Narendran P.
PLoS One. 2014;9(9):e108019
Trial protocol · 2013
Exercise to preserve beta cell function in recent-onset type 1 diabetes mellitus (EXTOD) - a study protocol for a pilot randomized controlled trial
Lascar N, Kennedy A, Jackson N, Daley A, Dowswell G, Thompson D, Stokes K, Greenfield S, Holder R, Andrews R, Narendran P.
Trials. 2013;14:180
Systematic review · 2013
Does exercise improve glycaemic control in type 1 diabetes? A systematic review and meta-analysis
Kennedy A, Nirantharakumar K, Chimen M, Pang TT, Hemming K, Andrews RC, Narendran P.
PLoS One. 2013;8(3):e58861
Review · 2012
What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review
Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P.
Diabetologia. 2012;55(3):542-551
RCT · 2011
Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial
Andrews RC, Cooper AR, Montgomery AA, et al.
Lancet. 2011;378(9786):129-139
Evidence behind the tools
What each tool is built on
Educational interpretation of research - not a medical device
Collaborate
Work with us
We are always looking for sites, collaborators and clinicians to help run trials and validate new tools.
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Training and events
EXTOD Education courses, the annual conference, webinars and patient days now live on their own page.