Attitudes and barriers to exercise in adults with type 1 diabetes (T1DM) and how best to address them: a qualitative study

Nadia Lascar, Amy Kennedy, Beverley Hancock, David Jenkins, Robert C Andrews, Sheila Greenfield, Parth Narendran, Nadia Lascar, Amy Kennedy, Beverley Hancock, David Jenkins, Robert C Andrews, Sheila Greenfield, Parth Narendran

Abstract

Background: Regular physical activity has recognised health benefits for people with T1DM. However a significant proportion of them do not undertake the recommended levels of activity. Whilst questionnaire-based studies have examined barriers to exercise in people with T1DM, a formal qualitative analysis of these barriers has not been undertaken. Our aims were to explore attitudes, barriers and facilitators to exercise in patients with T1DM.

Methodology: A purposeful sample of long standing T1DM patients were invited to participate in this qualitative study. Twenty-six adults were interviewed using a semi-structured interview schedule to determine their level of exercise and barriers to initiation and maintenance of an exercise programme.

Principal findings: Six main barriers to exercise were identified: lack of time and work related factors; access to facilities; lack of motivation; embarrassment and body image; weather; and diabetes specific barriers (low levels of knowledge about managing diabetes and its complications around exercise). Four motivators to exercise were identified: physical benefits from exercise; improvements in body image; enjoyment and the social interaction of exercising at gym or in groups. Three facilitators to exercise were identified: free or reduced admission to gyms and pools, help with time management, and advice and encouragement around managing diabetes for exercise.

Significance: Many of the barriers to exercise in people with T1DM are shared with the non-diabetic population. The primary difference is the requirement for education about the effect of exercise on diabetes control and its complications. There was a preference for support to be given on a one to one basis rather than in a group environment. This suggests that with the addition of the above educational requirements, one to one techniques that have been successful in increasing activity in patients with other chronic disease and the general public should be successful in increasing activity in patients with T1DM.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Atkinson MA, Eisenbarth GS, Michels AW (2014) Type 1 Diabetes. The Lancet 383(9911): 69–82.
    1. Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, et al. (2012) What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia 55(3): 542–51.
    1. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, et al. (2010) Exercise and type 2 diabetes: the American College of SportsMedicine and theAmerican Diabetes Association: joint position statement. Diabetes Care 33: e147–e167.
    1. Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, et al. (2007) Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Hear J 28: 88–136.
    1. WHO (2003) Adherence to long-term therapies:Evidence for Action. ISBN 92 4 154599 2. Available: Accessed 2014 Jul 2.
    1. Wadén J, Forsblom C, Thorn LM, Saraheimo M, Rosengård-Bärlund M, et al. (2008) Physical activity and diabetes complications in patients with type 1 diabetes: the Finnish Diabetic Nephropathy (FinnDiane) Study. Diabetes Care 31(2): 230–2.
    1. Makura CB, Ninantharakumar K, Girling AJ, Saravanan P, Narendran P (2013) Effects of physical activity on the development and progression of microvascular complications in type 1 diabetes: retrospective analysis of the DCCT study.BMC Endocr. Disord.13 1: 37.
    1. Tielemans SM, Soedamah-Muthu SS, De Neve M, Toeller M, Chaturvedi N, et al. (2013) Association of physical activity with all-cause mortality and incident and prevalent cardiovascular disease among patients with type 1 diabetes: the EURODIAB Prospective Complications Study.Diabetologia. 56(1): 82–91.
    1. Brazeau AS, Rabasa-Lhoret R, Strychar I, Mircescu H (2008) Barriers to physical activity among patients with type 1 diabetes. Diabetes Care 31(11): 2108–9.
    1. Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, et al. (2006) Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study. Diabetologia 49(2): 279–88.
    1. Ritchie J, Spencer L (1994) Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG (Eds) Analysing Qualitative Data, London: Routledge.
    1. Korkiakangas EE, Alahuhta MA, Husman PM, Keinänen-Kiukaanniemi S, Taanila AM, et al. (2011) Motivators and barriers to exercise among adults with a high risk of type 2 diabetes: a qualitative study. Scand J Caring Sci. 25(1): 62–9.
    1. Dubé MC, Valois P, Prud'homme D, Weisnagel SJ, Lavoie C (2006) Physical activity barriers in diabetes: development and validation of a new scale. Diabetes Res Clin Pract. 72(1): 20–7.
    1. Casey D, De Civita M, Dasgupta K (2010) Understanding physical activity facilitators and barriers during and following a supervised exercise programme in Type 2 diabetes: a qualitative study. Diabet. Med. 27, 79–84.
    1. Egan AM, Mahmood WA, Fenton R, Redziniak N, Kyaw Tun T, et al. (2013) Barriers to exercise in obese patients with type 2 diabetes. QJM. 106(7): 635–8.
    1. Thomas N, Alder E, Leese GP (2004) Barriers to physical activity in patients with diabetes. Postgrad Med J 80: 287–291.
    1. Booth AO, Lowis C, Dean M, Hunter SJ, McKinley MC (2013) Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals. Prim Health Care Res Dev.14 3: 293–306.
    1. Malone LA, Barfield JP, Brasher JD (2012) Perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise. Disability and Health Journal 5; 254e260.
    1. Slade SC, Patel S, Underwood M, Keating JL (2013) What are Patient Beliefs and Perceptions about Exercise for Non-specific Chronic Low Back Pain? A Systematic Review of Qualitative Studies. Clin J Pain. Epub ahead of print.
    1. Roberts SH, Bailey JE (2011) Incentives and barriers to lifestyle interventions for people with severe mental illness: a narrative synthesis of quantitative, qualitative and mixed methods studies. J Adv Nurs 67(4): 690–708.
    1. Brunet J, Taran S, Burke S, Sabiston CM (2013) A qualitative exploration of barriers and motivators to physical activity participation in women treated for breast cancer. Disabil Rehabil 35(24): 2038–45.
    1. Biedenweg K, Meischke H, Bohl A, Hammerback K, Williams B, et al. (2014) Understanding older adults' motivators and barriers to participating in organized programs supporting exercise behaviors. J Prim Prev 35(1): 1–11.
    1. Justine M, Azizan A, Hassan V, Salleh Z, Manaf H (2013) Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singapore Med J 2013 54(10): 581–586.
    1. Donahue KE, Mielenz TJ, Sloane PD, Callahan LF, Devellis RF (2006) Identifying Supports and Barriers to Physical Activity in Patients at Risk for Diabetes. Prev Chronic Dis. 3(4): A119.
    1. Mulligan H, Treharne GJ, Hale LA, Smith C (2013) Combining self-help and professional help to minimize barriers to physical activity in persons with multiple sclerosis: a trial of the “Blue Prescription” approach in New Zealand. J Neurol Phys Ther. 37(2): 51–7.
    1. Tse MM, Vong SK, Tang SK (2013) Motivational interviewing and exercise programme for community-dwelling older persons with chronic pain: a randomised controlled study. J Clin Nurs. 22(13–14): 1843–56.
    1. Lilienthal KR, Pignol AE, Holm JE, Vogeltanz-Holm N (2013) Telephone-Based Motivational Interviewing to Promote Physical Activity and Stage of Change Progression in Older Adults. J Aging Phys Act.

Source: PubMed

3
Iratkozz fel