Attitudes and Barriers to Exercise in Adults with Type 1 Diabetes (T1DM) and How Best to Address Them: A Qualitative Study

Abstract

BackgroundRegular 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.MethodologyA 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 findingsSix 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.SignificanceMany 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.

Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps

“…Lack of time and work schedules for adults and parents are also barriers [53, 59]. Thus, clinical recommendations for exercise may need to incorporate specific strategies to mitigate the risk of hypoglycemia associated with changes in activity level.…”

“…Thus, clinical recommendations for exercise may need to incorporate specific strategies to mitigate the risk of hypoglycemia associated with changes in activity level. Other barriers to physical activity for adults include lack of motivation, embarrassment about weight, lack of access to a gym, frustration with exercise-induced hypoglycemia [59], and lack of social support to engage in physical activity [52, 53]. …”

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“…Certain types of activity may be limited due to the perception of a greater risk of hypoglycemia and difficulty managing it (Lascar et al, 2014). Many struggle to adhere to the recommended guidelines due to anxiety, FOH, and habituated responses to FOH (Lawton et al, 2013).…”

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“…Barriers to exercise in T1D are also common. In a very interesting article, Lascar et al 15 identified the following barriers: inadequate access to facilities, embarrassment regarding body image, and diabetes-specific barriers such as insufficient knowledge about how to manage diabetes before, during, and after exercise. 9.…”