Negotiating exercise as medicine: Narratives from people with type 2 diabetes

Abstract

The dominant notion that exercise is medicine puts a strong normative emphasis on individual responsibility for participation in sport and physical activity. The aim of this article was to explore how people with type 2 diabetes, a condition strongly linked to lifestyle behaviour both in origin and in management, translate this notion into their daily life. Based on a critical narrative analysis of stories of 18 Dutch people diagnosed with type 2 diabetes collected between 2012 and 2016, we found a range of meanings given to sport and physical activity. In addition, almost all respondents seemed to subscribe to the notion of exercise as medicine on a general level, either quite explicitly or in more subtle ways, for example, elicited by the interview setting. However, they employed different strategies to negotiate with the translation of this notion into their daily life, ranging from (almost) total acceptance to resistance. In addition, nearly all stories revealed mostly negative experiences with care and professional support regarding the uptake or continuation of sport or physical activity participation after diagnosis.

Facilitators and barriers for the implementation of exercise are medicine in routine clinical care in Dutch university medical centres: a mixed methodology study on clinicians’ perceptions

“…This perception may, however, not be entirely in line with the patients’ actual perspective. Some studies have conducted qualitative studies in patients on the perception of E=M prescription 37 38. Some of the barriers, such as lack of knowledge, lack of time and lack of motivation, were indeed mentioned by patients with osteoporosis to hamper a physically active lifestyle 38.…”

“…The negative impact of discussing E=M on the relationship between patient and clinician, that some clinicians reported, may differ between patient groups. In patients with osteoporosis, this did not seem to be a problem,38 but many patients with type 2 diabetes responded defensively when asked about their physical activity pattern 37. The patients reported that they usually turned to their general practitioner for exercise advice,38 which indicates that not discussing a physically active lifestyle with clinicians may be a missed opportunity.…”

Putting the pieces together: A qualitative study exploring perspectives on self-management and exercise behavior among people living with multimorbidity, healthcare professionals, relatives, and patient advocates

“…Stuij et al explored how people with type 2 diabetes translate the notion of exercise as medicine into their daily lives and found that they employed a range of strategies to negotiate this translation ranging from (almost) total acceptance to resistance. 35 The study also revealed mostly negative experiences with care and professional support were related to sport or physical activity participation. This differs from our findings that pointed to a generally positive rapport between people living with multimorbidity and healthcare professionals.…”

Youth perspectives on weight‐related words used by healthcare professionals: A qualitative study

“…This should go further than types of words used (e.g., “negative,” “neutral,” or “positive”) and counselling techniques (e.g., aimed at motivation or empowerment), as other studies suggest (Pont, Puhl, Cook, & Slusser, ). Reflection requires professionals to examine their own normative notions about body weight and related lifestyle behaviour and the impact of these notions on their care relationships (Stuij, Elling, & Abma, ; van Ewijk, van der Vet, & de Waal, ).…”