Sex Differences in Physical Activity Among Individuals With Type 2 Diabetes Across the Life Span: A Systematic Review and Meta-analysis

Abstract

BACKGROUND Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals with T2DM are unclear. PURPOSE To summarize the evidence related to sex differences in participation in PA and barriers/facilitators to PA among individuals with T2DM across the life span. DATA SOURCES Systematic searches (CRD42021254246) were conducted with Ovid MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), APA PsychInfo, and SPORTDiscus. STUDY SELECTION We included studies with assessment of PA, sedentary behaviors (SB), or barriers/facilitators to PA among individuals with T2DM by sex or gender. DATA EXTRACTION Participant characteristics, meeting PA guidelines, participation in PA and SB, and barriers/facilitators to PA were extracted by two independent reviewers. DATA SYNTHESIS A total of 53 articles (65,344 participants) were included in the systematic review and 21 articles in the meta-analysis. Sex differences were not observed in meeting of PA guidelines among adolescents (odds ratio 0.70 [95% CI 0.31, 1.59]), but males were more likely than females to meet PA guidelines among adults (1.65 [1.36, 2.01]) and older adults (1.63 [1.27, 2.09]). Males performed more moderate-to-vigorous PA (MVPA) than females across all age-groups. Common barriers to PA were lack of time (men) and lack of social support and motivation (women). LIMITATIONS Limitations include heterogeneity of measures used to assess PA and lack of stratification of data by sex. CONCLUSIONS Sex differences in meeting PA guidelines were not observed among adolescents but were apparent among adults and older adults with T2DM. Females consistently engaged in less MVPA than males across the life span.

Cross Sectional and Case-Control Study to Assess Time Trend, Gender Differences and Factors Associated with Physical Activity among Adults with Diabetes: Analysis of the European Health Interview Surveys for Spain (2014 & 2020)

“…We also found marked gender differences in the practice of PA in subjects with diabetes in favor of males. These differences have been previously observed in Spanish and international studies [ 16 , 25 , 26 , 31 ]. In Spain, a multicenter population study on adherence to healthy lifestyles in type 2 diabetes patients found that male gender was the variable most strongly associated with adequate compliance with nutrition and PA recommendations [ 26 ].…”

“…Previous research studies in Spain on PA and diabetes have constantly shown a higher frequency of sedentary lifestyle among people with diabetes than in the general population and suggested a negative trend in the adherence to PA recommendations overtime [ 15 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Furthermore, several sociodemographic and clinical variables have shown an association with PA among people with diabetes [ 15 , 16 , 17 , 25 , 26 , 27 , 27 , 28 , 29 , 30 , 31 ]. These variables include among others, gender, obesity, age, lower educational level, current smoking, chronic conditions, mental disorders, and self-perceived health [ 15 , 16 , 17 , 25 , 26 , 27 , 27 , 28 , 29 , 30 , 31 ].…”

“…Furthermore, several sociodemographic and clinical variables have shown an association with PA among people with diabetes [ 15 , 16 , 17 , 25 , 26 , 27 , 27 , 28 , 29 , 30 , 31 ]. These variables include among others, gender, obesity, age, lower educational level, current smoking, chronic conditions, mental disorders, and self-perceived health [ 15 , 16 , 17 , 25 , 26 , 27 , 27 , 28 , 29 , 30 , 31 ]. However, the results are not conclusive and seem to be changing over time.…”

“…However, the results are not conclusive and seem to be changing over time. This may be due to differences in sampling methods, study variables, information collection, and control of confounding variables, among others [ 15 , 16 , 17 , 25 , 26 , 27 , 27 , 28 , 29 , 30 , 31 ]. Unlike most previous studies, in our investigation, we have matched people with and without diabetes by age, gender, and region of residence to improve study efficiency by increasing precision and therefore providing novel and more reliable results [ 32 ].…”

Sex Differences in the Feasibility of Aerobic Exercise Training for Improving Cardiometabolic Health Outcomes in Adults with Type 2 Diabetes

“…Therefore, it is difficult to determine the uptake of such interventions across sexes. As females with T2D are ~65% less likely than male counterparts to meet physical activity guidelines [ 11 ], it is important to examine the feasibility of aerobic training interventions to identify potential sex-specific barriers and considerations that may influence participant recruitment and engagement.…”