Motives for regular physical activity in women and men: a qualitative study in French adults with type 2 diabetes, belonging to a patients' association

Association of Physical Activity and Sleep Metrics with Depression in People with Type 1 Diabetes

Objective

This study aimed to investigate the association of physical activity and sleep metrics, measured via wrist-worn accelerometers, with depression in people with type 1 diabetes.

Patients and Methods

People with type 1 diabetes were recruited from the Dasman Diabetes Institute in Kuwait and were invited to wear a wrist-worn accelerometer device for 7 days. Mean physical activity (overall acceleration), inactivity, light activity, moderate activity, vigorous activity, the distribution of physical activity intensity (intensity gradient), sleep duration and sleep efficiency were quantified from the accelerometer data. The associations of these metrics with depression were investigated using multiple linear regression.

Results

A total of 551 people with type 1 diabetes (age 33.1 (9.5) years) were included. Overall physical activity (B = -0.09, CI = -0.14 to -0.04), moderate intensity activity (B = -0.02, CI = -0.02 to -0.01), vigorous intensity activity (B = -0.16, CI = -0.27 to -0.05), and the intensity gradient (B = -2.11, CI = -3.51 to -0.72) were negatively associated with depression score (p < 0.01) and these associations remain significant even after adjustment for age, sex, diabetes duration, and BMI. However, sleep duration and efficiency were not associated with depression. After mutual adjustment overall physical activity (B = -0.07, CI = -0.12 to -0.01), but not the intensity gradient (B = -0.90, CI = -2.47 to 0.68), remained associated with depression.

Conclusion

Overall, moderate and vigorous physical activity, and the intensity gradient were associated with lower symptoms of depression. Overall physical activity, rather than the distribution of activity intensity, appears more important in depression. This information can help guide physical activity interventions to improve depression in people with type 1 diabetes.

The Effect of COVID-19 on Middle-Aged Adults' Mental Health: A Mixed-Method Case-Control Study on the Moderating Effect of Cognitive Reserve

The COVID-19 pandemic has increased the vulnerability of adults to mental health effects, and the study of protective factors has become crucial. Cognitive reserve (CR) is a well-known protective factor against cognitive decline and several health factors; however, its protective effect on mental health during the pandemic has been rarely addressed. Thus, this study explored, through a mixed-method design, the effect of CR on perceived distress and PTSD-like symptoms in middle-aged participants who have survived severe COVID-19 and a matched control group. A total of 432 participants filled out self-report measures of CR, PTSD, depression, and anxiety, and were also asked to provide narration about their COVID-19-related experience. COVID-19 significantly affected the chances of reporting different mental health symptoms; levels of CR played a protective role in reducing their severity. Moreover, adults with higher CR seemed to be more realistic, focusing less on positive emotions, and elaborating more on the sense of anxiety when describing their experience: this might be an indication of a lower use of suppression to regulate emotions. Practical implications of these findings and future directions have been also discussed.

Assessing physical function after completing a supervised education and exercise program in adults with type 2 diabetes and exploring exercise motivation at one-year follow up: A case series study

BACKGROUND

Exercise programs for adults with type 2 diabetes (T2D) improve glycemic control and physical function. However, diabetes complications, disability, and motivation pose challenges for exercise participation.

OBJECTIVE

The purpose of the study was to: 1) measure change in fasting blood glucose, blood pressure, anthropometrics (i.e. BMI and waist circumference), and physical function (i.e. endurance, agility and balance, upper and lower-body strength and flexibility) after completing an eight-week education and exercise program for adults with T2D; and 2) explore the experience of exercise continuation in people living with T2D at one-year follow-up.

METHODS

A mixed methods case series design was conducted. Participants were ≥ 18 years and had a clinical diagnosis of T2D (glycated hemoglobin (A1C) ≥ 6.5%). Participants completed two one-hour exercise sessions and one one-hour education session per week for eight weeks. Blood glucose, blood pressure, body mass index (BMI), waist circumference, and physical function were measured at baseline and after completing the program. Follow-up telephone interviews were conducted at one, six, and 12-months and thematic analysis was employed to analyze interviews.

RESULTS

Twelve participants completed the program. Clinically significant improvements were observed for waist circumference, systolic blood pressure, six-minute walk test (6MWT), timed up-and-go test (TUG), 30-second chair stand test (CST) and arm curls. Three themes emerged from the interviews that described participant reflections and experiences with a supervised education and exercise program for management of their T2D: 1) medical management; 2) lifestyle management; and 3) finding what works. Conclusion: Supervised programming improves physical function and may mitigate disability. Physiotherapists are qualified to assess and treat physical function through education and exercise.

Will the Construction of Sports Facilities Nudge People to Participate in Physical Exercises in China? The Moderating Role of Mental Health

This study aims to examine the nudging effect of the sports facility construction on physical exercise (PE) participation with consideration of the moderating role of mental health in China. Multiple linear regression models are used in this study. The subjects are 4634 from the 2014 China Family Panel Studies (CFPS) data, which is a nationally representative longitudinal survey of Chinese individuals. We find that the construction of sports facilities nudges people to participate in PE, and gender, age, and education significantly influence people's participation in PE. Young, female, and better-educated people compose the "neo-vulnerable" population, who participate less in PE in China and need more interventions. Mental health status has no significant effect on people's PE participation, while it negatively moderates the nudging effect of the construction of sports facilities on PE. The results of this study suggest that only building sporting facilities is insufficient to encourage PE participation. Policies and interventions should be given to mentally disturbed individuals to guarantee and magnify the nudging effect of sports facilities on PE.

Effect of psychosocial motivations and technology on physical activity behaviours among community older men and women

BACKGROUND

Implementation of physical activity strategies in older populations may be influenced by underlying psychosocial and gender-based factors to physical activity. We explored associations between these factors and physical activity behaviors and technology among older men and women.

METHODS

Community older adults underwent echocardiography and interviewer administered questionnaires that collected physical activity habits, self-motivation, self-empowerment and smartphone usage patterns associated with physical activity. Aerobic capacity was denoted by VO₂max (High VO₂ was defined as VO₂ > 35 (ml/kg/min) for men or VO₂ > 27 (ml/kg/min) for women).

RESULTS

Among 180 participants (mean age 77 (71-80) years; 43% females), 101 (56.1%) had a low VO₂max. Barriers to activity were lack of time (27.8%), tiredness (26.7%), affordability (12.8%) and pain while exercising (12.2%). Compared to participants with high VO₂max, those with low VO₂max were less likely to report feeling good post-exercise (70.3% vs 86.1%, adjusted p = 0.041) and express barriers to exercise (72.3% vs 88.6%, adjusted p = 0.017). Compared to men, women were more likely to express motivation for exercise if they were guided by an instructor (20.5% vs 1.96%, adjusted p = 0.027), less likely to prefer control over exercise type and difficulty (57.7% vs 82.4%, adjusted p = 0.001), express interest in smartphone apps (7.84% vs 24.4%, adjusted p = 0.01) and participate in apps-guided exercise (10.3% vs 29.4%, adjusted p = 0.001). Major factors that motivated the use of smartphone applications to manage individual health were financial incentives (23.9%) and guidance on exercise routines (21.1%) while the reveal of personal information was a major deterrent (28.3%).

CONCLUSIONS

We observed differences in physical activity motivation, empowerment and technology use based on gender and functional status. Tailoring physical activity strategies, including digital health strategies, that target psychosocial and gender-based factors may improve activity participation in older adults.

Perceived barriers and facilitators of physical activity in adults living in activity-friendly urban environments: A qualitative study in Sri Lanka

Background

Despite reforming health policies to create more enabling environments, insufficient physical activity in Sri Lanka remains a major public health issue. Socio-culture specific determinants underlying the physical activity of adults living in such environments need to be identified. The aim of this study was to explore the barriers and facilitators for physical activity, as perceived by adult urban dwellers in activity-friendly environments in Colombo District, Sri Lanka.

Methods

A qualitative study using in-depth interviews was conducted among adults aged 20–60 years living in an urban area which has been recently re-designed for recreational and rejuvenating purposes in Sri Lanka. Recruitment targeted varying socio-economic status and risk of non-communicable diseases; and was continued until the data saturation point was reached. Interviews were conducted in homes, primary healthcare units and fitness centres, and were transcribed verbatim and analysed using framework analysis.

Results

A total of 31 eligible and consenting adults were interviewed. Of the reported barriers to physical activity, lack of time was very common. Other frequently reported barriers included unpleasant experiences following exercise and misconceptions about exercise, whereas physical environmental factors, weather and road safety were reported less frequently. All participants reported at least one facilitator for engaging in exercise. Expectations of preventing diseases, improving health, physical fitness, psycho-social wellbeing, optimising body functions and increasing lifespan were frequently cited as reasons to be active, while social factors such as positive attitudes of family members and the influence of peers were found to be motivating.

Conclusions

The study showed that while participants valued the health benefits of physical activity and refurbished activity-friendly urban environments, these were not sufficient to support them to overcome key perceived barriers to being physically active.

Structural equation model of psychological constructs of transtheoretical model, motives for physical activity, and amount of physical activity among people with type 2 diabetes mellitus in Malaysia

BACKGROUND

This study aimed determine the structural relationship between psychological constructs of the transtheoretical model (TTM; processes of change, decisional balance, and exercise self-efficacy), motives for physical activity (PA), and amount of PA among Malaysians with type 2 diabetes mellitus (T2DM).

METHOD

All participants were recruited from the Hospital Universiti Sains Malaysia using a cross-sectional study design with purposive) sampling method. A total of 331 participants were recruited for the present study. Before participation in the study, they were informed that participation in the study was totally voluntary. Those who agreed to participate voluntarily were required to complete the self-administered questionnaire set, which included the processes of change, decisional balance, exercise self-efficacy, physical activity and leisure motivation, and international physical activity questionnaires. Data analysis of structural equation modeling was performed using Mplus 8.

RESULTS

From the 331 participants, most of whom were male (52%) and Malay (89.4%), with a mean age of 62.6 years (standard deviation = 10.29). The final structural equation model fit the data well based on several fit indices [Root Mean Square Error of Approximation (RMSEA) = 0.059, Comparative Fit Index (CFI) = 0.953, Tucker-Lewis Index (TLI) = 0.925, Standardized Root Mean Square Residual (SRMR) = 0.031]. A total of 16 significant path relationships linked between the TTM, motives for PA, and amount of PA.

CONCLUSION

The pros of decisional balance, others' expectations, and psychological condition were constructs that directly affected PA, whereas the other constructs had a significant indirect relationship with the amount of PA. A positive mindset is crucial in deciding a behavioral change toward an active lifestyle in people with T2DM.

Exploring Female University Students' Participation in Physical Activity in Saudi Arabia: A Mixed-Methods Study

Background

The importance of physical activity in improving physical and mental health has been emphasized in many studies. Researchers in Saudi Arabia have reported an increase in physical inactivity among Saudis, especially among University female population. Current efforts in the field in Saudi Arabia have yet to explore barriers and facilitators that influence female University student's participation in physical activity. This study aims to provide an assessment of the situation regarding physical activity among female University students in Saudi Arabia.

Methods

This mixed method study preceded a participatory action research initiative. The first part of the mixed method consisted of a cross-sectional survey of 375 female University students in Saudi Arabia who completed the short form of the International Physical Activity Questionnaire. The second part consisted of semi-structured, in-depth interviews with 14 female University students and 16 female exercise trainers.

Results

Results showed that most participants (91%) spent more time in walking activity compared to moderate (66%) and vigorous activity (57%) for at least 10 min at a time over a period of 7 days. Results showed that 70% of participants did not meet the WHO recommendation of 150 min per week of moderate activity, while around 62% of participants did not meet the WHO recommendation of 75 min per week of vigorous activity. Barriers to participation included limited facilities for physical activities, academic workload, gender role, and the need to adhere to cultural standards. Facilitators included valuing positive results, general health concerns, and family support.

Conclusion

Knowledge gained from this study might support organizations and public health authorities to develop physical activity interventions that better address Saudi women's perceived needs. These findings are an important contribution to current knowledge in light of recent advances in women's rights in Saudi Arabia.

"I Tried Forcing Myself to do It, but Then It Becomes a Boring Chore": Understanding (dis)engagement in Physical Activity Among Individuals With Type 2 Diabetes Using a Practice Theory Approach

Lack of physical activity (PA) is common among individuals with type 2 diabetes (T2D). We apply a practice theory approach to investigate PA engagement in the context of T2D. Data were collected through semi-structured individual interviews (n = 23) and focus groups (n = 3x6) and analyzed by deductive-inductive reflexive thematic analysis using a practice theory framework. Forty-one purposefully selected individuals with T2D (29 men) between the ages of 54 and 77 years were included. The analysis resulted in three main themes informed by five subthemes, reflecting the key elements of practice theory (i.e., meanings, materialities, and competencies). One overarching theme identified PA engagement as an unsustainable and insurmountable project in constant and unequal competition with the practice of physical inactivity. To increase PA among individuals with T2D, future PA interventions and strategies should aim to establish a stronger link between PA and everyday life practices.

Physical activity and its associated factors in females with type 2 diabetes in Riyadh, Saudi Arabia

Despite the benefits of physical activity (PA) for the management of type 2 diabetes Mellitus (T2DM), the topic of PA is poorly addressed in Saudi Arabia (SA), especially in females with T2DM. The present study examined PA and its associated factors in females with T2DM in Riyadh, Saudi Arabia. This observational cross-sectional study was performed in a random sample of 372 women with T2DM. A face-to-face interview that covered PA, health and environmental correlates of PA was performed. Discriminant analysis was used to determine which barriers had the greatest impact on PA in these women. The results showed that approximately 26.3% of the study participants met PA recommendations. Multivariate linear regression revealed lower levels of PA were associated with women who had more than three children (β = -0.17) compared to women with no children, older age (β = -0.18), women with a duration of diabetes ≥ 6 years (β = -0.16), women who were obese (β = -0.23), women with no family support (β = -0.20), no friend support (β = -0.13) and no healthcare provider support (β = -0.14). Discriminant analysis indicated that culture and tradition, lack of skills and knowledge, safety, fatigue, lack of time, weather conditions, and lack of facilities were the barriers that differentiated between the women who met and those who did not meet the PA recommendations. The present study suggests that the prevalence of PA is low and number of children, age, duration of diabetes, Obesity, family support, friend support and healthcare provider support are identified correlates of PA. These findings are valuable and should be used to design and implement future PA interventions, especially for women with T2DM. Healthcare providers may improve exercise levels and identify the specific barriers to reaching the recommended level of PA to improve health outcomes for each patient.

Review of Randomized Controlled Trials Using e-Health Interventions for Patients With Eating Disorders

BACKGROUND

In a world of technological advancements, electronic devices and services seem to be a promising way to increase patients' engagement in treatment and to help manage their symptoms. Here, we identified and analyzed the current evidence of RCTs to evaluate the effectiveness and acceptability of e-health interventions in the eating disorder (ED) field.

METHODS

We screened an initial cluster of 581 papers. In the end, 12 RCTs in clinical ED cohorts were included.

RESULTS

Some studies were conceived as stand-alone interventions, while others were presented as add-ons to ED-specific treatments. Studies varied in the type of EDs under investigation and in the e-health intervention applied (with vs. without therapist support vs. blended interventions; smartphone- vs. web-based). Only four studies reported explicit acceptability measures. Out of those, two reported high acceptability, one reported low acceptability, and one reported no significant difference in acceptability between groups. Four studies reported higher effectiveness of the e-health intervention compared to the control condition, e.g., reduction in maladaptive eating behaviors. Regarding control groups, three used a wait list design and nine had another kind of intervention (e.g., face-to-face CBT, or treatment as usual) as control.

DISCUSSION

So far, the evidence for acceptability and effectiveness of e-health interventions in EDs is very limited. There is also a lack of studies in older patients, adolescents, men, sexual and ethnic minorities. Shame/stigma is discussed in the context of e-health interventions for EDs. It remains unclear how severity of EDs affects the effectiveness of e-health interventions, how patients can channel the knowledge they acquire from e-health interventions into their actual behaviors, and how such interventions can better fit the needs of the individual patient to increase acceptability and effectiveness.

Factors influencing participation in physical activity after dysvascular amputation: a qualitative meta-synthesis

Purpose: Identifying factors associated with physical activity after dysvascular lower limb amputation (LLA) could provide targets for improving rehabilitation outcomes. The purpose of this meta-synthesis was to identify modifiable factors that may influence physical activity after LLA, a condition characterized by amputation in the setting of older age, diabetes mellitus (DM), and/or peripheral artery disease (PAD).Methods: A systematic search of the literature identified qualitative studies exploring the perceptions of physical activity in people with lower limb amputation, older age, DM, or PAD. Qualitative rigor was assessed using the McMaster University's Guidelines for Qualitative Review. Meta-synthesis was undertaken to analyze the findings of included studies.Results: Fourteen studies of variable methodological quality were included for analysis. Three overarching factors that may influence physical activity after LLA emerged: 1) educational experiences and motivation, 2) support and self-efficacy, and 3) special concerns after lower limb amputation (e.g., prosthesis, equipment, and environment).Conclusions: Physical activity after LLA is influenced by relationships among health understanding, motivation, support, and self-efficacy in the presence of disability. Themes from this meta-synthesis can be used to develop and test behavior-based interventions to improve physical activity after LLA.Implications for rehabilitationPhysical activity participation after dysvascular lower limb amputation is complicated by the presence of chronic conditions, severe disability, and unaddressed psychosocial factors.Addressing a patient's self-efficacy, social support, motivation, and understanding during physically focused rehabilitation may improve participation in physical activity after dysvascular lower limb amputation.Rehabilitation professionals can address self-efficacy, motivation, and understanding by using collaborative, empathetic communication strategies known to enhance a patient's sense of support.

Middle-aged women negotiating the ageing process through participation in outdoor adventure activities

This study sought to examine the motivations middle-aged women give for belonging to an outdoor adventure group. As part of this, how the women were negotiating the ageing process was also examined. Fourteen women aged 36–64 (average age 51.4 years) were individually interviewed with the purpose of exploring their perceptions, values, motivations and the beliefs they attach to their participation. Findings highlight the women's belief that participation delays the ageing process, gives them confidence in their lives and offers social support from other group members. In addition, pride, satisfaction and pleasure were expressed in the belief that they challenged the cultural norms and expectations of older women. Whilst delaying the ageing process, they also highlighted that they thought about a time in the future when they would not be able to continue to participate. The study emphasises that more adventurous activities are becoming more normalised and can be undertaken by women in middle age. This may also suggest that more needs to be done to promote diverse activities such as outdoor adventurous activities to women.

Understanding 'context' in the self-management of type 2 diabetes with comorbidities: A systematic review and realist evaluation

OBJECTIVE

To identify contextual factors that affect self-management of diabetes with comorbidities, and to evaluate in what way these factors affect self-management effectiveness.

METHODS

A systematic review of literature considered English language articles published within Medline, PsycINFO, Pubmed, CINAHL Plus, and Scopus databases that focussed on individuals' experiences of type 2 diabetes from primary intervention or observational studies. A realist evaluation approach was used to analyse themes identified within the literature. Context-mechanism-outcome theories were constructed to identify underlying contextual factors and to construct a model illustrating diabetes self-management effectiveness.

RESULTS

Of 1519 articles identified, 30 met inclusion criteria. Adherence was found to be the common mechanism that (within given contexts) determined self-management effectiveness. Limited financial resources were identified as the key context. Our model makes explicit a structural weaknesses of diabetes self-management.

CONCLUSIONS

Coping with diabetes in the context of people's lives requires attention to issues that are often outside the remit of the person with diabetes, the health care team, and the health system within which self-management is located. Realist evaluations illuminate programme mechanisms and fine-tune context. They aid initial understandings of how an intervention or programme is thought to work, in order to influence and (re)design (new) programmes.

Barriers and facilitators to physical activity among urban residents with diabetes in Nepal

INTRODUCTION

Physical activity is an important component of type 2 diabetes management. Physical activity level among general population in Nepal is reported to vary considerably. However, knowledge on physical activity in Nepali diabetics is very limited. Engagement in physical activity could be influenced by perception of barriers against adopting the behavior and benefits of adopting it. This study explores the prevalence of physical activity and factors that promote and hinder the behavior among urban residing diabetic patients from Nepal.

METHODS

A descriptive cross-sectional design was adopted using a simple random sampling of type 2 diabetic patients from two diabetes clinics at Lalitpur and Kaski districts of Nepal. Two hundred and seventy participants were surveyed to obtain information on physical activity using Global Physical Activity Questionnaire. Metabolic equivalent values were calculated and categorized into high, moderate and low levels of physical activity. The information on perceived facilitators and barriers was collected by Exercise Barriers and Benefits Survey scale. Odds ratios and 95% confidence intervals of the measures were estimated using multinomial logistic regression.

RESULTS

The study showed relatively high prevalence of physical activity among the urban Nepali diabetic patients; 52% were moderately active and 28% highly active. Travel and work-related activities were the major contributors. Male participants, educated and those living in extended families were more motivated for physical activity than their counterparts. Physical fitness, strength and flexibility, better sleep at night, social interaction and longevity, were identified as the major facilitators. Family responsibilities, busy schedule and family discouragement were identified as barriers against being physically active.

CONCLUSION

The diabetic patients were mostly moderately physically active. Future research could explore different context-specific ways of remaining physically active, apart from walking and doing household chores. More focus should also be placed on leisure time physical activity as it was found to be low. Interventions could be designed by promoting the facilitators and addressing the barriers of physical activity, which is likely to reduce the healthcare costs of management of diabetic complications.

Sex-dependent differences in voluntary physical activity

Numbers of overweight and obese individuals are increasing in the United States and globally, and, correspondingly, the associated health care costs are rising dramatically. More than one-third of children are currently considered obese with a predisposition to type 2 diabetes, and it is likely that their metabolic conditions will worsen with age. Physical inactivity has also risen to be the leading cause of many chronic, noncommunicable diseases (NCD). Children are more physically inactive now than they were in past decades, which may be due to intrinsic and extrinsic factors. In rodents, the amount of time engaged in spontaneous activity within the home cage is a strong predictor of later adiposity and weight gain. Thus, it is important to understand primary motivators stimulating physical activity (PA). There are normal sex differences in PA levels in rodents and humans. The perinatal environment can induce sex-dependent differences in PA disturbances. This Review considers the current evidence for sex differences in PA in rodents and humans. The rodent studies showing that early exposure to environmental chemicals can shape later adult PA responses are discussed. Next, whether there are different motivators stimulating exercise in male vs. female humans are examined. Finally, the brain regions, genes, and pathways that modulate PA in rodents, and possibly by translation in humans, are described. A better understanding of why each sex remains physically active through the life span could open new avenues for preventing and treating obesity in children and adults. © 2016 Wiley Periodicals, Inc.

Support and Sabotage: A Qualitative Study of Social Influences on Health Behaviors Among Rural Adults

PURPOSE

Social environments exert an important influence on health behaviors, yet evidence from rural-specific contexts is limited. This study explored how social relationships influence health-related behaviors among midlife and older rural adults at increased risk of chronic disease.

METHODS

Seventeen focus groups were conducted with 125 sedentary, overweight/obese adults (aged 40-91 years) residing in "medically underserved" rural Montana towns in 2014. Groups were stratified by age (40-64 and ≥65) and gender. Transcripts were examined thematically using NVivo software according to social influences on diet, physical activity, and tobacco use. Analyses were conducted in 2015-2016.

RESULTS

Attitudes and actions of family members and friends were key influences on health behaviors, in both health-promoting and health-damaging ways. In these small, isolated communities, support from and accountability to family and friends were common facilitators of behavior change and maintenance. However, expectations to conform to social norms and traditional gender roles (eg, caregiving duties) often hindered healthy lifestyle changes.

CONCLUSIONS

These findings suggest that health behavior interventions targeting adults in rural settings need to consider and, if possible, integrate strategies to address the impact of social relationships in both supporting and sabotaging behavior change and maintenance.

Walking in Two French Neighborhoods: A Study of How Park Numbers and Locations Relate to Everyday Walking

Research indicates that people are drawn to green spaces with attractive amenities. This study extends that finding by comparing walking patterns in two neighborhoods with different numbers of parks; parks did not differ in rated attractiveness nor did neighborhoods differ substantially in rated walkability. Adults, aged 32-86 years (n = 90), drew their 3 most recent walking routes on maps of their neighborhood. Analyses showed that participants' round trips were longer by 265.5 meters (.16 mile) in the neighborhood with a single, large, centrally located park (p < .02). However, participants in the neighborhood with multiple, small, more distributed parks, visited more streets, p < .001, more streets with green spaces, p < .038, and used more varied routes, p < .012. Results suggest there are potential benefits to both layouts. Large centralized parks may invite longer walks; smaller, well-distributed parks may invite more varied routes suggestive of appropriation and motivation processes. Both layouts might be combined in a single neighborhood to attract more walkers.

Barriers to and motivators for physical activity among people with Type 2 diabetes: patients' perspectives

AIM

To explore barriers to and motivators for physical activity in a group of overweight and obese individuals with dysregulated Type 2 diabetes.

METHODS

Data were collected from the Steno Diabetes Center's outpatient clinic in Denmark. Four focus groups were conducted including 28 individuals with Type 2 diabetes aged 39-71 years. The facilitators used open-ended questions and probes such as images, statements and quotations about physical activity to foster active participation and interaction among participants. Focus groups were recorded on video and the discussions were transcribed and analysed thematically.

RESULTS

We identified four main themes: 1) the body as a barrier to physical activity because of functional limitations; 2) logistical challenges, including lack of time and awareness of where to exercise in the local area; 3) being physically active with others, providing a sense of mutual commitment and enjoyment; and 4) goal-setting and self-tracking, which was seen as an opportunity to track physical improvement over time.

CONCLUSIONS

The findings suggest that, once people are active, a high level of social interaction may help maintain their activity levels. Further research is needed to investigate the effect of combining individually tailored exercise plans with the establishment of customized and locally based exercise communities that offer enjoyment and support. Additionally, it is relevant to explore experiences of using self-tracking technologies to review short- and long-term goals.

A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN)

Background

Self-management support interventions can improve health outcomes, but their impact is limited by the numbers of patients able or willing to access them. Men’s attendance at, and engagement with, self-management support appears suboptimal despite their increased risk of developing serious and disabling long-term conditions (LTCs).

Objectives

To assess the effectiveness, cost-effectiveness, accessibility and acceptability of self-management support interventions in men with LTCs.

Methods

A quantitative systematic review with meta-analysis and a qualitative review using a metaethnography approach. The findings of the two reviews were integrated in parallel synthesis.

Data sources

In the quantitative review, the Cochrane Database of Systematic Reviews was searched to identify published reviews of self-management support interventions. Relevant reviews were screened to identify randomised controlled trials (RCTs) of self-management support interventions conducted in men alone, or which analysed the effects of interventions by gender. In the qualitative review, the databases Cumulative Index to Nursing and Allied Health Literature, EMBASE, Medical Literature Analysis and Retrieval System Online, PsycINFO and Social Science Citation Index (July 2013) were searched from inception to July 2013.

Review methods

In the quantitative review, data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted independently by two reviewers using the Cochrane risk of bias tool. Meta-analysis was conducted to compare the effects of interventions in male, female and mixed-sex groups. In the metaethnography, study details, participant quotes (first-order constructs) and study authors’ themes/concepts (second-order constructs) were extracted. Quality appraisal was conducted independently by two reviewers using the Critical Appraisal Skills Programme tool. Data were synthesised according to a metaethnography approach. Third-order interpretations/constructs were derived from the extracted data and integrated to generate a ‘line-of-argument’ synthesis.

Results

Forty RCTs of self-management support interventions in male-only samples, and 20 RCTs where an analysis by gender was reported, were included in the quantitative review. Meta-analysis suggested that interventions including physical activity, education and peer support have a positive impact on quality of life in men, and that men may derive more benefit than women from them, but there is currently insufficient evidence to draw definitive conclusions. Thirty-eight qualitative studies relevant to men’s experiences of, and perceptions of, self-management support were included in the qualitative review. The metaethnography identified four concepts: (1) need for purpose; (2) trusted environments; (3) value of peers; and (4) becoming an expert. Findings indicated that men may feel less comfortable engaging in support if it is perceived to be incongruous with valued aspects of masculine identities. Men may find support interventions more attractive when they have a clear purpose, are action-oriented and offer practical strategies that can be integrated into daily life. Support delivered in an environment that offers a sense of shared understanding can be particularly appealing to some men.

Conclusions

Health professionals and those involved in designing interventions may wish to consider whether or not certain components (e.g. physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this. Interventions are most likely to be accessible and acceptable to men when working with, not against, valued aspects of masculine identities.

Study registration

This study is registered as PROSPERO CRD42013005394.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Barriers and facilitators to physical activity amongst overweight and obese women in an Afro-Caribbean population: A qualitative study

Background

The proportion of obese women is nearly twice the proportion of obese men in Barbados, and physical inactivity may be a partial determinant. Using qualitative interviews and ‘semi-structured’ participant observation, the aim of this study was to identify modifiable barriers to physical activity and to explore the factors that facilitate physical activity amongst overweight and obese women in this low-resourced setting.

Methods

Seventeen women aged 25 to 35 years with a BMI ≥25, purposefully sampled from a population-based cross-sectional study conducted in Barbados, were recruited in 2014 to participate in in-depth semi-structured interviews. Twelve of these women participated in one or more additional participant observation sessions in which the researcher joined and observed a routine activity chosen by the participant. More than 50 hours of participant observation data collection were accumulated and documented in field notes. Thematic content analysis was performed on transcribed interviews and field notes using the software Dedoose.

Results

Social, structural and individual barriers to physical activity were identified. Social factors related to gender norms and expectations. Women tended to be active with their female friends rather than partners or male peers, and reported peer support but also alienation. Being active also competed with family responsibilities and expectations. Structural barriers included few opportunities for active commuting, limited indoor space for exercise in the home, and low perceived access to convenient and affordable exercise classes. Several successful strategies associated with sustained activity were observed, including walking and highly social, low-cost exercise groups. Individual barriers related to healthy living strategies included perceptions about chronic disease and viewing physical activity as a possible strategy for desired weight loss but less effective than dieting.

Conclusions

It is important to understand why women face barriers to physical activity, particularly in low-resourced settings, and to investigate how this could be addressed. This study highlights the role that gender norms and health beliefs play in shaping experiences of physical activity. In addition, structural barriers reflect a mix of resource-scarce and resource-rich factors which are likely to be seen in a wide variety of developing contexts.

Voluntary Organizations and Community Groups as New Partners in Diabetes Self-management and Education: A Critical Interpretative Synthesis

PURPOSE

The purpose of this study is to critically review the literature on the role and work of voluntary organizations and community groups and volunteers in diabetes self-management programs. It seeks to explain how these organizations are located and could be integrated further within a broader system of support.

METHODS

A critical interpretative synthesis of the literature was undertaken as part of the conceptual development of a European research project. Evidence (2000-November 2014) was searched in databases, with the use of key terms, and limited to the languages of the participating countries. This was supplemented by an additional hand search and snowballing technique. A total of 21 articles were included in the review.

RESULTS

Evidence regarding the involvement of voluntary organizations in diabetes self-management programs mainly related to: the nature and remit of their work, responsibilities, and attributes; key strategies of programs accounting for success; motivations/barriers for engaging in volunteering participation; relationships between volunteers and users; and connections/tensions with formal services.

CONCLUSIONS

This review has uncovered a range of facets of voluntary organizations and community groups relevant for supporting diabetes self-management such as the context within which they act and the nature of relationships developed with community and health services. The principles of "assistance, support, sharing, and link" seem essential for this voluntary initiative in self-management to establish effective reciprocal collaboration with health professionals.

The accessibility and acceptability of self-management support interventions for men with long term conditions: a systematic review and meta-synthesis of qualitative studies

BACKGROUND

Self-management support interventions can improve health outcomes, but their impact is limited by the numbers of people able or willing to access them. Men's attendance at existing self-management support services appears suboptimal despite their increased risk of developing many of the most serious long term conditions. The aim of this review was to determine whether current self-management support interventions are acceptable and accessible to men with long term conditions, and explore what may act as facilitators and barriers to access of interventions and support activities.

METHODS

A systematic search for qualitative research was undertaken on CINAHL, EMBASE, MEDLINE, PsycINFO and Social Science Citation Index, in July 2013. Reference lists of relevant articles were also examined. Studies that used a qualitative design to explore men's experiences of, or perceptions towards, self-management support for one or more long term condition were included. Studies which focused on experiences of living with a long term condition without consideration of self-management support were excluded. Thirty-eight studies met the inclusion criteria. A meta-ethnography approach was employed to synthesise the findings.

RESULTS

Four constructs associated with men's experience of, and perceptions towards, self-management support were identified: 1) need for purpose; 2) trusted environments; 3) value of peers; and 4) becoming an expert. The synthesis showed that men may feel less comfortable participating in self-management support if it is viewed as incongruous with valued aspects of their identity, particularly when activities are perceived to challenge masculine ideals associated with independence, stoicism, and control. Men may find self-management support more attractive when it is perceived as action-oriented, having a clear purpose, and offering personally meaningful information and practical strategies that can be integrated into daily life.

CONCLUSIONS

Self-management support is most likely to be successful in engaging men when it is congruent with key aspects of their masculine identity. In order to overcome barriers to access and fully engage with interventions, some men may need self-management support interventions to be delivered in an environment that offers a sense of shared understanding, connectedness, and normality, and involves and/or is facilitated by men with a shared illness experience.

Management of type 2 diabetes mellitus in self-motivated patients: optimized diet, exercise, and medication for weight loss and cardiometabolic fitness

Type 2 diabetes mellitus (T2DM) is a growing public health problem with significant lifetime health care costs. The majority of Americans do not achieve minimal targets for exercise, and individuals with T2DM typically engage in less exercise than the general adult population. However, those patients with T2DM who are sufficiently self-motivated to manage their condition have the potential to reverse diabetes and prevent its complications through behavioral and pharmacologic interventions. Marked improvements are possible through increased awareness and selection of healthy eating options, a willingness to incorporate vigorous exercise into their lifestyle, and the use of newer medications that essentially eliminate the risk of hypoglycemia while facilitating weight loss and the achievement of ideal glucose targets. For self-motivated patients, daily aerobic activity of 45 to 60 minutes per day may be a suitable target. For those who have cardiovascular clearance, high-intensity interval training accomplishes high levels of cardiometabolic fitness with shorter training periods by alternating moderate and intense exertion. Suitable medications that have a low risk of hypoglycemia during exercise include metformin, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium-glucose linked transporter-2 inhibitors. Specific daily caloric goals and incorporation of a mainly plant-based diet should be considered as a primary target for diabetes management. Self-management is important to achieving diabetes treatment goals, and mobile applications can be useful tools to support lifestyle changes in patients with T2DM.

Type 2 diabetes mellitus, physical activity, exercise self-efficacy, and body satisfaction. An application of the transtheoretical model in older adults

Physical activity (PA) is a relevant component of the treatment of Type 2 diabetes mellitus (T2DM). However, to prevent its related morbidities, PA requires an immediate and lasting change of lifestyle. Exercise self-efficacy and body satisfaction were used in a sample of older adults with T2DM, classified in different stages of change, to predict levels of PA. Results show that exercise self-efficacy increases linearly from precontemplation to maintenance stage, while body satisfaction shows an inverted U shape. However, only stages of change, other than exercise self-efficacy, add a significant and noticeable contribution to prediction of levels of PA. This evidence claims a tailored approach to PA in older adults with T2DM and advises behavioural health interventions based on exercise self-efficacy.

Renegotiating environments to achieve participation: A metasynthesis of qualitative chronic disease research

BACKGROUND

Qualitative studies describe environmental influences on participation in adults with chronic disease, but translating these findings into practice can be difficult.

PURPOSE

This study sought to synthesize qualitative research findings regarding the influence of environmental factors on participation among adults with chronic disease.

METHODS

Searching revealed 31 I articles that describe the link between environment and participation for adults with osteoarthritis, rheumatoid arthritis, diabetes mellitus, heart disease, cancer, chronic obstructive pulmonary disease, and/or depression. Study findings were analyzed using metasynthesis methods to identify themes.

FINDINGS

For adults with chronic disease, renegotiating their environments and occupations to achieve, maintain, or rework their participation involves understanding support processes, being ordinary and able, navigating systems, and navigating physical environments.

IMPLICATIONS

Key areas that occupational therapy interventions can target are facilitating constructive collaboration between client and support person, fostering connections with others, recognizing cultural pressure to be ordinary and able, and advocating for supportive policy and practice.

'It's not a disease, it's a nuisance': controlling diabetes and achieving goals in the context of men with Type 1 diabetes

Despite a steady growth in research into men's health, little is known about how men experience life with a chronic illness like Type 1 diabetes. To address this knowledge gap, we conducted an interview study with 15 men who have Type 1 diabetes. Following grounded theory analysis of the interview transcripts, we generated a number of inter-related themes which were then formulated as a theory of adjustment to life with Type 1 diabetes. This theory indicates that men reduce the seriousness of diabetes by defining it in ways other than a serious illness. By viewing diabetes in this way, men are then able to prioritise the pursuit of their personal goals over adherence to the diabetes regimen. Finally, men reassess their relationship with diabetes in light of diabetes-related complications. The goal of this process is to find the 'best fit' for diabetes in their lives - a place which will allow them to pursue and satisfy their personal goals. As men progress through life, personal goals may change and so too will their relationship with diabetes.

Intramyocellular lipid variations in active older men: relationship with aerobic fitness

AIMS

Intramyocellular lipid (IMCL) variations in older men are poorly explored. In young adults, IMCL can be influenced by both diet and exercise interventions; this flexibility is related to aerobic fitness. We evaluated in active older adults the influence of maximal aerobic capacity on short-term diet and exercise-induced variations in IMCL stores.

METHODS

Intramyocellular lipids were measured by (1) H magnetic resonance spectroscopy ((1) H-MRS) after a 3-day fat depletion-replenishment diet (IMCL(FDR) ) and immediately after a 2-h exercise at 50% VO(2) max (IMCL(FDR) (_) (EX) ). To further explore diet influence, the protocol was repeated after a high-fat diet (HF), with both pre- and post-exercise measurements (IMCL(HF) and IMCL(HF) (_) (EX) ).

RESULTS

In active older men (69.8 ± 5.2 years), IMCL(FDR) was lowered by exercise (IMCL(FDR) = 3.45 ± 1.52 vs. IMCL(FDR) (_) (EX) = 2.74 ± 1.15 mmol kg(-1) wet weight, P < 0.05), and exercise-induced variations were correlated to the initial store (P < 0.05, r = -0.72). IMCL(FDR) was linked with aerobic fitness (P < 0.05, r = 0.76), when adjusted by fat mass. IMCL(HF) was lower than IMCL(FDR) (P < 0.05), decreased after exercise (P < 0.05) and varied also as a function of initial store (P < 0.05, r = -0.89), but without link with aerobic fitness. Finally, diet-induced IMCL store variations were positively linked to aerobic fitness (P < 0.05, r = 0.89).

CONCLUSION

Variations of the IMCL stores in physically active older adults appear related to aerobic fitness, with similarly fast adaptation to short-term interventions combining diet and exercise as young active adults.

Individual influences on lifestyle change to reduce vascular risk: a qualitative literature review

BACKGROUND

Management of cardiovascular risk includes adoption of healthy lifestyles. Uptake and completion rates for lifestyle programmes are low and many barriers and facilitators to lifestyle behaviour change have been reported in the literature. Clarity on which barriers and facilitators to target during consultations in primary care may support a more systematic approach to lifestyle behaviour change in those at high risk of cardiovascular events.

AIM

To identify the main barriers and facilitators to lifestyle behaviour change in individuals at high risk of cardiovascular events.

DESIGN

A content synthesis of the qualitative literature reporting patient-level influences on lifestyle change.

METHOD

Qualitative studies involving patients at high risk of cardiovascular events were identified through electronic searching and screening against predefined selection criteria. Factors (reported influences) were extracted and, using a clustering technique, organised into categories that were then linked to key themes through relationship mapping.

RESULTS

A total of 348 factors were extracted from 33 studies. Factors were organised into 20 categories and from these categories five key themes were identified: emotions, beliefs, information and communication, friends and family support, and cost/transport.

CONCLUSION

It is possible to organise the large number of self-reported individual influences on lifestyle behaviours into a small number of themes. Further research is needed to clarify which of these patient-level barriers and facilitators are the best predictors of uptake and participation in programmes aimed at helping people to change lifestyle.

Mediators of physical activity change in a behavioral modification program for type 2 diabetes patients

BACKGROUND

Many studies have reported significant behavioral impact of physical activity interventions. However, few have examined changes in potential mediators of change preceding behavioral changes, resulting in a lack of information concerning how the intervention worked. Our purpose was to examine mediation effects of changes in psychosocial variables on changes in physical activity in type 2 diabetes patients.

METHODS

Ninety-two patients (62 ± 9 years, 30, 0 ± 2.5 kg/m(2), 69% males) participated in a randomized controlled trial. The 24-week intervention was based on social-cognitive constructs and consisted of a face-to-face session, telephone follow-ups, and the use of a pedometer. Social-cognitive variables and physical activity (device-based and self-reported) were collected at baseline, after the 24-week intervention and at one year post-baseline. PA was measured by pedometer, accelerometer and questionnaire.

RESULTS

Post-intervention physical activity changes were mediated by coping with relapse, changes in social norm, and social modeling from family members (p ≤ 0.05). One-year physical activity changes were mediated by coping with relapse, changes in social support from family and self-efficacy towards physical activity barriers (p ≤ 0.05)

CONCLUSIONS

For patients with type 2 diabetes, initiatives to increase their physical activity could usefully focus on strategies for resuming regular patterns of activity, on engaging family social support and on building confidence about dealing with actual and perceived barriers to activity.

TRIAL REGISTRATION

NCT00903500, ClinicalTrials.gov.

Leisure-time physical activities for community older people with chronic diseases

AIMS

(1) To explore the types and three components (frequency, duration and caloric expenditure) of leisure-time physical activity in community older people with chronic diseases. (2) To identify leisure-time physical activity-related factors in these community older people.

BACKGROUND

Previous research has focused primarily on measuring the actual physiological or psychological benefits of exercise or leisure-time physical activity, little is known about the factors that determine the frequency, intensity and duration of exercise or leisure-time physical activity. The identification of reliable predictors of the various components of leisure-time physical activity will enable healthcare providers to intervene and change the patterns of leisure-time physical activity in the sedentary older people more effectively.

DESIGN

A cross-sectional design was used for this study.

METHODS

Participants were recruited from the Xinyi District in Taipei, Taiwan. A total of 206 older people were recruited and were asked to complete three questionnaires during a face-to-face interview with a researcher at the activity setting.

RESULTS

The results showed that walking leisurely was the most frequent leisure-time physical activity for participants. The age, gender, living arrangement, affective feeling and environmental control were significant variables of leisure-time physical activity.

CONCLUSIONS

The study constructs accounted for moderate amounts of variance (22% for leisure-time physical activity frequency, 27% for leisure-time physical activity duration and 24% for leisure-time physical activity caloric expenditure). This study also showed that different variables play different influential roles in the different components of LTPA.

RELEVANCE TO CLINICAL PRACTICE

An effective intervention strategy for improving leisure-time physical activity of older people may involve tailoring the type, format, intensity, frequency and duration of a physical activity according to an individual's needs. This study described some environmental barriers to LTPA and recommended an increase in the accessibility to LTPA areas.

Motivators and barriers to exercise among adults with a high risk of type 2 diabetes--a qualitative study

PURPOSE

Type 2 diabetes (T2D) can be prevented through lifestyle changes. Regular exercise for more than 4 hours per week, combined with weight loss and changes in dietary habits reduces the incidence of T2D. The aim of this study was to describe motivators and barriers to exercise among adults with a high risk of T2D.

METHODS

Altogether, 74 subjects participated in a study on the Effectiveness and Feasibility of Activating Counseling Methods and Videoconferences in Dietary Group Counseling of Subjects with high risk of T2D. The qualitative data were gathered from video-recorded group counselling sessions and were analysed using content analysis.

RESULTS

Enjoyment from exercise, social relationships related to exercise, encouragement from others, benefits to health, and the aim of weight control motivated subjects to exercise. The wish to join people with an active lifestyle, admiration of active friends and willingness to serve as an example for children reflected why exercise was an important value in life. The barriers to exercise were weather/season, health problems, lack of time, work-related factors and lack of interest.

CONCLUSIONS

Adults with high risk of T2D experienced many individually meaningful motivators. They experienced few barriers to exercise and highlighted the motivators. Thus, we present that they had a positive attitude towards increasing exercise during participation to counselling. The results can be used when developing counselling methods because they provide concrete content for counselling discussion such as importance of work-related factors, family exercise, time management skills and social support for regular exercise.

Willingness to participate in a lifestyle intervention program of patients with type 2 diabetes mellitus: a conjoint analysis

BACKGROUND

Several studies suggest that lifestyle interventions can be effective for people with, or at risk for, diabetes. The participation in lifestyle interventions is generally low. Financial incentives may encourage participation in lifestyle intervention programs.

OBJECTIVE

The main aim of this exploratory analysis is to study empirically potential effects of financial incentives on diabetes patients' willingness to participate in lifestyle interventions. One financial incentive is negative ("copayment") and the other incentive is positive ("bonus"). The key part of this research is to contrast both incentives. The second aim is to investigate the factors that influence participation in a lifestyle intervention program.

METHODS

Conjoint analysis techniques were used to empirically identify factors that influence willingness to participate in a lifestyle intervention. For this purpose diabetic patients received a questionnaire with descriptions of various forms of hypothetical lifestyle interventions. They were asked if they would be willing to participate in these hypothetical programs.

RESULTS

In total, 174 observations were rated by 46 respondents. Analysis showed that money was an important factor independently associated with respondents' willingness to participate. Receiving a bonus seemed to be associated with a higher willingness to participate, but having to pay was negatively associated with participation in the lifestyle intervention.

CONCLUSION

Conjoint analysis results suggest that financial considerations may influence willingness to participate in lifestyle intervention programs. Financial disincentives in the form of copayments might discourage participation. Although the positive impact of bonuses is smaller than the negative impact of copayments, bonuses could still be used to encourage willingness to participate.

Motivation to physical activity among adults with high risk of type 2 diabetes who participated in the Oulu substudy of the Finnish Diabetes Prevention Study

Type 2 diabetes can be prevented by lifestyle changes such as sufficient level of physical activity. The number of persons at high risk of or diagnosed with type 2 diabetes is increasing all over the world. In order to prevent type 2 diabetes and develop exercise counselling, more studies on motivators and barriers to physical activity are needed. Thus, the aim of this qualitative study was to describe the motivators and barriers to physical activity among individuals with high risk of type 2 diabetes who participated in a substudy of the Finnish Diabetes Prevention Study in Oulu and to consider whether the motivators or barriers changed during the follow-up from 2003 to 2008. Questionnaires with open-ended questions were conducted twice: in the first follow-up in 2003 altogether 63 participants answered the questionnaire (n = 93), and in the second follow-up in 2008 altogether 71 participants answered the questionnaire (n = 82). Thus, response rate was 68% in 2003 and 87% in 2008. The study was conducted in the city of Oulu in Finland. Qualitative data were analysed by inductive content analysis using the QSR NVivo 8 software. The results of this study showed that motivators to physical activity included weight management, feelings of physical and mental well being. In addition, social relationships associated with exercise were also motivators. In conclusion, we present that regular counselling is important in order to promote exercise among older people, and that motivators to exercise are strengthened by positive experiences of exercise as one grows older.

Cascading crises, resilience and social support within the onset and development of multiple chronic conditions

OBJECTIVE

To describe and better understand adults' responses to the onset, accrual and influence of multiple chronic conditions and to social support in adapting to consequent difficulties.

METHODS

Qualitative study of 33 adults with multiple chronic illnesses randomly sampled from an urban primary care clinic. Semi-structured interviews targeted retrospective accounts of illness onset, consequent loss, as well as current accounts of social support and adaptation. All interviews were audio-recorded, professionally transcribed and analysed according to established phenomenological procedures.

RESULTS

Participants' responses revealed illness onset as a virtual cascade of medical, emotional and social hardships, leading to loss and subsequent adaptation through personal resilience and particularly, available social support. Participants also described patterns of adaptation punctuated by the felt need and rewards of providing care to others.

DISCUSSION

The experience of multiple chronic illnesses has a distinct pattern of development and consequence, involving challenges to personal identity and the benefits of social support from and to others. Our results suggest that programmes addressing the needs of persons with multiple chronic conditions might tailor interventions in ways that maximally address their unique challenges.