Physical activity level and barriers to physical activity among an adult type 1 diabetes population

Abstract

Context: Information on physical activity (PA) levels and its association with glycaemic control and cardiovascular disease (CVD) risk is lacking among Irish adults with T1DM. Aims: (1) PA levels were assessed in this population using objective (accelerometry) and subjective [International Physical Activity Questionnaire (IPAQ)] PA measures and the relationship between PA, glycated haemoglobin (HbA1c) and CVD risk factors was evaluated. (2) Objective and subjective measures of PA were compared to determine the reliability of a subjective measure of PA. (3) Barriers to PA were identified using the Barriers to Physical Activity in Diabetes (Type 1) scale (BAPAD-1 scale). (4) Qualitative research was used to explore the attitudes, needs and expectations of an mHealth app for the management of type 1 diabetes and exercise Methods: (a) Using an observational cross-sectional design, PA was measured objectively over 7 days in 72 participants (34 males) using accelerometry (ActiGraph), and subjectively using the IPAQ long form. Participants also completed the BAPAD-1 scale. Anthropometrical, biochemical and clinical parameters were recorded. Multiple linear regression models were applied to assess how PA influenced HbA1c and cardiovascular risk factors. (b) An additional 186 participants completed one or both of the questionnaires (IPAQ and BAPAD-1 scale). Anthropometric, biochemical and clinical data was extracted retrospectively from data sources and participant records within the hospital. (c) Three focus groups were conducted with a total of 25 participants with T1DM [mean age was 38 (SD 11.1) years and mean HbA1c was 7.4 % (SD 1.4)]. Dictaphones were used and focus groups were transcribed verbatim. Qualitative analysis of the focus group data was performed using Interpretative Phenomological Analysis. Results: (a) Mean age (±SD) was 40.9 (±12.9) years, diabetes duration was 18 (±11.6) years and HbA1c was 8.0 (±1.3) %. Twenty-three (32%) participants exercised to PA recommendations as measured by accelerometry, compared to 69 (97%) participants reporting meeting the recommendations as per the IPAQ. Those meeting recommendations (accelerometry) had a lower HbA1c (p=0.001), BMI (p=0.032), waist circumference (p=0.006) and fat mass (p=0.032) and a greater number of hypoglycaemic events (p= 0.004). Fear of hypoglycaemia was the strongest barrier to PA (3.4 ± 2.0). Other barriers included low fitness levels, weather and loss of control over diabetes. (b) 151 participants completed the IPAQ and 168 participants completed the BAPAD-1 scale. Median age was 35 (23.5, 49.7) years and diabetes duration was 13.9 (6.8, 21.4) years. The IPAQ captured 143 (95%) participants as meeting the PA guidelines. The highest barrier score was fear of hypoglycaemia (3.3 ± 1.9), followed by low fitness level (2.8 ± 1.9); weather (2.8 ± 1.9) and loss of control over your diabetes (2.7 ± 1.9). Glycaemic control, as measured by HbA1c, was positively correlated with BAPAD-1 score (p=0.047). (c) From the themes that emerged there appear to be many frustrations and issues with currently available apps. Previously used apps were found to be burdensome, time consuming, complicated, and the data they received back to be overwhelming. Suggestions that will aid in the design of a T1DM and exercise app included tailoring advice to the individuals based on their individual profile and data entry, advice in the form of suggestions rather than specific figures, and making the app uncomplicated and user friendly. Conclusion: The majority of participants fail to meet PA recommendations, however those that do have healthier cardiovascular risk factor profiles. Participants likely overestimate their PA level using a subjective measure. Several barriers to PA were identified. Participants with T1DM require support and education to safely improve activity levels. Involving individuals with T1DM early in the design of a T1DM and exercise app could help support those looking to commence or increase exercise.