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This article originally posted 14 July, 2011 and appeared in  PreventionPhysical ActivityIssue 582

Why Do Patients with Diabetes Walk Less?

Physical activity is a cornerstone of treatment for diabetes, yet people with diabetes perform less moderate and vigorous physical activity (MVPA) than people without diabetes....

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Diabetes-specific barriers to physical activity are a possible explanation for lower MVPA in patients with diabetes. Some barriers that have been identified are "fear of hypoglycemia," the presence of "bad feet due to diabetes," and an "unwillingness to exercise in the presence of people who do not have type 2 diabetes." Other barriers include lack of social support, lack of knowledge of the types of exercise to perform, health problems, pain/difficulty taking part in exercise, lack of local exercise facilities, and aversion to exercising in poor weather. Regular walking activity is the preferred activity of people with diabetes. 

The study compares adults' barriers to physical activity by diabetes status in a rural, population sample.

Walking is a preferred form of activity in diabetes, but people with diabetes walk less than people without diabetes, often citing fear of injury, according to the results of a study.

"In contrast, whether differences in walking activity exist has been understudied. Diabetes-specific barriers to physical activity are one possible explanation for lower MVPA in diabetes," the authors write. "We hypothesized that people with diabetes would perform less walking and combined MVPA and would be less likely to anticipate increasing physical activity if barriers were theoretically absent compared with people without diabetes."

From 2002 to 2004, 1848 randomly selected adult residents of rural Colorado were surveyed by telephone regarding their weekly duration of walking and MVPA. They were also asked about their likelihood of increasing their physical activity if each of 7 barriers was theoretically removed. Odds ratios (ORs) for persons with vs. without diabetes were adjusted for age, sex, body mass index (BMI), and ethnicity. "Less active" persons were defined as those who reported less than 150 minutes of weekly MVPA, and "more active" persons were defined as those who reported 150 minutes or more of weekly MVPA.

Compared with persons without diabetes, those with diabetes (n = 129) had lower odds of walking and MVPA for 10 or more vs. less than 10 minutes/week (walking-adjusted OR, 0.62; 95% confidence interval [CI], 0.40 - 0.95; MVPA-adjusted OR, 0.60; 95% CI, 0.36 - 0.99).

Fear of injury was reported to be a barrier to physical activity more often by respondents with diabetes than by respondents without diabetes (56% vs. 39%; P = .0002). However, adjustment for age and BMI attenuated this association (OR, 1.36; 95% CI, 0.93 - 1.99).

"Although walking is a preferred form of activity in diabetes, people with diabetes walk less than people without diabetes," the study authors write. "Reducing fear of injury may potentially increase physical activity for people with diabetes, particularly in older and more overweight individuals."

"Further research is needed to identify and overcome physical activity barriers for people with diabetes," the study authors conclude. "From a public health perspective, we need to identify key modifiable physical activity barriers that are related to physical activity levels in larger studies that are representative of the overall population with diabetes. The identification of key modifiable barriers should guide health policy decisions and the design of future behavioral intervention trials to increase physical activity for people with diabetes."

Diabetes Care. Published online June 23, 2011

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This article originally posted 14 July, 2011 and appeared in  PreventionPhysical ActivityIssue 582

Past five issues: Diabetes Clinical Mastery Series Issue 204 | Issue 744 | Diabetes Clinical Mastery Series Issue 203 | Issue 743 | Diabetes Clinical Mastery Series Issue 202 |


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