Background: The benefits of regular exercise are well recognized in type 2 diabetes subjects. However, a substantial proportion of patients don’t exercise at all. We aimed to enumerate the barriers to exercise in Type 2 Diabetes Mellitus (T2DM) patients and factors associated with these barriers.
Methodology: We conducted a cross-sectional study of successive type 2 diabetes patients attending routine out-patient diabetes clinics in five tertiary care hospitals in Kolkata, India from 1st April,2017 to 31st March 2018. All patients who matched our study eligibility criteria were interviewed by diabetes care providers using a structured questionnaire modeled after a systematic review of similar studies but tuned to regional preferences. Besides demographic details, patient particulars and laboratory investigations, the questionnaire included 2 direct questions on possible barriers to exercise. The questions were grouped into five categories viz. environmental (4 questions), behavioral (9 questions), occupational (2 questions), physical inability (7 questions) and medical reason (1 question). Patients’ who didn’t meet the ADA-EASD recommended exercise (at least 150 minutes moderate intensity aerobic physical activity viz. brisk walking at 3-4 km-hr) were classified as non-exercisers.
Results: The present study included a total of 1061 patients of which 617 were males versus 444 females. 636 (59.9%) were not doing physical activity as per current international standards. A substantial higher proportion of females (68.9%) did not exercised as compared to males (53.5%), which is statistically significantly higher, p<0.001. Insulin usage was found to be significantly associated to hamper exercise (p=0.017), physical activity being 8% lower (34.5% in insulin users versus 42.5% in non-insulin users). Male gender (OR-1.877, 95% CI=1.217-2.894, p=0.004) and doctor’s prior advice for exercise (OR-3.397, 95% CI=2.035-5.671, p<0.001) were found as significant predictors for increased physical activity.
Conclusion: This study elaborates the need for awareness regarding possible barriers when counseling T2DM patients. Exercise remains one of the cheapest pillars of DM management, the benefits of which extend beyond glycemic control. However, as this study illustrates about 60% of patients with T2DM do not carry out the recommended exercise. This study also highlights the importance of physician advice regarding exercise. Behavioural causes seem to be the commonest barrier to exercise and hence strategies to target the same needs to be thought of.
Physical Activity of Moderate Intensity and Risk of Type 2 Diabetes: A systematic review
