A thematic analysis of barriers and facilitators of physical activity, and strategies for management of blood glucose levels around physical activity for adolescents with type 1 diabetes

Background

Optimal blood glucose management is essential for optimal managing type 1 diabetes (T1D). Exercise is an efficacious, non-pharmacological, and cost-efficient adjunctive treatment that provides additional health benefits. Nevertheless, many adolescents with T1D are not meeting recommended physical activity levels and struggle with implementing appropriate management strategies around exercise.

Aims

To investigate in adolescents with T1D: 1) physical activity levels; 2) management strategies utilised around physical activity; and 3) barriers and facilitators to physical activity engagement.

Methods

Physical activity levels were assessed using the PAQ-C and PAQ-A questionnaires. A cut-off score of 2.75 was adopted to classify participants as meeting the recommended ≥60 minutes of moderate-to-vigorous daily physical activity. Semi-structured interviews with 16 adolescents were conducted, followed by NVivo-assisted thematic analysis.

Results

The mean PAQ-score was 2.7(SD±0.77), with 25% adhering to the recommended physical activity guidelines. Themes related to management strategies were explored, including blood glucose monitoring, insulin-related, exercise-related, and nutrition-related strategies. Identified barriers included limited T1D management knowledge, negative social impact, difficulty with technology, poor planning and organisation, individual physiological responses, and the burden of T1D management. Facilitators included the ability to optimally manage the condition, having supportive people who understand and service supports.

Conclusions

This study identified barriers and facilitators to managing blood glucose levels around and during physical activity in adolescents with T1D. This provides clinical insights into the management strategies utilised around physical activity and factors affecting participation that can inform the future promotion of physical activity in this population. In this cohort, two-thirds did not meet the recommended physical activity levels. Physical activity participation was primarily influenced by adolescents' confidence and ability to manage their condition around exercise. Exercise promotion strategies should focus on supporting optimal exercise management patterns for adolescents with T1D.