title: Attitudes and barriers to exercise in adults with type 1 diabetes (T1DM) and how best to address them: a qualitative study.
abstract: BACKGROUND
  Regular physical activity has recognised health benefits for people with T1DM. However a significant proportion of them do not undertake the recommended levels of activity. Whilst questionnaire-based studies have examined barriers to exercise in people with T1DM, a formal qualitative analysis of these barriers has not been undertaken. Our aims were to explore attitudes, barriers and facilitators to exercise in patients with T1DM.
  
  
  METHODS
  A purposeful sample of long standing T1DM patients were invited to participate in this qualitative study. Twenty-six adults were interviewed using a semi-structured interview schedule to determine their level of exercise and barriers to initiation and maintenance of an exercise programme.
  
  
  RESULTS
  Six main barriers to exercise were identified: lack of time and work related factors; access to facilities; lack of motivation; embarrassment and body image; weather; and diabetes specific barriers (low levels of knowledge about managing diabetes and its complications around exercise). Four motivators to exercise were identified: physical benefits from exercise; improvements in body image; enjoyment and the social interaction of exercising at gym or in groups. Three facilitators to exercise were identified: free or reduced admission to gyms and pools, help with time management, and advice and encouragement around managing diabetes for exercise.
  
  
  CONCLUSIONS
  Many of the barriers to exercise in people with T1DM are shared with the non-diabetic population. The primary difference is the requirement for education about the effect of exercise on diabetes control and its complications. There was a preference for support to be given on a one to one basis rather than in a group environment. This suggests that with the addition of the above educational requirements, one to one techniques that have been successful in increasing activity in patients with other chronic disease and the general public should be successful in increasing activity in patients with T1DM.
authors.affiliation: School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Diabetes, Nuffield House, The Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: Nadia
authors.initials: N
authors.lastname: Lascar
authors.affiliation: School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Diabetes, Nuffield House, The Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: Amy
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Beverley
authors.initials: B
authors.lastname: Hancock
authors.affiliation: Department of Diabetes, Nuffield House, The Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Jenkins
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Andrews
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Sheila
authors.initials: S
authors.lastname: Greenfield
authors.affiliation: School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Diabetes, Nuffield House, The Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: Parth
authors.initials: P
authors.lastname: Narendran
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D001294:Attitude to Health; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000523:psychology / Q000628:therapy*; D015444:Exercise / Q000523:psychology*; D005081:Exercise Therapy / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D036301:Qualitative Research; D017748:Time Management