title: General Practitioners' Barriers to Prescribe Physical Activity: The Dark Side of the Cluster Effects on the Physical Activity of Their Type 2 Diabetes Patients.
abstract: OBJECTIVE
  To describe barriers to physical activity (PA) in type 2 diabetes patients and their general practitioners (GPs), looking for practitioner's influence on PA practice of their patients.
  
  
  METHODS
  We conducted a cross-sectional study on GPs (n = 48) and their type 2 diabetes patients (n = 369) measuring respectively barriers to prescribe and practice PA using a self-assessment questionnaire: barriers to physical activity in diabetes (BAPAD). Statistical analysis was performed accounting hierarchical data structure. Similar practitioner's patients were considered a cluster sharing common patterns.
  
  
  RESULTS
  The higher the patient's BAPAD score, the higher the barriers to PA, the higher the risk to declare practicing no PA (p<0.001), low frequency and low duration of PA (p<0.001). A high patient's BAPAD score was also associated with a higher risk to have HbA1c ≥7% (53 mmol/mol) (p = 0.001). The intra-class correlation coefficient between type 2 diabetes patients and GPs was 34%, indicating a high cluster effect. A high GP's BAPAD score, regarding the PA prescription, is predictive of a high BAPAD score with their patients, regarding their practice (p = 0.03).
  
  
  CONCLUSIONS
  Type 2 diabetes patients with lower BAPAD score, thus lower barriers to physical activity, have a higher PA level and a better glycemic control. An important and deleterious cluster effect between GPs and their patients is demonstrated: the higher the GP's BAPAD score, the higher the type 2 diabetes patients' BAPAD score. This important cluster effect might designate GPs as a relevant lever for future interventions regarding patient's education towards PA and type 2 diabetes management.
authors.affiliation: Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital (CHU), BP 68, 63001, Clermont-Ferrand, Cedex 1, France; Clermont University, University of Auvergne, Clermont-Ferrand, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lanhers
authors.affiliation: Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital (CHU), BP 68, 63001, Clermont-Ferrand, Cedex 1, France; Laboratory of Human Nutrition, INRA UMR 1019, Clermont-Ferrand, France; Clermont University, University of Auvergne, Clermont-Ferrand, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Duclos
authors.affiliation: Clermont-Ferrand University Hospital, Department of Public Health, Biostatistics Unit, Clermont-Ferrand, France; Laboratory of Image Sciences for Interventional Techniques, UMR CNRS UdA 6284 ISIT, Auvergne University, Clermont-Ferrand, F-63001, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Guttmann
authors.affiliation: Clermont University, University of Auvergne, Clermont-Ferrand, France; Clermont-Ferrand University Hospital, Department of Physical Medicine and Rehabilitation, Clermont-Ferrand, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coudeyre
authors.affiliation: Laboratory of Image Sciences for Interventional Techniques, UMR CNRS UdA 6284 ISIT, Auvergne University, Clermont-Ferrand, F-63001, France; Clermont-Ferrand University Hospital, Innovation and Clinical Research, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Clermont-Ferrand University Hospital, Department of Public Health, Biostatistics Unit, Clermont-Ferrand, France; Laboratory of Image Sciences for Interventional Techniques, UMR CNRS UdA 6284 ISIT, Auvergne University, Clermont-Ferrand, F-63001, France.
authors.forename: Lemlih
authors.initials: L
authors.lastname: Ouchchane
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D005081:Exercise Therapy / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D055656:Prescriptions / Q000706:statistics & numerical data*