Factors influencing physical activity among diabetics in Malta and Gozo

Abstract

Background: Diabetes mellitus is one of the fastest growing global health emergencies of the 21st century. Type 2 diabetes, which is the most common type, was historically a disease of adults but is increasingly presenting itself as a concern in children and young people due to the rising obesity rates. The prevalence of diabetes among adults in Malta was estimated at 11.2% in 2021 and local mortality rates from diabetes are on the increase, demonstrating worse outcomes than the European average. While treatment guidelines recommend regular physical activity, individuals living with diabetes are generally inactive, which may be a result of both internal and external factors. The purpose of this study was to examine the knowledge, adherence to physical activity, and explore perceived benefits and barriers to physical activity among adults with type 2 diabetes mellitus in Malta and Gozo.

Methodology: A cross-sectional survey was conducted between March and August 2023 by distributing a paper-based questionnaire to type 2 diabetic adults aged 18-69 years attending diabetes clinics at two hospitals and three health centres. Knowledge about physical activity was assessed and physical activity level was measured by the International Physical Activity Questionnaire (IPAQ) short form. Benefits and barriers were assessed using the Exercise Benefits/Barriers Scale (EBBS) and Barriers to Physical Activity in Diabetes (BAPAD) scale. Anthropometric measurements and glycated haemoglobin were obtained. The tool was tested for validity and reliability and piloted. Data was analysed using SPSS and NVivo.

Results: 384 questionnaires were collected (response rate of 95.5%). Participants demonstrated good knowledge of the importance of physical activity and recommended levels, although most (41.7%) were inactive. The majority (over 90%) were overweight/obese and had an increased waist circumference. Physical activity level was significantly associated with body mass index (p=0.016) and waist circumference (p<0.01). The most recognised exercise benefits were those related to physical performance and psychological outlook. The greatest perceived barriers were physical health status, having a low fitness level, the perception that exercise is tiring/fatiguing, and weather conditions. Barriers to physical activity were significantly associated with activity level, such that higher barriers scores predicted lower physical activity levels (p<0.01). Enablers to physical activity were improved health and well-being, environmental factors, and receiving encouragement and support from family, peers, and healthcare professionals.

Conclusions: This was the first local study to explore the perceived benefits, enablers, and barriers to physical activity among type 2 diabetic adults. The study findings revealed that multiple factors can influence adherence to physical activity and a one-size-fits-all approach is unlikely to reap the intended benefits on a national scale. The outcomes of this study may be utilised to inform future national policies and strategies and clinical practice to improve diabetes outcomes among the population of Malta and Gozo.