Transforming Motivation for Exercise in a Safe and Kind Environment-A Qualitative Study of Experiences among Individuals with Type 2 Diabetes.

Exercise is a cornerstone in diabetes care; however, adherence is low and sustaining physical activity remains a challenge. Patient-centered diabetes self-management education and support are recommended; however, sparse literature exists on how to design exercise interventions that improve self-management in individuals with complications of type 2 diabetes mellitus (T2D). We aimed to gain insights into needs, barriers, and motivation based on experiences with exercise participation among individuals with T2D and complications to adjust and develop new types of tailored, supervised exercise classes in specialized care at three hospitals in Denmark. In keeping with a constructivist research paradigm, a qualitative hermeneutic approach using focus group interviews was applied to explore perspectives among different participants in terms of disease severity. Seven interviews with 30 participants (aged 49-88) representing seven different exercise classes, were conducted over three years. Reflective thematic analysis was used. Four themes were generated: People like us, Getting started with exercise, Game changers, and Moving forward. An overarching theme 'The transformation of motivation when exercising in a safe and kind environment' links the themes together, resembling the participants' development of physical literacy encompassing motivation, confidence, physical competence as well as an ability to value physical activity. Supportive patient-centered exercise classes promoted a transformation of motivation grounded in the development of physical literacy among participants in specialized diabetes care. However, participants were concerned with continuing to exercise on their own after the intervention, as they experienced a lack of continuous, supervised exercise opportunities in local communities.

Effectiveness and acceptability of a pragmatic exercise intervention for patients with type 2 diabetes in specialized care.

AIMS: Physical activity improves glycaemic control in type 2 diabetes (T2D), but adherence is low, and diabetes complications are barriers towards adopting physical activity. We investigated adherence and effects of individualized supervised exercise. METHODS: Patients with intermediate (level 2) to high (level 3) risk of complications to T2D (stratified by Danish risk stratification model) were offered 12 weeks of exercise. Primary outcomes were working capacity assessed with the Åstrand-Rhyming cycling test (Åstrand), functional capacity assessed with the 30-second chair-stand test(30 s-CST) and health-related quality of life assessed with EuroQoL-5D-5L (EQ-5D-5L). Associations between stratification levels (2vs3) and drop-out, changes in 30 s-CST and EQ-5D-5L were analysed using multiple regression. RESULTS: In total 350 patients accepted participation and 254 (73%) completed with 26 patients experiencing an adverse event. Odds ratio (OR) for non-completion were 1.82 [1.02-3.23] (p = 0.043) for patients stratified level 3 vs 2.Improvements were seen in Åstrand 2.71 [1.59; 3.83] ml O2/kg/min (p < 0.001), in 30 s-CST2.34 [2.01; 2.67] repetitions (p < 0.001) andin EQ-5D-5L 0.01 (-0.05 to 0.11) (p = 0.002). There were no associations between changes and risk-stratification levels. CONCLUSIONS: Clinically relevant changes were seen after exercising regardless of the stratification levels in patients with intermediate to high risk of complications to T2D.