Exercise adherence in diabetes: Evaluating the role of behavioral factors in managing diabetes

Background: Although regular exercise can effectively reduce blood pressure (BP) and diabetic complications, adherence to exercise recommendations is a major challenge facing diabetic adults. We examined demographic and behavioral variables that could influence exercise in diabetic patients.

Methods: Exercise (hours/week) was measured using the 7-day Physical Activity Recall and exercise adherence was classified using established exercise recommendations (>3 days/week for at least 20 minutes each). We assessed exercise self-efficacy (SE), a validated 5-30 point scale and exercise-related social support, a two-dimension scale assessing participation in exercise and rewards and punishments for exercise from others. Demographics and BP medications were obtained from patient records. Robust regressions examined these variables' relationship to duration of exercise, and logistic regression evaluated predictors of exercise adherence.

Results: We evaluated data from 226 male hypertensive diabetic veterans participating in a clinical trial to control BP. Each point increase in social support (p<.05) and exercise SE (p<.001) was associated with a 0.29 and 0.14 hours/week increase in exercise. Results also revealed that exercise SE (p<.01) increased the likelihood of exercise adherence. A lower number of prescribed BP medications (p<.05) was associated with increased exercise adherence as well. Age, race, BMI, and BP were not multivariately associated with any aspects of exercise.

Conclusion: Our findings suggest that interventions should incorporate often ignored behavioral aspects by increasing SE, providing social support, and reducing number of prescribed medications. Incorporating these into standardized treatment may lead to increased physical activity and higher adherence to exercise recommendations, improving management of diabetes.