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Barriers to Physical Activity in Children and Adults Living With Type 1 Diabetes: A Complex Link With Real-life Glycemic Excursions

Published:October 26, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.10.006

      Abstract

      Objectives

      Ever since the first research on barriers to physical activity (PA) highlighting fear of hypoglycemia as a major barrier, many studies have attempted to understand their demographic and behavioural determinants. However, no research has been conducted on whether these perceived barriers toward PA are based on real-life–experienced adverse glycemic effects of exercise.

      Methods

      Sixty-two adults and 53 children/adolescents living with type 1 diabetes along with their parents completed the Barriers to Physical Activity in Type 1 Diabetes-1 (BAPAD-1) questionnaire on barriers to PA. Continuous glucose-monitoring data were collected during 1 week of everyday life for 26 adults and 33 children/adolescents. Multiple linear regressions were used to explore links between BAPAD-1 scores and glycemic excursions experienced during and after everyday-life self-reported PA sessions, controlling for behavioural (accelerometry) and demographic confounders.

      Results

      In children/adolescents, the more time spent in hypoglycemia on nights after PA sessions, the more they reported hypoglycemic risk as a barrier (ß=+0.365, p=0.034). Conversely, in adults, the higher the proportion of PA sessions accompanied by a drop in blood glucose, the less hypoglycemia was a barrier (ß=−0.046, p=0.004). In parents, BAPAD-1 scores were unrelated to children/adolescents’ everyday-life exercise-induced hypo/hyperglycemia.

      Conclusions

      In children/adolescents, fear of hypoglycemia was predominant in those exposed to nocturnal hypoglycemia associated with PA sessions. In adults, fewer barriers may mean they accept a bigger drop in their glycemia during PA. This shows the importance of finding and promoting age-specific solutions to prevent exercise-induced hypoglycemia.

      Résumé

      Objectifs

      Depuis les premières recherches sur les obstacles à l’activité physique (AP) qui ont démontré que la peur de l’hypoglycémie était un obstacle majeur, plusieurs études ont tenté de comprendre leurs déterminants démographiques et comportementaux. Toutefois, aucune recherche visant à déterminer si ces obstacles perçus à l’AP sont fondés sur les effets indésirables réels de l’exercice sur la glycémie n’a été réalisée.

      Méthodes

      Soixante-deux adultes et 53 enfants/adolescents diabétiques de type 1 et leurs parents ont rempli le questionnaire Barriers to Physical Activity in Type 1 Diabetes-1 (BAPAD-1) sur les obstacles à l’AP. Les données de surveillance de la glycémie en continu ont été collectées durant 1 semaine de vie habituelle chez 26 adultes et 33 enfants/adolescents. Des régressions linéaires multiples ont été utilisées pour explorer les liens entre les scores BAPAD-1 et les excursions glycémiques vécues pendant et après les séances quotidiennes d’AP auto-déclarées en tenant compte des facteurs de confusion comportementaux (accélérométrie) et démographiques.

      Résultats

      Plus les enfants/adolescents passaient de longues périodes en hypoglycémie au cours des nuits qui suivaient les séances d’AP, plus ils déclaraient que le risque d’hypoglycémie était un obstacle (ß = +0,365, p = 0,034). À l’inverse, plus les adultes avaient une proportion de séances d’AP accompagnées d’une baisse de la glycémie, moins l’hypoglycémie était un obstacle (ß = −0,046, p = 0,004). Chez les parents, les scores BAPAD-1 n’étaient pas reliés aux hypo/hyperglycémies des enfants/adolescents induites par l’exercice quotidien.

      Conclusions

      Chez les enfants/adolescents, la peur de l’hypoglycémie était prédominante chez ceux qui étaient exposés à l’hypoglycémie nocturne associée aux séances d’AP. Chez les adultes, le fait d'avoir moins de barrières peut signifier qu’ils acceptent une baisse plus importante de leur glycémie durant l’AP. Ceci démontre l’importance de trouver et de promouvoir des solutions en fonction de l’âge pour prévenir l’hypoglycémie induite par l’exercice.

      Keywords

      Mots clés

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