Research Summary

Barriers, Facilitators, and Predictors of Physical Activity Among Adults with Type 1 Diabetes

Anthony Calabro, MA

Key Highlights

  • Only 53% of surveyed adults with type 1 diabetes met physical activity (PA) recommendations.
  • Key modifiable barriers to PA included hypoglycemia risk, fatigue, cost, and location.
  • Higher income was significantly associated with meeting PA recommendations.
  • Insurance reimbursement, group classes, and individual advising were commonly cited PA facilitators.

In a cross-sectional online survey of 281 adults with type 1 diabetes (T1D), 53% reported meeting recommended physical activity (PA) guidelines. The most endorsed facilitators for PA included insurance coverage for gym memberships or programs, participation in exercise groups, and one-on-one support from a health advisor. Among those not meeting activity targets, top barriers included fear of hypoglycemia and adverse weather, with additional differences observed in fatigue, cost, location, and perceived loss of glycemic control. This study was presented at ENDO 2025 in San Francisco, CA.

Despite the well-established benefits of PA for people with T1D—including improved glycemic control, quality of life, and mortality—adults with T1D remain less active than their peers. This study was designed to better understand why this gap exists by identifying personal and systemic factors that may help or hinder exercise engagement, and whether certain demographic or psychosocial variables predict PA participation.

Adults aged 18 years and older with T1D were recruited online via the T1D Exchange and Reddit platforms. The survey assessed exercise quantity and intensity, diabetes quality of life (DQOL), self-efficacy, and demographics, including age, gender, income, insurance, location, and use of automated insulin delivery (AID). Barriers to exercise were rated using a 7-point Likert scale. Descriptive statistics, Mann-Whitney U tests, and logistic regression were used to identify differences between those meeting and not meeting PA recommendations and to determine independent predictors.

Among the 281 respondents, 162 (62%) were women, and the average age was 52.6 years. Key facilitators included insurance reimbursement (50.9%), participation in exercise groups (39.9%), and individual counseling (37.4%). In the group not meeting PA targets, median responses indicated that hypoglycemia risk and weather were “likely” to prevent activity (Likert score = 5). Other barriers that significantly differed between groups included fatigue (before and during exercise), cost, location, and loss of glycemic control (all P < .01). Of the variables analyzed, only upper-income status was independently associated with meeting PA recommendations (adjusted odds ratio, 2.3; 95% CI, 1.2–4.4). No significant associations were found for age, gender, insurance status, urban/rural location, automated insulin delivery system use, or diabetes quality of life.

“In this cohort with T1D not meeting recommended PA, most commonly reported modifiable barriers to PA were fear of hypoglycemia/loss of control, fatigue before and during exercise, exercise cost and location,” the study authors concluded.

Reference
Mauro SA, Anderson KC, Panzer AA, Fitzgibbon KS, Love KM. Physical activity facilitators and barriers in adults with type 1 diabetes: a survey-based research study. Presented at: ENDO 2025; July 12-15, 2025; San Francisco, CA. Abstract presented July 12, 2025.