How do we support walking prescriptions for type 2 diabetes management? Facilitators and barriers following a 3-month prescription
Andrew N. Reynolds 1 2 4 5 , Ian Moodie 3 , Bernard Venn 2 , Jim Mann 1 2 41 Department of Medicine, University of Otago, Dunedin, New Zealand
2 Department of Human Nutrition, University of Otago, Dunedin, New Zealand
3 Department of English Education, Mokpo National University, Muan, South Korea
4 Edgar Diabetes and Obesity Research Centre, University of Otago, Dunedin, New Zealand
5 Corresponding author. Email: andrew.reynolds@otago.ac.nz
Journal of Primary Health Care 12(2) 173-180 https://doi.org/10.1071/HC20023
Published: 12 June 2020
Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: Prescribing physical activity is an inexpensive method to promote patients’ long-term health, but determinants of adherence with physical activity prescriptions are seldom considered.
AIM: To identify facilitators and barriers experienced by adults with type 2 diabetes when prescribed regular walking.
METHODS: Participants were prescribed a regular walking routine that met current physical activity guidelines for type 2 diabetes management for a period of 3 months. Pre- and post-intervention questions considered participants’ self-rated health and physical activity amount. Thematic analysis of recorded interviews held after the 3-month prescription identified barriers and facilitators to adherence for participants.
RESULTS: Twenty-eight adults (aged 60 ± 9 years, body mass index 32.3 ± 4.0 kg/m2, HbA1c 59 ± 16 mmol/mol) participated in the 3-month intervention, providing 7 years of lived experience. Self-rated health (14%; 95% confidence interval (CI) 7–22%) and time spent walking (+11 min/day; 95% CI 4–18 min/day) increased following the prescription. Major themes motivating participants were: establishing a walking routine; the support of their family members; observing health benefits; and being monitored by a health professional. The greatest barriers were associated with walking in the evening and included feelings of insecurity in the dark or a preference for sedentary behaviour.
DISCUSSION: A prescription to walk increased time spent in physical activity and self-rated health in adults with type 2 diabetes. Health-care professionals can support walking prescriptions by promoting facilitators and reducing barriers to prescription adherence. Practical solutions to barriers include identifying alternative physical activity opportunities within the house or advice to develop support networks to provide company while walking.
KEYwords: Physical activity prescriptions; motivational behaviours; health promotion; obesity
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