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28-06-2011 | Diabetes | Article

Diabetic adults more fearful of exercise injury than nondiabetics


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MedWire News: People with diabetes have a greater fear of injury during exercise than nondiabetics, which may explain why they tend to engage in less physical activity, researchers at Colorado University have found.

The strong relationship between physical inactivity and cardiovascular disease in people with diabetes is well established, but this is the first population-based research to demonstrate that people with diabetes not only perform less moderate-to-vigorous physical activity (MVPA) but also engage in less regular walking activity. The study also revealed that diabetic people worried more about getting injured during exercise than did nondiabetics, although this appeared to be at least partly due to older age and being overweight.

The study explored potential barriers deterring diabetic patients from engaging in physical activity, ranging from fear of injury to lack of social and material support. These barrier themes were established using survey questions which generated a picture of the perceived obstacles through feedback such as "afraid of hurting or injuring myself", "I lack people to be physically active with," and "there needs to be better or less expensive facilities available."

Between 2002 and 2004, Amy Huebschmann (University of Colorado, Denver, USA) and team surveyed 2050 randomly selected residents of Alamosa County, a rural biethnic (50% Hispanic) low-income county in south-central Colorado. Respondents self-reported demographic, physical activity and barriers data which were collated into categories: diabetes (Type 1 or 2); no prior diagnosis of diabetes; and gestational diabetes.

These data were then used to compare characterisitics of patients who were "less active" (<150 min of weekly MVPA) compared with those who were "more active" (≥150 min per week of MVPA). The categorization was based on physical activity guideline targets set by the Centers for Disease Control and American College of Sports Medicine in 1995.

The study found that participants with diabetes were 40% less likely than nondiabetic participants to perform at least 10 minutes of MPVA per week and to walk for at least 10 minutes per week.

Among potential barriers to exercise, fear of injury was the only one that differed significantly by diabetes status. However, after adjustment for age and BMI, diabetes status was no longer significantly related to fear of injury, but older age and greater BMI were.

"This study is the first to identify fear of injury as an important barrier to people with diabetes. Older age and greater BMI were more strongly related to having a fear of injury barrier than was the presence of diabetes itself," explain the authors.

They say that their data support continued research to understand and overcome physical activity barriers to diabetes patients, particularly older and heavier patients.

And they suggest that well developed and validated questionnaires could be used in clinical care settings to provide tailored recommendations to overcome barriers.

"The identification of key modifiable barriers should guide health policy decisions and the design of future behavioral intervention trials to increase physical activity for people with diabetes," Huebschmann and team conclude.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Sally Robertson

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