Study On The Trajectory Of Physical Activity And Influencing Factors In Patients With Type 2 Diabetes Mellitus

Objective1.To investigate the current status of physical activity and stage distribution in patients with type 2 diabetes mellitus.2.To investigate the trajectory of physical activity changes and related influencing factors in patients with type 2 diabetes mellitus.3.To explore the experience and demands of physical activity in patients with type 2 diabetes mellitus in different trajectories.MethodsThe data related to physical activity were collected from September 2021 to December 2022 from patients with type 2 diabetes mellitus who met the inclusion-exclusion criteria,and consisted of three main parts.1.Study on the current status of physical activity and stage distribution in patients with type 2 diabetes mellitusIn this section,a cross-sectional survey was conducted in two tertiary hospitals in Yangzhou City from September 2021 to January 2022 among 315 patients with type 2 diabetes mellitus.Self-made general information Questionnaire and International Physical Activity Questionnaire(IPAQ)were used to understand their current physical activity status.The sixstage behavior scale in the "The four steps from Inactivity to Activity Model" were used to understand the stage distribution of physical activity behavior.The study was analyzed using SPSS25.0 software.The statistical methods included descriptive analysis,chi-square tests,and multinomial logistic regression analysis.2.Study on the trajectory of physical activity changes and factors influencing in patients with type 2 diabetes mellitusIn this part,based on the previous cross-sectional study,we continued to follow the physical activity of patients with type 2 diabetes mellitus at 3 months,6 months,and 9 months after baseline.We used latent class growth model to describe the general change trend of physical activity levels of 276 patients with type 2 diabetes mellitus,and then to fit the best trajectory groups of physical activity.The General Information Questionnaire,Exercise Selfefficacy Scale(ESES),Attitude towards Regular Exercise Behavior Scale,Social Impact Scale and Planned Behavior Intention Scale were used to evaluate the influencing factors of the change trajectory of physical activity of patients.SPSS25.0 and Mplus8.0 softwares were used to data analysis.The statistical methods included descriptive analysis,chi-square test,analysis of variance,nonparametric test,generalized estimating equation,latent class growth model and multinomial logistic regression analysis.3.Qualitative study on experience and demands of physical activity in patients with type 2 diabetes mellitus in different trajectory groupsTo conduct qualitative interviews with type 2 diabetes patients in different trajectory groups,analyze and compare the physical activity experience,promoting or hindering factors and their own exercise needs of patients in different trajectory groups,so as to provide a basis for the construction of targeted physical activity intervention programs.The study used Nvivo 11.0 software for case editing and Colaizzi content analysis for data tabulation.Results1.Study on the current status of physical activity and stage distribution in patients with type 2 diabetes mellitusThis part of the study included 315 patients with type 2 diabetes mellitus with an overall physical activity level of 1038(660,1590)MET-min/w,with leisure-related physical activity as the main type of physical activity and walking as the main intensity of physical activity,and 82.54%of patients met the physical activity criteria of the IPAQ.In the phase distribution survey,26 patients were in the "pre-consideration phase"(8.25%),37 patients were in the"consideration phase"(11.74%),32 patients were in the "preparation phase"(10.15%),38 patients were in the "exploration phase"(12.06%),74 patients were in the "fluctuation phase"(23.50%),and 108 patients were in the "maintenance phase"(34.30%).Univariate results showed that age,duration of diabetes,education level,occupation,place of residence,personal monthly income/pension,body mass index,physical activity attainment and level of physical activity had statistically significant differences in the distribution of behavior stages(P<0.05).Logistic regression analysis showed that age,occupation,duration of diabetes,mode of residence,body mass index and physical activity attainment were factors affecting the stage distribution of physical activity behavior in patients with type 2 diabetes mellitus(P<0.05).2.Study on the trajectory of physical activity changes and factors influencing in patients with type 2 diabetes mellitusA total of 276 patients with type 2 diabetes who completed follow-up were included in this section.The patients were examined for dynamic changes in physical activity over 9 months using generalized estimating equations.The results showed that the patients were statistically significant(P<0.05)in the dimensions of overall level,type of housework-related,type of leisure-related,walking intensity,and high intensity.Three sets of trajectories of changes in total physical activity with different characteristics were fitted with the latent class growth model:"low-level stable group"(N=181,65.7%),"medium-level fluctuating group"(N=79,28.7%)and "high-level decreasing group"(N=16,5.6%).The housework-related type,leisure-related type,and walking intensity dimensions of physical activity were also explored separately,and the fitting results were similar to the trajectory of change in total physical activity.Univariate results showed statistically significant differences(P<0.05)in the distribution of patients in the 3-category trajectory group by gender,age,personal monthly income/pension,comorbidities,and family environment.The results of variance analysis showed that the variables of attitude,social support,subjective norms,self-efficacy and intention had statistical differences in the distribution of the three locus groups(P<0.05),while the social role model had no statistical significance(P>0.05).Multiple logistic regression showed that self-efficacy,complications,family environment and intention were the predictive factors of the change trajectory of physical activity.3.Qualitative study on experience and demands of physical activity in patients with type 2 diabetes mellitus in different trajectory groupsA total of 17 interviewees were included in this part of the study.Interview analysis of 4 patients in the "high-level decreasing group" yielded 3 themes:Physical activity is a habit,and the benefit of exercise is shared.Physical activity at work is physically demanding and a sense of responsibility drives adherence to goals.Doctor-patient communication is enhanced and personalized professional guidance is provided.Interview analysis of 6 patients in the"medium-level fluctuation group" yielded 4 themes:Correct illness perception and willingness to increase social support.Increased physical activity time and self-efficacy.Heavy fear of illness and fluctuations in the amount of exercise stability.Provision of continuity of service support and maintenance of long-term health education.Interview analysis of 7 patients in the"low-level stable group" yielded 5 themes:Heavy life of burden and degradation of patient’s role.Inadequate disease awareness and force majeure hindrance.Severe negative emotions and lack of motivation to be physically active.Increased material attraction to drive disease focus.Reduce barriers to disease movement and increase motivation for physical activity.Conclusions1.The physical activity of patients with type 2 diabetes mellitus was generally at a medium level,among which leisure-related physical activity was the main type of physical activity,and walking was the main physical activity intensity.The physical activity of most patients was in the "fluctuation phase" and the "maintenance phase".The "fluctuation phase" is easily neglected but very important behavior stage.It is suggested that medical staff should pay attention to patients in this stage,formulate targeted interventions to promote them to change to the "maintenance phase" and maintain stable and regular physical activity behavior.2.There were three different trajectories of physical activity in patients with type 2 diabetes mellitus.The fit results for the dimensional trajectory groupings of housework-related,leisurerelated,and walking intensity were similar to the overall physical activity change trajectory group.Self-efficacy,presence or absence of complications,family environment and intention were the predictors of grouping the patients’ physical activity trajectories.3.There were differences in the influencing factors of physical activity experience and demands among patients in different trajectory groups.It is suggested that medical staff should formulate targeted and systematic health education and intervention measures according to patients with different characteristics and needs,to promote patients to maintain physical activity behavior and obtain stable exercise benefits.