Facilitators, barriers, and interventions for exercise adherence in patients with prediabetes: a mixed-methods systematic review.

Abstract

Background: As a critical preclinical stage of type 2 diabetes (T2D), prediabetes necessitates urgent lifestyle interventions to halt disease progression. Despite robust evidence supporting the efficacy of exercise in improving glycemic control, exercise adherence remains suboptimal among individuals with prediabetes.

Objectives: This review aimed to identify barriers and facilitators to exercise adherence in individuals with prediabetes while also extracting evidence-based behavior change techniques (BCTs) that may enhance physical activity maintenance.

Design: Mixed-methods systematic review.

Data sources and methods: A comprehensive literature search was performed in 10 databases from inception to November 2024. Guided by the JBI Manual for Evidence Synthesis, a convergent integrated approach was used to map barriers and facilitators to the Behavior Change Wheel (BCW) and Theoretical Domains Framework (TDF). TDF domains were ranked by frequency across studies, while adherence-promoting interventions were mapped to BCW intervention functions and BCTs. Barriers were systematically linked to BCW intervention functions and BCTs to guide implementation design.

Results: A total of 36 studies were included, consisting of 9 qualitative studies, 24 quantitative studies (15 randomized controlled trials, 5 cross-sectional studies, and 4 quasi-experimental studies), and 3 mixed-methods studies. The synthesis identified "lack of time," "lack of appropriate exercise equipment or venues," and "health-related physical limitations" as predominant barriers. Conversely, "perceived health benefits," "social support," and "tools or methods to help with exercise adherence" emerged as key facilitators. These factors were mapped to five primary TDF domains: reinforcement, environmental context and resources, behavioral regulation, social influences, and skills. Furthermore, seven intervention functions derived from the BCW were linked to 21 BCTs.

Conclusion: This review highlights multifaceted determinants of exercise adherence in individuals with prediabetes and identifies theory-informed strategies to address barriers to adherence. Determinants supported more consistently across studies may provide a stronger basis for intervention development, whereas less frequently reported findings should be interpreted more cautiously.

Trial registration: PROSPERO CRD42024605588.