systematic review and thematic synthesis of the barriers and facilitators to physical activity for women after gestational diabetes: a socio-ecological approach

Physical activity can reduce risk of type 2 diabetes (T2DM) after gestational diabetes. Understanding barriers and facilitators to physical activity, using a socio-ecological approach, could better direct multi-level interventions. The present review aimed to synthesise barriers and facilitators to physical activity, and to develop an understanding of where, across the socio-ecological model, these factors exist and/or are interrelated. Eligible studies included women with a history of gestational diabetes and a discussion around physical activity. A systematic search of MEDLINE, the Cochrane Library, Web of Science, CINAHL Complete and Scopus was conducted in October 2022. Barriers and facilitators to physical activity were thematically analysed and themes organised according to the socio-ecological model. Twenty-nine studies were included. Barriers pertained to leisure time physical activity, while other types of activity including housework and transport were overlooked, despite being routine. Partner and family support were vital for engagement with activity, whether emotional support or provision of childcare. Most barriers and facilitators at the social and organisational levels were interrelated with those at the individual level. These findings suggest that multi-level physical activity interventions after gestational diabetes could be most effective.