Trajectories of physical activity and influencing factors in patients with type 2 diabetes mellitus: a mixed-methods study.

Aim: To explore the different trajectories of physical activtity (PA) change in Type 2 diabetes mellitus (T2DM) patients and the factors affecting them, and to delve deeper into the PA experiences and needs of the different trajectory groups.

Design: An observational longitudinal study and a descriptive qualitative study.

Methods: 276 patients with T2DM were recruited from two tertiary hospitals and followed them up in this longitudinal study. Over nine months, Latent Class Growth Modeling (LCGM) was used to identify distinct PA trajectories among patients with T2DM. The Attitude-Social Influence-Self-Efficacy (ASE) model provided the theoretical framework. Data were collected through General Information Questionnaires, Exercise Self-Efficacy Scales, Exercise Behavioral Attitude and Social Influence Scale, and Behavioural Planning Intention Scale. The analysis sought to identify factors affecting changes in PA trajectories. Subsequently, the PA experiences supportive/hindering factors and PA needs of T2DM patients with different trajectories were explored through qualitative interviews. The GRAMMS (Good Reporting of a Mixed Methods Study) checklist was used to guide the reporting of this study.

Results: Patients with T2DM were categorized into 3 distinct trajectories of total PA change: a low-level stabilization group (N = 181, 65.7%), a medium-level fluctuation group (N = 79, 28.7%), and a high-level decline group (N = 16, 5.6%). Logistic regression analysis identified self-efficacy, comorbidities, family environment, and intentions as significant predictors of these trajectories. Additionally, qualitative interviews with 17 participants revealed 7 experiential themes and 3 categories of need.

Conclusion: Three distinct PA trajectories were identified in T2DM patients, each with notable differences in PA experiences and needs. It is suggested that healthcare providers should therefore develop targeted, systematic health education and intervention programs tailored to individual patient characteristics to sustain PA behavior and achieve long-term PA benefits.