ESPE Abstracts (2018) 89 RFC12.3

Barriers and Sources of Support for the Performance of Physical Activity in Pediatric Type 1 Diabetes

Ruth Livnya, Wasim Saida, Smadar Shiloa, Shoshana Gala, Meirav Orena, Ram Weissa, Nehama Zuckerman-Levina,b, Naim Shehadeha,b & Michal Cohena,b

aRuth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel; bThe Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Background: The advantages of physical activity are particularly emphasized in children with type-1-diabetes and 60 minutes of regular daily activity is recommended. However, reports suggest that children with type-1-diabetes perform less than the recommended daily activity and are less active than their non-diabetic peers. This study aimed to: i) Identify barriers and sources of support for exercise performance in children and adolescents with type-1-diabetes. ii) Identify strengths and limitations in the exercise-directed education provided by our diabetes team.

Methods: Patients with type-1-diabetes 2–20 years of age, followed at the pediatric diabetes clinic, Ruth Rappaport Children’s Hospital were recruited while attending a routine visit. After signing consent, participants completed a set of questionnaires assessing demographic and health data, physical activity and barriers to its performance, family and social support, diabetes related exercise education and its implementation. The clinics’ medical staff, including physicians, nurses and dietitians filled a questionnaire assessing the exercise-directed education provided in clinic.

Results: One-hundred and one patients with type-1-diabetes were included in this study. Mean age was 13.2±4.2 years. Median weekly time of reported exercise was 4 hours (range 0–22), with no significant difference between males and females. The two most prevalent perceived barriers were risk of hypoglycemia and low fitness (reported by 75%, and 51% respectively). Family support scores were generally favorable, mean score 4.1±0.7 (1–5 scale). However, scores for variables reflecting active exercise-participation were in the lower half for over 50% of participants. On the other hand, social support scores were the highest for exercising together and correlated with the amount of activity performed (cc=0.360, P<0.001). The majority of patients (97%) reported that guidance for physical activity was provided in clinic, to their satisfaction. Yet, only 75% reported adjusting food, insulin or activity in order to control glucose during exercise, and less than 50% were familiar with the glucose lowering effect of exercise. All staff members reported conducting routine exercise-directed teaching in clinic, with variations in frequency. The effects of different types of exercise, guidance regarding planning exercise and the diabetes-specific equipment required were topics less consistently included in teaching.

Conclusions: In order to increase the amount of safely performed exercise in pediatric type-1-diabetes, efforts should focus on: i) encouraging active family and social involvement ii) providing structured periodic teaching by diabetes team members and assessing its implementation.

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