Manutenção do exercício físico por indivíduos com pré-diabetes e diabetes durante a pandemia de COVID-19, após a conclusão de um programa de exercícios estruturado: percepções, motivos e adesão

Abstract

Physical exercise is essential in treating people with diabetes being recommended at least 150 minutes of aerobic exercises of intensity or vigor and 2 to 3 sessions of muscle endurance exercises per week. Although the benefits of regular exercise practice are well established in the literature, about 60% to 70% of the population of people with diabetes is considered insufficiently active. Given the scenario of the COVID-19 pandemic, the harms of physical inactivity gained even more attention. This study aimed (1) to analyze the behavior of individuals with prediabetes or diabetes about exercise after completing a structured physical exercise program delivered partially remote in the midst of the COVID-19 pandemic, taking into consideration their perceptions about living conditions, the facilitators, barriers, and motives to maintain exercise at home and adherence to recommended exercise and the motives that supported physical activity, as well as (2) understanding, from the individual's point of view, the perceptions, experiences, and perspectives about health treatment through digital technologies. The study outcomes were assessed by a bespoke questionnaire developed by the research team; the Brazilian Portuguese adapted version of the Exercise Adherence Rating scale - EARS-Br; the Motives for Physical Activity Measure-Revised scale - MPAM-R; and holding an online focus group. Fifteen individuals (8 women, 58 ± 11 years) participated in the study. The statistical analysis of quantitative data was performed by calculating frequency distributions and central tendency and dispersion measures. The analysis of qualitative data was performed based on thematic content analysis methodology. Although most of the fifteen participants reported positive perceptions about their living conditions and few difficulties to maintain physical exercise at home. The median [interquartile] scores obtained to each motive for physical activity assessed by MPAMR scale were as follow: fitness (7.0 [6.0-7.0]), enjoyment (5.5 [4.2-7.0]), competence (5.4 [3.7-7.0]), social (4.0 [1.8–5.8]) and appearance (3.1 [1.9–5.3]). Seven participants were present in the online focus group (4 women, 54 ± 11 years). Most participants coped well with their health condition during the pandemic and reported little difficulty staying physically active at home, motivated primarily by health concerns. Lack of adequate space was the most significant barrier to exercise at home. Time flexibility, no need to travel and a greater sense of autonomy were the main facilitators for maintaining physical activity. Seven participants attended the online focus group (4 women, 54 ± 11 years). After analyzing the transcript of the discussion, 4 thematic categories emerged: 1) Understanding about health care, 2) Positive and negative aspects of telehealth, 3) Relationship between professional and patient: “there has to be a certain connection” 4) The world digital: “we have to adapt, it's here to stay”. Telehealth was a well-accepted tool, and the main benefits perceived were in relation to time optimization with regard to commuting and waiting lines. The handling of technologies and the lack of coexistence between professional and patient were the most cited difficulties.