Comparative analysis of the demographic, clinical, and social-cognitive factors associated with physical activity among middle-aged women with and without diabetes

Background: Middle-aged women are at high risk for diabetes and cardiovascular disease. Despite the known benefits, 80% of middle-aged women do not meet the physical activity recommendations, especially those with diabetes. The U.S. Department of Health and Human Services recommendation for middle-aged women includes 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity or an equivalent combination of moderate- and vigorous-intensity physical activity (MVPA) spread throughout the week. While appropriate interventions are needed to increase physical activity in middle-aged women with and without diabetes, there is little information about the differences in demographic, clinical, and social-cognitive factors associated with MVPA between these two groups of women. Framework: The conceptual framework for this study, the Behavioral Model of Physical Activity, was based on Social Cognitive Theory and the Theory of Planned Behavior and the demographic, clinical and social-cognitive factors found to be associated with physical activity in the literature. Purpose: The primary purpose of the study was to explore the demographic, clinical, and social-cognitive factors associated with minutes per day of MVPA in middle-aged women with and without diabetes and to compare the two groups on these factors and their MVPA. A secondary purpose was to determine the degree of agreement between a self-report measure, the International Physical Activity Questionnaire (IPAQ) short form, and accelerometry for measuring minutes per day of MVPA. Research Questions: What were the differences between middle-aged women with and without diabetes in their minutes per day of MVPA as measured by the two physical activity measures and their associated demographic, clinical, and social-cognitive factors? What was the degree of agreement in minutes per day of MVPA between the IPAQ short form and the accelerometer? Which demographic, clinical and social-cognitive factors of middle-aged women with and without diabetes were associated with minutes per day of MVPA as measured by the (a) IPAQ short form, and (b) accelerometer? Sample and Setting: Women, 42 with diabetes and 67 without diabetes, between the ages of 45 and 64, were recruited from four urban primary care clinics. Women who fulfilled the inclusion criteria met individually with the investigator at an initial clinic appointment to complete a paper-and-pencil survey and to obtain height and weight. Each woman was provided with an accelerometer and a daily log to complete during the wear-time. During a second clinic appointment with the investigator, the women returned the accelerometer and daily log and completed the IPAQ short version. Results: The majority of women were overweight or obese (n = 93, 86.1%). Women with diabetes had fewer minutes per day of vigorous physical activity than women without diabetes. Middle-aged women with diabetes were more likely to be non-White and have higher body mass index (BMI), higher comorbidity index, lower perceived benefits of physical activity, and lower physical activity self-efficacy than those without diabetes. Minutes per day of MVPA in the women were negatively associated with educational level, BMI, and depressive symptom severity. Implications: Nursing interventions through increased MVPA are needed to decrease high rates of overweight and obesity in middle-aged women with and without diabetes. Nursing strategies targeted toward enhancing perceived benefits of physical activity and physical activity self-efficacy may be promising for achieving this objective for middle-aged women with diabetes.