Introduction
In people with type 2 diabetes mellitus (T2DM), physical activity has been shown conclusively to improve blood glucose levels,1 2 maintain a healthy weight,3 reduce cardiovascular risks4 and reduce overall mortality,5 as well as reducing depressive symptoms and improving quality of life.6 National and international T2DM management guidelines advocate for a minimum of 150 min of moderate-intensity aerobic physical activity spread across most, if not all, days of the week,7 8 which is equivalent to 600 MET-min. However, it is estimated that only one-third of adults with T2DM meet these physical activity recommendations and that inactivity is responsible for 7% of the burden of disease caused by all types of diabetes globally.5
The complex, chronic and progressive nature of T2DM requires ongoing multidisciplinary clinical support, including regular diabetes consultations with health professionals (recommended every 3–12 months).7 The majority of T2DM clinical care is provided in the primary care setting,7 and the role of the general practitioner (GP) includes monitoring of clinical outcomes, complication risk, emotional well-being, timely review and prescription of treatment, and facilitation of diabetes self-management education and support. From diagnosis, irrespective of treatment progression, GPs should provide ongoing education, goal setting and monitoring of physical activity, including discussion of risks, benefits and safety advice.7
There is evidence that people with T2DM attending appointments with GPs who use counseling principles within their consultations (eg, person centered, compassionate, respectful, unrushed) are more likely to achieve the recommended level of physical activity.9–11 Research suggests that the majority of GPs perceive physical activity counseling to be important and within the scope of their role.12 However, GPs report several challenges to providing physical activity counseling, including systemic barriers (eg, lack of time, resources or counseling protocols/guidelines) and professional barriers (eg, lack of knowledge and skills).12 Lifestyle counseling may not be prioritized when trying to address the various and complex aspects of managing diabetes, as well as other comorbidities, and other concerns/priorities of the person with T2DM within a single appointment.13 GPs may perceive that they are left with little time to discuss the need for lifestyle modifications such as physical activity, or to help motivate patients to be more active.13 Evidence suggests that GPs may also feel uncomfortable providing detailed or authoritative advice about physical activity (eg, ‘exercise prescriptions’).12
By avoiding, delaying or minimizing discussion of physical activity within primary care, there are missed opportunities to raise awareness of its benefits, identify barriers to reaching recommended targets, and support people with T2DM to increase their physical activity level. Previous research has demonstrated the effectiveness of primary care-based behavioral interventions, compared with usual care, in increasing physical activity among people with T2DM.9 A study incorporating the findings of a systematic review of 17 interventions identified the behavior change techniques (BCT) that were associated with increased physical activity.9 BCTs are ‘observable and replicable components of behaviour change interventions’ used to elicit a specific and more desirable response.14 In a separate study, Avery and colleagues15 also identified four specific BCTs from a recognized taxonomy,16 which were associated with increased physical activity: (1) prompt focus on (memory of) past success, (2) barrier identification/problem solving, (3) use of follow-up prompts, for example, motivational telephone calls, and (4) providing information on where and when to perform physical activity. This research suggests that GPs could optimize lifestyle counseling by applying these evidence-based strategies in their brief consultations. However, it remains unclear whether these or other BCTs are currently and commonly used in primary care consultations about physical activity with people with T2DM, and whether these are associated with achieving the recommended physical activity level in the ‘real-world’.
Therefore, the aim of this study, in a general population of Australian adults with T2DM, was to examine associations between participants’ self-reported engagement in the recommended level of physical activity and recall of specific physical activity-related interactions used by their GPs.7 17 18