Adherence to physical activity guidelines associated with self-care management and self-regulatory efficacy for type 2 diabetes among Black/African American men

Background: Existing literature primarily focuses on predominantly Caucasian populations, creating a gap in understanding the factors influencing physical activity (PA) adherence and self-care behaviors specifically in Black/African American men with Type 2 diabetes (T2D), a group disproportionately affected by the condition. This study aimed to examine the relationship between adherence to PA guidelines, self-care management and self-regulatory efficacy for T2D among Black/African American men. Methods: Cross-sectional data from 1225 Black/African American men with T2D were analyzed, with adherence to PA guidelines defined as 450 Metabolic Equivalent of Task (MET)-minutes/week or more. Self-care management and self-regulatory efficacy were measured using validated questionnaires. Results: Descriptive statistics, bivariate analyses and logistic regression models were used to analyze the relationships between PA adherence, self-care management and self-regulatory efficacy. The average of participants’ age was 41.9 years old (±14.5), and number of chronic conditions was 2.5 (±1.9). Participants who adhered to PA guidelines demonstrated significantly higher self-care management and self-regulatory efficacy compared to non-adherents. Younger participants (aged 21–40) reported an average of 4.33 days per week of self-care management, while middle-aged and older participants (aged 40 and above) reported 4.42 days. Non-adherents across all age groups reported lower self-care management and self-regulatory efficacy scores. Logistic regression analysis revealed that self-regulatory efficacy, age, Body Mass Index (BMI) and employment status were significant predictors of PA adherence. Higher self-regulatory efficacy is associated with improved confidence in managing T2D, making individuals more likely to engage in regular PA, which is essential for effective diabetes management. Conclusions: Targeted interventions to enhance self-regulatory efficacy and promote PA adherence, particularly tailored to address barriers faced by younger and unemployed individuals, could have substantial benefits for diabetes self-management.

Physical activity; Type 2 diabetes; Self-care management; Self-regulatory efficacy; Black/African American men

[1] Tinajero MG, Malik VS. An update on the epidemiology of type 2 diabetes: a global perspective. Endocrinology and Metabolism Clinics of North America. 2021; 50: 337–355.

[2] Magliano DJ, Boyko EJ, Atlas ID. What is diabetes? c IDF diabetes atlas (pp. 11–19). 10th edn. International Diabetes Federation: Brussels Belgium. 2021.

[3] Ma RC, Tong PC. Epidemiology of type 2 diabetes. In Richard IG Holt and Allan Flyvbjerg (eds.) Textbook of diabetes (pp. 55–74). 6th edn. Wiley-Blackwell: Hoboken. 2024.

[4] Centers for Disease Control and Prevention. National diabetes statistics report, 2017: estimates of diabetes and its burden in the United States. (Report No.: CS279910-A). Atlanta; 12 July 2017. 2017.

[5] Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, et al. Social determinants of health and diabetes: a scientific review. Diabetes Care. 2021; 44: 258–279.

[6] Constant MJ. Socioeconomic status on the management of Type-2 diabetes among African Americans (aged 26–64) in rural Pennsylvania [doctoral thesis]. Walden University. 2024.

[7] Swaray AF. African American adults with Type 2 diabetes and self-management education: a phenomenological study in the Twin Cities of Minnesota [doctoral thesis]. Saint Mary’s University of Minnesota. 2024.

[8] Wadi NM, Asantewa-Ampaduh S, Rivas C, Goff LM. Culturally tailored lifestyle interventions for the prevention and management of type 2 diabetes in adults of Black African ancestry: a systematic review of tailoring methods and their effectiveness. Public Health Nutrition. 2022; 25: 422–436.

[9] Bunsawat K, Grosicki GJ, Jeong S, Robinson AT. Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: physiological underpinnings. Progress in Cardiovascular Diseases. 2022; 71: 11–19.

[10] Kanaley JA, Colberg SR, Corcoran MH, Malin SK, Rodriguez NR, Crespo CJ, et al. Exercise/physical activity in individuals with type 2 diabetes: a consensus statement from the American College of Sports Medicine. Medicine and Science in Sports and Exercise. 2022; 54: 353.

[11] Małkowska P. Positive effects of physical activity on insulin signaling. Current Issues in Molecular Biology. 2024; 46: 5467–5487.

[12] Mambrini SP, Grillo A, Colosimo S, Zarpellon F, Pozzi G, Furlan D, et al. Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility. Frontiers in Nutrition. 2024; 11: 1426551.

[13] WHO. WHO guidelines on physical activity and sedentary behaviour. World Health Organization: Geneva. 2020.

[14] Hamasaki H. Daily physical activity and type 2 diabetes: a review. World Journal of Diabetes. 2016; 7: 243–251.

[15] Hamman RF, Wing RR, Edelstein SL, Lachin JM, Bray GA, Delahanty L, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care. 2006; 29: 2102–2107.

[16] Dutton GR, Tan F, Provost BC, Sorenson JL, Allen B, Smith D. Relationship between self-efficacy and physical activity among patients with type 2 diabetes. Journal of Behavioral Medicine. 2009; 32: 270–277.

[17] Rippe JM. The health benefits of regular physical activity. In James MR (ed.) Lifestyle medicine (pp. 147–155). 4th edn. CRC Press: Boca Raton. 2024.

[18] Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Physical activity in US adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care. 2007; 30: 203–209.

[19] Wiebe DJ, Berg CA, Munion AK, Loyola MDR, Mello D, Butner JE, et al. Executive functioning, daily self-regulation, and diabetes management while transitioning into emerging adulthood. Annals of Behavioral Medicine. 2023; 57: 676–686.

[20] McMullan II, Bunting BP, Blackburn NE, Wilson JJ, Deidda M, Caserotti P, et al. The mediating role of self-regulation and self-efficacy on physical activity change in community-dwelling older adults (≥65 years): an experimental cross-lagged analysis using data from SITLESS. Journal of Aging and Physical Activity. 2021; 29: 931–940.

[21] Gao Y, Shan Y, Jiang T, Cai L, Zhang F, Jiang X. Dietary adherence, self-regulatory fatigue and trait self-control among Chinese patients with peritoneal dialysis: a cross-sectional study. Patient Preference and Adherence. 2021; 15: 443–451.

[22] Stavric V, Kayes NM, Rashid U, Saywell NL. The effectiveness of self-guided digital interventions to improve physical activity and exercise outcomes for people with chronic conditions: a systematic review and meta-analysis. Frontiers in Rehabilitation Sciences. 2022; 3: 925620.

[23] Rigby RR, Williams LT, Mitchell LJ, Ball L, Hamilton K. Understanding dietary behaviour change after a diagnosis of diabetes: a qualitative investigation of adults with type 2 diabetes. PLOS ONE. 2022; 17: e0278984.

[24] Ting CY, Ahmad Zaidi Adruce S, Lim CJ, Abd Jabar AHA, Ting RS, Ting H, et al. Effectiveness of a pharmacist-led structured group-based intervention in improving medication adherence and glycaemic control among type 2 diabetes mellitus patients: a randomized controlled trial. Research in Social and Administrative Pharmacy. 2021; 17: 344–355.

[25] Booker AF. An intervention to promote self-efficacy and physical activity in individuals with Type 2 diabetes or prediabetes [doctoral thesis]. The University of North Carolina at Greensboro. 2022.

[26] Encantado J, Marques MM, Gouveia MJ, Santos I, Sánchez-Oliva D, O’Driscoll R, et al. Testing motivational and self-regulatory mechanisms of action on device-measured physical activity in the context of a weight loss maintenance digital intervention: a secondary analysis of the NoHoW trial. Psychology of Sport and Exercise. 2023; 64: 102314.

[27] Deci EL, Ryan RM. The “what” and “why” of goal pursuits: human needs and the self-determination of behavior. Psychological Inquiry. 2000; 11: 227–268.

[28] Bodziony V. Understanding associations between chronic illness identity, psychological flexibility, and type 2 diabetes emotional, behavioral, and psychosocial functioning [doctoral thesis]. University of Louisville. 2023.

[29] Tao Y, Xu T, Wang X, Liu C, Wu Y, Liu M, et al. The relationships between emerging adults self-efficacy and motivation levels and physical activity: a cross-sectional study based on the self-determination theory. Frontiers in Psychology. 2024; 15: 1342611.

[30] Zhang S, Miao C. The mediating role of competence, autonomy, and relatedness in the activation and maintenance of sports participation behavior. Scientific Reports. 2024; 14: 27124.

[31] Dorey T. Improving the care of people with diabetes and severe mental illness [doctoral thesis]. University of London. 2024.

[32] Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Medicine & Science in Sports & Exercise. 2003; 35: 1381–1395.

[33] Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Medicine & Science in Sports & Exercise. 2000; 32: S498–S504.

[34] Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000; 23: 943–950.

[35] Vincent D, McEwen MM, Pasvogel A. The validity and reliability of a Spanish version of the summary of diabetes self-care activities questionnaire. Nursing Research. 2008; 57: 101–106.

[36] Kamradt M, Bozorgmehr K, Krisam J, Freund T, Kiel M, Qreini M, et al. Assessing self-management in patients with diabetes mellitus type 2 in Germany: validation of a German version of the Summary of Diabetes Self-Care Activities measure (SDSCA-G). Health and Quality of Life Outcomes. 2014; 12: 185.

[37] Ausili D, Bezze S, Canizzaro C, Bulgheroni M, Toolbert DJ, Genovese S, et al. Self-care assessment in type-2 diabetes: the Italian translation and validation of the summary of diabetes self-care activities. Professioni Infermieristiche. 2015; 68: 9–18.

[38] Ansari RM, Harris MF, Hosseinzadeh H, Zwar N. Psychometric evaluation and validation of an Urdu version of the Summary of Diabetes Self-Care Activities Measure (U-SDSCA). American Journal of Medical Quality. 2021; 36: 131–132.

[39] Adarmouch L, Sebbani M, Elyacoubi A, Amine M. Psychometric properties of a Moroccan version of the Summary of Diabetes Self-Care Activities Measure. Journal of Diabetes Research. 2016; 2016: 5479216.

[40] Al Hashmi I, Al-Noumani H, Alaloul F, Murthi S, Khalaf A. Translation and psychometric validation of the Arabic version of Summary of the Diabetes Self-Care Activities (SDSCA) among pregnant women with gestational diabetes. BMC Pregnancy Childbirth. 2022; 22: 563.

[41] Stanford patient education research center. Chronic disease self-management questionnaire. American Journal of Public Health. 1990; 80: 446–452.

[42] Lorig K. Outcome measures for health education and other health care interventions. Sage: Thousand Oaks. 1996.

[43] Mirahmadizadeh A, Khorshidsavar H, Seif M, Sharifi MH. Adherence to medication, diet and physical activity and the associated factors amongst patients with type 2 diabetes. Diabetes Therapy. 2020; 11: 479–494.

[44] Collado-Mateo D, Lavín-Pérez AM, Peñacoba C, Del CJ, Leyton-Román M, Luque-Casado A, et al. Key factors associated with adherence to physical exercise in patients with chronic diseases and older adults: an umbrella review. International Journal of Environmental Research and Public Health. 2021; 18: 2023.

[45] Richards EA, Franks MM, McDonough MH, Porter K. “Let’s move:” a systematic review of spouse-involved interventions to promote physical activity. International Journal of Health Promotion and Education. 2018; 56: 51–67.

[46] Osuka Y, Jung S, Kim T, Okubo Y, Kim E, Tanaka K. Does attending an exercise class with a spouse improve long-term exercise adherence among people aged 65 years and older: a 6-month prospective follow-up study. BMC Geriatrics. 2017; 17: 1–9.

[47] Plotnikoff RC, Lippke S, Courneya KS, Birkett N, Sigal RJ. Physical activity and social cognitive theory: a test in a population sample of adults with type 1 or type 2 diabetes. Applied Psychology. 2008; 57: 628–643.

[48] Coventry PA, Young B, Balogun-Katang A, Taylor J, Brown JV, Kitchen C, et al. Determinants of physical health self-management behaviours in adults with serious mental illness: a systematic review. Frontiers in Psychiatry. 2021; 12: 723962.

[49] Okati-Aliabad H, Nazri-Panjaki A, Mohammadi M, Nejabat E, Ansari-Moghaddam A. Determinants of diabetes self-care activities in patients with type 2 diabetes based on self-determination theory. Acta Diabetologica. 2024; 61: 297–307.

[50] Tzeng WC, Tai YM, Feng HP, Lin CH, Chang YC. Diabetes self‐care behaviours among people diagnosed with serious mental illness: a cross‐sectional correlational study. Journal of Psychiatric and Mental Health Nursing. 2024; 31: 364–375.

[51] Zhu Y, Sidell MA, Arterburn D, Daley MF, Desai J, Fitzpatrick SL, et al. Racial/ethnic disparities in the prevalence of diabetes and prediabetes by BMI: patient outcomes research to advance learning (PORTAL) multisite cohort of adults in the US. Diabetes Care. 2019; 42: 2211–2219.

[52] Plotnikoff RC, Trinh L, Courneya KS, Karunamuni N, Sigal RJ. Predictors of physical activity in adults with type 2 diabetes. American Journal of Health Behavior. 2011; 35: 359–370.

[53] Golden SH, Brown A, Cauley JA, Chin MH, Gary-Webb TL, Kim C, et al. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors—an Endocrine Society scientific statement. The Journal of Clinical Endocrinology & Metabolism. 2012; 97: E1579–E1639.

[54] Teixeira PJ, Carraça EV, Markland D, Silva MN, Ryan RM. Exercise, physical activity, and self-determination theory: a systematic review. International Journal of Behavioral Nutrition and Physical Activity. 2012; 9: 1–30.