Martin Rivett

Background: Adherence to cardiac rehabilitation (CR) programmes may be an important element for improving and maintaining physical activity (PA) behaviour in secondary prevention. Little is known about the PA behaviour in patients who have withdrawn from CR programmes. Therefore, a study was carried out to identify the reasons for withdrawal and the stage of PA readiness in those patients previously engaged in a Leeds-based community CR programme. Methods: A cross-sectional study was conducted using a telephone questionnaire to determine causes of withdrawal. A questionnaire based on the transtheoretical model of change was used to assess changes in PA readiness in these patients. Results: 101 withdrawn patients (mean age = 61 years; 72% male) were identified. It was found that 20 patients had relapsed beyond baseline (preparation phase) into pre-contemplation and contemplation phases and 15 reported they were in the preparation phase. However, the majority of patients remained in the action (18) and maintenance (48) phases of the transtheoretical model. Patients reported the following reasons for withdrawal: joined other facilities (16%); injury or illness (3%); family demands (7%); work demands (14%); lack of motivation (4%); lack of enjoyment (11%); lack of transport (10%); lack of time (10%); too expensive (6%); too crowded (4%). Conclusion: 66% of patients who had withdrawn from a phase IV CR programme remained in an advanced stage of PA readiness. Drop-out was due to a combination of financial, physical and lifestyle factors.

Physical activity is a key component in the management of diabetes, but most people do not engage in recommended levels of physical activity. A recent consensus statement on exercise management in type 1 diabetes (T1D) fails to mention behavioral change and the specific determinants impacting on exercise management. The aim of this study is to investigate the needs of adults with T1D around physical activity and the challenges they face. Using a person-centered approach, focus groups and individual semi-structured interviews recorded the perspectives of 67 adults aged ≥18 with diabetes. Four global themes were identified: (i) it's a balancing act, (ii) winging it, (iii) engagement and (iv) encouraging uptake. These findings suggest that adults with T1D find it difficult to manage their diabetes and physical activity and decision-making is based on trial and error with minimal input from healthcare professionals. Participants want more information to enable them to manage their diabetes and physical activity effectively. Adults with T1D face unique challenges in relation to physical activity. Participants reported key determinants for being active. Research is needed to understand how physical activity promotion is best developed for those with T1D and the preparedness of healthcare professionals for delivering guidance to adults with T1D.