Barriers and Enablers to Physical Activity in Adults and Children with Type 1 Diabetes: A National Survey and Theoretical Mapping

Aims: to identify and compare barriers and enablers influencing physical activity (PA) in adults and children with type 1 diabetes in the UK. Methods: A cross-sectional, national survey was distributed via BreakthroughT1D (formerly JDRF) networks between December 2022 and January 2023. The survey included closed and open-ended questions on PA behaviours and influencing factors. Responses were collected from adults with T1D and parents of children with type 1 diabetes. Quantitative data were analysed using descriptive statistics and two-proportion z-tests. Free-text responses were analysed thematically. Barriers and enablers were synthesised using the COM-B model and socioecological framework to identify behavioural determinants and intervention targets. Results: 311 responses were analysed (182 adults; 129 parent proxies for children). Stigma and negative comments were reported by nearly three-quarters of both groups. Adults more frequently reported clinical and motivational barriers: fear of hypoglycaemia (53%) and lack of motivation (39%). Adults reported significantly less healthcare provider support for physical activity (24%) compared to children (57%), revealing a critical care gap. Children more frequently reported external barriers, including lack of education among coaches (31%). Conclusion: this is the first UK-wide study to comprehensively compare barriers and enablers across age groups. Stigma in physical activity and sports settings emerges as a major, under-recognised barrier requiring urgent attention. Multi-level interventions are required, targeting individual knowledge and motivation alongside systemic changes. These should include mandatory diabetes education for coaches and teachers, policy enforcement to address discrimination, and enhanced healthcare provider support for physical activity.