Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States

Emily J Nicklett; Jieling Chen; Xiaoling Xiang; Leah R Abrams; Amanda J Sonnega; Kimson E Johnson; Jianjia Cheng; Shervin Assari

doi:10.1093/geroni/igz048

Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States

Innov Aging. 2020 Feb 20;4(1):igz048. doi: 10.1093/geroni/igz048. eCollection 2020.

Authors

Emily J Nicklett¹, Jieling Chen², Xiaoling Xiang¹, Leah R Abrams³, Amanda J Sonnega⁴, Kimson E Johnson³, Jianjia Cheng¹, Shervin Assari⁵

Affiliations

¹ School of Social Work, University of Michigan, Ann Arbor.
² Department of Social Work and Social Administration, The University of Hong Kong.
³ Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor.
⁴ Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor.
⁵ Department of Family Medicine, Charles R. Drew University of Medicine and Science, University of California, Los Angeles.

Abstract

Background and objectives: Physical activity (PA) is an effective strategy for diabetes self-management and is central to the diabetes regimen. Diagnostic events present an opportunity for health behavior change; however, many older adults with type 2 diabetes (T2D) do not engage in regular PA. The relationships between diagnosis events and subsequent changes in PA are not well understood. Drawing upon life-course theory, this is the first study to examine whether the diagnosis of T2D is followed by a change in PA, whether these changes are sustained, and the sociodemographic characteristics associated with these changes.

Research design and methods: We examined associations between T2D diagnosis and PA changes among 2,394 adults ages 51+ from the Health and Retirement Study (2004-2014). PA changes were measured using metabolic equivalents of task (METs) estimated values accounting for the vigor and frequency of self-reported PA. Using piecewise mixed models, we examined initial and sustained changes in METs over time and tested whether these changes were modified by race/ethnicity, educational level, gender, and age at diagnosis.

Results: Across participants, a significant postdiagnosis increase was observed in self-reported PA following the diagnostic event (β: 0.54, 95% CI: 0.10, 0.97). The steepness of decline in PA participation over time did not change significantly following T2D diagnosis. Age at diagnosis and race/ethnicity significantly moderated these relationships: participants diagnosed at older ages were less likely to improve PA following diagnosis and non-Hispanic whites experienced relatively steeper rates of decline following diagnosis with T2D.

Discussion and implications: Modest diagnosis-related increases in PA were observed among participants overall. The usual rate of decline in PA appears unaffected by diagnosis overall. Age at diagnosis and race/ethnicity moderated these relationships. Key implications for future research and clinical practice are discussed.

Keywords: Age at diagnosis; Chronic disease self-management; Event-oriented model; Life-course perspective; Piecewise regression; Race/ethnicity.