Gender May Affect Whether, Why Patients With T1D Exercise

Although all people with type 1 diabetes (T1D) can benefit from exercise, a new report suggests gender may play an important role in how patients think about exercise and which health care messages to which they are most likely to respond.

The authors of the new study, which was based on semistructured patient interviews, say their findings can help health care providers tailor their recommendations to patients. The study was published in the Canadian Journal of Diabetes.¹

People with T1D face similar barriers to physical exercise as people without the disease; limits on time, lack of motivation, and financial barriers can all stop people from exercising an optimal amount, noted the study investigators. However, people with T1D also face additional challenges, such as fear of hypoglycemia and glycemic dysregulation, they said.

Jane E.Yardley, PhD, | Image Credit: Montréal Clinic Research Institute

Four years ago, corresponding author Jane E. Yardley, PhD, of the Montreal Clinical Research Institute, worked with a different team of investigators to see whether resistance exercise led to different blood glucose responses in males and females with T1D. They performed a secondary pooled data analysis on 2 studies with identical exercise protocols and found that males had significant decreases in plasma glucose during exercise, while females did not. Moreover, in the 6 hours following exercise, male patients had a significantly higher risk of hypoglycemia.²

Yet, Yardley and colleagues noted that the prior research was based on physiological differences between patients of different sexes. In the new report, they sought to look more closely at gender to see how behavioral differences between men and women might affect patients’ feelings about exercise.

“By better understanding differences in behavior, gender may emerge as a partial explanation for differencing glycemic responses to exercise that were previously attributed to differences in physiology,” they wrote.

The investigators conducted semistructured interviews with 20 patients with T1D, half of whom were men and half of whom were women. The participants ranged in age from 21 to 74 years. The interviews included questions about patients’ exercise routines (if applicable), glucose management strategies, exercise preferences, and barriers to exercise.

They said 6 themes emerged from the interviews, and in half of those themes, notable differences were identified between the responses of men and women.

In this analysis, participants were asked about their exercise routines, glucose management, exercise preference, and exercise barriers| Image Credit: ViDi Studio-stock.adobe.com

“Women self-reported more frequent and intense exercise than men, participated in more cardio and HIIT (high-intensity interval training), and were more motivated by weight loss,” they said. “Men engaged in more sports, were more motivated to stay in shape and gain muscle, and felt less supported by their health care providers.”

The investigators also found that women in the study were more likely to seek community and exercise in groups than men.

The authors said there are several potential reasons for the apparent differences. For one, they said previous research has shown that women are more likely to respond to questions in a socially desirable manner, which in this case might have made them more likely to emphasize a desire to lose weight, since the authors said women in particular face societal pressure to have a low body weight.

“The gender-specific impact of social desirability on weight may be further emphasized by the response of several men in this study that weight perhaps should be a concern but wasn’t for them,” the authors wrote.

For health care providers, the authors said these findings might prompt consideration of more gender-specific conversations with patients. For instance, they said men might benefit from more specific recommendations about how to exercise with T1D. They also said providers might pay more attention to helping patients connect with T1D patient groups.

The investigators noted that their sample size was small, and may not be representative of the general population. They also noted that the study did not consider race/ethnicity or socioeconomic status, both of which may affect how patients perceive and participate in exercise.

“Despite these limitations, this research bridges an important gap in considering the differences in attitudes and behaviors between men and women, as these may help explain some of the previously observed differences in glycemic responses between male and female participants,” they concluded.

References

1. Logan JE, Prévost M, Brazeau AS, et al. The impact of gender on physical activity preferences and barriers in adults with type 1 diabetes: a qualitative study. Can J Diabetes. Published online May 31, 2024. doi:10.1016/j.jcjd.2024.05.003

2. Brockman NK, Sigal RJ, Kenny GP, Riddell MC, Perkins BA, Yardley JE. Sex-related differences in blood glucose responses to resistance exercise in adults with type 1 diabetes: a secondary data analysis. Can J Diabetes. 2020;44(3):267-273.e1. doi:10.1016/j.jcjd.2019.08.006