A Qualitative Descriptive Study of Motivation States for Physical Activity Among Middle-Aged Adults with Type 1 Diabetes Mellitus

Background Adults with type 1 diabetes mellitus (T1DM) have barriers to physical activity (PA), including physiological, psychological, emotional, and/or contextual. To complement prior quantitative work, we employed a qualitative study to explore momentary motivational states for movement and rest and to understand how internal and external factors shape these experiences among middle-aged adults with T1DM who had recently completed an exercise-support intervention.

We interviewed 23 middle-aged adults with T1DM (mean age 48, SD 11 years, 78% female, 91% non-Hispanic white, 35% overweight, and 26% obese), who recently completed an exercise intervention, using semi-structured interviews guided by the Wants and Aversions for Neuromuscular Tasks (WANT) model. This model addresses desires and aversions (i.e., fears) for movement and rest. We utilized directed content analysis to identify common themes, with both deductive and inductive coding.

Participants exhibited simultaneous desires to move and rest, opting for activities like yoga or outdoor walks for active recovery. Competing motivations also emerged, such as the internal drive to exercise conflicting with physical fatigue or glycemic levels necessitating rest.

Our findings align with previous studies using the WANT model, underscoring the dynamic nature of motivation influenced by physiological parameters, aversive states, and recent activities. These insights gained can inform future interventions targeting psychological aspects of physical activity for this unique population. Competing Interest Statement The authors have declared no competing interest. Clinical Trial NCT06098729 Funding Statement GIA and the study were funded by the National Institute of Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health (NIDDK/NIH) under a mentored research scientist development award (K01DK129441). SG is funded by grant NIDDK/NIH, R01DK136604. The sponsor NIDDK/NIH had no role in the design of the study nor collection, analysis, and interpretation of data nor in writing the manuscript. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Yale University IRB (#2000035846). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Author Emails: xxw700{at}case.edu; Garrett.ash{at}yale.edu; Estefania.hernandez{at}case.edu; matthew.stults{at}ynhh.org; stephanie.griggs2{at}emory.edu Clarified what is meant by 'prior quantitative surveys on these topics' in the Abstract. Specified the study population in the study aims. Corrected spelling errors (e.g., 'fmovement'). Added citation support where requested in the Introduction. Reframed statements suggesting theoretical models are limited in describing motivation. Added explanation supporting use of the WANT model in adults with T1DM. Clarified how this study provides new insights beyond prior work on motivation and physical activity in T1DM populations. Clarified the role of internal and external factors influencing motivation. Expanded explanation of the WANT model and clarified distinctions between movement, sedentary behavior, and rest. Improved clarity in the Methods section, including participant eligibility criteria, interview duration reporting, transcription accuracy description, and explanation of how codes were developed into themes. Revised paragraph openings throughout the manuscript to improve clarity and readability. Applied minor grammar and punctuation corrections (e.g., punctuation formatting). Availability of data and materials The data will be available immediately following publication, with no end dates. The data will be shared with researchers who provide a methodologically sound proposal to achieve the aims of the approved proposal. Data will be truncated to meet the proposal aims without compromising participant confidentiality. The proposals should be directed to Dr. Garrett Ash at Yale University (garrett.ash{at}yale.edu). To gain access, data requesters must sign a data access agreement. Glossary - HbA1c - hemoglobin A1c - T1DM - type 1 diabetes mellitus - WANT - Wants and Aversions for Neuromuscular Tasks model.