Sex Differences in Physical Activity Among Individuals With Type 2 Diabetes Across the Life Span: A Systematic Review and Meta-analysis

Abstract

Background: Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals with T2DM are unclear.

Purpose: To summarize the evidence related to sex differences in participation in PA and barriers/facilitators to PA among individuals with T2DM across the life span.

Data sources: Systematic searches (CRD42021254246) were conducted with Ovid MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), APA PsychInfo, and SPORTDiscus.

Study selection: We included studies with assessment of PA, sedentary behaviors (SB), or barriers/facilitators to PA among individuals with T2DM by sex or gender.

Data extraction: Participant characteristics, meeting PA guidelines, participation in PA and SB, and barriers/facilitators to PA were extracted by two independent reviewers.

Data synthesis: A total of 53 articles (65,344 participants) were included in the systematic review and 21 articles in the meta-analysis. Sex differences were not observed in meeting of PA guidelines among adolescents (odds ratio 0.70 [95% CI 0.31, 1.59]), but males were more likely than females to meet PA guidelines among adults (1.65 [1.36, 2.01]) and older adults (1.63 [1.27, 2.09]). Males performed more moderate-to-vigorous PA (MVPA) than females across all age-groups. Common barriers to PA were lack of time (men) and lack of social support and motivation (women).

Limitations: Limitations include heterogeneity of measures used to assess PA and lack of stratification of data by sex.

Conclusions: Sex differences in meeting PA guidelines were not observed among adolescents but were apparent among adults and older adults with T2DM. Females consistently engaged in less MVPA than males across the life span.

Figure 1

Sex differences in meeting PA guidelines among individuals with T2DM across age-groups. A: Bubble graph of meeting PA guidelines by age and sex. B: Forest plot for inverse variance, random effects meta-analysis of studies on sex differences in meeting PA guidelines among individuals with T2DM across age-groups, presented as OR between prevalence of meeting PA guidelines for males and females. Weight represents an estimation of precision for each study included in the meta-analysis. These percentages represent how much each individual study/result contribute to weighted average. We also present the sum of percentages for each subgroup analysis (2.8%, 79.9%, and 17.3%) and the overall (100%), which means that all studies have been considered in the random-effects model. y, years.