The purpose of this study was to explore the knowledge, beliefs and experiences of HCPs about the provision of PA education and support to parents of children with T1D and children with T1D. Importantly, the results show that HCPs do recognise the importance of PA for maintaining health and inform patients of the importance of regular PA. Positively the majority (82%) of participants reported discussing the general health benefits of maintaining a physically active life, however, the type of information provided to children and parents varies: 56% of participants discuss different types of activity and the impact of activity on glycemic control. 57% of participants do not provide information about the impact of intensity and length of activity on glycemic control. 69% of participants do not discuss the impact or aerobic versus anaerobic activity on glycemic control. There are important metabolic differences in response to PA between children with and without T1D. Type, duration and intensity of PA will influence metabolic response in T1D and careful planning is required to prevent instances of hyperglycemia or hypoglycemia. HCPs reported that 87% of parents do ask about hypoglycemia, unfortunately only 31% of HCP report that they discuss the role of aerobic versus anaerobic activity on glycemic control. During aerobic activity, skeletal muscle glucose uptake increases noradrenaline to generate energy for muscle contraction, which suppresses hepatic gluconeogenesis and thus promotes a decrease in blood glucose levels and increased risk of hypoglycemia. Adequate carbohydrate replacement before, during, and after exercise and reduction of pre-prandial rapid-acting insulin doses are the main approaches used to avoid severe hypoglycemic events among diabetic children and adolescents. It is especially important to plan for long duration or intense aerobic exercise. In contrast, anaerobic activities that last only a short time (sometimes only seconds) but may increase the blood glucose level dramatically due to the release of the hormones adrenaline and glucagon. This rise in blood glucose is usually transient and can be followed by hypoglycemia in the hours after finishing the exercise 14–16. Thus, the results of this study highlight a clear need for additional education and support for HCPs to provide appropriate support about type, duration and intensity of activity to support safe engagement in PA and reduce fear of hypoglycemia as a barrier to PA for both children and parents.
Additionally, HCPs reported that they found particular groups of patients more challenging to discuss PA promotion with (Table 5). Notably, patients and parents of patients with higher BMI were reported as sometimes presenting a challenge to HCPs. HCPs reported that they worry about bringing up the topic as it can cause a defensive response. HCPs also reported that they sometimes do not feel comfortable discussing PA with individuals from different cultural backgrounds. HCPs also reported that they find discussing PA habits with adolescent girls more challenging. Unfortunately, the populations that HCPs reported as most challenging to discuss PA with are those most at risk of disengaging in PA. There is a clear need for further education and support for HCPs in the delivery of PA information that considers age, gender and cultural factors.
Strengths And Limitations:
This study is not without limitations. The questionnaire-based approach used to gather data restricted the extent to which rich, qualitative information was captured. Further research that using interview or focus group techniques should be considered going forward to explore the perceptions, beliefs and experiences of HCPs in more detail. Additionally, important members of the multidisciplinary team who may play a role in the provision of information about PA were not included in this study (e.g. physiotherapist, psychologist) thus the findings may not be generalisable or representative of more diverse multidisciplinary teams. Whilst limited in terms of sample size and representation, this study provides insight into the challenges faced by multidisciplinary team members in providing PA information in Irish clinical outpatient settings. Importantly, specific areas such as ethnic minorities, female adolescents and overweight or obese individuals were identified as areas where non-consultant hospital doctors and members of the MDT did not feel confident in providing information. Thus, this study identified clear areas that could benefit from for continual professional development and education to support PA promotion in the paediatric outpatient setting.