Barriers and Facilitators to Physical Activity Adherence in People With Type 2 Diabetes: A Mixed-Methods Systematic...

Although the health benefits of physical activity for individuals with type 2 diabetes are well-established, physical inactivity remains widespread, and existing interventions often demonstrate limited long-term effectiveness. This review aimed to explore the barriers and facilitators to physical activity adherence in individuals with type 2 diabetes.

PubMed, Web of Science, EMBASE, CENTRAL, and PsycINFO were systematically searched for relevant studies published up to 27 July 2025. Eligible studies included qualitative, quantitative, and mixed methods studies. Study quality was assessed using the Mixed Methods Appraisal Tool. The COM-B model and Theoretical Domains Framework were used to identify potential barriers and facilitators, while behavior change techniques were employed to identify potential intervention strategies. The registration number of this study is CRD42024622295.

A total of 43 studies were included, including 17 randomized controlled trials, 11 qualitative studies, 6 mixed methods studies, 5 non-randomized studies, and 4 quantitative descriptive studies. The analysis identified 46 barriers and facilitators influencing adherence. Additionally, 26 potentially effective behavior change techniques were extracted and categorized into six key implementation strategies: flexible and personalized physical activity programs, multidimensional social support, participant education, enhancing self-efficacy and motivation, monitoring and feedback, and managing emotional experiences.

This review systematically synthesizes the behavioral determinants of physical activity adherence in individuals with type 2 diabetes and proposes corresponding implementation strategies for intervention design. Future research should refine, evaluate, and validate these strategies while exploring the dynamic interactions between COM-B components to enhance intervention effectiveness.