What Are the Barriers and Facilitators of Resistance Training in Mildly Frail Older Adults with Insulin-Treated Diabetes? A Qualitative Analysis Using the Capability, Opportunity, Motivation, and Behaviour (COM-B) Behavioural Science Model

Background: Resistance exercise offers many benefits for those with frailty and sarcopenia and may carry less risk of exercise induced hypoglycaemia. However most older adults do not meet recommended levels of exercise. Little is known about why, especially for mildly frail older adults with insulin treated diabetes. Our aim was to investigate behavioural related influences to undertaking resistance exercise in this vulnerable group. Methods: A phenomenological qualitative study using semi structured interviews with mildly frail adults aged ≥60 with insulin-treated diabetes (Type 1 (n=12); Type 2 (n=3)) recruited via online advert, in the UK. Frailty was assessed using the Rockwood Clinical Frailty Scale. Those with a history of myocardial infarction, stroke, renal failure, severe hypertension or liver disease in the last 12 months were excluded. Data were analysed inductively using thematic analysis, then aligned to the COM-B. Results: Barriers to exercise centred on the physical capability, opportunity, and reflective motivation COM-B domains. Primary barriers included exacerbating existing fatigue or diabetes-related complications, exercise induced hypoglycaemia and injury, and inability to use resistance equipment. Most were unaware of the benefits of exercise on diabetes and muscle health. Many with a decades-long diagnosis were initially told that exercise was unsafe. Facilitators included an informative and flexible training environment, clarity on potential diabetes specific benefits, and having a supportive partner ideally also capable of exercise. Conclusion: Older, mildly frail adults with insulin-treated diabetes are a vulnerable group whose beliefs may prevent them from undertaking regular exercise. They may benefit from a specific programme of awareness raising and a tailored, flexible exercise environment. Disclosure R.Stocker: None. J.A.Shaw: Advisory Panel; Betalin Therapeutics, Provention Bio, Inc., Consultant; Mogrify. M.D.Witham: None. G.Taylor: None. D.J.West: None. Funding UK Wellcome Trust