Psychological determinants of physical activity: differences between adults with type 2 diabetes, prediabetes, and without diabetes

Cogen Psychology ISSN: 2331-1908 (Online) Jou nal homepage: www. and online.com/jou nals/oaps20 Psychological de e minan s o physical ac i i y: diffe ences be ween adul s wi h ype 2 diabe es, p ediabe es, and wi hou diabe es I is Pahmeie , And ea Te i & Michael B aksiek To ci e his a icle: I is Pahmeie , And ea Te i & Michael B aksiek (2024) Psychological de e minan s o physical ac i i y: diffe ences be ween adul s wi h ype 2 diabe es, p ediabe es, and wi hou diabe es, Cogen Psychology, 11:1, 2407694, DOI: 10.1080/23311908.2024.2407694 To link o his a icle: h ps://doi.o g/10.1080/23311908.2024.2407694 © 2024 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup Published online: 01 Oc 2024. Submi you a icle o his jou nal A icle iews: 743 View ela ed a icles View C ossma k da a Full Te ms & Condi ions o access and use can be ound a h ps://www. and online.com/ac ion/jou nalIn o ma ion?jou nalCode=oaps20 Heal H PsycHology | ReseaRcH aR icle Cogen PsyChology 2024, Vol. 11, no. 1, 2407694 Psychological de e minan s o physical ac i i y: di e ences be ween adul s wi h ype 2 diabe es, p ediabe es, and wi hou diabe es i is Pahmeie a, and ea e ib and Michael B aksieka aDepa men o spo science, Uni e si y o Vech a, Vech a, ge many; bIns i u e o ge on ology, Uni e si y o Vech a, Vech a, ge many ABSTRACT his s udy aimed o compa e psychological cons uc s ela ed o physical ac i i y (Pa) among adul s wi h ype 2 diabe es ( 2D), p ediabe es, and wi hou diabe es. he ocus was on unde s anding di e ences in social-cogni i e de e minan s and indi idual mo i es ega ding Pa in o de o ailo Pa in e en ions mo e e ec i ely. he s udy u ilized a sample om he andomized con olled ial ac i a e_P e en ion, including pa icipan s wi h 2D, p ediabe es and wi hou diabe es a baseline (n = 214). socio-demog aphic a iables, diabe es pa ame e s, psychological cons uc s, and he le el o spo ac i i y we e ga he ed. he da a we e analyzed using eg ession models. adul s wi h 2D exhibi ed signi ican ly lowe sel -e icacy, eco e y sel -e icacy, and a ec i e a i ude owa d physical ac i i y compa ed o hose wi hou diabe es. hey also pe cei ed s onge ba ie s. Pa icipan s wi h p ediabe es and 2D exhibi ed s onge ex insic mo i es bu lowe in insic mo i es han hose wi hou diabe es. he odds o no engaging in spo ac i i y we e highe in pa icipan s wi h p ediabe es and 2D. he s udy highligh s di e ences in socio-cogni i e a iables, ba ie pe cep ion, and mo i a ional p o iles among adul s wi h a ying diabe es s a uses. hese indings unde line he need o ailo ed in e en ion s a egies ha conside hese di e ences, emphasizing in insic mo i es and add essing he physical and men al heal h bene i s o exe cise. In oduc ion ype 2 diabe es ( 2D) ep esen s a p e alen ch onic-degene a i e disease associa ed wi h sub- s an ial physical and men al heal h implica ions. While li es yle ac o s like physical ac i i y (Pa) and educing seden a y beha io signi ican ly impac 2D managemen , indi iduals wi h 2D o en s uggle o adop necessa y beha io al changes o achie e op i- mal heal h e ec s (cle en e  al., 2020; Kenne ly & Ki k, 2018). Recen (spo ) psychology esea ch has unde lined he in luence o social-psychological a i- ables wi hin beha io change heo ies in d i ing heal h- ela ed spo s ac i i ies, pa icula ly in popula- ions wi h p ediabe es and 2D (de Man e  al., 2020; Heiss & Pe osa, 2016; Rhodes e  al., 2019). Howe e , hese a iables appea no ably dis inc be ween indi- iduals wi h di e en diabe es s a uses, necessi a ing a deepe unde s anding o hese a iances (Plo niko e  al., 2009). cu en ly, limi ed knowledge exis s abou hese speci ic di e ences ega ding indi iduals wi h p edia- be es, despi e he po en ial o Pa-based in e en- ions o educe he isk o de eloping 2D in his coho (Hu unen-lenz e  al., 2018). Unde s anding hese a ia ions is c ucial o de eloping ailo ed Pa in e en ions add essing he unique needs o pa ien s wi h (p e-)diabe es. ye , heo e ical ame- wo ks beyond social-cogni i e heo ies, such as humanis ic and p ocess- ela ed pe spec i es, ha e ecei ed insu icien a en ion in his domain (Rhodes e  al., 2019). explo ing a iables om hese al e na- i e amewo ks could ill gaps le by social-cogni i e heo ies and p o ide a mo e comp ehensi e unde - s anding o pe sonal de e minan s in luencing Pa beha io (Rhodes e  al., 2019). his s udy aimed o add ess his gap by compa - ing cons uc s om social-cogni i e models, human- is ic (goal con en heo y), and p ocess- ela ed models (heal h ac ion p ocess app oach - HaPa) © 2024 he Au ho (s). Published by In o ma UK limi ed, ading as aylo & F ancis g oup CONTACT I is Pahmeie i is.pahmeie @uni- ech a.de Depa men o spo science, Uni e si y o Vech a, D i e s aße 22, Vech a 49377, ge many h ps://doi.o g/10.1080/23311908.2024.2407694 his is an open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion license (h p://c ea i ecommons.o g/licenses/by/4.0/), which pe mi s un e- s ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. he e ms on which his a icle has been published allow he pos ing o he Accep ed Manusc ip in a eposi o y by he au ho (s) o wi h hei consen . ARTICLE HISTORY Recei ed 10 Janua y 2024 Re ised 17 sep embe 2024 accep ed 18 sep embe 2024 KEYWORDS ype 2 diabe es; p ediabe es; physical ac i i y; humanis ic app oach; social-cogni i e app oach; mo i es SUBJECTS Physical ac i i y and Heal h; spo s Psychology; Diabe es 2 i. PaHMeieR e al. among adul s wi h 2D, p ediabe es, and wi hou diabe es. Backg ound 2D s ands as one o he mos p e alen ch onic dis- eases among adul s (scheid -Na e & icks, 2019). cha ac e ized by ele a ed blood glucose le els (hype glycemia), 2D is in luenced by gene ic, age- ela ed, and li es yle ac o s, including physical inac i i y, poo nu i ion, and smoking (ge man Medical associa ion, 2023; scheid -Na e & icks, 2019). No ably, low socioeconomic s a us is associa ed wi h an inc eased isk o de eloping 2D (aga dh e  al., 2011; Kau zky-Wille e al., 2019). ele a ed blood glu- cose le els bu no a 2D le els, indica es p ediabe- es. Hype glycemia associa ed wi h (p e-)diabe es leads o a ious complica ions a ec ing he eyes, kidneys, ne es, and ca dio ascula sys em (ge man Medical associa ion, 2023). Mo eo e , 2D co ela es wi h highe occu ences o dep essi e symp oms and illnesses compa ed o una ec ed indi iduals (Da wish e  al., 2018). Regula Pa se es as a pi o al p ima y and e ia y p e en i e measu e agains associa ed diseases in 2D. s udies emphasize i s ole in educing he isk o 2D de elopmen , pa icula ly when combined wi h main aining a heal hy weigh (cloos e mans e al., 2015). li es yle modi ica ions, including die a y changes and Pa p omo ion, a e undamen al s a e- gies o p e en ing and managing 2D (Me lo i e al., 2014; oplak e al., 2019). Howe e , despi e he ecognized impo ance o Pa, indi iduals wi h 2D o en s uggle o ini ia e and main ain sui able Pa egimens, displaying lowe ac i i y le els and inc eased seden a y beha io compa ed o hose wi hou diabe es (Kenne ly & Ki k, 2018; lees & Boo h, 2004). hey also showed low adhe ence in supe ised p og ams accompanied by high d opou a es (Bulla d e  al., 2019). his p esen s a c i ical challenge in mo i a ing and engaging indi iduals wi h 2D in egula spo s and physical ac i i ies. Li e a u e e iew Heiss and Pe osa (2014) p o ided insigh s in o demo- g aphic, beha io al, and en i onmen al ac o s ela ed Pa in adul s wi h 2D. Fac o s such as highe BMi, olde age, lowe income, and pe cei ed disease se e i y co ela ed wi h inac i i y. Psychosocial ac- o s like lowe sel -e icacy and pe cei ed ba ie s, along wi h en i onmen al aspec s such as limi ed social suppo and wea he cons ain s, we e also associa ed wi h ac i i y le els. When i comes o unde s anding, explaining and also p omo ing Pa, he use o heo e ical amewo ks has p o en use ul (Rhodes e al., 2019). social-cogni i e pe spec i es, as exempli ied by Plo niko e  al. (2009), examined social-cogni i e aspec s ega ding Pa in pa ien s wi h ype 1 diabe es ( 1D), 2D, and hose wi hou diabe- es. No ably, di e ences in Pa- ela ed cons uc s om a ious social cogni i e models we e obse ed depending on hese diabe es s a uses. he models included he social cogni i e heo y, heo y o planned beha io , ans heo e ical model, and heo y o p o ec ion mo i a ion. While he in en ion-beha io gap emained a challenge in hese heo ies, hey explained only a modes po ion o he a iance in objec i e and sel - epo ed Pa. he Heal h ac ion P ocess app oach (HaPa) add esses his gap by desc ibing p e-in en ional (mo i a ional) and pos -in en ional ( oli ional) phases in beha io change. Voli ional a iables play a c i ical ole in ealizing in ended beha io , especially con- ce ning ba ie s commonly epo ed by pa ien s wi h 2D (gómez e  al., 2021; lidegaa d e  al., 2016). he HaPa’s inclusion o eco e y sel -e icacy acknowl- edges dealing wi h ailu e a a ba ie as pi o al o sus ained beha io change (schwa ze , 2008). No ably, lippke and Plo niko (2014) alida ed HaPa’s assump ions in he con ex o Pa among adul s wi h 2D. Fu he mo e, he HaPa has demons a ed suc- cess in c a ing in e en ions o indi iduals wi h 2D, acili a ing speci ic heal h beha io changes like die modi ica ion (MacPhail e al., 2014). Howe e , i s applica ion in p omo ing Pa among his popula ion emains ela i ely unexplo ed. Despi e he HaPa’s ad an ages o e classical social-cogni i e heo ies due o i s in eg a ion o oli ional componen s, bo h heo e ical amewo ks p ima ily ope a e unde he assump ion ha Pa is a consequence o delibe a e con empla ion abou alues and expec a ions (Rhodes e  al., 2019). hese amewo ks p edomi- nan ly ocus on pa ame e s oo ed in conscious cog- ni i e con ol. F om a humanis ic pe spec i e, he impo ance o he in luence o unconscious pa s o beha io is emphasized. an es ablished heo y in his con ex is Deci and Ryan (1985, 2000) sel -de e mina ion heo y (sD ). s udies highligh ing he posi i e associa ion be ween au onomous mo i a ion and sel - epo ed Pa among 2D pa ien s suppo his heo y (Miquelon & cas onguay, 2016). gou lan e  al. (2016) iden i ied di e en mo i a ional p o iles among adul s wi h 2D, emphasizing he need o pe son-cen e ed app oaches in unde s anding he mo i a ion o Pa. cogeN PsycHology 3 Wi hin sD , goal con en heo y di e en ia es be ween ex insic (e.g., appea ance and social ecog- ni ion) and in insic goals (e.g., enjoymen and sense o belonging) sugges ing ha in insic goals p omo e g ea e mo i a ion, need sa is ac ion, and well-being (Rheinbe g & engese , 2018). o da e, he e a e se e al s udies di e en ia ing explici goals and mo i es o ec ea ional and heal h spo s, such as heal h, igu e and appea ance, social con ac and enjoymen (lehne e al., 2011). hus, i is asked in mo e de ail wha mo i a es people o pa icipa e in spo s and wha hei goals a e. Unde s anding hese mo i a ions and goals acili- a es a mo e ailo ed alignmen be ween indi idual mo i es and he con en and s uc u e o Pa-based in e en ion p og ams. his ailo ed app oach aims o op imize he e ec i eness o such p og ams, p o- mo ing bo h he ini ia ion and main enance o Pa (scho no e  al., 2022). Howe e , cu en esea ch lacks speci ic insigh s in o con en - ela ed mo i es o Pa among indi iduals wi h (p e-)diabe es, which hinde s he cus omiza ion o in e en ions o ma ch indi idual goals and mo i es e ec i ely. in ligh o he empi ical and heo e ical ame- wo ks elucida ed, his s udy endea o ed o ad ance ou comp ehension o heo y-based Pa- ela ed a i- ables among adul s diagnosed wi h p ediabe es and 2D. ou p ima y objec i e was o gain insigh s essen ial o cus omizing ailo ed Pa-based in e en- ions o his clien ele. o achie e his, we in es i- ga ed di e ences in (1) a iables de i ed om es ablished social cogni i e heo ies, u he aug- men ed by insigh s om p ocess models, (2) pe cep- ions su ounding a ious ba ie s ha impede he ini ia ion o Pa, and (3) mo i es d i ing engagemen in Pa among his speci ic popula ion. Me hods Design and sample he sample consis ed o pa icipan s o he andom- ized con olled ial ac i a e_P e en ion a baseline (Mähs e  al., 2022). he p ima y aim o he ial was o in es iga e he e ec s o an ac i i y acke -based in e en ion and an addi ional digi al mo i a ional in e en ion on he physical ac i i y le el and heal h ou comes in adul s wi h p ediabe es, 2D and wi h- ou diabe es. Baseline da a was collec ed successi ely om he end o June 2021 o he beginning o May 2022. he in e en ion las ed o 6 mon hs wi h a 3-mon h ollow-up pe iod. cu en ly, he da a collec- ion is comple ed, and he analysis o he longi udinal da a is ongoing. Pa icipan s wi h p edi- abe es and 2D we e ec ui ed om a pa ne ed dia- be es cen e . Heal hy indi iduals we e ec ui ed om a local coope a ing company, ha was in e es ed in he heal h p omo ion o hei wo ke s. addi ionally, pa icipa ion in he s udy was p omo ed ia local p in media and he s udy websi e o ec ui people om he gene al popula ion, ega dless o hei dia- be es s a us. Baseline assessmen s included a ques- ionnai e cap u ing socio-demog aphic, heal h- ela ed in o ma ion, Pa, and psychosocial cons uc s. Diabe es pa ame e s we e clinically assessed by ained pe - sonnel. he analysis included pa icipan s wi h p edi- abe es (n = 33), 2D (n = 76), and hose wi hou me abolic diso de s (n = 105), esul ing in a o al ana- lyzed sample o 214 pa icipan s. Due o he p ede- e mined p ojec du a ion and a delayed s a o ec ui men caused by he coViD-19 pandemic, i was no possible o gene a e balanced subsamples. Rec ui men had o be comple ed o ensu e ha all pa icipan s had su icien ime in he s udy. he dis- c epancy in pa icipan numbe s was p ima ily due o he a ying p e alence o hese condi ions in he popula ion and he challenges in ec ui ing indi idu- als wi h p ediabe es and 2D. he diabe es cen e in ol ed in he s udy ea s a limi ed numbe o pa ien s, mos o whom ha e 2D a he han p edi- abe es. addi ionally, no incen i es we e p o ided o pa icipa ion in he s udy. e hical app o al was ob ained om he e hical Re iew Boa d o he med- ical associa ion o lowe saxony, ge many (05/2021), and pa icipan s p o ided olun a y w i en consen . Measu es Demog aphic cha ac e is ics o he pa icipan s we e measu ed using s anda dized ques ions including age, gende , and socio-economic a iables (lampe e al., 2013). Following lampe e al. (2013) he edu- ca ional and p o essional quali ica ions and he ne equi alen income o he pa icipan s we e ans- o med in o indices anging om 1 o 7. Psychosocial cons uc s we e measu ed using ali- da ed scales. he alues o he in e nal consis encies o he scales a e shown in able 1. Sel -e icacy o exe cise was assessed wi h a 5-poin like scale consis ing o i e i ems (e.g., ‘i am con i- den i can pa icipa e in egula exe cise when i am i ed’) (Fuchs, 1997; Ma cus e  al., 1992). he scale anges om 0 (no sa e a all) o 4 (ex emely sa e). Reco e y sel -e icacy was also assessed wi h a 5-poin like scale consis ing o i e i ems (e.g., ‘i am 4 i. PaHMeieR e al. su e ha i can be physically ac i e again on a egula basis, e en i i ha e no been ac i e egula ly o mo e han a mon h’) (B ehm e  al., 2010; schwa ze , 2008). he scale anges om 0 (no sa e a all) o 4 (ex emely sa e). o assess he pa icipan s’ oli ional inhibi ion ega ding exe cise, he dimension o pos poning aining om he Voli ion in exe cise Ques ionnai e was used (e.g., ‘i o en expe ience ha i need o pull mysel oge he o pa icipa e in my exe cise ac i - i y’) (P e e e  al., 2020). his scale consis ed o ou i ems ha could be answe ed on a scale om 0 (s ongly disag ee) o 3 (s ongly ag ee). o assess he pa icipan s’ indi idual mo i es and goals in exe cise and spo he Be nese Mo i e and a ge in en o y (lehne e  al., 2011) was used. he in en o y consis s o 24 i ems co e ing se en mo i es ha can be easons o indi iduals o do exe cise and spo ac i i ies: con ac (5 i ems), compe i ion/ pe o mance (4 i ems), ac i a ion/enjoymen (3 i ems), dis ac ion/ca ha sis (4 i ems), igu e/appea - ance (3 i ems), i ness/heal h (3 i ems), and aes he ics (2 i ems). each i em was p esen ed wi h a 5-poin a ing scale anging om 0 (s ongly disag ee) o 4 (s ongly ag ee). he a ec i e a i ude owa d PA was measu ed using a seman ic di e en ial scale (B and, 2006). Pa icipan s we e p esen ed wi h he s a emen ‘When i hink abou being physically ac i e, i eel…’. Following his s a emen , hey we e shown pai s o opposi e adjec i es (e.g., ‘no elaxed’ e sus ‘ e y elaxed’). Fo each pai , pa icipan s a e hei eelings on a scale om 1 o 7, whe e 1 indica es one ex eme o he eeling (e.g., ‘no elaxed’) and 7 indica es he opposi e ex eme (e.g., ‘ e y elaxed’) allowing hem o indica e he deg ee o which each adjec i e desc ibes hei eelings abou being physically ac i e. Pe cei ed ba ie s o PA we e measu ed using ou scales de eloped by B ehm e  al. (2010) assessing he indi idual ele ance o ba ie s using 7-poin a - ing scales: lack o ime/s ess (4 i ems), lack o mo i- a ion (6 i ems), insecu i y ega ding physical compe ence (3 i ems), and social con ex (2 i ems). he scales ange om 0 (s ongly disag ee) o 6 (s ongly ag ee). a single i em was used o measu e he social sup- po o PA (sel -cons uc ed: ‘i eel suppo ed in my physical ac i i ies by my social en i onmen (e.g., amily, iends, acquain ances)’). he scale o he i em anges om 0 (s ongly disag ee) o 4 (s ongly ag ee). In en ion o PA was also measu ed wi h a single i em (‘How s ong is you in en ion o be egula ly ac i e in he coming weeks and mon hs?’) (ge be e  al., 2010). he scale o he i em anges om 0 (I ha e no in en ion a all) o 5 (I ha e a e y s ong in en ion). Fo all scales, mean alues we e used o he anal- yses. addi ionally, he mean alues o he mo i es we e p ocessed acco ding o he p inciple o in ain- di idual s anda diza ion o compensa e o gene al Table 1. o e iew o a iables, summa y s a is ics and eliabili y. Va iables non-diabe es P ediabe es ype 2 diabe es Full sample In e nal consis ency (Mc Donald’s ω)MsD MsD MsD MsD sel -e icacy o exe cisea 2.3 0.9 2.1 0.8 1.8 1.0 2.1 1.0 0.83 Reco e y sel -e icacya 3.0 0.9 2.7 0.9 2.4 1.1 2.7 1.0 * Voli ional inhibi ionb0.7 0.7 1.1 0.8 1.0 0.9 0.9 0.8 0.90 A ec i e a i ude owa d PAc5.2 1.3 4.9 1.6 4.6 1.4 5.0 1.4 0.95 social suppo b2.8 1.2 2.4 1.1 2.1 1.4 2.5 1.3 * In en iond4.2 0.8 4.0 0.7 3.6 1.2 4.0 1.0 * Mo i es (s anda dized)e Fi ness/heal h 111.2 4.1 108.1 7.0 110.5 4.7 110.5 5.0 0.81 Figu e/ Appea ance 104.1 9.1 111.3 6.4 110.2 6.9 107.2 8.6 0.91 Con ac 98.4 7.0 99.2 8.2 99.6 7.6 99.2 7.5 0.94 Dis ac ion/ Ca ha sis 103.2 7.3 102.9 6.1 100.5 6.2 102.1 6.9 0.90 Ac i a ion/Joy 107.9 5.4 102.5 5.5 105.4 6.8 106.2 6.3 0.83 Compe i ion/ Pe o mance 92.9 6.8 92.0 5.7 91.3 4.6 92.2 6.0 0.92 Aes he ics 93.6 7.8 92.1 5.3 92.9 5.7 93.0 6.7 * Ba ie s lack o ime/s ess 1.9 1.6 2.4 1.5 2.0 1.5 1.9 1.5 0.88 lack o mo i a ion 1.3 1.1 2.2 1.4 2.0 1.4 1.6 1.3 0.89 Insecu i y ega ding physical compe ence 0.6 0.8 1.3 1.2 1.4 1.1 1.0 1.0 0.72 social con ex 0.9 1.0 1.4 1.3 1.4 1.4 1.1 1.2 * *less han h ee i ems. aRange: 0–4. bRange: 0–3. cRange: 1–7. dRange: 0–5. eRange: 80–120. Range: 0–6. cogeN PsycHology 5 esponse endencies and o be e accoun o ela- ional exp essions o he mo i es (sudeck e al., 2011). Values a ound 100 co espond o he a e age impo - ance o a mo i e in ela ion o he o he indi idual mo i es (conzelmann e  al., 2012). Pa was assessed using a scale om he Physical ac i i y, exe cise, and spo Ques ionnai e (Fuchs e  al., 2015). Pa icipan s epo ed up o h ee di e en spo and exe cise ac i i ies engaged in o e he las ou weeks, de ail- ing equency, and du a ion. he spo ac i i y index (sai) was de i ed om hese da a, ep esen ing min- u es pe week engaged in spo s ac i i ies. S a is ical analyses Da a we e analyzed using sPss 27 (iBM co p, 2020) and R s udio (Rs udio eam, 2020). o in es iga e di - e ences in he psychological a iables be ween he h ee g oups (p ediabe es, 2D and non-diabe ic) con olling o gende , age, educa ional and p o es- sional quali ica ions (ePQ), and he ne equi alen income (NeQ), linea eg ession models we e con- duc ed ( abachnick & Fidell, 2018). Be o ehand, miss- ing alues we e analyzed, and he assump ions o he eg ession analyses we e checked. he e we e only missing alues in he indices o ePQ, NeQ and sai. hese we e missing comple ely a andom (li le’s es : χ2 = 7.309, p = 1.00). subsequen ly, hey we e impu ed by he R package mice using mul i a - ia e impu a ion by chained equa ions ( an Buu en & g oo huis-oudshoo n, 2011). Reg ession assump ions we e checked using s anda d diagnos ic plo s ( o linea i y, no mali y, homogenei y, and ou line s) and a iance in la ion ac o (ViF) ( o mul icollinea i y) (B uce e  al., 2020; Pi uch & s e ens, 2016). he plo models indica ed ha mos o he assump ions we e me . Howe e , some plo s and Whi e’s es indica ed he e oscedas ici y in he models. he e o e, he R packages sandwich and lm es we e used o gene a e he e oscedas ici y-consis en co a iance ma ices and he e oscedas ici y- obus s anda d e o s o he eg ession models o handle he e oscedas ici y. he ViFs o all p edic o s we e below 10 (1.1–1.5) indica ing ha mul icollinea i y did no in la e he es ima ions. a powe analysis was conduc ed using g*Powe e sion 3.1.9.6 (Faul e  al., 2009) o sample size es ima ion, based on esul s om compa able s udies (Plo niko e  al., 2009). Wi h an e o p oba- bili y o α = 0.05, powe = 0.80 and six p edic o s in he eg ession models he minimum sample size o small e ec s ( 2= 0.05) in single eg ession coe i- cien s is N = 159. hus, he ob ained sample size o N = 214 is adequa e o es he s udy hypo hesis. he spo ac i i y index (sai) analysis e ealed a subs an ial numbe o ze os and a igh -skewed dis- ibu ion in he da ase . o add ess his, ze o-in la ed nega i e binomial eg ession models we e employed u ilizing he pscl package in R (Zeileis e  al., 2008). Ze o-in la ed nega i e binomial eg essions assume da a o s em om a nega i e binomial dis ibu ion, accommoda ing he high numbe o ze o alues. his app oach in ol es a wo-pa model: i s , a logis ic eg ession model de e mines he p obabili y o ze o coun s e sus non-ze o coun s, ollowed by a nega- i e binomial eg ession model ha examines coun da a among non-ze o coun s (slymen e  al., 2006). Resul s able 2 displays desc ip i e s a is ics. he sample consis ed o 61% emales and esponden s had an a e age age o 51 yea s. Pa icipan s wi hou diabe- es ep esen ed he la ges g oup (49.1%) ollowing by he pa icipan s wi h 2D (35.5%) and p ediabe- es (15.4%). on a e age, indi iduals wi h 2D we e olde han he o he g oups. socio-demog aphically, pa icipan s wi hou diabe es had sligh ly highe educa ional quali ica ions and ne equi alen income han he o he g oups. Weekly Pa showed ha pa - icipan s wi hou diabe es engaged o o e wo hou s, p ediabe es pa icipan s o sligh ly o e one and a hal hou s, and hose wi h 2D o less han an hou . able 1 p esen s summa y s a is ics o socio- cogni i e a iables. in e nal consis ency o he scales was good, enabling hei u iliza ion o u he analysis. Desc ip i e alues aligned closely wi h heo- e ical means o scales. Mo i e alues indica ed low, medium, and high impo ance, wi hou ex eme al- ues. cons uc s heo e ically associa ed posi i ely wi h Pa (e.g., sel -e icacy) ended o su pass scale Table 2. sociodemog aphic cha ac e is ics o pa icipan s a baseline. Baseline cha ac e is ic non-diabe es P ediabe es ype 2 diabe es Full sample n%n%n%n% gende 105 33 76 214 Female 62 59.0 27 81.8 41 53.9 130 60.7 Male 43 41.0 6 18.2 35 46.1 84 39.3 M SD M SD M SD M SD Age 48.8 13.9 41.7 12.6 58.1 12.5 51.3 14.4 sAI 137.6 184.8 93.3 185.8 50.9 93.9 100.2 163.4 ePQ 5.5 1.5 4.8 1.4 4.3 1.3 5.0 1.5 neI 4.5 1.7 3.7 1.8 3.3 1.8 4.0 1.8 sAI: spo ac i i y index; ePQ: educa ional and p o essional quali ica- ions; neI: ne equi alen income. 6 i. PaHMeieR e al. means, while hose nega i ely linked ended o all below (e.g., ba ie s). he esul s o he eg ession models a e shown in he ables 3–6. all models we e used o analyze he di e ence in he Pa- ela ed a iables o spo ac i i y among pa icipan s wi h p ediabe es, 2D and wi hou diabe es, con olling o age, gende , and socio-economic ac o s. able 3 indica es ha indi iduals wi h 2D displayed signi ican ly lowe sel -e icacy o exe cise, eco e y sel -e icacy, and a ec i e a i ude owa d exe cise compa ed o hose wi hou diabe es. hey also pe cei ed lowe social suppo o Pa, exhibi ed lowe in en ion o Pa, and demons a ed highe oli ional inhibi ion han pa icipan s wi hou diabe es. No di e - ences we e obse ed be ween pa icipan s wi hou diabe es and hose wi h p ediabe es. among con ol a iables, only age showed a posi i e associa ion wi h pe cei ed social suppo . he o e all signi icance o he models indica ed a signi ican po ion o a iance explained by p edic o s (6% ≤ adj. R2 ≤ 12%). able 4 shows ha bo h pa icipan s wi h p edi- abe es and 2D pe cei ed lack o mo i a ion and insecu i y ega ding physical compe ence as s on- ge ba ie s o Pa compa ed o hose wi hou dia- be es. addi ionally, pa icipan s wi h 2D el ime cons ain s and s ess mo e acu ely. he e we e no di e ences ega ding he social con ex as po en ial ba ie . Rega ding he con ol a iables, emales and younge indi iduals pe cei ed ewe ime con- s ain s and less s ess. addi ionally, age was nega- i ely associa ed wi h a lack o mo i a ion. he socioeconomic a iables we e no associa ed wi h any pe cep ion o ba ie s. all models explained a signi ican pa o he a iance in he ba ie s ang- ing om 8% o 13%. Di e ences in mo i es o exe cise and spo a e shown in able 5. Pa icipan s wi h p ediabe es and 2D exp essed a s onge igu e/appea ance mo i e bu a lowe ac i a ion/joy and dis ac ion/ca ha sis mo i e han hose wi hou diabe es. he e we e no di - e ences ega ding he o ien a ion o i ness and heal h, con ac , compe i ion and pe o mance as well aes he - ics be ween he analyzed g oups, bu he e was a di - e ence be ween gende s: women had a signi ican ly lowe o ien a ion o compe i ion and pe o mance bu highe exp essions o he dis ac ion/ca ha sis and ac i- a ion/joy mo i es. age and socioeconomic ac o s showed a ied associa ions wi h di e en mo i es. he mo i e con ac was no a ec ed by any o he p edic- o s a all esul ing in an insigni ican o e all model. all o he models explained a signi ican pa o he a i- ance in he mo i es bu wi h di e ences in he e ec size. Wi h 22% (adjus ed R2), a compa a i ely highe pa o he a iance o he mo i e ac i a ion/joy could be explained, whe eas he a iance o mo i e aes he - ics could be explained less well (6%). o ensu e ha he e a e also di e ences be ween he g oups in e ms o spo ac i i y, an addi ional model was calcula ed o es o di e ences. able 6 shows ha he odds o no engaging in any spo ac i i y a e signi ican ly highe in pa icipan s wi h p ediabe es wi h a ac o o 2.6 and wi h a ac o o 3.3 in pa icipan s wi h 2D. When being ac i e, he minu es o he spo ac i i y a e no associa ed wi h he diabe es s a us. No con ol a iable was associ- a ed wi h he spo ac i i y. Table 3. Reg ession analyses o socio-cogni i e a iables. sel -e icacy o exe cise Reco e y sel -e icacy Voli ional inhibi ion A ec i e a i ude social suppo In en ion P ediabe esa−0.14 −0.24 0.30 −0.20 −0.23 −0.17 (0.19) (0.20) (0.17) (0.34) (0.34) (0.24) ype-2 diabe esa−0.61*** −0.62*** 0.31* −0.61* −0.69** −0.65** (0.15) (0.17) (0.14) (0.26) (0.26) (0.22) Age 0.005 0.004 −0.01 0.01 0.02* 0.01 (0.005) (0.01) (0.004) (0.01) (0.01) (0.01) sexb−0.10 −0.01 0.02 0.05 0.13 0.20 (0.14) (0.15) (0.11) (0.22) (0.22) (0.18) neI 0.03 −0.02 −0.002 0.09 0.03 0.03 (0.04) (0.05) (0.03) (0.06) (0.06) (0.05) ePQ 0.02 0.03 −0.05 −0.02 0.09 0.02 (0.05) (0.05) (0.04) (0.07) (0.07) (0.06) Cons an 2.04*** 2.67*** 1.35*** 4.40*** 1.14 3.27*** (0.45) (0.48) (0.37) (0.69) (0.69) (0.64) obse a ions 214 214 214 214 214 214 R20.10 0.08 0.07 0.06 0.11 0.12 Adjus ed R20.07 0.05 0.05 0.03 0.08 0.09 Residual s d. e o (d = 207) 0.92 1.00 0.77 1.40 1.20 0.92 F s a is ic (d = 6; 207) 3.88** 2.87* 2.67* 2.26* 4.29*** 4.57*** ePQ: educa ional and p o essional quali ica ions; neI: ne equi alen income. *p < .05; **p < .01; ***p < .001. aRe e ence ca ego y a e pa icipan s wi hou diabe es. bRe e ence ca ego y a e male pa icipan s. cogeN PsycHology 7 Discussion he p ima y aim o his s udy was o deepen ou unde s anding o he dispa i ies in psychological a iables ela ed o Pa among adul s based on hei diabe es s a us – non-diabe es, p ediabe es, and 2D. his explo a ion se es as a ounda ion o ailo ing in e en ions in bo h p ima y and seconda y p e en ion con ex s, aiming o bols e he e ec i e- ness o hese ini ia i es and mi iga e ea ly d op-ou a es. he app oach in ol ed a comp ehensi e com- pa ison o a iables de i ed om es ablished social cogni i e heo ies, ex ended by ace s om p ocess models. addi ionally, i del ed in o unde s anding he pe cep ion o ba ie s hinde ing Pa ini ia ion and he mo i es d i ing Pa p ac ice ac oss di e en dia- be es s a uses among adul s. he indings gene ally indica ed less a o able al- ues o adul s wi h 2D ac oss mos analyzed a i- ables, wi h some simila ly disad an ageous ou comes o p ediabe ic indi iduals in speci ic a iables. hese esul s ein o ce and expand upon ea lie esea ch, pa icula ly in echoing socio-cogni i e pe spec i e indings (Plo niko e  al., 2009). he majo i y o p e- iously analyzed a iables align wi h he p e-in en ional phase in he Heal h ac ion P ocess app oach (HaPa), such as sel -e icacy o exe cise. Howe e , his s udy e eals di e ences ex ending in o he pos -in en ional phase (e.g., eco e y sel -e icacy and oli ional inhibi ion), highligh ing he necessi y o in e en ion s a egies ha b idge he in en ion-beha io gap speci ically conce ning spo s and exe cise ac i i ies. s a egies ocused on ac ion and coping planning, as ad oca ed in HaPa (schwa ze e al., 2011), ha e shown po en ial in p o- mo ing heal hy ea ing among adul s wi h 2D (MacPhail e  al., 2014) and in enhancing medical pa ame e s ele an o 2D p e en ion (laa ikainen e  al., 2007), al hough no di ec ly a ge ed a indi- iduals wi h 2D. Table 4. Reg ession analyses o ba ie s. lack o ime/s ess lack o mo i a ion Insecu i y ega ding physical compe ence social con ex P ediabe esa0.36 0.77** 0.70** 0.34 (0.31) (0.29) (0.24) (1.13) ype-2 diabe esa 0.53* 0.77*** 0.73*** 0.53 (0.24) (0.21) (0.17) (0.74) Age −0.04*** −0.02* −0.001 −0.02 (0.01) (0.01) (0.01) (0.03) sexb−0.42* −0.07 −0.09 −0.24 (0.21) (0.19) (0.15) (0.69) neI 0.02 −0.06 −0.04 −0.08 (0.06) (0.06) (0.04) (0.18) ePQ −0.04 −0.01 −0.004 −0.04 (0.08) (0.07) (0.05) (0.27) Cons an 4.67*** 2.56*** 1.01* 2.68 (0.73) (0.66) (0.49) (2.71) obse a ions 214 214 214 214 R20.16 0.13 0.14 0.11 Adjus ed R20.13 0.11 0.12 0.08 Residual s d. e o (d = 207) 1.44 1.25 0.97 1.18 F s a is ic (d = 6; 207) 6.51*** 5.21*** 5.78*** 4.16*** ePQ: educa ional and p o essional quali ica ions; neI: ne equi alen income. **p < .05; **p < .01; ***p < .001. aRe e ence ca ego y a e pa icipan s wi hou diabe es. bRe e ence ca ego y a e male pa icipan s. Table 5. Reg ession analyses o mo i es (s anda dized). Fi ness/ heal h Figu e/ Appea ance Con ac Dis ac ion/ Ca ha sis Ac i a ion/Joy Compe i ion/ Pe o mance Aes he ics P ediabe esa−2.11 6.47*** 1.10 −1.35*** −4.55*** −0.78 −0.89 (1.52) (1.76) (1.25) (0.20) (0.17) (1.21) (1.37) ype-2 diabe esa−1.14 5.35*** 1.60 −1.02*** −4.16*** −0.53 −1.24 (1.35) (1.28) (1.12) (0.17) (0.14) (1.17) (1.14) Age 0.10* −0.04 0.04 −0.16*** 0.15*** −0.09** 0.10** (0.05) (0.04) (0.03) (0.01) (0.004) (0.03) (0.03) sexb−0.06 −0.26 0.37 0.58*** 0.77*** −3.19** 1.73 (1.24) (1.14) (0.98) (0.15) (0.11) (0.97) (0.95) neI −0.01 −0.38 0.31 −0.14** 0.09* 0.16 −0.04 (0.34) (0.31) (0.26) (0.05) (0.03) (0.30) (0.28) ePQ 0.64 −0.39 −0.21 0.42*** 0.17*** −0.23 0.24 (0.42) (0.43) (0.33) (0.05) (0.04) (0.34) (0.34) Cons an 103.26*** 110.21*** 95.65*** 108.19*** 98.35*** 102.90*** 84.70*** (4.24) (3.74) (3.20) (0.48) (0.37) (3.43) (3.19) obse a ions 214 214 214 214 214 214 214 R20.15 0.16 0.03 0.14 0.22 0.11 0.06 Adjus ed R20.12 0.13 −0.003 0.12 0.20 0.08 0.03 Residual s d. e o (d = 207) 4.66 7.98 7.47 6.47 5.62 5.78 6.58 F s a is ic (d = 6; 207) 5.92*** 6.45*** 0.89 5.65*** 9.64*** 4.08*** 2.06 ePQ: educa ional and p o essional quali ica ions; neI: ne equi alen income. *p < .05; **p < .01; ***p < .001. aRe e ence ca ego y a e pa icipan s wi hou diabe es. bRe e ence ca ego y a e male pa icipan s. 8 i. PaHMeieR e al. addi ionally, he esul s un eiled a lowe a ec i e a i ude owa d Pa among adul s wi h 2D. P io s udies o en me ged a ec i e and cogni i e a i- udes ollowing heo ies like he heo y o planned beha io (Plo niko e  al., 2010). gi en ecen esea ch emphasizing he pi o al ole o a ec i e ac o s in Pa main enance (B and & ekkekakis, 2018), he disc epancies ound in he a ec i e a i ude dimension signal he impo ance o ocusing on a ec i e mechanisms when designing spo s p o- g ams o adul s wi h 2D o explo ing easons o d op-ou om hese p og ams. he absence o di e - ences be ween p ediabe ic indi iduals and hose wi hou diabe es in social cogni i e a iables sug- ges s ha dis inc ions end o mani es as he dis- ease p og esses. Fu u e longi udinal s udies should in es iga e he causal ela ionship unde lying his de elopmen . he socio-cogni i e de e minan s o Pa analyzed in his s udy a e ins umen al in su moun ing ba i- e s ha impede Pa ini ia ion o con inui y. adul s wi h 2D epo ing highe pe cep ions o ime con- s ain s and mo i a ion de iciencies align wi h p io esea ch (gómez e  al., 2021; Plo niko e  al., 2009). his s udy ex ended hese indings, e ealing ha a lack o mo i a ion simila ly impedes adul s wi h p e- diabe es om engaging in Pa o he same ex en as adul s wi h 2D. addi ionally, bo h g oups exp essed unce ain y abou hei physical compe ence, hinde - ing hei Pa. Heiss and Pe osa (2016) p e iously linked lowe con idence in pe o ming physical exe - cises p ope ly wi h educed mode a e Pa in adul s wi h 2D. his s udy expands upon his unde s and- ing by highligh ing ha his sen imen is mo e p onounced in adul s wi h p ediabe es and 2D han in hose wi hou diabe es. hese indi iduals a e no only awa e ha his eeling hinde s hei Pa bu also pe cei e his ba ie as challenging as he lack o mo i a ion. his necessi a es conside a ions beyond psychological s a egies, u ging he inclusion o exe - cise and aining con en adjus men s in p e en i e and p omo ional measu es o pa ien s wi h p edia- be es and 2D. encou agingly, p ediabe ic and dia- be ic adul s do no pe cei e hei social en i onmen as an obs acle o being physically ac i e. he analyzed indi idual mo i es o engaging in spo s can be classi ied in ex insic, pu pose- ela ed (e.g., i ness/heal h), and in insic, ac i i y- ela ed mo i es (e.g., ac i a ion/joy) (Rheinbe g & engese , 2018). his s udy un eiled ha he ex insic mo i e o shaping igu e and ou e appea ance is much mo e impo an o adul s wi h p ediabe es and 2D. in con as , in insic mo i es like dis ac ion/ca ha sis and ac i a ion/joy appea o be less in luen ial ea- sons o hei pa icipa ion in spo s. Rega ding esul s om p e ious s udies, showing ha in insic mo i a ion is gene ally mo e impo an o being physically ac i e, adul s wi h p ediabe es and 2D seem o ha e less a o able mo i e p o iles conce n- ing Pa and spo s. Fu he mo e, he esul s p o ide mo e de ailed insigh s in o which mo i es a e mo e o less ele an o adul s wi h p ediabe es and 2D compa ed o hose wi hou diabe es. Despi e he less a o able ex insic mo i es o Pa, i emains c ucial o o e spo s ac i i ies ha align wi h indi idual mo i es, pa icula ly o sus aining Pa (scho no e  al., 2022; sudeck & conzelmann, 2011). consequen ly, he mo i e o body image and appea ance should be mo e s ongly conside ed in heal h p omo ion mea- su es o his clien ele. gi en indica ions ha indi id- uals wi h 2D may ha e a nega i e body image (P eiss e  al., 2013; Weinbe ge e  al., 2016) add ess- ing body image conce ns psychologically alongside physical ans o ma ions should be con empla ed. he ac ha he in insic mo i es dis ac ion/ ca ha sis and ac i a ion/joy a e mino easons o adul s wi h p ediabe es and 2D o engage in exe - cise and spo ac i i ies p o ides a no el insigh . his could s em om he lowe engagemen o absence o hese indi iduals in physical ac i i ies, leading o a lack o he expe iences associa ed wi h hese mo i es. al e na i ely, his could a ise om hei inabili y o egula e o con ol hei exe cise ou ines o a ain such expe iences. i is possible ha indi iduals in his g oup may engage in ac i i ies aimed a quicke physiological e ec s (e.g., Hii , (Na di e  al., 2018)) Table 6. Reg ession analyses o ac i i y. spo ac i i y Coun model Ze o-in la ed model es ima es (SE) odds es ima es (SE) odds P ediabe esa0.06 1.06 0.94* 2.57 (0.24) (0.44) ype-2 diabe esa−0.28 0.75 1.18* 3.27 (0.20) (0.44) Age −0.01 0.99 −0.01 0.99 (0.01) (0.01) sexb0.02 1.02 −0.35 0.70 (0.17) (0.31) ePQ 0.02 1.02 0.07 1.08 (0.06) (0.11) neI −0.01 0.99 −0.06 0.94 (0.05) (0.09) Cons an 5.74*** 311.97 0.35 1.42 (0.46) (1.04) ePQ: educa ional and p o essional quali ica ions; neI: ne equi alen income. *p < .05; **p < .01; ***p < .001. aRe e ence ca ego y a e pa icipan s wi hou diabe es. bRe e ence ca ego y a e male pa icipan s.