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
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UK Limi ed, ading as Taylo & F ancis
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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.
