What does this research mean for the field?

Higher frequencies of self-reflection are positively associated with increased physical activity engagement and a shift from perceived barriers to facilitators over time among Diabetes Prevention Program participants. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to analyze the barriers and facilitators affecting sustained physical activity after participation in a diabetes prevention program.

May 21, 2026Open Access

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Physical Activity Self-Reflections: A Year-Long Analysis of Barriers and Facilitators in a Diabetes Prevention Program

Key Points

This study aims to analyze the barriers and facilitators affecting sustained physical activity after participation in a diabetes prevention program.
Conducted a secondary analysis of 6,684 self-reflections from 86 participants over one year.
Used a mobile app for participants to log daily physical activity and reflections on their experiences.
Reflections were coded using the Theoretical Domains Framework for analysis.
Participants engaged in physical activity on average 143 days throughout the year.
Higher frequencies of self-reflections correlated with increased physical activity engagement (r(84) = 0.42, p=0.01).
Facilitators were referred to in 48% of reflections, while barriers decreased over time, with key TDF domains including behavioral regulation (75%) and environmental context (68%).

Abstract

AbstractBackground Type 2 Diabetes (T2D) is a public health issue. Diabetes Prevention Programs (DPPs) reduce T2D risk by encouraging changes in diet and physical activity (PA) behaviors, yet long-term PA adherence is challenging. Sustaining regular PA is not only crucial for reducing T2D risk, but also plays an important role in maintaining weight loss achieved during DPPs, which further reinforces long-term metabolic health. This study examines barriers and facilitators to sustained PA following DPP participation, and the role of self-reflection in promoting PA adherence. Methods We conducted a secondary analysis of 6,684 self-reflections collected via a mobile app from Small Steps for Big Changes (SSBC) DPP participants. Participants (n=86) logged daily PA and optionally recorded reflections on their exercise experiences for one year. Reflections were coded using the Theoretical Domains Framework (TDF) and classified by PA engagement (exercise/rest day/non-exercise day). Results Participants engaged in PA on an average of 143 days, with higher self-reflection frequencies correlating with increased PA engagement (r(84) = 0.42, p=0.01). Self-monitoring appeared in 73% of reflections, and remained present across the year. Facilitators were mentioned in 48% of reflections, peaking in the fourth quarter, while barriers (23%) declined over time. Commonly cited TDF domains included Behavioral regulation (75%) and Environmental context and resources (68%). Conclusion Self-reflections were positively associated with PA engagement, with participants primarily focusing on tracking specific PA behaviors and environmental contexts. The integration of self-reflection and monitoring tools in DPPs could offer valuable support for behavior change by enabling participants to be aware, document, and respond to real-time barriers and facilitators. Future DPPs may benefit from embedding flexible self-reflection tools that encourage sustained engagement and promote PA behavior.

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Physical Activity Self-Reflections: A Year-Long Analysis of Barriers and Facilitators in a Diabetes Prevention Program

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