Comparative Analysis of Physical Activity, Time Management, and Self-Care Among Individuals with Type 2 Diabetes: A Multi-Population Cross-Sectional Study

Authors

    Somayeh Azarian Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
    Marefat Siahkouhian * Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran m_siahkohian@uma.ac.ir
    Ana Sofia Alves University of Beira Interior, Department of Sports Sciences, Covilhã, Portugal & Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, Portugal
    Hadi Nobari LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science (INEF), Universidad Politécnica de Madrid, Madrid, Spain

Keywords:

Diabetes Mellitus Type 2, T2DM, Self-Care, Physical Activity, Time Management, Cultural Characteristics

Abstract

Objective: The present study aims to examine the relationships among time management, physical activity, and self-care behaviors in individuals with T2DM, with a cross-population comparative method to better understand adherence challenges and inform culturally responsive strategies for diabetes care.

Methods: This cross-sectional descriptive-analytical study examined the relationships between physical activity, time management, and self-care behaviors in adults with type 2 diabetes from Spanish and Iranian populations (n= 404, ). Validated questionnaires—IPAQ-SF, TMBS, and DSMQ—were used to assess physical activity Met, time use, and diabetes-related self-care, respectively, with all data collected ethically under approval code. Statistical analyses included MANOVA, Bonferroni-adjusted post hoc tests, and Pearson correlations to evaluate differences and associations across country, gender, and interaction effects.

Results: Significant differences were found in physical activity and time management across gender, age, and cultural groups, with Spanish males demonstrating higher scores. No group-level differences were observed in self-care behaviors. Time management was positively correlated with both physical activity and self-care in both populations.

Conclusion: This comparative study highlights time management as a key behavioral determinant of self-care in individuals with type 2 diabetes, surpassing physical activity in predictive strength across Spanish and Iranian cohorts. Findings underscore the need for culturally tailored, time-focused interventions that support sustainable self-management, particularly among older adults and women. Culturally tailored strategies—such as Iran’s localized health instruction initiatives and Spain’s region-specific dietary counseling rooted in Mediterranean traditions—play a fundamental role in enhancing diabetes self-management. By connecting clinical objectives with cultural recognition and personal relevance, these suggestions foster greater patient engagement, behavioral adherence, and long-term health improvement.

Downloads

Download data is not yet available.

References

1. Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes. Lancet. 2017;389(10085):2239-51. [PMID: 28190580] [DOI]

2. Zhuo X, Zhang P, Hoerger TJ. Lifetime direct medical costs of treating type 2 diabetes and diabetic complications. Am J Prev Med. 2013;45(3):253-61. [PMID: 23953350] [DOI]

3. Qin L, Knol MJ, Corpeleijn E, Stolk RP. Does physical activity modify the risk of obesity for type 2 diabetes: a review of epidemiological data. Eur J Epidemiol. 2010;25(1):5-12. [PMID: 19847656] [PMCID: PMC2807936] [DOI]

4. Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-79. [PMID: 27926890] [PMCID: PMC6908414] [DOI]

5. Umpierre D, Ribeiro PAB, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes. JAMA. 2011;305(17):1790-9. [PMID: 21540423] [DOI]

6. Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. Journal of Diabetes & Metabolic Disorders. 2013;12(1):14. [PMID: 23497559 ] [PMCID: PMC3599009] [DOI]

7. Al-Khawaldeh OA, Al-Hassan MA, Froelicher ES. Self-care behaviors of Jordanian patients with type 2 diabetes. International Journal of Nursing Practice. 2012;18(3):282-91.

8. Claessens BJ, van Eerde W, Rutte CG, Roe RA. A review of the time management literature. Personnel Review. 2007;36(2):255-76. [DOI]

9. Kumar S, Moseson H, Uppal J, Juusola JL. A diabetes self-management program designed for low-income populations: A randomized controlled trial. Preventing Chronic Disease. 2018;15:E26.

10. Gellert P, Ziegelmann JP, Lippke S, Schwarzer R. Future time perspective and health behaviors: Temporal framing of self-regulatory processes in physical exercise and dietary behaviors. Annals of Behavioral Medicine. 2015;49(5):707-15. [PMID: 22015438]

11. Kocalevent RD, Hinz A, Brähler E. Standardization of a time management scale in the general population. BMC Psychology. 2014;2(1):1-7.

12. Forde C. Scoring the international physical activity questionnaire (IPAQ). 2018.

13. Indreica A, López-Moreno A, Sánchez-Gutiérrez C. Time management, Mediterranean diet adherence, and physical activity among university students. Nutrients. 2022;14(18):3762.

14. Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health and quality of life outcomes. 2013;11(1):138. [PMID: 23937988] [PMCID: PMC3751743]

15. Narayanan S, Patel R, Koenig M. Routine matters: Time management, exercise, and mental health in young adults. Journal of Wellness Psychology. 2025;12(1):77-89.

16. Yan Z, Liu Q, Zhang W. Age and activity: Longitudinal links between physical activity intensity and mental health in adolescents. Youth Wellness Quarterly. 2024;9(4):203-14.

17. Altunalan H, Yilmaz Y, Arican G. The impact of physical activity on sleep quality in adults: A cross-sectional study. Journal of Health and Wellness. 2024;19(2):55-64.

18. Bailey JR, Tsai L, Chandra N. Timing matters: Morning exercise and cardiometabolic outcomes in middle-aged adults. Preventive Cardiology Review. 2024;27(3):118-26.

19. Domínguez-Amorós M, Aparicio-Chueca P. Physical activity behaviors across Europe: Motivation vs time availability. European Journal of Sport Studies. 2020;8(1):12-21.

20. Kundakcı H, Gençoğlu C, Demirtaş M. Psychological barriers in physical activity engagement among Turkish university students. Journal of Cultural Health Psychology. 2024;11(2):91-104.

21. Zhang S, Wu J, Chen Y. Motivation and procrastination as predictors of physical activity among college students. Asian Journal of Behavioral Health. 2024;6(1):34-45.

22. Terzi N, Mert E, Topçu B. Leisure satisfaction vs time structure: Impacts on life quality in older adults. International Journal of Aging and Society. 2024;10(3):150-62.

23. Healy S, Kirk A, Vincent R. Reconsidering time constraints in physical activity: Introduction of the EXPERT model. International Journal of Behavioral Medicine. 2024;31(1):47-59.

24. Morris A, Greene T. Interdependent behavioral systems in chronic illness management. Chronic Care Perspectives. 2022;13(2):33-49.

25. Sakai H, Nikkhah S, Tinsley J. Multifaceted models of behavior in chronic illness contexts. Global Chronic Disease Journal. 2023;30(1):17.

26. Liang X, Zane A, McClure H. Identity-focused behavior models and their impact on health adherence. Journal of Health Identity. 2021;11(3):58-70.

27. Tobias A, Nordin K. Emotional drivers of physical activity: Toward a non-clinical understanding of exercise motivation. Behavioral Insights Review. 2022;8(3):92-104.

28. Ellis J, Nguyen R, Jacobs M. Planning and persistence: Time structure and therapeutic engagement among diabetic patients. Health Psychology Frontiers. 2023;21(2):110-24.

29. Foster G, Tang W, Ramirez J. Time planning and diet monitoring: Behavioral predictors in diabetes self-care. Journal of Nutrition & Behavior. 2022;29(1):45-57.

30. Rahmani S, Karimi L, Behnam H. Cultural restrictions and gendered time access: A study in Iranian urban centers. Journal of Sociology and Health. 2023;28(1):72-86.

31. Al-Sabbagh R, El-Deek S. Time inequality and female health behaviors in Middle Eastern urban contexts. Arab Journal of Public Health. 2021;15(1):25-39.

32. Thorne S, Kamal A. Aging and physical activity: A scoping review of barriers in culturally diverse populations. Journal of Gerontology & Health Promotion. 2023;39(4):145-60.

33. Neto JP, Sakamoto R, Lima F. Aging and physical activity disengagement: Institutional and personal barriers. Geriatric Policy Review. 2022;19(3):84-95.

34. Choi H, Menon A. Work-life imbalance and self-care neglect: Findings from busy professionals with diabetes. Occupational Health Insights. 2022;14(1):64-72.

35. DeWitt K, Chen L. Time structure as a stress-buffer in chronic disease: Experimental evidence. Journal of Behavioral Science. 2023;38(3):203-19.

36. Villanueva C, Desai P, Arvidsson L. Emotional regulation and self-management in chronic illness: A transdiagnostic perspective. Journal of Behavioral Medicine. 2022;45(1):58-74.

37. Nasiri N, Bolton P. Affective engagement in habit formation: Rethinking motivation in chronic disease contexts. Emotion and Behavior. 2021;12(4):119-30.

38. Park Y, Shim H, Ghosh S. Digital scheduling and health adherence in diabetic populations: Comparative analytics. Mobile Health Science. 2023;14(2):38-49.

39. Cárdenas E, Hill C. Bridging digital gaps in chronic illness care: Equity strategies for eHealth adoption. Journal of Digital Wellness. 2022;9(4):191-203.

40. Rocha T, Faramarzi S. Behavioral adaptation under cultural constraint: Comparing diabetes management across nations. International Social Health Review. 2021;16(2):141-56.

41. Al-Mutairi A, Hassan Y, Sahab A. Culture-bound health beliefs and diabetes management: A global review. International Journal of Health Psychology. 2022;17(2):88-103.

42. Kim D, Soraya F. Social support networks and behavioral synchrony: A cross-cultural study of health routines. Global Psychology Bulletin. 2022;34(4):102-18.

43. Schwarzer R, Lippke S, Luszczynska A. The Health Action Process Approach revisited: Planning and behavior maintenance in chronic care. Applied Psychology: Health and Well-Being. 2023;15(2):89-108.

44. Lau M, D'Souza S. The Behavioral Cascade Hypothesis: Foundational habits and lifestyle resilience. Behavioral Research Digest. 2022;18(2):89-97.

45. Mukherjee R, Khan F, Badawi A. Behavioral scaffolding in chronic disease prevention: A training model. Applied Health Promotion. 2023;26(1):71-83.

46. Michie S, van Stralen MM, West R. The behavior change wheel: A new method for characterizing and designing behavior change interventions. Implementation Science. 2011;6(1):42. [PMID: 21513547] [PMCID: PMC3096582] [DOI]

47. Sheikholeslami L, Duncan M. Narrative inquiry in health psychology: Capturing lived experience in diabetes. Qualitative Health Research. 2022;32(6):312-26.

Additional Files

Published

2026-01-01

Submitted

2025-08-07

Revised

2025-08-27

Accepted

2025-09-05

Issue

Section

Articles

How to Cite

Azarian, S., Siahkouhian, M., Alves, A. S., & Nobari, H. . (2026). Comparative Analysis of Physical Activity, Time Management, and Self-Care Among Individuals with Type 2 Diabetes: A Multi-Population Cross-Sectional Study. International Journal of Sport Studies for Health, 1-13. https://journals.kmanpub.com/index.php/Intjssh/article/view/4313