Physical activity and diabetes in german primary care: a qualitative interview study with individuals living with diabetes

Abstract Background Physical activity (PA) plays a crucial role in the management of Type 2 Diabetes Mellitus (T2DM). Despite its known benefits, many individuals living with T2DM face challenges in maintaining regular PA. General practitioners (GPs) are often seen as key facilitators of lifestyle change, yet little is known about how individuals living with T2DM perceive PA and the role of GPs in promoting it. This study aims to explore the personal perceptions, motivators, and barriers related to PA among individuals living with T2DM, and to understand their expectations for GP support within the primary care setting. Methods A qualitative study was conducted in primary care settings in Germany. Participants were recruited from self-help groups and GP practices across Hesse, Bavaria, and Berlin. Semi-structured interviews were conducted with 13 individuals living with T2DM. Interviews were transcribed verbatim and analysed using an inductive-deductive thematic analysis approach (Braun and Clarke) informed by the Health Belief Model. Results Participants recognised PA as essential for diabetes management and reported diverse experiences and challenges. Motivators included fear of complications, self-efficacy, enjoyment, goal-setting, and perceived health benefits. However, self-efficacy played a complex role—while it encouraged PA, it also increased feelings of personal responsibility, sometimes resulting in stress, guilt, or excessive self-monitoring. Barriers included comorbidities, lack of companionship, time constraints, and reluctance. Participants valued GP support, valuing a partnership-relationship, while also feeling motivated through authorities. Suggestions for GP involvement included tailored PA counselling, regular follow-up, structured goal-setting, and addressing emotional aspects of diabetes. Conclusion PA was widely acknowledged as important, yet its adoption was influenced by personal and contextual factors. Self-efficacy played a dual role, acting as both a motivator and a psychological burden. GPs were seen as important in PA promotion, but their support needed to be flexible and personalised.