Research Article| Volume 56, P7-12, January 2021

Exercise Adherence in Hispanic Adolescents with Obesity or Type 2 Diabetes

Published:November 09, 2020DOI:


      • Exercise improves health perception in Hispanic adolescents with obesity or type 2 diabetes.
      • Hispanic adolescents with type 2 diabetes experience increased barriers to exercise.
      • Cultural preferences are needed in regular exercise for Hispanic adolescents.



      Hispanic adolescents experience high rates of obesity and type 2 diabetes. The purpose of this study was to examine adherence to a 16-week personalized exercise intervention and the perception of family support for exercise, benefits and barriers to exercise and overall health in Hispanic adolescents diagnosed with obesity or type 2 diabetes.

      Design and methods

      Using a secondary analysis of a larger feasibility trial, data from 21 Hispanic adolescents, 13 with T2D and 8 who were obese and 14 that completed the entire 16-week study (7 T2D; 7 obese) were analyzed. Adolescents wore an Actigraph™ accelerometer for tracking exercise throughout the 16-week intervention.


      The adherence rate for the intervention was 59% for those with T2D and was 88% for those with obesity. Overall perceptions of health improved for those completing the 16-week intervention. Barriers to exercise were negatively associated with moderate-to-vigorous physical activity and were higher in those with T2D.


      Adolescents with T2D were less adherent to their personalized exercise program than those who were obese.

      Practice implications

      Strategies that address cultural preferences and family engagement are needed to address barriers to exercise for Hispanic youth, particularly those already diagnosed with T2D that have high risks for early onset of disease complications.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • American Diabetes Association
        Children and adolescents: Standards of medical care in diabetes−2020.
        Diabetes Care. 2020; 43: S163-S182
        • Arslanian S.
        • Bacha F.
        • Grey M.
        • Marcus M.D.
        • White N.H.
        • Zeitler P.
        Evaluation and management of youth-onset type 2 diabetes: A position statement by the American Diabetes Association.
        Diabetes Care. 2018; 41: 2648-2668
        • Aviles-Santa M.L.
        • Colon-Ramos U.
        • Lindberg N.M.
        • Mattei J.
        • Pasquel F.J.
        • Perez C.M.
        From sea to shining sea and the great plains to Patagonia: A review on current knowledge of diabetes mellitus in Hispanics/Latinos in the US and Latin America.
        Front Endocrinol (Lausanne). 2017; 8: 298
        • Bandura A.
        Social cognitive theory: An agentic perspective.
        Annual Review of Psychology. 2001; 52: 1-26
        • Bird S.R.
        • Hawlley J.A.
        Update on the effects of physical activity on insulin sensitivity in humans.
        BMJ Open Sport & Exercise Medicine. 2017; 2e000143
        • Bowling A.
        Just one question: If one question works, why ask several?.
        Journal of Epidemiology and Community Health. 2005; 59: 342-345
        • Broderick C.
        Understanding family process.
        CA: Sage, Newbury Park1993
        • Buse J.B.
        • D’Alessio D.A.
        • Riddle M.C.
        Can we RISE the challenge of youth-onset type 2 diabetes.
        Diabetes Care. 2018; 41: 1560-1562
        • Carrel A.L.
        • Sledge J.S.
        • Ventura S.J.
        • Eickhoff J.C.
        • Allen D.B.
        GPS suggests low physical activity in urban Hispanic school children: A proof of concept study.
        International Journal of Pediatric Endocrinology. 2014; 2014: 25
        • Clamp L.D.
        • Hume D.J.
        • Lambert E.V.
        • Kroff J.
        Enhanced insulin sensitivity in successful, long-term weight loss maintainers compared with matched controls with no weight loss history.
        Nutrition & Diabetes. 2017; 7e282
        • de Andrade M.I.S.
        • Oliveira J.S.
        • Sa Leleal V.
        • da Silva Lima N.M.
        • Costa E.K.
        • de Auino. N.B.
        • de Lira I.C., P.
        Identification of cutoff points for Homeostatic Model Assessment for insulin resistence index in adolescents: Systematic review.
        Revista Paulista de Pediaria. 2016; 34: 234-242
        • Faulkner M.S.
        • Michaiszyn S.
        • Hepworth J.T.
        A personalized approach to exercise promotion in adolescents with type 1 diabetes.
        Pediatric Diabetes. 2010; 11: 166-174
        • Faulkner M.S.
        • Michaliszyn S.
        • Hepworth J.T.
        • Wheeler M.
        Personalized exercise for adolescents with diabetes or obesity.
        Biological Research in Nursing. 2014; 16: 46-54
        • Flynn J.T.
        • Kaelber D.C.
        • Baker-Smith C.M.
        • Blowey D.
        • Carroll A.E.
        • Daniels S.R.
        • Subcommittee on Screening and Mangement of High Blood Pressure in Children
        Clinical practice guideline for screening and management of high blood pressure in children and adolescents.
        Pediatrics. 2017; 140
        • Freedson P.
        • Pober D.
        • Janz K.F.
        Calibration of accelerometer output for children.
        Medicine in Science in Sports & Exercise. 2005; 37: S523-S530
        • Garcia A.W.
        • Broda M.A.
        • Frenn M.
        • Coviak C.
        • Pender N.J.
        • Ronis D.L.
        Gender and developmental differences in exercise beliefs among youth and prediction of their exercise behavior [published erratum appears in J Sch Health 1995 Oct;65(8):311].
        Journal of School Health. 1995; 65: 213-219
        • Grace A.
        • Chan E.
        • Giallauria F.
        • Graham P.L.
        • Smart N.A.
        Clinical outcomes and glycemic responses to different aerobic exercise training intensities in type II diabetes: A systematic review and meta-analysis.
        Cardiovascular Diabetology. 2017; 16: 37
        • Guthold R.
        • Stevens G.A.
        • Riley L.M.
        • Bull F.C.
        Global trends in insufficient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1.6 million participants.
        Lancet Child & Adolescent Health. 2020; 4: 23-35
        • Hales C.M.
        • Carroll M.D.
        • Fryar C.D.
        • Ogden C.L.
        Prevalence of obesity among adults and youth: United States, 2015-2016.
        NCHS Data Brief. 2017; 288: 1-8
        • Ingersoll G.M.
        • Marrero D.G.
        A modified quality-of-life measure for youths: Psychometric properties.
        Diabetes Educator. 1991; 17: 114-118
        • Isasi C.R.
        • Parrinello C.M.
        • Ayala G.X.
        • Delamater A.M.
        • Perreira K.M.
        • Daviglus M.L.
        • Carnethon M.R.
        Sex differences in cardiometabolic risk factors among Hispanic/Latino youth.
        Journal of Pediatrics. 2016; 176e121
        • Kim Y.
        • Park H.
        Does regular exercise without weight loss reduce insulin resistance in children and adolescents?.
        International Journal of Endocrinology. 2013; 2013: 402592
        • La Greca A.M.
        • Bearman K.J.
        The diabetes social support questionnaire-family version: Evaluating adolescents’ diabetes-specific support from family members.
        Journal of Pediatric Psychology. 2002; 27: 665-676
        • Lee S.S.
        • Yoo J.H.
        • So Y.S.
        Effect of the low- versus high-intensity exercise training on endoplasmic reticulum stress and GLP-1 in adolescents with type 2 diabetes mellitus.
        Journal of Physical Therapy Science. 2015; 27: 3063-3068
        • Lora K.R.
        • Cheney M.
        • Branscum P.
        Hispanic mothers’ views of the fathers’ role in promoting healthy behaviors at home: Focus group findings.
        Journal of Academy of Nutrition and Dietetics. 2017; 117: 914-922
        • Magge S.N.
        • Silverstein J.
        • Elder D.
        • Nadeau K.
        • Hannon T.S.
        Evaluation and treatment of prediabetes in youth.
        The Journal of Pediatrics. 2020; 216: 11-22
        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • Naylor B.A.
        • Treacher D.F.
        • Turner R.C.
        Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetologia. 1985; 28: 412-419
        • Menke A.
        • Casagrande S.
        • Cowie C.C.
        Prevalence of diabetes in adolescents aged 12 to 19 years in the United States, 2005-2014.
        JAMA. 2016; 316: 344-345
        • Nadeau K.J.
        • Zeitler P.S.
        • Bauer T.A.
        • Brown M.S.
        • Dorosz J.L.
        • Draznin B.
        • Regensteiner J.G.
        Insulin resistance in adolescents with type 2 diabetes is associated with impaired exercise capacity.
        Journal of Clinical Endocrinology and Metabolism. 2009; 94: 3687-3695
      1. Naylor, L. H., Davis, E. A., Kalic, R. J., Paramalingam, N., Abraham, M. B., Jones, T. W., & Green, D. J. (2016). Exercise training improves vascular function in adolescents with type 2 diabetes Physiological Reports, 4(4). Doi:10.14814/phy2.12713.

        • Ostchega Y.
        • Seu R.
        • Sarafrazi N.
        • Zhang G.
        • Hughes J.P.
        • Miller I.
        Waist circumference measurement methodology study: National Health and nutrition examination survey, 2016.
        Vital Health Statistics. 2019; 2: 1-20
        • Pinto T.E.
        • Gusso S.
        • Hofman P.L.
        • Derraik J.G.
        • Hornung T.S.
        • Cutfield W.S.
        • Baldi J.C.
        Systolic and diastolic abnormalities reduce the cardiac response to exercise in adolescents with type 2 diabetes.
        Diabetes Care. 2014; 37: 1439-1446
        • Sallis J.F.
        • Buono M.J.
        • Roby J.J.
        • Micale F.G.
        • Nelson J.A.
        Seven-day recall and other physical activity self-reports in children and adolescents.
        Medicine in Science in Sports & Exercise. 1993; 25: 99-108
        • Shaibi G.Q.
        • Ryder J.R.
        • Kim J.Y.
        • Barraza E.
        Exercise for obese youth: Refocusing attention from weight loss to health gains.
        Exercise and Sport Science Reviews. 2015; 43: 41-47
        • Skinner A.C.
        • Ravanbakht S.N.
        • Skelton J.A.
        • Perrin E.M.
        • Armstrong S.C.
        Prevalence of obesity and severe obesity in US children, 1999-2016.
        Pediatrics. 2018; 141
        • Soltero E.G.
        • Olson M.L.
        • Williams A.N.
        • Konopken Y.P.
        • Castro F.G.
        • Arcoleo K.J.
        • Shaibi G.Q.
        Effects of a community-based diabetes prevention program for Latino youth with obesity: A randomized controlled trial.
        Obesity (Silver Spring). 2018; 26: 1856-1865
        • Stevens M.
        • Rees T.
        • Coffee P.
        • Steffens N.K.
        • Haslam S.A.
        • Polman R.
        A social identity approach to understanding and promoting physical activity.
        Sports Medicine. 2017; 47: 1911-1918
        • TODAY Study Group
        A clinical trial to maintain glycemic control in youth with type 2 diabetes.
        The New England Journal of Medicine. 2012; 366: 2247-2256
        • Tovar A.
        • Mena N.Z.
        • Risica P.
        • Gorham G.
        • Gans K.M.
        Nutrition and physical activity environments of home-based child care: What Hispanic providers have to say.
        Childhood Obesity. 2015; 11: 521-529
        • Welk G.J.
        • Schaben J.A.
        • Morrow J.R.
        Reliability of accelerometry-based activity monitors: A generalizability study.
        Medicine in Science in Sports & Exercise. 2004; 36: 1637-1645
        • Yli-Piipari S.
        • Berg A.
        • Laing E.M.
        • Hartzell D.L.
        • Parris K.O.
        • Udwadia J.
        • Lewis R.D.
        A twelve-week lifestyle program to improve cardiometabolic, behavioral, and psychological health in Hispanic children and adolescents.
        Journal of Alternative & Complementary Medicine. 2018; 24: 132-138
        • Zhang Y.
        • Hurtado G.A.
        • Flores R.
        • Alba-Meraz A.
        • Reicks M.
        Latino fathers’ perspectives and parenting practices regarding eating, physical activity, and screen time behaviors of early adolescent children: Focus group findings.
        Journal of the Academy of Nutrition & Dietetics. 2018; 118: 2070-2080