Exercise management in pediatric type 1 diabetes: a multicenter study of healthcare professionals’ perspectives

Regular exercise is an important component of care for children with type 1 diabetes (T1D), supporting both physical and psychological health. However, many do not meet recommended activity levels, and exercise does not consistently improve glycemic control. Exercise management in T1D is complex and influenced by multiple factors, including child, activity, and treatment characteristics. These challenges highlight the importance of comprehensive exercise-directed guidance (EDG). This study aimed to characterize EDG practices in pediatric T1D and identify key challenges faced by healthcare professionals (HCPs). Physicians, nurses, and dietitians from 11 pediatric diabetes centers participated. Participants completed anonymized electronic questionnaires assessing current practices, content, and perceived challenges related to EDG. Response rate was 87.2%; 130 HCPs participated; all reported providing EDG to patients. Considerable variability was observed in the timing, content, and educational resources used. While the majority (85.9%) reported offering guidance to all patients, others indicated guiding only when specific needs arose. The most frequently addressed topics included the immediate effects on blood glucose, adjusting carbohydrate intake, and general preparations for exercise. Less frequently discussed topics were planning exercise regimens and encouraging involvement of family or peers. Challenges by order of prevalence were insufficient teaching aids (42.3%), EDG complexity (40.0%), visit duration (36.2%), and knowledge gaps (33.1%). CONCLUSION: Although HCPs acknowledge the importance of exercise in pediatric T1D and incorporate EDG into clinical care, substantial variability exists in its delivery. Improving the availability and usability of educational tools and strengthening social support components may enhance exercise education for children with T1D. WHAT IS KNOWN: • Exercise-directed guidance (EDG) is essential for children with type-1-diabetes, yet challenging to implement. • Knowledge of barriers to EDG is growing, but evidence remains limited across healthcare settings and professional groups. WHAT IS NEW: • In this national multicenter study of healthcare professionals, all participants reported providing EDG, yet its timing,content, and availability of educational tools varied. • Limited teaching aids, the complexity of EDG, and time constraints were the main barriers; addressing family and peer involvement and exercise-specific planning were identified as areas for improvement.