Physical Nudging: Effects of Adherence to Physical Activity Guidelines on Physical Fitness and Self-Management Capacity in Young Adults with Type 2 Diabetes

This study examined the effects of physical activity (PA) guideline adherence on physical fitness, hypoglycemia awareness, and glycemic control in young adults with type 2 diabetes mellitus (T2DM), framing PA adherence as a behavioral nudge toward selfmanagement. METHODS:This cross-sectional study analyzed 108 young adults with T2DM (aged 20-44 years), categorized into two groups based on PA guideline adherence: those meeting guidelines (G-Met; ≥150 min/week of moderate-to-vigorous PA, n=52) and those not meeting guidelines (G-Unmet; <150 min/week, n=56).Lower-body muscle strength, flexibility, hypoglycemia awareness, and HbA1c levels were assessed.Between-group differences were examined using independent t-tests, and independent predictors of HbA1c and hypoglycemia awareness were identified via multiple linear regression. RESULTS:The G-Met group demonstrated significantly greater lower-body muscle strength (p=.003) and flexibility (p=.018) compared with the G-Unmet group.Additionally, the G-Met group reported significantly higher awareness of hypoglycemia causes, including excessive PA (p=.037) and insufficient food intake (p=.014).Multiple linear regression confirmed that PA guideline adherence was independently associated with higher hypoglycemia awareness (p=.021).Although HbA1c levels did not differ significantly between groups, multiple regression analysis identified lower-body muscle strength as a factor independently associated with lower HbA1c (β=-0.343,p=.043).CONCLUSIONS: Adherence to PA guidelines was associated with improved physical fitness and greater hypoglycemia awareness in young adults with T2DM.Importantly, higher levels of lower-body muscle strength, associated with PA guideline adherence, were independently associated with better glycemic control, suggesting that regular PA functions as a behavioral nudge that simultaneously builds physiological capacity and promotes cognitive engagement in diabetes self-management.