Although healthcare professionals acknowledge the importance of exercise in pediatric T1D and incorporate exercise-directed guidance into clinical care, substantial variability exists in its delivery, with insufficient teaching aids, EDG complexity, visit duration, and knowledge gaps identified as the main barriers.
Key Findings
Results
All participating healthcare professionals reported providing exercise-directed guidance (EDG) to patients with pediatric type 1 diabetes, but the majority (85.9%) offered guidance to all patients while others guided only when specific needs arose.
130 healthcare professionals (HCPs) from 11 pediatric diabetes centers participated
Response rate was 87.2%
Participants included physicians, nurses, and dietitians
The remaining HCPs indicated they provided guidance only when specific needs arose, suggesting inconsistent universal delivery
Results
Considerable variability was observed in the timing, content, and educational resources used for exercise-directed guidance across centers and professional groups.
The study was multicenter, covering 11 pediatric diabetes centers
Variability was noted across all three dimensions: timing, content, and educational tools
Participants completed anonymized electronic questionnaires assessing current practices, content, and perceived challenges
No single standardized approach was identified across the participating centers
Results
The most frequently addressed EDG topics were the immediate effects of exercise on blood glucose, adjusting carbohydrate intake, and general preparations for exercise.
These three topics were reported as the most commonly discussed with patients
Less frequently discussed topics included planning exercise regimens and encouraging involvement of family or peers
The relative neglect of family and peer involvement represents an identified area for improvement
Exercise-specific planning was also identified as an area needing greater attention
Results
The four most prevalent barriers to exercise-directed guidance, in order of frequency, were insufficient teaching aids, EDG complexity, visit duration, and knowledge gaps.
Insufficient teaching aids was reported by 42.3% of HCPs
EDG complexity was reported by 40.0% of HCPs
Visit duration (time constraints) was reported by 36.2% of HCPs
Knowledge gaps were reported by 33.1% of HCPs
Discussion
Improving the availability and usability of educational tools and strengthening social support components were identified as key strategies to enhance exercise education for children with T1D.
Limited teaching aids were the single most commonly cited barrier (42.3%)
Family and peer involvement was among the least frequently addressed topics in current EDG practice
The authors identified these as actionable areas for improvement in clinical practice
The findings suggest that addressing both resource availability and social support dimensions could improve EDG delivery
Background
Exercise management in pediatric type 1 diabetes is characterized as complex and influenced by multiple factors including child, activity, and treatment characteristics.
Regular exercise is described as an important component of care supporting both physical and psychological health
Many children with T1D do not meet recommended activity levels
Exercise does not consistently improve glycemic control in T1D
These complexities were used to frame the rationale for studying EDG practices across professional groups and settings
What This Means
This research surveyed 130 healthcare professionals—including doctors, nurses, and dietitians—from 11 pediatric diabetes centers about how they advise children with type 1 diabetes on exercise. While every participant reported giving some form of exercise guidance, there was wide variation in when guidance was given, what topics were covered, and what educational materials were used. Most providers focused on immediate blood sugar effects, adjusting carbohydrate intake, and general exercise preparation, but fewer addressed longer-term exercise planning or how to involve family members and peers in supporting physical activity.
The study found that the biggest obstacles to providing good exercise guidance were a lack of useful teaching aids (reported by 42% of providers), the overall complexity of exercise management in diabetes (40%), not enough time during clinic visits (36%), and gaps in providers' own knowledge (33%). These barriers varied across professional roles and settings, suggesting there is no consistent, standardized approach to exercise counseling in pediatric diabetes care across the country.
This research suggests that children with type 1 diabetes may be receiving inconsistent and incomplete guidance about exercise, which could affect their willingness and ability to be physically active. Developing better educational tools, creating more time-efficient ways to deliver exercise counseling, and placing greater emphasis on involving families and peers could help improve exercise support for these children. The findings highlight a need for standardized, practical resources that healthcare teams can use across different clinic settings.
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Reznik H, Brener A, Sharkia M, Rachmiel M, Yeshayahu Y, Zalmon-Koren I, et al.. (2026). Exercise management in pediatric type 1 diabetes: a multicenter study of healthcare professionals' perspectives.. European journal of pediatrics. https://doi.org/10.1007/s00431-026-07472-7