Sex Differences in Physical Activity Among Individuals with Type 2 Diabetes Across the Lifespan: A Systematic Review and Meta-Analysis

   Background: Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals with T2DM are unclear. Purpose: To summarize the evidence related to sex differences in participation in PA and barriers/facilitators to PA among individuals with T2DM across the lifespan. Data Source: Systematic searches (CRD42021254246) were conducted using Ovid Medline, EMBASE, Web of Science, CINAHL, AMED, PsychINFO, and SPORTDiscus. Study Selection: Studies assessing PA, sedentary behaviors (SB) or barriers/facilitators to PA among individuals with T2DM by sex or gender. Data Extraction: Participant characteristics, meeting PA guidelines, participation in PA and SB, and barriers/facilitators to PA were extracted by two independent reviewers.  Data Synthesis: Fifty-three articles (65,344 participants) were included in the systematic review; 21 articles in the meta-analysis. Sex differences were not observed in meeting PA guidelines among adolescents (OR [95% CI], 0.70 [0.31, 1.59]), but males were more likely than females to meet PA guidelines among adults (1.65 [1.36, 2.01]) and older adults (1.63 [1.27, 2.09]). Males performed more moderate to vigorous PA (MVPA) than females across all age groups. Common barriers were lack of time (men) and lack of social support and motivation (women).  Limitations: Limitations include heterogeneity of measures used to assess PA and lack of stratification of data by sex. Conclusions: Sex differences in meeting PA guidelines were not observed among adolescents, but were apparent among adults and older adults with T2DM. Females consistently engaged in less MVPA than males across the lifespan.</p