Sedentary behaviour change: barriers and strategies reported by individuals with type 2 diabetes during a multi-component intervention

Sitting down for hours on end is one of the most common behaviors of modern life, and for the more than half a billion people worldwide living with type 2 diabetes, it may be quietly undermining their health. A new study published in the Journal of Activity, Sedentary and Sleep Behaviors offers one of the most detailed looks yet at what actually happens when people with type 2 diabetes try to sit less, revealing both the stubborn obstacles that stand in their way and the practical tactics they deploy to overcome them. The findings come from a randomized controlled feasibility trial in which adults with type 2 diabetes received a remotely delivered, multi-component intervention designed specifically to reduce sedentary time. Rather than focusing solely on whether the intervention changed objectively measured behavior, the researchers turned their attention to the lived experience of the participants themselves, asking what got in the way of sitting less and what participants actually did in response.

The research team was led by Stuart J. H. Biddle of the University of Southern Queensland and Daniel P. Bailey of Brunel University of London, working alongside colleagues from Brunel University of London, the University of Bedfordshire, University College London, the University of Leicester, and Curtin University. The collaboration brought together expertise spanning physical activity research, behavior change science, diabetes care, and physiotherapy. The team went beyond simply measuring whether participants sat less. As part of a process evaluation embedded within the trial, they asked the 35 intervention participants directly about the barriers they encountered and the strategies they attempted while trying to break up their sitting time. This qualitative lens is critical, because interventions that fail often fail for reasons that accelerometer data alone cannot explain. Numbers can show that sitting time did or did not fall, but only participants can articulate why, and those reasons are exactly what future interventions need to address.

The scale of the qualitative dataset was substantial. Using template analysis, a structured qualitative method in which coding frameworks are developed and refined against the data in iterative passes, the researchers analyzed 44 statements describing barriers, contributed by 18 participants, and 99 statements describing attempted behavior change strategies, contributed by 17 participants. Crucially, these statements were drawn from two separate time periods, three months and six months into the intervention, allowing the team to check whether the same themes held steady over time or shifted as the program progressed. This dual time-point design matters, because behavior change is rarely static. What feels manageable in the early weeks of a program can become harder as novelty fades, and obstacles that seem minor at first can accumulate into reasons for disengagement. By comparing themes across both windows, the researchers could assess whether the experience of trying to sit less was consistent or evolving.

What emerged was a remarkably consistent picture of obstruction. The barrier themes were similar at both the three-month and six-month assessments, falling into four broad categories. The first was fatigue and sleep, with participants reporting feelings such as drowsiness that made remaining upright or active feel unappealing. Tiredness is a familiar companion of diabetes, and it directly competes with the energy required to stand and move. The second was disability and health problems, reflecting the reality that many people with type 2 diabetes also manage other health conditions that make standing and moving more difficult. The third category was work-related barriers, encompassing both the demands of work tasks and the physical constraints of work facilities, such as desk-bound roles and environments not configured for standing or walking. The fourth was contextual barriers, a theme capturing social and environmental circumstances, from household routines to surroundings that simply did not invite movement.

These findings matter because sedentary behavior is not merely the absence of exercise. High volumes of sitting are associated with an increased risk of adverse health outcomes, and that risk is understood to be especially concerning for individuals with type 2 diabetes, whose metabolic systems are already compromised. Designing interventions that target sitting time, rather than only structured exercise, has therefore attracted growing attention in diabetes care. Yet designing such interventions requires knowing what participants are actually up against, day after day. An intervention can prescribe regular breaks from sitting with perfect logic, but if participants are battling drowsiness, painful health conditions, inflexible jobs, and unsupportive environments, the prescription collides with reality. The process evaluation was designed to surface exactly that collision, giving researchers a map of the terrain any future program would need to navigate.

The strategy themes reported by participants offered a counterpart to the barrier analysis, and they clustered around three behavioral approaches. The first involved ways to break up sitting itself, deliberately interrupting prolonged periods in a chair with other behaviors. The second centered on increasing incidental physical activity, the unplanned, everyday movement woven into daily routines. The third involved adding in purposeful physical activity, intentional exercise layered on top of daily life. Together, these strategies reveal that participants understood the core message of the intervention: the goal is substitution, replacing sitting with alternative postures and activities, rather than simply exercising more while otherwise remaining sedentary. That distinction is central to the science of sedentary behavior, because a person can meet exercise guidelines and still accumulate long, uninterrupted stretches of sitting that carry their own risks.

The alignment between barriers and strategies is instructive. Where fatigue and drowsiness undermined efforts to stand, participants could respond with low-effort movement rather than strenuous activity, suggesting that interventions should calibrate expectations to energy levels. Where work environments enforced sitting, participants attempted to carve out movement within constraints, a finding that points toward workplace-level environmental changes as complementary supports. And where health conditions limited mobility, the emphasis on gentle, incidental movement offered a realistic pathway that pure exercise prescriptions often miss. The fact that the same strategy themes appeared across both assessment periods suggests that participants had internalized a flexible repertoire rather than a rigid set of rules, adapting the same underlying principles to whatever circumstances they faced.

The study’s design also carries lessons for the field. As a feasibility trial, it was built to evaluate whether a remotely delivered sedentary behavior intervention could work in this population, and the process evaluation shows why such evaluations are indispensable. Remotely delivered interventions remove geographic barriers to participation but also strip away in-person supervision, leaving participants to translate guidance into action on their own. Understanding that participants gravitate toward breaking up sitting and boosting incidental activity, and that they repeatedly collide with fatigue, health limitations, and unsupportive environments, gives future trial designers concrete targets for refinement. Rather than guessing at what might help, designers can build directly on the barriers and strategies that participants themselves identified, strengthening the bridge between intervention content and everyday life.

The consistency of themes across the three- and six-month data points is arguably the study’s most reassuring signal. Behavior change research has long grappled with the problem of decay, in which strategies that work initially fade as novelty wears off. Here, the same core barriers and the same core strategies persisted across both assessment windows, suggesting that the intervention’s framework gave participants a stable vocabulary of tactics even as they continued to face familiar obstacles. Stability, in this context, is not stagnation; it indicates that the behavioral targets were durable and comprehensible enough to remain salient half a year into the program. It also suggests that the barriers participants faced were not transient inconveniences but ongoing features of their lives, which reinforces the case for interventions that plan for them from the outset rather than treating them as surprises.

For clinicians, public health practitioners, and the millions of people managing type 2 diabetes, the takeaways are refreshingly concrete. Reducing sitting time does not require heroic workouts; it requires substituting other behaviors for sitting, inserting short bouts of standing and movement into desk-bound days, and layering both incidental and purposeful physical activity on top of daily routines. But the study is equally clear that individual effort operates within a web of individual and contextual constraints: tired bodies, health conditions, rigid workplaces, and environments built for chairs. Future interventions that anticipate these barriers and equip participants with a repertoire of substitution strategies are more likely to succeed and, in doing so, to chip away at the sitting-driven risks that shadow life with type 2 diabetes. The authors suggest that such information may prove useful in future interventions to reduce sedentary behavior, and this study provides a detailed, participant-centered foundation for building them.

Subject of Research: Sedentary behaviour change: barriers and strategies reported by individuals with type 2 diabetes during a multi-component intervention

Article Title: Sedentary behaviour change: barriers and strategies reported by individuals with type 2 diabetes during a multi-component intervention

Article References: Biddle, S. J. H., Brierley, M. L., Chater, A. M., Edwardson, C. L., Castle, E., Hunt, E. R., & Bailey, D. P. (2026). Sedentary behaviour change: barriers and strategies reported by individuals with type 2 diabetes during a multi-component intervention. Journal of Activity, Sedentary and Sleep Behaviors. https://doi.org/10.1186/s44167-026-00112-3

Image Credits: AI Generated

DOI: 10.1186/s44167-026-00112-3

Keywords: Sedentary, behaviour, change, barriers, strategies, reported, individuals, type, diabetes, during, multi-component, intervention