Barriers to Physical Activity in Patients with Diabetic Cardiomyopathy: A Qualitative Study on Perceived Risks and Motivational Challenges

Background: Diabetic cardiomyopathy (DCM) is a distinct but underrecognized complication of diabetes mellitus, characterized by myocardial dysfunction in the absence of overt coronary artery disease or hypertension. While physical activity is a core component of cardiac rehabilitation, little is known about how older adults with DCM perceive and engage with exercise, particularly within diverse sociocultural contexts. Methods: This qualitative study explored perceived barriers to physical activity among older adults with DCM. Semi-structured interviews were conducted with 11 patients recruited from the geriatrics department of a tertiary hospital in Nanjing, China. Thematic analysis was used to identify recurring patterns in participants’ narratives related to psychological, sociocultural, and systemic influences on exercise behavior. Results: Four key themes emerged: (1) limited disease awareness and diagnostic ambiguity, (2) fear of symptom exacerbation and kinesiophobia, (3) cultural beliefs emphasizing energy conservation and bodily protection, and (4) lack of individualized guidance in existing rehabilitation services. Participants often framed physical activity decisions through culturally influenced perceptions of risk, expressing hesitancy due to perceived frailty and lack of tailored support. Conclusion: This study identified four interconnected barriers to physical activity in patients with diabetic cardiomyopathy: diagnostic ambiguity, fear of symptom exacerbation, family and age-related expectations, and limited individualized guidance from health professionals. These barriers were mutually reinforcing and reflected not only personal concerns but also gaps in routine care. Improving physical activity in this high-risk population requires both patient-focused strategies—such as clear communication and tailored reassurance—and system-level measures, including consistent referral pathways, greater rehabilitation availability, and family-inclusive support.