Sex differences in the association of psychological status with measures of physical activity and sedentary behaviour in adults with type 2 diabetes



To assess the association of psychological variables on leisure-time physical activity and sedentary time in men and women with type 2 diabetes mellitus (T2D).


In this cross-sectional study, we evaluated 163 patients with T2D, consecutively recruited at the Diabetes Centre of the Verona General Hospital. Scores on depression and anxiety symptoms, psychosocial factors (including self-efficacy, perceived interference, perceived severity, social support, misguided support behaviour, spouse’s positive behaviour), physical activity and time spent sitting were ascertained using questionnaires responses to the Beck Depression Inventory-II, Beck Anxiety Inventory, Multidimensional Diabetes Questionnaire, International Physical Activity Questionnaire.


Physical activity was significantly associated with higher social support in women and with increased self-efficacy in men. Sedentary time was significantly associated with higher perceived interference, anxiety and depressive symptoms, and with reduced diabetes self-efficacy in women, while it was associated solely with anxiety in men. Depressive symptoms and self-efficacy in women and anxiety symptoms in men were independent predictors of sedentary time when entered in a multivariable regression model also including age, BMI, haemoglobin A1c, diabetes duration, perceived interference and self-efficacy as covariates.


Lower self-efficacy and higher symptoms of depression were closely associated with increased sedentary time in women, but not in men, with T2D. It is possible that individualized behavioural interventions designed to reduce depressive symptoms and to improve diabetes self-efficacy would ultimately reduce sedentary behaviours, particularly in women with T2D.

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  1. 1.

    Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2001) The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 24(6):1069–1078

    Article  PubMed  CAS  Google Scholar 

  2. 2.

    Indelicato L, Dauriz M, Santi L et al (2017) Psychological distress, self-efficacy and glycemic control in type 2 diabetes. Nutr Metab Cardiovasc Dis 27(4):300–306

    Article  PubMed  CAS  Google Scholar 

  3. 3.

    Rubin RR, Peyrot M (2001) Psychological issues and treatments for people with diabetes. J Clin Psychol 57(4):457–478

    Article  PubMed  CAS  Google Scholar 

  4. 4.

    Ehrmann D, Schmitt A, Reimer A, Haak T, Kulzer B, Hermanns N (2017) The affective and somatic side of depression: subtypes of depressive symptoms show diametrically opposed associations with glycemic control in people with type 1 diabetes. Acta Diabetol 54(8):749–756

    Article  PubMed  CAS  Google Scholar 

  5. 5.

    Lin EH, Rutter CM, Katon W et al (2010) Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care 33(2):264–269

    Article  PubMed  Google Scholar 

  6. 6.

    Demakakos P, Muniz-Terrera G, Nouwen A (2017) Type 2 diabetes, depressive symptoms and trajectories of cognitive decline in a national sample of community-dwellers: a prospective cohort study. PLoS ONE 12(4):e0175827

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. 7.

    van Dooren FE, Nefs G, Schram MT, Verhey FR, Denollet J, Pouwer F (2013) Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PLoS ONE 8(3):e57058

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. 8.

    Mezuk B, Eaton WW, Albrecht S, Golden SH (2008) Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 31(12):2383–2390

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Tong A, Wang X, Li F, Xu F, Li Q, Zhang F (2016) Risk of depressive symptoms associated with impaired glucose metabolism, newly diagnosed diabetes, and previously diagnosed diabetes: a meta-analysis of prospective cohort studies. Acta Diabetol 53(4):589–598

    Article  PubMed  CAS  Google Scholar 

  10. 10.

    Nouwen A, Nefs G, Caramlau I et al (2011) European Depression in Diabetes Research C: prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: a systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium. Diabetes Care 34(3):752–762

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Sun JC, Xu M, Lu JL et al (2015) Associations of depression with impaired glucose regulation, newly diagnosed diabetes and previously diagnosed diabetes in Chinese adults. Diabet Med 32(7):935–943

    Article  PubMed  CAS  Google Scholar 

  12. 12.

    Demakakos P, Zaninotto P, Nouwen A (2014) Is the association between depressive symptoms and glucose metabolism bidirectional? Evidence from the English Longitudinal Study of Ageing. Psychosom Med 76(7):555–561

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. 13.

    Kuniss N, Rechtacek T, Kloos C et al (2017) Diabetes-related burden and distress in people with diabetes mellitus at primary care level in Germany. Acta Diabetol 54(5):471–478

    Article  PubMed  CAS  Google Scholar 

  14. 14.

    Babyak M, Blumenthal JA, Herman S et al (2000) Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 62(5):633–638

    Article  PubMed  CAS  Google Scholar 

  15. 15.

    Knowler WC, Barrett-Connor E, Fowler SE et al (2002) Diabetes Prevention Program Research G: reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346(6):393–403

    Article  PubMed  CAS  Google Scholar 

  16. 16.

    Tuomilehto J, Lindstrom J, Eriksson JG et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344(18):1343–1350

    Article  PubMed  CAS  Google Scholar 

  17. 17.

    American Diabetes Association (2018) 5. Prevention or Delay of Type 2 Diabetes: Standards of medical care in diabetes—2018. Diabetes Care 41(Suppl 1):S51–S54

    Article  Google Scholar 

  18. 18.

    IDF Clinical Guidelines Task Force (2006) Global Guideline for Type 2 Diabetes: recommendations for standard, comprehensive, and minimal care. Diabet Med 23(6):579–593

    Article  Google Scholar 

  19. 19.

    Kirk AF, Barnett J, Mutrie N (2007) Physical activity consultation for people with Type 2 diabetes: evidence and guidelines. Diabet Med 24(8):809–816

    Article  PubMed  CAS  Google Scholar 

  20. 20.

    Balducci S, D’Errico V, Haxhi J et al (2017) Effect of a behavioral intervention strategy for adoption and maintenance of a physically active lifestyle: The Italian Diabetes and Exercise Study 2 (IDES-2): a randomized controlled trial. Diabetes Care 40(11):1444–1452

    Article  PubMed  Google Scholar 

  21. 21.

    Bauman AE, Sallis JF, Dzewaltowski DA, Owen N (2002) Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders. Am J Prev Med 23(2 Suppl):5–14

    Article  PubMed  Google Scholar 

  22. 22.

    Talbot F, Nouwen A, Gingras J, Gosselin M, Audet J (1997) The assessment of diabetes-related cognitive and social factors: the multidimensional diabetes questionnaire. J Behav Med 20(3):291–312

    Article  PubMed  CAS  Google Scholar 

  23. 23.

    Bandura A (1986) Social Foundations of thought and action: a social cognitive theory. Prentice Hall, Englewood Cliffs

    Google Scholar 

  24. 24.

    Dunn AL, Trivedi MH, O’Neal HA (2001) Physical activity dose-response effects on outcomes of depression and anxiety. Med Sci Sports Exerc 33(6 Suppl):S587–S597 (discussion 609–510)

    Article  PubMed  CAS  Google Scholar 

  25. 25.

    Pate RR, O’Neill JR, Lobelo F (2008) The evolving definition of “sedentary”. Exerc Sport Sci Rev 36(4):173–178

    Article  PubMed  Google Scholar 

  26. 26.

    Sedentary Behaviour Research Network (2012) Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab 37(3):540–542

    Article  Google Scholar 

  27. 27.

    Fitzgerald JD, Johnson L, Hire DG et al (2015) Association of objectively measured physical activity with cardiovascular risk in mobility-limited older adults. J Am Heart Assoc 4(2):e001288

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Tremblay MS, Colley RC, Saunders TJ, Healy GN, Owen N (2010) Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab 35(6):725–740

    Article  PubMed  Google Scholar 

  29. 29.

    Cooper AJ, Brage S, Ekelund U et al (2014) Association between objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes. Diabetologia 57(1):73–82

    Article  PubMed  CAS  Google Scholar 

  30. 30.

    Cooper AR, Sebire S, Montgomery AA et al (2012) Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes. Diabetologia 55(3):589–599

    Article  PubMed  CAS  Google Scholar 

  31. 31.

    Owen N, Healy GN, Matthews CE, Dunstan DW (2010) Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev 38(3):105–113

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Hamer M, Stamatakis E, Mishra GD (2010) Television- and screen-based activity and mental well-being in adults. Am J Prev Med 38(4):375–380

    Article  PubMed  Google Scholar 

  33. 33.

    Teychenne M, Ball K, Salmon J (2010) Sedentary behavior and depression among adults: a review. Int J Behav Med 17(4):246–254

    Article  PubMed  Google Scholar 

  34. 34.

    Vallance JK, Winkler EA, Gardiner PA, Healy GN, Lynch BM, Owen N (2011) Associations of objectively-assessed physical activity and sedentary time with depression: NHANES (2005–2006). Prev Med 53(4–5):284–288

    Article  PubMed  Google Scholar 

  35. 35.

    Kato A, Fujimaki Y, Fujimori S et al (2016) Association between self-stigma and self-care behaviors in patients with type 2 diabetes: a cross-sectional study. BMJ Open Diabetes Res Care 4(1):e000156

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Snoek FJ, Bremmer MA, Hermanns N (2015) Constructs of depression and distress in diabetes: time for an appraisal. Lancet Diabetes Endocrinol 3(6):450–460

    Article  PubMed  Google Scholar 

  37. 37.

    Pinto BM, Marcus BH, Clark MM (1996) Promoting physical activity in women: the new challenges. Am J Prev Med 12(5):395–400

    Article  PubMed  CAS  Google Scholar 

  38. 38.

    Barrett JE, Plotnikoff RC, Courneya KS, Raine KD (2007) Physical activity and type 2 diabetes: exploring the role of gender and income. Diabetes Educ 33(1):128–143

    Article  PubMed  Google Scholar 

  39. 39.

    Ghisi MFG, Montano A, Sanavio E, Sica C (2006) BDI-II, Beck Depression Inventory-II. Manuale: Giunti O.S., Florence

    Google Scholar 

  40. 40.

    Sica CCD, Ghisi M, Sanavio E (2006) BAI-II, Beck Anxiety Inventory. Manuale: Giunti O.S, Florence

    Google Scholar 

  41. 41.

    Lazzari D, Pisanti R, Marici CG, Fatati G (2009) Il Multidimensional Diabetes Questionnaire (MDQ): analisi fattoriale confermativa e proprietà psicometriche della traduzione italiana. Psicoterapia Cognitiva e Comportamentale (Italian) 15(2):171–188

    Google Scholar 

  42. 42.

    Bauman A, Ma G, Cuevas F et al (2011) Equity, non-communicable Disease Risk Factors Project Collaborative G: cross-national comparisons of socioeconomic differences in the prevalence of leisure-time and occupational physical activity, and active commuting in six Asia-Pacific countries. J Epidemiol Community Health 65(1):35–43

    Article  PubMed  Google Scholar 

  43. 43.

    Jetté M, Sidney K, Blumchen G (1990) Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 13(8):555–565

    Article  PubMed  Google Scholar 

  44. 44.

    Craig CL, Marshall AL, Sjostrom M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395

    Article  PubMed  Google Scholar 

  45. 45.

    Rosenberg DE, Bull FC, Marshall AL, Sallis JF, Bauman AE (2008) Assessment of sedentary behavior with the International Physical Activity Questionnaire. J Phys Act Health 5(Suppl 1):S30–S44

    Article  PubMed  Google Scholar 

  46. 46.

    Breland JY, Fox AM, Horowitz CR (2013) Screen time, physical activity and depression risk in minority women. Ment Health Phys Act 6(1):10–15

    Article  PubMed  Google Scholar 

  47. 47.

    Salmon P (2001) Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev 21(1):33–61

    Article  PubMed  CAS  Google Scholar 

  48. 48.

    Teychenne M, Ball K, Salmon J (2010) Physical activity, sedentary behavior and depression among disadvantaged women. Health Educ Res 25(4):632–644

    Article  PubMed  Google Scholar 

  49. 49.

    Cherrington A, Wallston KA, Rothman RL (2010) Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. J Behav Med 33(1):81–89

    Article  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Hallal PC, Victora CG, Wells JC, Lima RC (2003) Physical inactivity: prevalence and associated variables in Brazilian adults. Med Sci Sports Exerc 35(11):1894–1900

    Article  PubMed  Google Scholar 

  51. 51.

    Martin KR, Koster A, Murphy RA et al (2014) Changes in daily activity patterns with age in U.S. men and women: National Health and Nutrition Examination Survey 2003–04 and 2005–06. J Am Geriatr Soc 62(7):1263–1271

    Article  PubMed  PubMed Central  Google Scholar 

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This study was supported by Fondazione Diabete Ricerca (Fo.Di.Ri., Rome, Italy). The funder had no role in the study design, data collection, data analysis, manuscript preparation and/or publication decision. The support of the administrative and clinical personnel of the Verona Diabetes Center (University and General Hospital of Verona, Verona, Italy) is gratefully acknowledged.

Author information




LI, MD and ELB researched and analysed data and wrote the manuscript. LS analysed data. CN and VC provided care for study patients. AN, ENB and PM edited the manuscript and provided substantial contribution to the overall discussion. LI, MD and ELB are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity and the accuracy of the data analysis.

Corresponding authors

Correspondence to Liliana Indelicato or Marco Dauriz.

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Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

The study protocol was approved by the Ethics Committee of the Hospital Trust of Verona.

Informed consent

All participants gave written informed consent upon recruitment.

Additional information

Managed by Antonio Secchi.

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Indelicato, L., Dauriz, M., Bacchi, E. et al. Sex differences in the association of psychological status with measures of physical activity and sedentary behaviour in adults with type 2 diabetes. Acta Diabetol 55, 627–635 (2018).

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  • Diabetes
  • Depression
  • Anxiety
  • Physical activity
  • Sedentary behaviour