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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
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
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
Rubin RR, Peyrot M (2001) Psychological issues and treatments for people with diabetes. J Clin Psychol 57(4):457–478
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Bandura A (1986) Social Foundations of thought and action: a social cognitive theory. Prentice Hall, Englewood Cliffs
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)
Pate RR, O’Neill JR, Lobelo F (2008) The evolving definition of “sedentary”. Exerc Sport Sci Rev 36(4):173–178
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
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
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
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
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
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
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
Teychenne M, Ball K, Salmon J (2010) Sedentary behavior and depression among adults: a review. Int J Behav Med 17(4):246–254
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
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
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
Pinto BM, Marcus BH, Clark MM (1996) Promoting physical activity in women: the new challenges. Am J Prev Med 12(5):395–400
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
Ghisi MFG, Montano A, Sanavio E, Sica C (2006) BDI-II, Beck Depression Inventory-II. Manuale: Giunti O.S., Florence
Sica CCD, Ghisi M, Sanavio E (2006) BAI-II, Beck Anxiety Inventory. Manuale: Giunti O.S, Florence
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
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
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
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
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
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
Salmon P (2001) Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev 21(1):33–61
Teychenne M, Ball K, Salmon J (2010) Physical activity, sedentary behavior and depression among disadvantaged women. Health Educ Res 25(4):632–644
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
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
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
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.
Conflict of interest
The authors declare that they have no conflict of interests.
The study protocol was approved by the Ethics Committee of the Hospital Trust of Verona.
All participants gave written informed consent upon recruitment.
Managed by Antonio Secchi.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
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). https://doi.org/10.1007/s00592-018-1132-0
- Physical activity
- Sedentary behaviour