Association Between Depression and Decreased Physical Activity For T2DM Patients

Link between depression and decreased physical activity: can depression affect the individual’s ability to perform any physical activity?

The effects of depression can be devastating in all areas of an individual’s life. The side effects of depression can often be seen at work, school, and home as well as in the personal relationships of the patient. In addition to that, adults who are depressed may engage in less physical activity than adults who are not depressed. Physical activity is a cornerstone of lifestyle modifications aimed at preventing and managing type 2 diabetes. Evidence from randomized controlled trials has demonstrated that maintenance of modest weight loss through physical activity reduces the incidence of type 2 diabetes by as much as 40-60% over 3-4 years. Patients with type 2 diabetes should always be counseled and encouraged to engage in more physical activities. This study aimed to investigate the impact of major affective disorders on the effectiveness of diabetes prevention programs at promoting increased physical activity.

This study used data from two randomized controlled trials, Walking Away from Type 2 Diabetes and Let’s Prevent Type 2 Diabetes. The trials included patients with type 2 diabetes and utilized similar intervention methods to help promote physical activity among those individuals. Participants were followed up annually over the duration of 36 months. Depressive symptoms were measured by the Hospital Anxiety and Depression scale while Physical activity was measured by a piezoelectric pedometer or n accelerometer and was expressed as steps per day. The total sample size was 1163 participants (571 control, 592 intervention) of which 35% were women and the mean age was 65 years. Depressive symptoms were evaluated at baseline through questionnaires, then again annually for three years. The median depression score at baseline was 3; 11% of individuals were classified as having mild to severe depression.

The researchers observed that those with no depressive symptoms at baseline or during follow-up increased their physical activity by 592 steps per day (P< 0.001) vs. 571 steps in the control group. For every additional depressive symptom score at baseline, steps per day were decreased by 88 steps (95% CI 21-155). Each increase in the depressive symptom score between baseline and follow-up further decreased physical activity by 99 steps per day (95% CI 2-196).

In conclusion, depression has a huge impact on the patient and must not be ignored. The findings of this study suggest that depressive symptoms are associated with a decrease in the effectiveness of diabetes prevention programs in promoting physical activity among individuals with type 2 diabetes. In addition to that, this study demonstrates the importance of not neglecting depressive symptoms which may be affecting the patient’s ability to perform any physical activity. Therefore, diabetes prevention programs should consider broadening their content to include a focus on depression as a core aim.

Practice Pearls:

• Physical activity is a cornerstone of lifestyle modifications aimed at preventing and managing type 2 diabetes. 
• There was a decrease in the number of steps as the depressive symptom score increased. 
• Prevention programs should consider broadening their content to include a focus on depression as a core aim.

Reference for “Association Between Depression and Decreased Physical Activity For T2DM Patients”:

Yates T, et al. Impact of depression and anxiety on a change to physical activity following a pragmatic diabetes prevention program within primary care: Pooled Analysis from two randomized controlled trials. Diabetes Care. 2019 Aug; 42(9)

Nadeen Ayad, BCPS, PharmD candidate, Skaggs School of Pharmacy, University of Colorado