title: Depressive symptoms predict non-completion of a structured exercise intervention for people with Type 2 diabetes.
abstract: OBJECTIVE
  To quantify the impact of depressive symptoms on completion of exercise-based rehabilitation for Type 2 diabetes management.
  
  
  METHODS
  Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale in a prospective cohort of consecutive patients with Type 2 diabetes entering a 6-month hybrid (home- and clinic-based) exercise rehabilitation programme. Attendance at exercise sessions was monitored and programme completion/non-completion was ascertained.
  
  
  RESULTS
  Of the programme participants (n=624, mean age 55.6±10.5 years, 47% male), 26.8% endorsed significant depressive symptoms (depression score ≥16) and 68.1% completed the intervention, attending 54.6±30.0% of supervised exercise sessions. Baseline depressive symptoms (depression scale score ≥16) increased the risk of non-completion [hazard ratio 1.49 (95% CI 1.10-2.03); P = 0.010], and predicted fewer sessions attended (β=-2.1, P= 0.002) in adjusted models. A depression score threshold of ≥10 (48.4% of participants) predicted non-completion [hazard ratio 1.60 (95% CI 1.19-2.17); P= 0.002) with optimum accuracy. Non-completions resulting from lack of interest (18.9 vs. 11.0%; P= 0.026) and medical complications (14.6 vs. 6.6%; P= 0.006) were more common among participants with depression scores ≥10. Greater hazard ratios for depression scores ≥10 were observed in subgroups not currently using insulin [hazard ratio 1.70 (95% CI 1.24-2.33); P= 0.001), or an antidepressant [hazard ratio 1.83 (95% CI 1.32-2.54); P<0.001].
  
  
  CONCLUSIONS
  Depressive symptoms were highly prevalent among participants with Type 2 diabetes entering exercise-based rehabilitation, and even mild depressive symptoms posed a significant barrier to completion. Depression screening may help target additional supports to facilitate completion of exercise interventions for people with Type 2 diabetes.
authors.affiliation: University of Toronto, Toronto, ON, Canada.|Sunnybrook Research Institute, Toronto, ON, Canada.|University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Swardfager
authors.affiliation: University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Yang
authors.affiliation: University of Toronto, Toronto, ON, Canada.|Sunnybrook Research Institute, Toronto, ON, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: University of Toronto, Toronto, ON, Canada.|Sunnybrook Research Institute, Toronto, ON, Canada.|University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada.
authors.forename: K L
authors.initials: KL
authors.lastname: Lanctôt
authors.affiliation: University of Toronto, Toronto, ON, Canada.|Sunnybrook Research Institute, Toronto, ON, Canada.
authors.forename: B R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: University of Toronto, Toronto, ON, Canada.|Sunnybrook Research Institute, Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Kiss
authors.affiliation: University of Toronto, Toronto, ON, Canada.|Sunnybrook Research Institute, Toronto, ON, Canada.|University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada.
authors.forename: P I
authors.initials: PI
authors.lastname: Oh
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003863:Depression / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000534:rehabilitation*; D005081:Exercise Therapy; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010349:Patient Compliance; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012306:Risk
chemical_list: D000928:Antidepressive Agents; D007004:Hypoglycemic Agents; D007328:Insulin