Variabilidad interindividual en los efectos psicológicos del ejercicio
supervisado en adultos con diabetes tipo 2


Marco Guicciardi, Romina Lecis y Davide Massidda, Universidad de Cagliari, Italia
Lucina Corgiolu, Adelina Porru, Matteo Pusceddu y Francesca Spanu, Hospital Universitario San Giovanni, Cagliari, Italia


Exercise is a key component in the management of Type 2 Diabetes Mellitus (T2DM), however despite the strong evidence of its protective effects, a majority of the population with this diagnosis remains inactive and those who start an exercise program are not willing to train themselves over the long-term. Self-efficacy and perceived stress are related to barriers to exercise in T2DM, therefore the aim of this longitudinal study is to investigate variations across time and individual differences in both variables as effects of a supervised exercise training (6 months) in a small sample of persons diagnosed with T2DM. Results show a general decline in the mean values of self-efficacy and perceived stress at 6 months and a high individual variability in both variables. These results support the need to develop customized programs of exercise in T2DM that take into account different phases of the exercise process and individual variability.

Keywords: exercise, self-efficacy, perceived stress, diabetes, variability


El ejercicio es un componente clave en la prevención y el tratamiento de Diabetes Mellitus Tipo 2 (DMT2); sin embargo, a pesar de la fuerte evidencia de sus efectos protectores, la mayoría de las personas con este diagnóstico permanece inactiva y aquellos que comienzan un programa de ejercicio no están dispuestos a entrenar a largo plazo. La autoeficacia y la percepción de estrés se relacionan con las barreras para realizar ejercicio en pacientes T2DM; por lo tanto, el objetivo de este estudio longitudinal consiste en investigar las variaciones a través del tiempo y las diferencias individuales en ambas variables, como efectos de un entrenamiento de ejercicio supervisado (6 meses), en una muestra pequeña de pacientes diagnosticados con TD2M. Los resultados muestran una disminución general de los valores promedio de la autoeficacia y del estrés percibido a los 6 meses y una alta variabilidad individual en ambas variables. Estos resultados apoyan la necesidad de desarrollar programas personalizados de ejercicio en pacientes T2DM con el objetivo de considerar las diferentes fases del proceso de ejercicio y de la variabilidad individual.

Palabras claves: ejercicio, autoeficacia, estrés percibido, diabetes, variabilidad




Akaike, H. (1974). A new look at the statistical model identification. IEEE Transactions on Automatic Control, 19 (6), 716-723.
American Diabetes Association (2014). Standards of medical care in diabetes. Diabetes Care, 37 (1), S14–S80.
Armstrong, M. (2015). Facilitating access and adherence to exercise in people with Type 2 Diabetes (Doctoral dissertation). Retrieved from
Balducci, S., Leonetti, F., Di Mario, U., and Fallucca, F. (2004). Is a longterm aerobic plus resistance training program feasible for and effective on metabolic profiles in type 2 diabetic patients? Diabetes Care, 27, 841–842.
Balducci, S., Sacchetti, M., Haxhi, J., Orlando, G., D’Errico, V., Fallucca, S., Menini, S. and Pugliese, G. (2014). Physical exercise as therapy for type 2 diabetes mellitus. Diabetes/Metabolism Research and Reviews, 30 (Suppl. 1), 13–23.
Bandura, A. (1986). Social foundations of thought and action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall.
Bates, D. (2006). [R] lmer, p-values and all that. [Electronic mailing list message]. Retrieved from
Bates, D., Maechler, M., Bolker, B., and Walker, S. (2015). lme4: linear mixed-effects models using Eigen and S4 [Computer software]. Retrieved from (R package version 1.1-9).
Bates, D., Maechler, M., Bolker, B., and Walker, S. (in press). lme4: linear mixed-effects models using Eigen and S4. Journal of Statistical Software. Retrieved from
Bruce, R. A. (1971). Exercise testing of patients with coronary heart disease. Principles and normal standards for evaluation. Annals of clinical research, 3, 323-332.
Church, T. S., Blair, S. N., Cocreham, S., Johannsen, N., Johnson, W., Kramer, K., et al. (2010). Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA, 304, 2253–2262.
Cohen, S., Kamarck, T. and Mermelstein, R. (1983). A global measure of perceived stress. Journal of health and social behavior, 24, 385–396.
Colberg, S. R., Albright, A. L., Blissmer, B. J., Braun, B., Chasan-Taber, L., Fernhall, B., et al. (2010). Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care, 33 (12), e147-167.
Dunstan, D. W., Daly, R. M., Owen, N., Jolley, D., De Courten, M., Shaw, J. and Zimmet, P. (2002). High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care, 25, 1729–1736.
Dutton, G. R., Tan, F., Provost, B. C., Sorenson, J. L., Allen, B. and Smith, D. (2009). Relationship between selfefficacy and physical activity among patients with type 2 diabetes. Journal of behavioral medicine, 32, 270–277.
Erickson, D. (2013). Barriers to physical activity in people with type 2 diabetes enrolled in a worksite Diabetes disease management program. The Diabetes Educator, 39, 626–634.
Guicciardi, M., Lecis, R., Anziani, C., Corgiolu, L., Porru, A., Pusceddu, M. and Spanu, F. (2014). Type 2 diabetes mellitus, physical activity, exercise self-efficacy, and body satisfaction. An application of the transtheoretical model in older adults. Health Psychology and Behavioral Medicine: An Open Access Journal, 2, 748–758.
Holmes, M. E., Ekkekakis, P., and Eisenmann, J. C. (2010). The physical activity, stress and metabolic syndrome triangle: a guide to unfamiliar territory for the obesity researcher. Obesity reviews: an official journal of the International Association for the Study of Obesity, 11 (7), 492–507.
Hughes, S. L., Seymour, R. B., Campbell, R., Pollak, N., Huber, G. and Sharma, L. (2004). Impact of the fit and strong intervention on older adults with osteoarthritis. Gerontologist, 44, 217–228.
Kirk, A., MacMillan, F. and Webster, N. (2010). Application of the transtheoretical model to physical activity in older adults with Type 2 diabetes and/or cardiovascular disease. Psychology of Sport and Exercise, 11, 320–324.
Laugero, K. D., Falcon, L. M. and Tucker, K. L. (2011). Relationship between perceived stress and dietary and activity patterns in older adults participating in the Boston Puerto Rican Health Study. Appetite, 56, 194–204.
Lazarus, R. S., and Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.
Lutz, R. S., Stults-Kolehmainen, M. A. and Bartholomew, J. B. (2010). Exercise caution when stressed: stages of change and the stress–exercise participation relationship. Psychology of Sport and Exercise, 11 (6), 560–567.
Maiorana, A., O’Driscoll, G., Goodman, C., Taylorb, R., and Green, D. (2002). Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes research and clinical practice, 56, 115–123.
Marcus, B. H., Selby, V. C., Niaura, R. S. and Rossi, J. S. (1992). Self-efficacy and the stages of exercise behaviour change. Research Quarterly for Exercise and Sport, 63, 60–66.
Marwick, T. H., Hordern, M. D., Miller, T., Chyun, D. A., Bertoni, A. G., Blumenthal, R. S., et al. (2009). Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Circulation, 119 (25), 3244-3262.
McAuley, E., Courneya, K. S., Rudolph, D. L. and Lox, C. L. (1994). Enhancing exercise adherence in middle-aged males and females. Preventive Medicine, 23, 498–506.
McAuley, E., Jerome, G. J., Marquez, D. X., Elavsky S. and Blissmerr, B. (2003). Exercise self-efficacy in older adults: social, affective, and behavioral influences. Annals of behavioral medicine: a publication of the Society of Behavioral Medicine, 25, 1–7.
McAuley, E., Mailey, E. L., Mullen, S. P., Szabo, A. N., Wójcicki, T. R., White, S. M., Gothe, N., Olson, E. A. and Kramer, A.F. (2011). Growth trajectories of exercise self-efficacy in older adults: influence of measures and initial status. Health Psychology, 30 (1), 75–83.
McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological reviews, 87 (3), 873–904.
Moore, S. M., Charvat, J. M., Gordon, N. H., Pashkow, F., Ribisl, P., Roberts, B. L. and Rocco, M. (2006). Effects of a CHANGE intervention to increase exercise maintenance following cardiac events. Annals of Behavioral Medicine, 31, 53–62.
Oman, R. F., and King, A. C. (1998). Predicting the adoption and maintenance of exercise participation using selfefficacy and previous exercise participation rates. American Journal of Health Promotion, 12, 154–161.
Plotnikoff, R. C., Brez, S. and Hotz, S. B. (2000). Exercise behavior in a community sample with diabetes: Understanding the determinants of exercise behavioral change. The Diabetes Educator, 26, 450–459.
Plotnikoff, R. C., Lippke, S., Courneya, K., Birkett, N., and Sigal, R. (2008). Physical activity and social-cognitive theory: A test in a population sample of adults with type 1 or type 2 diabetes. Applied Psychology: An International Review, 57 (4), 628-643.
Plotnikoff, R. C., Lippke, S., Johnson, S. T. and Courneya, K. S. (2010). Physical activity and stages of change: A longitudinal test in types 1 and 2 diabetes samples. Annals of behavioral medicine: a publication of the Society of Behavioral Medicine. Med, 40, 138–149.
R Core Team (2015). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Retrieved from
Sigal, R. J., Kenny, G. P., Boulé, N. G., Wells, G. A., Prud’homme, D., Fortier, M., Reid, R. D., Tulloch, H., Coyle, D., Phillips, P., Jennings, A. and Jaffey, J. (2007). Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Annals of internal medicine, 147, 357–369.
Stults-Kolehmainen, M. A., and Sinha, R. (2014). The effects of stress on physical activity and exercise. Sports medicine, 44 (1), 81–121.
Taylor, J. D., Fletcher, J. P. and Tiarks, J. (2009). Impact of physical therapist– directed exercise counseling combined with fitness center– based exercise training on muscular strength and exercise capacity in people with type 2 diabetes: a randomized clinical trial. Physical therapy, 89, 884 – 892.
van der Heijden, M. M .P., van Dooren, F. E. P., Pop V. J. M. and Pouwer, F. (2013). Effects of exercise training on quality of life, symptoms of depression, symptoms of anxiety, and emotional well-being in type 2 diabetes mellitus. A systematic review. Diabetologia, 56, 1210-1225.
van de Vijver, F. J. R., and Hambleton, R. K. (1996). Translating tests: Some practical guidelines. European Psychologist, 1, 89-99.
Zanuso, S., Jimenez, A., Pugliese, G., Corigliano, G. and Balducci, S. (2010). Exercise for the management of type 2 diabetes: a review of the evidence. Acta diabetologica, 47, 15–22.