EQOL Journal (2022) 14(2): 5-12
ORIGINAL ARTICLE
5
Physical activity and its relationship with health-related quality of life
in type II diabetics
Eliana Romina Meza-Miranda
1
✉ • Beatriz Elizabeth Núñez-Martínez
2
Received: 14
th
August, 2022 DOI: 10.31382/eqol.221201
Accepted: 25
th
November, 2022
© The Author(s) 2022. This article is published with open access.
Abstract
Due to the chronic nature of the disease, type II
Diabetes mellitus (DM2) can affect the quality of
life and perception of health. The objective of this
study was to evaluate the quality of life, perception
of health, and level of physical activity in type II
diabetics in December 2021. A descriptive,
analytical cross-sectional design study, which
included 116 volunteers with DM2 through an
online survey where sociodemographic data, quality
of life according to the EuroQoL-5D, health
perception according to a visual analog scale, and
level of physical activity according to the
international IPAQ questionnaire. The study was
approved by the Scientific and Ethics Committee of
the Paraguayan Association of Graduates in
Nutrition (code number 128/2021). The average age
was 51.9 years, 63.8 were female, 79.3% resided in
Asunción and the Metropolitan Area, and 39.5% had
a secondary education level. 94% continued
treatment, hypertension being the most frequent
comorbidity. The quality of life showed 38% with
moderate depression and/or anxiety. The quality-of-
life index was 0,62±0.12 and the perception of
health was 65.3±17.6. The predominant level of
physical activity was low (45%). When comparing
the quality-of-life index and the perception of health
according to the level of physical activity, it was
found that these variables showed better scores in
those who perform moderate to high physical
activity. The level of physical activity is a
determinant of health-related quality of life, the
greater the intensity of physical activity, the better
the quality and perception of health indices in
diabetics patients.
Keywords diabetes • quality of life • physical
activity.
Introduction
Type II diabetes (DM2) is a metabolic disease
whose main characteristic is chronic
hyperglycemia. It is considered the third disease
with the highest morbidity and mortality
worldwide after cancer and cerebrovascular
disease. By 2030, it is estimated that the
prevalence of DM2 will increase to 4.4% and that
the 200 million people affected will increase to
400 million by 2035 (Shi and Hu, 2014). Diabetes
in Paraguay currently represents 9.7% of the total
population, approximately 700,000 people live
with this pathology, of which only 50% know their
disease. The number of people treated in health
services by the Ministry of Public Health is
100,000, of which 66% are female and 34% male
(MSPyBS, 2020).
Complications of this disease increase hospital
costs and medical treatment, a situation that
directly affects the quality of life of people with
this disease (Ambriz et al., 2015; Gonzalez et al.,
2008). The factors that most affect the quality of
life in diabetic patients are those related to mental
health, medication, concomitant diseases, and
others of a socioeconomic nature (Altınok y
Marakoğlu, 2016; Jannoo et al., 2017; Koekkoek
✉
eliana.romina59@gmail.com
1
Multidisciplinary Centre of Technological
Research, San Lorenzo, Paraguay
2
Autonomous University of Asuncion, Asunción,
Paraguay
EQOL Journal (2022) 14(2): 5-12
6
et al., 2015; Zhang et al., 2016). According to the
American Diabetes Association (ADA) guidelines,
one of the goals of optimal diabetes management is to
improve quality of life. This indicates the importance
of assessing the quality of life as an outcome of
diabetes (Jeong, 2020).
Diabetes treatment aims to prevent complications
and provide a high quality of life for patients (Huang
et al., 2007). Mounting evidence supports the
effectiveness of physical exercise as a therapy
(Sudeck & Honer, 2011). It is known that exercise
training in particular can positively impact diabetic
people by modifying their body composition,
glycaemic control, blood pressure, and insulin
resistance, which all play an increasingly protective
role (Umpierre et al., 2011; Boule et al., 2001). In this
sense, cross-sectional studies showing the benefit of
physical activity have also been carried out in people
with type 2 diabetes (Green et al., 2011; Imayama et
al., 2010).
Despite these recommendations, many patients
with type 2 diabetes are sedentary or insufficiently
active (Plotnikoff et al., 2006). Diabetic patients have
a significantly lower level of physical activity (PA),
PA compared to healthy people and a low level of PA
or lack of it is associated with the onset and
development of this disease. (Kumar et al., 2016).
Diabetics who have high PA have a lower incidence
of cardiovascular events and mortality in general and
high-intensity PA improves their metabolic profile.
(Hidekatsu et al., 2018; Jelleyman et al., 2015).
Another parameter related to the quality of life is
the perception of each person's health. Self-perceived
health is an indicator used in surveys and, although
subjective, it is strongly related to morbidity,
mortality, longevity, and health status in different
population subgroups. Therefore, it is interesting to
measure it and compare it with quality of life
(Robinson Cohen et al., 2014).
The problem with the quality of life and health
perception of patients with diabetes is that it is
negatively conditioned by the disease itself, but at the
same time it can be improved through the
introduction of physical activity according to the
possibilities of each patient, so it is important to
evaluate these three variables and identify the real
situation in this context. Therefore, the main objective
of this study was to evaluate the level of physical
activity in ambulatory patients with DM2 and its
relationship with quality of life and perception of
health in this population.
Method
Study design and eligibility
A cross-sectional analytical observational study
conducted in Paraguayan adult patients with type II
diabetes of both sexes with outpatient treatment was
evaluated in December 2021. Sociodemographic data
such as sex, age, origin, and education level were
collected. The International Physical Activity
Questionnaire (IPAQ) short version was used to
measure physical activity levels and the EuroQol-5D
questionnaire (EQ-5D) to assess the quality of life, in
addition to a visual analog scale from 1 to 10 to assess
the perception of patients' health.
Data collecting
The data was collected through Google forms
virtually. The survey was disseminated through the
official pages of public hospitals dependent on the
Ministry of Public Health and Social Welfare and the
Nutrition career unions. The inclusion criteria were
that they were ambulatory type II diabetic patients
older than 18 years of age, with comorbidities such as
hypertension, dyslipidemia, and insulin-dependent
patients. Diabetic pregnant women and people who
could not answer the survey were excluded. All
participants accessed a data sheet for the study and
gave their informed consent. The confidentiality of
the data was protected at all times and the decision to
participate or not in the study of the subjects was
above the interests of the research. and handling of
the data collected, as well as explicitly accepting
informed consent. The research was developed in
accordance with the guidelines of the Declaration of
Helsinki about research involving human subjects
and was approved by the Scientific and Ethics
Committee of the Paraguayan Association of
Graduates in Nutrition (code number 128/2021).
Data processing and analysis
The data was digitized, processed, and analyzed in a
Microsoft Excel 2010 spreadsheet. After checking the
consistency of the database and identifying the
distribution of the quantitative variables, the data
were analyzed, expressing: average and standard
deviations as appropriate. In the case of qualitative
variables, they were expressed in frequency (n) and
percentage (%). To determine if there is a relationship
between the level of physical activity and quality of
life and health perception, the one-way analysis of
variance (ANOVA) was used. The statistical study
was completed with post hoc analysis (SIDAK
correction) to detect significant differences between
EQOL Journal (2022) 14(2): 5-12
7
the different groups established according to the level
of physical activity. Statistical significance was p
<0.05. The SPSS 21.0 package for Microsoft
Windows (SPSS) was used for all statistical tests.
Results
A total of 116 diabetes patients were evaluated. As
we can see in Table 1 regarding the
sociodemographic variables of the population, 63.8%
were female, 79.3% lived in Asunción and the
Metropolitan Area, 39.5% had a secondary education
level and in the same proportion university. The mean
age of the population was 51.9 ± 16.6 years. The most
prevalent age range was 60-79 in 39%, the youngest
patient was 18 years old and the oldest was 89 years
old.
Table 1. Sociodemographic data
N (%)
42 (36.2)
74 (63.8)
116 (100)
92 (79.3)
24 (20.7)
116 (100)
24 (21)
46 (39.5)
46 (39.5)
116 (100)
24 (21)
44 (38)
45 (39)
3 (2)
116 (100)
Age (mean ± SD)
51.95 ± 16.6
Regarding clinical variables, 94% were under
treatment, 45.6% had hypertension as a comorbidity,
and 93% were taking medication to treat diabetes. See
Table 2.
Table 2. Clinical characteristics
Variable
N (%)
Diabetes under treatment
Yes
109 (94)
No
7 (6)
Total
116 (100)
Associated comorbidities
Atherosclerosis
2 (1.7)
Heart disease
3 (2.5)
Dyslipidemia
2 (1.7)
Liver disease
1 (1.1)
Hypertension
53 (45.6)
Others
55 (47.4)
Total
116 (100)
Medication consumption
Yes
108 (93)
No
8 (7)
Total
116 (100)
Regarding the level of physical activity, it was
observed that 27.5% had a moderate, 45% has a low
and 27,5% has a vigorous level of physical activity.
See Table 3.
Table 3. Level of physical activity
Variable
N (%)
Level of physical activity
Low
52 (45)
Moderate
32 (27.5)
Vigorous
32 (27.5)
Total
116 (100)
When evaluating the quality of life associated with
health, a global index of 0.62 ± 0.12 was observed and
the health perception evaluated by the visual analog
scale had an average of 65.3 ± 17.6. See Table 4.
Table 4. Quality of life
Variable
mean ± SD
Quality of life
Global quality of life index
0.62 ± 0.12
Health perception
65.3 ± 17.6
Data from Table 5 described the quality of life
according to the EuroQol-5D questionnaire according
to its 5 dimensions confirmed that in terms of
mobility and personal care, almost the majority had
no problems (81% and 89% respectively. Daily
EQOL Journal (2022) 14(2): 5-12
8
activities, 12% of individuals with some problems
were observed, 36.2% of individuals with moderate
pain or discomfort in this dimension, and 38% of the
population reported having moderate anxiety and
depression.
Table 5. Quality of life according to EuroQol-5D dimensions
Dimension
N (%)
Mobility
I have no problem walking
94 (81)
I have some trouble walking
16 (14)
I have to be in bed
6 (5)
Total
116 (100)
Personal care
I have no problems with personal care
103 (89)
I have some trouble washing or dressing
7 (6)
I am unable to wash or dress
6 (5)
Total
116 (100)
Daily activities
I have no problems doing my daily activities
96 (83)
I have some problems doing my daily activities
14 (12)
I am unable to carry out my daily activities
6 (5)
Total
116 (100)
Pain/discomfort
I have no pain or discomfort
67 (58)
I have moderate pain or discomfort
42 (36,2)
I have a lot of pain or discomfort
7 (5,8)
Total
116 (100)
Anxiety/Depression
I am not anxious or depressed
63 (54,3)
I am moderately anxious and depressed
44 (38)
I am very anxious and depressed
9 (7,7)
Total
116 (100)
When analyzing whether there are differences
between the levels of physical activity according to
the global quality of life index, significant values
were found between the groups (p = 0.018). The
higher the level of physical activity, the higher the
global quality of life index. See Figure 1.
When analyzing whether there are differences
between the level of physical activity and the
perception of health, significant values were found
between the groups (p = 0.042). The higher the level
of physical activity, the better the perception of
health. See Figure 2.
EQOL Journal (2022) 14(2): 5-12
9
Figure 1. Quality of life according to level of physical
activity
Figure 2. Health perception according to level of
physical activity
Discussion
It has been shown that performing a physical activity
at high levels is related to a better quality of life.
Physical activity has a positive effect on the
regulation of lipidemia, vascular endothelium, and
blood pressure. In addition, physical activity
improves insulin sensitivity, which improves diabetes
control. Gopinath et al., 2012).
Regarding sociodemographic characteristics, the
predominant gender was female 63.8% in contrast to
what was found by Zurita-Cruz et al. in their 2019
study on the deterioration of the quality of life in
diabetics, which was 49.9% of women. The average
age observed in this study was 51.9 years, an amount
lower than that found by Zurita-Cruz et al, who
observed a mean age of 62 years (Zurita et al., 2019).
According to educational level, this research revealed
that 39.5% had a secondary level, a figure lower than
that found by Toselli et al. in their study on body
composition and sociodemographic characteristics in
type 2 diabetics, which was 42.6%. of diabetics with
a secondary level (Toselli et al., 2019).
The most frequent comorbidity in the population
observed was hypertension in 45.6%, an amount
much lower than that found by Iglay et al. in their
study on the prevalence of comorbidities in type 2
diabetics, who found 82.1% of their population with
hypertension (Iglay et al., 2016).
It was observed that 45% have a low level of
physical activity in contrast to the 34% of adults with
a low level of physical activity found in the study by
Meza and Giménez in their study on physical activity
and quality of life carried out in healthy Paraguayan
adults (Meza and Giménez. 2021). When we contrast
this percentage with the study by Thiel et al., in their
study on physical activity related to the quality of life
in diabetic patients, we observe that it is less than
78.6% of their population with low physical activity
(Thiel et al., 2017).
The evaluation of the quality of life through the
EuroQol-5D questionnaire revealed that the most
altered dimensions were pain/discomfort and
anxiety/depression, within which 32% had moderate
pain/discomfort and 38% were moderately
anxious/depressed. The study by Meza and Giménez
found an in the pain/discomfort dimension, 23% had
a moderate problem and in the anxiety/depression
dimension, 33% had a moderate problem., using the
same questionnaire (Meza and Giménez, 2021). It
should be noted that, in the last two dimensions, a
notable percentage of the population in this study
presented some or severe problem, which affected the
quality-of-life index, therefore, it can be said that the
quality of life of itself is affected by pain/discomfort
and anxiety and/or depression, making it relatively
low. An average global quality of life index of 0.62
was found. This amount is similar to that found by
Meza and Giménez, which was 0.67 in an adult
population, using the same questionnaire (Meza and
Giménez, 2021). In contrast, Thiel et al., have
observed an EQ-5D index score of 0.79±0.17, a
higher amount than ours. For this reason, it can be
said that the perception of the health of the population
of this research is relatively low/bad.
The perception of health in the study population,
evaluated by a visual analog scale from 0 to 100,
showed an average of 65,3 This translates into an
index that finally remains at 0.65 and this figure is
EQOL Journal (2022) 14(2): 5-12
10
lower than that evidenced by Meza and Giménez,
who found an index of 0.79 (Meza and Giménez,
2021).
The quality of life according to the level of
physical activity revealed that, at a higher level, a
higher quality of life index. In this sense, a study
showed that individuals with type 2 diabetes who
meet physical activity recommendations report better
quality of life compared to those who do not. These
findings also suggested that there may be an
association between higher weekly levels of physical
activity and physical components of quality of life in
this population. This suggests that people with type 2
diabetes who can exceed the recommended amount of
physical activity may experience a better quality of
life on dimensions related to physical health than
those who simply meet baseline recommendations
(Thiel et al., 2017).
The perception of health according to physical
activity showed higher values if the level of physical
activity was higher. The higher the level of physical
activity, the higher the score reported by the
participants regarding their perception of their health.
Regarding these variables, it has been shown that
people who do not engage in physical activity in their
free time are more likely to have self-perceived
negative health, therefore, engaging in physical
activity is considered a protective factor against
people feel that they are not in good health (Silva et
al., 2019).
As a limitation of this research work, it can be
mentioned that due to the type of survey, biochemical
parameters that could be related to the level of
physical activity and quality of life in this type of
patient were not evaluated.
As a strength, it can be highlighted that few studies
assess the level of physical activity and quality of life
in the diabetic population in general and therefore, the
relevance of this study lies in providing data on these
variables and the relationship between them.
Conclusions
Daily physical activity of Paraguayan adult DM2
patients was generally low. According to the levels of
physical activity, it was possible to corroborate that at
a higher level, better scores on the global index of
quality of life and health perception were observed.
Because of the results provided by this research, the
evaluation of physical activity performance, quality
of life, and health perception in patients with DM II
should be included, in addition, promotion strategies
should be developed to increase and improve physical
activity performance physical in these types of
patients.
Conflict of interest
All authors declare that they have no conflicts of
interest.
Funding
This research work was self-financed.
Authors' contributions
All the authors contributed from the conception to the
execution of the project and finally in the writing and
approval of the manuscript for publication.
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