**Conflict of interest**

*Quality of Life - Biopsychosocial Perspectives*

and loss of energy or increased fatigue [57].

respectively [58].

It can be classified on (i) major depression, when the presence of depressive mood and anhedonia (reduced positive affect) for 2 weeks is accompanied by at last five symptoms such as depressed mood, uncontrolled weight for no apparent reason, lack of motivation, psychomotor disorder, loss of energy or increased fatigue, alteration in sleep, difficulty thinking and thoughts of dead or suicide; (ii) minor depression, which is similar to major depression, but the patient has few than five symptoms; and (iii) dysthymia, when the patient experiences an acute depressive mood for most of the day which persists for at least 2 years. However, at least two of the following symptoms should be present: changes in appetite, low self-esteem, sleep alteration, difficulty thinking, discouragement,

The nine-item patient health questionnaire is a valid and reliable screaming tool frequently used for the diagnosis of depression. It is an easy and brief self-report questionnaire and can be used in patient with T2D. It consists of nine questions based in the depressive symptoms with score of "0" (not at all) to "3" (nearly every day). It calculated a total score, and it ranges from 0 to 27. A cutoff score of 10–14, 15–19, and 20–27 indicates moderate, moderately severe, and severe depression,

Referring to anxiety, it is defined as a subjective feeling of fear, worry, and discomfort, for no reason at all or derived from anticipation of something [59]. Results from a recent meta-analysis support scientifically evidence that people with T2DM exhibit an increased likelihood of having anxiety disorder and anxiety symptoms than people without diabetes, and on the other side, it is associated with poor glycemic control and increased diabetes complications [53]. Those patients can experience physiologic sensation such as tachycardia, dizziness, sweating, headaches, and gastrointestinal disorder and also avoid places, people, and events. The diagnosis of the disease may induce anxiety because the patient has to adopt a severe lifestyle change in function of the disease treatment with a daily management of diabetes and worry of the long-term micro- and macrovascular complication [53]. It is common to diagnose anxiety using self-report symptom scales, mainly the Spielberger Trait Anxiety Questionnaire, the general health questionnaire for anxiety subscale, Hospital Anxiety and Depression

It is important to note that the idea that physical exercise has positive effects on depression and anxiety of patients with T2D in some cases is not unanimous. For instance, results from a systematic review of intervention studies [60] concluded that the evidences of physical exercise on psychological outcomes are conflicting. In this review, aerobic exercise shows to improve symptoms of anxiety. Significant difference in depression was found only in resistance training. For quality of life, among 6 studies (478 participants examined), only 2 reported significant effect of aerobic training compared to control group. Previous studies examined (361 participants), a mixed effect of resistance training on the mental domain of the SF-36 and SF-12 questionnaire was found. The authors stand out that heterogeneity of the studies was reflected on the mixed results found [60]. On the other side, a randomized controlled trial of 218 inactive patients with T2D found that no exercise was superior to resistance or combined exercise of 22 weeks, three times per week for improving mental health status [61]. Against the mixed evidence of physical exercise to improve mental health in T2D, it is necessary for future studies to confirm some findings. The literature showed that physical activity can mitigate mental disorder in active patient with T2D [15], and in this sense, an important benefit of physical activity or physical

For these patients, it is expressly recommended to perform at least 150 min of aerobic exercise of moderate-to-vigorous intensity and at least 2 sessions of resistance exercise. The compliance with these recommendations may have a positive

Scale for anxiety (HADS), and Hopkins symptom checklist [59].

exercise for mental health on those patients could be speculated.

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Authors have no conflict of interest to disclose.
