Aquatic training and sleep quality, depressive symptoms and quality of life in patients with type 2 diabetes: Diabetes and Aquatic Training Study (DATS2)- A Randomized Controlled Trial

Background: Aquatic training is one type of exercise used for type 2 diabetes (T2D) management, but it has not been investigated in depth. Purpose: To verify the effects of both aerobic and combined (aerobic plus resistance) aquatic training on sleep quality, depressive symptoms, and quality of life in patients with T2D. Methods: Patients with T2D were randomly assigned to the aerobic (AERO) training group, combined (COMB) training group, and control (CON) group. The intervention period lasted 15 weeks, consisting of three 50-min weekly sessions. The AERO and COMB groups were structured in three mesocycles with progressive increases in intensity. The CON group performed sessions of stretching and relaxation in the aquatic environment. Sleep quality, depressive symptoms, and quality of life (secondary outcomes of the Diabetes and Aquatic Training Study) were evaluated before and after the intervention period. Analysis was performed using generalized estimating equations, adopting alpha = 0.05. Results: The AERO, COMB, and CON groups showed significant improvements in sleep quality, depressive symptoms, and quality of life in the overall, psychological, and physical domains, with time effects being statistically significant (p < 0.05). However, no significant changes were observed in their quality of life in the environmental and social domains (p > 0.05). Effect sizes were small for both intervention and CON groups. The AERO group exhibited larger increases than the COMB group in overall quality of life. Conclusion: Participation in an aquatic training program, regardless of the modality, is effective in reducing depressive symptoms and improving the sleep quality and overall quality of life of patients with T2D.