INS and depressive symptom measurement: Depression frequently leads to reduced physical activity (64), while exercise benefits multiple metabolic parameters through various mechanisms: enhancing glucose uptake via GLUT4 translocation (65), improving mitochondrial function in skeletal muscle (66), reducing abdominal adiposity (67, 68), increasing insulin sensitivity (69, 70), improving vascular function (71, 72), and regulating metabolic gene expression (73, 74).