Sedentary behaviour as a new behavioural target in the prevention and treatment of type 2 diabetes

A Physical Activity and Sitting Time Balance Index and All-Cause Mortality Risk

INTRODUCTION

Achieving a healthier balance of more time spent in physical activity (PA) and less time in sedentary behavior is now widely advocated for achieving multiple health benefits. This study introduces a Physical Activity and Sitting Time Balance Index (PASTBI), a potential risk identification tool addressing the interplay between PA and sedentary behavior; and aims to explore its association with the risk of all-cause mortality in Australian adults.

METHODS

This prospective cohort study analyzed the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) data on 5,836 Australian adults. The PASTBI was calculated by dividing the total duration of PA (minutes/day) by the duration of sitting time (ST) (hours/day), both self-reported at baseline (2004-2005). The PASTBI was expressed in quartiles ranging from Q1 - low PA/high ST to Q4 - high PA/low ST. The association between PASTBI and all-cause mortality was explored (in 2022) using the Cox proportional hazards regression models adjusted for socio-demographics, lifestyle factors, waist circumference, and the number of comorbidities.

RESULTS

During 78,406 person-years of follow-up (median follow-up of 14.3 years), there were 885 deaths (15%). In the fully adjusted model, compared to those in the highest PASTBI category (Quartile 4 - high PA/low ST), participants from the lowest PASTBI category (Quartile 1 - low PA/high ST) were at a higher risk of all-cause mortality [HR (95% CI) = 1.47 (1.21-1.79)].

CONCLUSIONS

A less favorable balance of time spent in PA and ST (as characterized by a parsimonious PASTBI index approach) was associated with a higher risk of all-cause mortality.

Associations between physical activity and all-cause and cardiovascular mortality in adults with type 2 diabetes mellitus: A prospective cohort study from NHANES 2007-2018

AIMS

To investigate the dose-response association between physical activity and all-cause and cardiovascular mortality in adults with type 2 diabetes mellitus and the effects of replacing sedentary behavior with physical activity.

METHODS

4808 adults with type 2 diabetes mellitus were included in NHANES 2007-2018. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals. Isotemporal substitution analyses were further to determine the possible benefit of replacing sedentary time.

RESULTS

During a median follow-up of 6.58 years, 902 deaths occurred, including 290 deaths from cardiovascular disease. Compared with the inactive group, the low-active and high-active groups were associated with declined risks of all-cause mortality [HRs (95% CIs) 0.64 (0.50, 0.83); 0.60 (0.50, 0.73), respectively] and cardiovascular mortality [0.50 (0.29, 0.88); 0.54 (0.39, 0.76)), respectively]. Dose-response analysis showed a significant U-shaped curve between physical activity and all-cause and cardiovascular mortality. Replacing 30 min/day of sedentary time with physical activity was substantially linked to a reduced risk of 8-32% mortality.

CONCLUSION

A high level of PA of 40.52 and 31.66 MET-h/week was respectively related to the lowest risk of all-cause and cardiovascular mortality. Replacing sedentary time with physical activity could benefit the type 2 diabetes mellitus population.

A socio-ecological approach to reduce the physical activity drop-out ratio in primary care-based patients with type 2 diabetes: the SENWI study protocol for a randomized control trial

Background

Physical activity (PA) is a key behaviour for patients with type 2 diabetes (T2DM). However, healthcare professionals’ (HCP) recommendations (walking advice), which are short-term and individually focused, did not reduce the PA drop-out ratio in the long run. Using a socio-ecological model approach may contribute to reducing patient dropout and improving adherence to PA. The aim of this study is threefold: first, to evaluate the effectiveness of a theory-driven Nordic walking intervention using a socio-ecological approach with T2DM patients in Spain; second, to explore the feasibility on the PA adherence process in T2DM patients while participating in the SENWI programme; and third, to understand the HCPs’ opinion regarding its applicability within the Spanish healthcare system.

Methods

A three-arm randomized control trial (n = 48 each group) will assess the efficacy of two primary care-based PA interventions (Nordic walking vs. Nordic walking plus socio-ecological approach; two sessions per week for twelve weeks) compared to a control group (usual HCPs’ walking advice on PA). Inclusion criteria will include physically inactive patients with T2DM, older than 40 years and without health contraindications to do PA. PA levels and drop-out ratio, quality of life and metabolic and health outcomes will be assessed at baseline, post-intervention and at 9- and 21-month follow-ups. The effect of the different interventions will be assessed by a two-factor analysis of variance: treatment group vs time. Also, a two-factor ANOVA test will be performed with linear mixed models for repeated measures.

A qualitative analysis using focus groups will explore the reasons for the (in)effectiveness of the new PA interventions. Qualitative outcomes will be assessed at post-intervention using thematic analysis.

Discussion

Compared with the general PA walking advice and Nordic walking prescriptions, integrating a socio-ecological approach into Spanish primary care visits could be an effective way to reduce the PA drop-out ratio and increase PA levels in patients with T2DM. Such interventions are necessary to understand the role that multiple socio-complex process in day-to-day PA behaviour has in patients with T2DM in the Spanish context.

Trial registration

ClinicalTrials.gov NCT05159089. Physical Activity Drop-out Ratio in Patients’ Living with Type 2 Diabetes. Prospectively registered on 15 December 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06742-7.

Objectively-Measured Physical Activity and Sedentary Behaviors and Related Factors in Chinese Immigrants in the US with Prior Gestational Diabetes Mellitus

Chinese immigrants in the US are disproportionately affected by gestational diabetes mellitus (GDM) and type 2 diabetes (T2D). The aims of this study were to describe their physical activity (PA) and sedentary behaviors (SB) patterns and to identify determinates of objectively-measured PA and SB among Chinese immigrants in the US with prior GDM. We conducted a cross-sectional study among 106 Chinese immigrants with prior GDM across the US. PA and SB were measured by GT9X+ hip accelerometers for 7 consecutive days. Validated questionnaires in English and Chinese were used to assess knowledge and risk perceptions as well as cultural and psychosocial characteristics. Descriptive, bivariate, and multiple regression analyses were performed. Only 27% of participants met the PA guidelines. The median duration of moderate-vigorous-intensity PA (MVPA) per week was 79 (IQR 38-151) minutes. Participants had an average of 9.2 ± 1.4 h of sedentary time per day. Living with parents (who may provide family support) was associated with more MVPA minutes per week, more steps per day, and a greater likelihood of meeting PA guidelines. Higher levels of acculturative stress were associated with fewer MVPA minutes per week. Being employed and having a lower BMI were associated with more SB. Strategies are needed to increase MVPA among this high-risk group, including decreasing acculturative stress and increasing family support. Different strategies are needed to decrease SB among this population.

Sedentary behavior and cardiovascular disease risk: An evolutionary perspective

A ubiquitous aspect of contemporary societies is sedentary behavior (SB), defined as low intensity activities in a seated, reclined, or supine posture. Leading public health agencies, including the World Health Organization, have recognized the strong association between SB and poor health outcomes, particularly cardiovascular disease. However, while public health agencies have begun to advocate for “reductions” in SB, the current US guidelines are typically vague and non-specific. There is good reasoning behind this non-committal advocacy—there is limited mechanistic and clinical evidence to support policy development. To guide SB policy development, it is important to first consider the origins and evolution of SB, including the following: 1) is SB really a novel/contemporary behavior? i.e., how has this behavior evolved? 2) how did our ancestors sit and in what contexts? 3) how does SB interact with 24-hour activity behaviors, including physical activity and sleep? 4) what other historical and contemporary facets of life interact with SB? and 5) in what context do these behaviors occur and how might they provide different evolutionarily novel stressors? This perspective article will synthesize the available evidence that addresses these questions and stimulate discussion pertaining to the lessons that we can learn from an historical and evolutionary perspective. Last, it will outline the gaps in current SB interruption literature that are hindering development of feasible SB reduction policy.

Cardiometabolic and neuromuscular analyses of the sit-to-stand transition to question its role in reducing sedentary patterns

To counteract the detrimental health effect of sitting all day long, it has been suggested to regularly break sitting time by standing. However, while the difference in energy expenditure, neuromuscular and/or cardiovascular demand of various postures from lying, sitting, and standing is well documented, little is known regarding the dynamic changes occurring during the sit-to-stand transition itself. The aim of the present study was then to describe the cardiometabolic and neuromuscular responses from sitting to standing and specifically during the time-course of this transition. Twelve healthy young participants were asked to perform standardized raises from sitting posture, while cardiometabolic (cardiorespiratory and hemodynamic variables) and neuromuscular (calf muscles' myoelectrical activity, spinal and supraspinal excitabilities) parameters were monitored. As a result, while there was a rapid adaptation for all the systems after rising, the neuromuscular system displayed the faster adaptation (~ 10 s), then hemodynamic (~ 10 to 20 s) and finally the metabolic variables (~ 30 to 40 s). Oxygen uptake, energy expenditure, ventilation, and heart rate were significantly higher and stroke volume significantly lower during standing period compared to sitting one. In calf muscles, spinal excitability (H-reflexes), was lowered by the sit-to-stand condition, while supraspinal drive (V-wave) was similar, indicating different cortico-spinal balance from sitting to standing. Although very heterogenous among participants in terms of magnitude, the present results showed a rapid adaptation for all the systems after rising and the health benefit, notably in terms of energy expenditure, appears rather modest, even if non negligeable.

Impact of BMI, Physical Activity, and Sitting Time Levels on Health-Related Outcomes in a Group of Overweight and Obese Adults with and without Type 2 Diabetes

Physical activity level and sedentary behaviors affect health status in people with obesity and type 2 diabetes (DM2); their assessment is mandatory to properly prescribe exercise programs. From January 2011 to February 2014, 293 overweight/obese adults (165 women and 128 men, mean age of 51.9 ± 9.5 years and 54.6 ± 8.3 years, respectively), with and without DM2, participated in a three-month intensive exercise program. Before starting, participants were allocated into three subgroups (overweight, body mass index or BMI = 25-29.9; class 1 of obesity, BMI = 30-34.4; or class 2 (or superior) of obesity, BMI > 35). The international physical activity questionnaire (IPAQ-it) was used to evaluate participants' baseline sitting time (SIT) and physical activity level (PAL). Stratified multiple analyses were performed using four subgroups of SIT level according to Ekelund et al., 2016 (low, 8 h/day of SIT) and three subgroups for PAL (high, moderate, and low). Health-related measures such as anthropometric variables, body composition, hematic parameters, blood pressure values, and functional capacities were studied at the beginning and at the end of the training period. An overall improvement of PAL was observed in the entire sample following the three-month intensive exercise program together with a general improvement in several health-related measures. The BMI group factor influenced the VO₂ max variations, leg press values, triglycerides, and anthropometric variables, while the SIT group factor impacted the sitting time, VO₂ max, glycemic profile, and fat mass. In this study, baseline PAL and SIT did not seem to influence the effects of an exercise intervention. The characteristics of our educational program, which also included a physical exercise protocol, allowed us to obtain positive results.

Cardiac Autonomic Modulation in Response to Three Types of Exercise in Patients with Type 2 Diabetic Neuropathy

Purpose

Physical exercise is necessary in the handling DM, but it is not distinct which kind of physical exercise can improve cardiac autonomic modulation in T2DM. The purpose of this study was to compare the effects of three different modalities of exercise (aerobic, resistant, and combined) on cardiac autonomic modulation as measured by HRV in patients with type 2 diabetic neuropathy.

Methods

The participants were 45 men (age: 55.24 ± 8.11 years, weight: 89.5 ± 13.4 kg, height: 171.85 ± 6.98 cm, duration of diabetes: 12.51 ± 6.46 years) with type 2 diabetic neuropathy who were clinically free from signs and symptoms of cardiovascular disease. Participants were randomly assigned to one of four groups: aerobic-training (n = 11), dynamic resistant-training (n = 11), Combined-training (n = 11), or a non-exercise control group (n = 12). The exercise groups performed aerobic and resistant exercise for 25-45 min per day, 3-5 times per week for 12 weeks. Anthropometrics, biochemical markers (FBS, HbA1c, Lipid Profile, and Insulin), and heart rate variability in the exercise laboratory and under ambulatory conditions by 3-channel ECG digital Holter recorder were examined.

Results

All time and frequency-domain HRV parameters (except LF power) were significantly improved in the exercise groups, compared with the control group (p < 0.05). SDNN, rMSSD, and HF power were boosted, LF power was not different, and the LF/HF ratio decreased after versus before exercise training, independent of exercise modality. HbA1c in aerobic and resistant-training groups, and insulin and LDL in the resistant-training group were decreased after exercise training (p < 0.05).

Conclusions

Exercise training, independent of modality, in patients with type 2 diabetic neuropathy who were clinically free of the cardiovascular disease cause to significant progress in cardiovascular autonomic function assessed by HRV via enhancing cardio-vagal and reducing cardio-sympathetic tone.

Risk assessment of metabolic syndrome prevalence involving sedentary occupations and socioeconomic status

OBJECTIVES

To determine whether occupation type, distinguished by socioeconomic status (SES) and sedentary status, is associated with metabolic syndrome (MetS) risk.

METHODS

We analysed two data sets covering 73 506 individuals. MetS was identified according to the criteria of the modified Adult Treatment Panel III. Eight occupational categories were considered: professionals, technical workers, managers, salespeople, service staff, administrative staff, manual labourers and taxi drivers; occupations were grouped into non-sedentary; sedentary, high-SES; and sedentary, non-high-SES occupations. A multiple logistic regression was used to determine significant risk factors for MetS in three age-stratified subgroups. R software for Windows (V.3.5.1) was used for all statistical analyses.

RESULTS

MetS prevalence increased with age. Among participants aged ≤40 years, where MetS prevalence was low at 6.23%, having a non-sedentary occupation reduced MetS risk (OR=0.88, p<0.0295). Among participants aged >60 years, having a sedentary, high-SES occupation significantly increased (OR=1.39, p<0.0247) MetS risk.

CONCLUSIONS

The influence of occupation type on MetS risk differs among age groups. Non-sedentary occupations and sedentary, high-SES occupations decrease and increase MetS risk, respectively, among younger and older adults, respectively. Authorities should focus on individuals in sedentary, high-SES occupations.

Examining 24-Hour Activity and Sleep Behaviors and Related Determinants in Latino Adolescents and Young Adults With Obesity

Background. Few studies have examined 24-hour activity and sleep behaviors and their contribution to type 2 diabetes (T2D) in Latino adolescents and young adults with obesity. Aim. This study included quantitative data on T2D risk and 24-hour activity and sleep behaviors and qualitative data on individual, social, and environmental behavioral determinants. Method. A 7 day, 24-hour, wrist-worn accelerometer protocol assessed moderate-to-vigorous physical activity (PA), sedentary behaviors (SB), sleep, and sleep regularity, in adolescents (N = 38; 12-16 years) and young adults (N = 22; 18-22 years). T2D-related outcomes included adiposity (BMI, BF%, waist circumference), fasting, and 2-hour glucose. A subsample of participants (N = 16 adolescents, N = 15 young adults) completed interviews to identify behavioral determinants. Results. High levels of PA were observed among adolescents (M = 103.8 ± 67.5 minutes/day) and young adults (M = 96.8 ± 78.8 minutes/day) as well as high levels of SB across both age groups (≥10 hours/day). Sleep regularity was negatively associated with adiposity (all ps < .05) in both age groups as well as fasting and 2-hour glucose in young adults (all ps < .05). Social support was associated with PA in both age groups as well as SB in younger youth. Auditory noises, lights, and safety inhibited sleep in both age groups. Conclusion. PA is critical for disease reduction, yet reducing SB and improving sleep are also important targets for reducing T2D risk in Hispanic adolescents and young adults. Future health promotion and disease prevention strategies should leverage qualitative findings regarding behavioral determinants.

Trained Volunteers With Type 2 Diabetes Experience Significant Health Benefits When Providing Peer Support

Trained lay volunteers may have value in supporting lifestyle change programs in the prevention of type 2 diabetes, but the potential health benefits (or harms) experienced by these lay volunteers have not been well described. This is important, as this is an appealing model in terms of workforce planning. The aim of the prespecified quantitative study reported here, was to examine the possible health benefits or harms experienced by these trained lay volunteers with type 2 diabetes. In a large type 2 diabetes prevention program, we recruited and trained 104 lay volunteers with type 2 diabetes themselves, to act as diabetes prevention mentors and codeliver the lifestyle intervention. Mentors made motivational telephone calls to 461 participants randomized to one of the trial arms to encourage lifestyle changes. Weight, diet, physical activity, well-being, quality of life, diabetes-specific self-efficacy, and glycaemic control were measured at baseline, 12 and 24 months. Average mentor age was 62.0 years, 57 (54.8%) were male, 92 (88.5%) were overweight or obese (BMI>30 kg/m²). At 12 months, mentor dietary behaviors (fat and fiber intake) improved significantly, sedentary time spent fell significantly, and diabetes specific self-efficacy scores significantly increased. These significant improvements, with no evidence of harms, suggest lay volunteers with type 2 diabetes codelivering a lifestyle intervention, may themselves experience health benefits from volunteering.

Sedentary Lifestyle Matters as Past Sedentariness, Not Current Sedentariness, Predicts Cognitive Inhibition Performance among College Students: An Exploratory Study

Background: Currently, sedentariness is assessed over a short period of time, thus it is difficult to study its cognitive implications. To investigate the cognitive consequences of a sedentary lifestyle, the past level (i.e., the sedentary time accumulated over the years) and current level of sedentariness should be considered. This pilot study aimed to investigate the negative association between a sedentary lifestyle and cognition by considering both the current and past sedentariness. It was expected that the physical activity level moderates the potential negative association between sedentariness and cognition. Methods: 52 college students (M_age = 20.19, SD_age = 2; 36 women) participated in the study. Current sedentariness (ratio of sedentary time in the last year), past sedentariness (ratio of sedentary time accumulated in previous years), and physical activity (ratio of time spent in physical activity in years) were assessed using a questionnaire. Cognitive inhibition, cognitive flexibility, and working memory updating were measured through three specific tests. Results: Past sedentariness significantly explained the inhibition performance when controlled for physical activity, whereas current sedentariness did not. More precisely, past sedentariness only negatively predicted cognitive inhibition when the physical activity level was low (β = -3.15, z(48) = -2.62, p = 0.01). Conclusions: The impact of sedentariness on cognitive functioning might only be revealed when past sedentariness and physical activity are controlled.

Replacement of Sedentary Behavior by Various Daily-Life Physical Activities and Structured Exercises: Genetic Risk and Incident Type 2 Diabetes

OBJECTIVE

To prospectively analyze the association of sedentary behavior time with type 2 diabetes (T2D) risk and perform the isotemporal substitution analyses to estimate the effect of substitution of sedentary behaviors by equal time of different types of daily-life physical activities and structured exercise. We also examined modifications by the genetic predisposition to T2D.

RESEARCH DESIGN AND METHODS

We included 475,502 participants free of T2D in the UK Biobank. Sedentary time was quantified by summing up the time spent on television watching, computer use, and driving.

RESULTS

During a median follow-up of 11 years, we documented 18,169 incident T2D cases. In comparison of the extreme categories (≥6 vs. <2 h/day), the hazard ratio for T2D was 1.58 (95% CI 1.47, 1.71) after adjustment for age, race, sex, lifestyle factors, and other covariates. Replacing 30 min of sedentary behavior per day with an equal amount of time of different types of daily-life activities and structured exercise was significantly associated with a 6-31% risk reduction of T2D, with strenuous sports showing the strongest (31%, 95% CI 24, 37) benefit. Moreover, we found a significant interaction between sedentary behavior and genetic predisposition for the risk of T2D (P interaction = 0.0008). The association was more profound among participants with a lower genetic risk of T2D.

CONCLUSIONS

Our study indicates that sedentary behavior time is associated with an increased risk of T2D; replacing sedentary behavior with a short duration (30 min/day) of daily-life physical activities or structured exercise is related to a significant reduction in T2D risk. Furthermore, such association was stronger among those with a lower genetic risk of T2D.

Impact of Reducing Sitting Time in Women with Fibromyalgia and Obesity: A Randomized Controlled Trial

BACKGROUND

Sitting time has negative effects on health, increasing the risk of obesity, osteoporosis, diabetes, and cancer. Thus, primary health care education interventions aimed to reduce sitting time and sedentary behavior could have beneficial effects on people's health and wellbeing. The purpose of this study was to assess the effectiveness of an intervention based on reducing sitting time to decrease cardiometabolic risk on a sample of women diagnosed with fibromyalgia and moderate obesity.

METHODS

Randomized controlled trial to evaluate the effectiveness of an intervention to decrease cardiometabolic risk in 84 participants. Sedentary behavior was monitored using an accelerometer before and at 3-month follow-up.

RESULTS

Compared with the control group, body mass index decreased, and the number of steps taken increased, in the intervention group 3 months after the intervention. No significant differences were found in the rest of the variables measured.

CONCLUSION

The intervention group decreased sitting time after the intervention. Group activities and support from primary care may be useful to improve treatment adherence. RCT registration: NCT01729936.

Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial

BACKGROUND

Physical activity is associated with a reduced risk of type 2 diabetes and cardiovascular disease but limited evidence exists for the sustained promotion of increased physical activity within diabetes prevention trials. The aim of the study was to investigate the long-term effectiveness of the Walking Away programme, an established group-based behavioural physical activity intervention with pedometer use, when delivered alone or with a supporting mHealth intervention.

METHODS

Those at risk of diabetes (nondiabetic hyperglycaemia) were recruited from primary care, 2013-2015, and randomised to (1) Control (information leaflet); (2) Walking Away (WA), a structured group education session followed by annual group-based support; or (3) Walking Away Plus (WAP), comprising WA annual group-based support and an mHealth intervention delivering tailored text messages supported by telephone calls. Follow-up was conducted at 12 and 48 months. The primary outcome was accelerometer measured ambulatory activity (steps/day). Change in primary outcome was analysed using analysis of covariance with adjustment for baseline, randomisation and stratification variables.

RESULTS

One thousand three hundred sixty-six individuals were randomised (median age = 61 years, ambulatory activity = 6638 steps/day, women = 49%, ethnic minorities = 28%). Accelerometer data were available for 1017 (74%) individuals at 12 months and 993 (73%) at 48 months. At 12 months, WAP increased their ambulatory activity by 547 (97.5% CI 211, 882) steps/day compared to control and were 1.61 (97.5% CI 1.05, 2.45) times more likely to achieve 150 min/week of moderate-to-vigorous physical activity. Differences were not maintained at 48 months. WA was no different to control at 12 or 48 months. Secondary anthropometric and health outcomes were largely unaltered in both intervention groups apart from small reductions in body weight in WA (~ 1 kg) at 12- and 48-month follow-up.

CONCLUSIONS

Combining a pragmatic group-based intervention with text messaging and telephone support resulted in modest changes to physical activity at 12 months, but changes were not maintained at 48 months.

TRIAL REGISTRATION

ISRCTN 83465245 (registered on 14 June 2012).

Feasibility and acceptability of "active" classroom workstations among French university students and lecturers: a pilot study

BACKGROUND

Sedentary lifestyles plague today's society in terms of physical, psychosocial and cognitive health. Students are particularly at risk because they spend most of their daily time sitting and inactive. The current pedagogical model must be rethought in order to promote students' health, well-being and therefore their success. The objective of this project was to equip one classroom of the sport science department at a university with various active workstations (standing desks, Swiss balls, cycling desks, pedal- or stepper-board) and to evaluate the feasibility and influence of these types of active workstations on the cognitive and psychological factors of the students, and to collect the feedback of lecturers during this experience.

METHODS

Participation in the study was voluntary and students had the opportunity to choose or not to use an active workstation during lectures. A total of 663 students and 14 lecturers completed a survey to evaluate subjective feelings about physical, psycho-cognitive and academic aspects after their first experience with active workstations in the classroom.

RESULTS

The majority of students and lecturers reported positive effects of active workstations in reducing fatigue, distraction, and boredom. The preferred active workstations were the cycling desks and the Swiss balls. Finally, 89.4% of students favoured using active workstations in future lectures if they had the option, as well as 71% of lecturers, demonstrating the acceptance of such active workstations.

CONCLUSION

The present study brings promising results toward a more general implementation of active workstations in universities. Once a familiarisation period is observed, having such workstations in the classroom could help prevent the deleterious effect of sedentary behaviour and promote a more active daily life for the future.

Prospectively Reallocating Sedentary Time: Associations with Cardiometabolic Health

PURPOSE

This study aimed to investigate whether prospectively reallocating time away from sedentary behavior (SB) into different physical activity intensities is associated with 12-month change to cardiometabolic health in a cohort at high risk of type 2 diabetes (T2DM).

METHODS

Participants with known risk factors for T2DM were recruited from primary care (Leicestershire, United Kingdom) as part of the Walking Away from Type 2 Diabetes trial (n = 808). Participants were followed up at 12, 24, and 36 months. SB, light-intensity physical activity (LPA) and moderate-to-vigorous intensity physical activity (MVPA) were measured objectively by accelerometer. Postchallenge glucose, triglycerides, HDL cholesterol, systolic blood pressure, and waist circumference were analyzed individually and combined into a clustered cardiometabolic risk score (CMRS). Associations of changing SB over each consecutive 12-month period were analyzed taking account of repeated measures.

RESULTS

Reallocating 30 min from SB to LPA was associated with 0.21-cm (95% confidence interval, 0.03-0.38 cm) reduction in waist circumference, 0.09-mmol·L (0.04-0.13 mmol·L) reduction in 2-h glucose, 0.02-mmol·L (0.00-0.04 mmol·L) reduction in triglycerides, and 0.02 (0.01-0.03) reduction in CMRS. Every 30-min reallocation from SB to MVPA was associated with 1.23-cm (0.68-1.79 cm) reduction in waist circumference, 0.23-mmol·L (0.10-0.36 mmol·L) reduction in 2-h glucose, 0.04-mmol·L (0.00-0.09 mmol·L) reduction in triglycerides, and 0.07 (0.04-0.11) reduction in CMRS. Reallocating 30 min from LPA into MVPA was also associated with 1.02-cm (0.43-1.60 cm) reduction in waist circumference, 0.16-mmol·L (0.02-0.30 mmol·L) reduction in 2-h glucose, and 0.05 (0.01-0.09) reduction in CMRS.

CONCLUSION

Over 12 months, reallocating time away from SB into LPA or MVPA was associated with improved cardiometabolic health in a population at risk of T2DM, with the greatest benefits observed for MVPA.

Metabolic Effects of Breaking Prolonged Sitting With Standing or Light Walking in Older South Asians and White Europeans: A Randomized Acute Study

Background

Prolonged sitting is common in older adults and is associated with insulin resistance and poor cardiometabolic health. We investigate whether breaking prolonged sitting with regular short bouts of standing or light walking improves postprandial metabolism in older white European and South Asian adults and whether effects are modified by ethnic group.

Methods

Thirty South Asian (15 women) and 30 white European (14 women) older adults (aged 65–79 years) undertook three experimental conditions in random order. (a) Prolonged sitting: continuous sitting during an observation period if 7.5 hours consuming two standardized mixed meals. (b) Standing breaks: sitting interrupted with 5 minutes of standing every 30 minutes (accumulating 60 minutes of standing over the observation period). (c) Walking breaks: sitting interrupted with 5 minutes of self-paced light walking every 30 minutes (accumulating 60 minutes of walking). Blood samples (glucose, insulin, triglycerides) and blood pressure were sampled regularly throughout each condition.

Results

Compared with prolonged sitting, walking breaks lowered postprandial insulin by 16.3 mU/L, (95% CI: 19.7, 22.0) with greater reductions (p = .029) seen in South Asians (22.4 mU/L; 12.4, 32.4) than white Europeans (10.3 mU/L; 5.9, 14.7). Glucose (0.3 mmol/L; 0.1, 0.5) and blood pressure (4 mm Hg; 2, 6), but not triglycerides, were lower with walking breaks, with no ethnic differences. Standing breaks did not improve any outcome.

Conclusions

Breaking prolonged sitting with short bouts of light walking, but not standing, resulted in clinically meaningful improvements in markers of metabolic health in older adults, with South Asians gaining a greater reduction in postprandial insulin.

Trial Registration

NCT02453204

Objective measurement of physical activity and sedentary behavior among South Asian adults: A systematic review

Background

South Asians are one of the fastest growing ethnic groups in western countries with a high incidence of chronic diseases like metabolic syndrome and cardiovascular disease occurring at younger ages and lower body weight compared with white Europeans. Physically active lifestyle and reduced sedentary time are modifiable risk factors that can decrease burden of chronic diseases. Population-level surveys based on self-report show South Asians engage in low levels of physical activity. Because of known limitations with self-report data, we aimed to synthesize available evidence to generate a physical activity /sedentary time profile of South Asians from studies using accelerometry.

Methods

We systematically searched Medline, EMBASE, CINAHL, PsycINFO, and SportDiscus. We included studies applying accelerometry to measure physical activity /sedentary time under free-living. Studies with an exclusive focus on drugs or including participants with health conditions/physical disability, and special populations (athletes/pregnant women) were excluded. Two authors independently adjudicated inclusion of citations at title/abstract and full text. We applied a standardized data abstraction form to extract relevant data. We evaluated methodological quality using Newcastle Ottawa Quality Assessment Scale. Due to variability and inconsistencies in measurement and reporting of physical activity /sedentary time, we only provide a narrative synthesis.

Findings

We identified only 14 studies(n = 1,338). Despite using similar accelerometry assumptions, we noted variability in reported outcomes for physical activity and sedentary time. Sedentary time ranged from 482(98) to 587 min/day. Mean light physical activity ranged from 211.69(67. 38) to 574(227) min/day. Moderate to vigorous physical activity among South Asian women ranged from 17–41 min/day and among men, 32–43 min/day.

Conclusion

South Asians exhibited higher levels of physical activity when compared to the Canadian population level survey but not when compared to the American population level survey. Overall, fewer studies, and small sample sizes led to considerable variability limiting any effective comparisons. Results highlight the importance of conducting methodologically robust studies based on random sampling to advance the field, and to capture true levels of sedentary time and physical activity in the South Asian population.

Effect of high-fat diet on peripheral blood mononuclear cells and adipose tissue in early stages of diet-induced weight gain

Subcutaneous adipose tissue (scAT) and peripheral blood mononuclear cells (PBMC) play a significant role in obesity-associated systemic low-grade inflammation. High-fat diet (HFD) is known to induce inflammatory changes in both scAT and PBMC. However, the time course of the effect of HFD on these systems is still unknown. The aim of the present study was to determine the time course of the effect of HFD on PBMC and scAT. New Zealand white rabbits were fed HFD for 5 or 10 weeks (i.e. HFD-5 and HFD-10) or regular chow (i.e. control (CNT)-5 and CNT-10). Thereafter, metabolic and inflammatory parameters of PBMC and scAT were quantified. HFD induced hyperfattyacidaemia in HFD-5 and HFD-10 groups, with the development of insulin resistance in HFD-10, while no changes were observed in scAT lipid metabolism and inflammatory status. HFD activated the inflammatory pathways in PBMC of HFD-5 group and induced modified autophagy in that of HFD-10. The rate of fat oxidation in PBMC was directly associated with the expression of inflammatory markers and tended to inversely associate with autophagosome formation markers in PBMC. HFD affected systemic substrate metabolism, and the metabolic, inflammatory and autophagy pathways in PBMC in the absence of metabolic and inflammatory changes in scAT. Dietary approaches or interventions to avert HFD-induced changes in PBMC could be essential to prevent metabolic and inflammatory complications of obesity and promote healthier living.

Sedentariness and Urinary Metabolite Profile in Type 2 Diabetic Patients, a Cross-Sectional Study

Recent findings indicate a significant association between sedentary (SED)-time and type 2 diabetes mellitus (T2DM). The aim of this study was to investigate whether different levels of SED-time could impact on biochemical and physiological processes occurring in sedentary and physically inactive T2DM patients. In particular, patients from the “Italian Diabetes and Exercise Study (IDES)_2 trial belonging to the first and fourth quartile of SED-time were compared. Urine samples were analyzed by comprehensive two-dimensional gas chromatography (GC × GC) with parallel detection by mass spectrometry and flame ionization detection (GC × 2GC-MS/FID). This platform enables accurate profiling and fingerprinting of urinary metabolites while maximizing the overall information capacity, quantitation reliability, and response linearity. Moreover, using advanced pattern recognition, the fingerprinting process was extended to untargeted and targeted features, revealing diagnostic urinary fingerprints between groups. Quantitative metabolomics was then applied to analytes of relevance for robust comparisons. Increased levels of glycine, L-valine, L-threonine, L-phenylalanine, L-leucine, L-alanine, succinic acid, 2-ketoglutaric acid, xylitol, and ribitol were revealed in samples from less sedentary women. In conclusion, SED-time is associated with changes in urine metabolome signatures. These preliminary results suggest that reducing SED-time could be a strategy to improve the health status of a large proportion of diabetic patients.

SOCS3 methylation mediated the effect of sedentary time on type 2 diabetes mellitus: The Henan Rural Cohort study

BACKGROUND AND AIMS

To assess the associations of sedentary time, suppressor of cytokine signaling (SOCS)-3 DNA methylation with type 2 diabetes mellitus (T2DM), and further identify the role of SOCS3 methylation in mediating the association of sedentary time with T2DM in a Chinese rural population.

METHODS AND RESULTS

A case-control study including 1032 participants from the Henan Rural Cohort study was conducted. Restricted cubic spline analysis and logistic regression model were performed to evaluate the associations between sedentary time, SOCS3 methylation and T2DM. The mediation effect of SOCS3 methylation on the association between sedentary time and T2DM was assessed. Sensitivity analysis was conducted by excluding individuals with diagnosed T2DM. Linear dose-response relationships were found between sedentary time, methylation level of Chr17:76356190 (one novel site on SOCS3) and T2DM. Compared with the first quartile (less than 5 h/d) of sedentary time, the adjusted odds ratio (OR, 95% confidence interval, 95%CI) for those in the third (7-10 h/d) and fourth (≥10 h/d) quartiles were 1.87 (1.22-2.85) and 3.54 (2.14-5.85), respectively. Participants in the fourth quartile of methylation level of Chr17:76356190 had lower risk of T2DM than those in the first quartile (OR (95%CI): 0.23 (0.14-0.38)). Mediation analysis showed 9.66% (6.38%-14.80%) of the association between sedentary time and T2DM was attributable to Chr17:76356190. The comparable effect estimates were observed between sedentary time, methylation level of Chr17:76356190 and undiagnosed T2DM.

CONCLUSION

Sedentary time and methylation level of Chr17:76356190 were both independently associated with T2DM in the Chinese rural population. Furthermore, Chr17:76356190 appeared to partially mediate the effect of sedentary time on T2DM.

CHINESE CLINICAL TRIAL REGISTRATION

ChiCTR-OOC-15006699 (URL: http://www.chictr.org.cn/showproj.aspx?proj=11375).

Hours lying down per day, as a proxy for sedentary behaviour and risk of diabetes in young and middle-aged adults in Norway: an 11-year follow-up of the HUNT study

OBJECTIVE

We aimed to examine relationship between hours lying down per day, as a proxy for sedentary behaviour and risk of diabetes in young and middle-aged adults, and to assess if leisure-time physical activity and body mass index (BMI) modified this relationship.

DESIGN

A population-based prospective cohort study.

SETTING

Nord-Trøndelag, Norway.

PARTICIPANTS

The cohort included 17 058 diabetes-free adults, at an age of 20-55 years in 1995-1997, who were followed-up to 2006-2008.

PRIMARY OUTCOME MEASURES

Incident diabetes was defined by self-report of diabetes or non-fasting glucose levels greater than 11 mmol/L at the follow-up.

METHODS

Multivariable logistic regression models were used to obtain OR with 95% CI for risk of diabetes by the categories of hours lying down (≤7, 8 and ≥9 hours/day).

RESULTS

362 individuals (2.1%) developed diabetes during an average of 11-year follow-up. Individuals who reported lying down ≥9 hours/day had an adjusted OR of 1.35 (95% CI 1.01 to 1.80) for incident diabetes compared with those lying down 8 hours/day. Lying down ≤7 hours/day was not associated with the risk of diabetes. In analysis stratified by physical activity, the ORs associated with lying down ≥9 hours/day were 1.41 (95% CI 1.05 to 1.90) and 0.90 (95% CI 0.23 to 3.55), respectively, among the less active and highly active individuals (p_interaction=0.048). There was little evidence that the association differed by BMI status (p_interaction=0.62).

CONCLUSIONS

Prolonged hours lying down per day was associated with an increased risk of diabetes in young and middle-aged adults. The positive association appeared to be modified by physical activity but not by BMI.

Effects of 8-Week Whole-Body Vibration Training on the HbA1c, Quality of Life, Physical Fitness, Body Composition and Foot Health Status in People with T2DM: A Double-Blinded Randomized Controlled Trial

The aim of this study was to analyze the effects of an 8-week whole-body vibration (WBV) on the quality of life, physical fitness, body composition, glycosylate hemoglobin (HbA1c), lipid profile, and foot health status in people with type II diabetes mellitus (T2DM). It was performed as a double-blinded randomized controlled trial of 90 people with T2DM. Primary care facilities were used. The 8-week WBV training consisted of maintaining a knee flexion at 45° during five to nine series of 30-60 s in a vibration frequency that oscillated between 12.5-18.5 and 30 s of recovery between series. The placebo group had to perform the same protocol but without vibration. Participants performed the protocol three times per week. The WBV training significantly reduced the fat mass (%) of people with T2DM. However, significant effects of WBV training were not found in the quality of life, physical fitness, foot health status, lipid profile, blood pressure, fasting blood glucose, or HbA1c. Nevertheless, within groups enhances were found in HbA1c, blood pressure, fasting blood glucose, foot health status, health-related quality of life, timed-up and go test, and chair-stand test in both WBV and placebo groups. WBV was shown to be beneficial for reducing the fat mass and lipid profile of people with T2DM. The improvements of the placebo group could be due to both the social benefits of enrolling in an intervention and the physical fitness benefits of isometric contractions. Further studies are needed to clarify the effects of WBV and to establish a dose-response relationship in people with T2DM.

Cacao extract enriched in polyphenols prevents endocrine-metabolic disturbances in a rat model of prediabetes triggered by a sucrose rich diet

ETHNOPHARMACOLOGICAL RELEVANCE

Cocoa extracts rich in polyphenols are used as potential agent for treating diabetes. Cocoa polyphenols have been proved to ameliorate important hallmarks of type-2 diabetes (T2D). They can regulate glucose levels by increasing insulin secretion, promoting β-cell proliferation and a reduction of insulin resistance. In addition, epidemiological evidence indicates that consumption of flavonoid decreases the incidence of T2D.

AIM OF THE STUDY

T2D is preceded by a prediabetic state in which the endocrine-metabolic changes described in T2D are already present. Since epidemiological evidence indicates that consumption of flavonoid decreases its incidence, we evaluated possible preventive effects of polyphenol-enriched cocoa extract on a model of prediabetes induced by sucrose.

MATERIALS AND METHODS

We determined circulating parameters and insulin sensitivity indexes, liver protein carbonyl groups and reduced glutathione, liver mRNA expression levels of lipogenic enzymes, expression of different pro-inflammatory mediators, fructokinase activity and liver glycogen content. For that, radioimmunoassay, real-time polymerase chain reaction, Western blot, spectrophotometry, and immunohistochemistry were used.

RESULTS

We demonstrated that sucrose administration triggered hypertriglyceridemia, insulin-resistance, and liver increased oxidative stress and inflammation markers compared to control rats. Additionally, we found an increase in glycogen deposit, fructokinase activity, and lipogenic genes expression (SREBP-1c, FAS and GPAT) together with a decrease in P-Akt and P-eNOS protein content (P < 0.05). Sucrose-induced insulin resistance, hepatic carbohydrate and lipid dysmetabolism, oxidative stress, and inflammation were effectively disrupted by polyphenol-enriched cocoa extract (PECE) co-administration (P < 0.05).

CONCLUSION

Dietary administration of cocoa flavanols may be an effective and complementary tool for preventing or reverting T2D at an early stage of its development (prediabetes).

Pilot Study of Impact of a Pedal Desk on Postprandial Responses in Sedentary Workers

Physical inactivity has been linked to rates of obesity, diabetes, and heart disease through insulin resistance and other mechanisms. Although sedentary workplace environments have unintentionally contributed to the risk for chronic diseases, innovations in the workplace environment could potentially rectify this public and occupational health problem.

PURPOSE

To evaluate the effects of light-intensity physical activity using a pedal desk (PD) compared with a standard desk (STD) in a pilot study on postprandial metabolic responses and work skills.

METHODS

Twelve overweight/obese full-time sedentary office workers (six men and six women; body mass index, 28.7 ± 3.6 kg·m) were tested in two conditions: 1) PD, pedaling at self-selected light-intensity pace for 2 h and 2) STD, remaining seated for 2 h in a conventional workstation setup while performing scripted computer-based work tasks. Blood samples were analyzed for plasma glucose, insulin, and free-fatty acids in response to a standardized meal and work skills were evaluated. Paired samples t-tests were used to examine the differences in metabolic responses and work performance tasks between the conditions.

RESULTS

Pedal desk use required significantly less insulin to maintain glucose concentrations compared with STD condition (peak insulin concentration, 42.1 μU·mL vs 66.9 μU·mL; P = 0.03; and area under the curve, 302.6 vs 441.8 μU·min·mL; P < 0.001). No significant changes in plasma glucose and free-fatty acid concentrations were observed at any timepoints (all P > 0.05). In addition, pedaling at a self-paced rate caused no adverse effects on work skills (P > 0.05).

CONCLUSIONS

The PD resulted in lower postmeal insulin concentrations without an overall negative impact on work skills. Thus, the PD could have the potential to achieve public and occupational health goals in sedentary work environments.

Benefits of 8-wk Mindfulness-based Stress Reduction or Aerobic Training on Seasonal Declines in Physical Activity

Mindfulness-based stress reduction (MBSR) and aerobic exercise training (AET) programs improve health and well-being. Exercise participation has been related to mindfulness and may be altered by MBSR training.

Sedentary behavior after breast cancer: motivational, demographic, disease, and health status correlates of sitting time in breast cancer survivors

PURPOSE

Sedentary behavior is associated with poor health outcomes including obesity, lower quality of life, and mortality in breast cancer survivors. This study sought to identify motivational, demographic, and disease characteristics of breast cancer survivors who engage in greater amounts of sedentary behavior.

METHODS

Multivariate linear regression models estimated associations between demographic, disease, and health characteristics with reported sitting in breast cancer survivors (n = 279; M_age = 60.7 (± 9.7) years). Regression models estimated associations between motivational factors and reported sitting adjusted for demographic and disease and health covariates.

RESULTS

Working at least part-time and marital status were associated various sitting domains including weekday and non-leisure sitting. Higher BMI was associated with more average daily, weekend, and weekday sitting. High income was additionally associated with less non-leisure sitting. The belief that sedentary behavior is bad for health, physical function, and self-evaluative OE, and lifestyle self-efficacy were associated with multiple sitting domains in both univariate and covariate-adjusted models.

CONCLUSIONS

Future work should examine the relationships between motivational, demographic, and disease predictors and objectively measured sedentary behavior over time and across different sedentary behavior domains. Understanding activity changes during and after treatment is needed to identify intervention targets and develop effective interventions.

Discontinuously supervised aerobic training vs. physical activity promotion in the self-management of type 2 diabetes in older Italian patients: design and methods of the 'TRIPL-A' randomized controlled trial

Background

Physical activity (PA) has health benefits for people with type 2 diabetes (T2D). Indeed, regular PA is considered an important part of any T2D management plan, yet most patients adopt a sedentary lifestyle.

Exercise referral schemes (ERS) have the potential to effectively promote physical activity among T2D patients, and their effectiveness may be enhanced when they are supported by computer-based technologies.

The ‘TRIPL-A’ study (i.e., a TRIal to promote PhysicaL Activity among patients in the young-old age affected by T2D) aims to assess if realizing an innovative ERS, based on a strong partnership among general practitioners, specialist physicians, exercise specialists, and patients, and supported by a web-based application (WBA), can effectively lead sedentary older T2D patients to adopt an active lifestyle.

Methods

A randomized controlled design will be used, and an ERS, supported by a WBA, will be implemented. 300 physically inactive T2D patients (aged 65–74 years) will be assigned to either an intervention or control arm. Control arm patients will only receive behavioral counseling on physical activity and diet, while intervention arm patients will also undergo an 18-month (3 day/week), discontinuously supervised aerobic exercise training program. The trial will be divided into six three-month periods: during first, third and fifth period, an exercise specialist will supervise the training sessions and, using the WBA, prescribe exercise progression and monitor exercise adherence. Patients will exercise on their own in the other periods.

Patients’ sedentary behaviors (primary outcome), PA level, fitness status, metabolic profile, psychological well-being, quality of life, and use of health care services (secondary outcomes) will be assessed at baseline and at 6, 12, and 18 months from baseline.

Repeated measure ANCOVAs will be used to compare the intervention and control arm with respect to each study outcome measure.

Discussion

Primary and secondary outcome results will allow us to evaluate the effectiveness of an ERS, specifically designed for the management of T2D clinical conditions and supported by a WBA, in promoting PA within Italian primary care settings.

Trial registration

This trial is retrospectively registered under the Australian New Zealand Clinical Trials Registry (reference number: ACTRN12618001164280; registered 13 July 2018).

Is Cannabis Use Associated with Sedentary Behavior during Leisure Time? A Study in Canada, 2011-2012

BACKGROUND

Sedentary behavior, defined as lying or sitting, is a global health concern. As researchers continue to identify modern-day risk factors for sedentary behavior, few have explored the role of illicit drug use.

OBJECTIVE

To examine the association between leisure-time sedentary behavior and cannabis use, in adolescents and adults.

METHODS

We conducted a cross-sectional study relating cannabis use to total leisure-time sedentary behavior (hr/wk using the computer, playing video games, watching television or videos, and reading for leisure) using data from the 2011-2012 Canadian Community Health Survey (CCHS), a population-based survey of Canadians age ≥12 years. Analyses were possible for 48,240 respondents in Saskatchewan, Ontario, and Nunavut who reported on sedentary behavior. We used logistic regression modeling to relate frequency of cannabis use (never, occasional, heavy) to high-risk sedentary behavior (<35 versus ≥35 hr/wk) overall and stratified by sex, age, and rural location.

RESULTS

Approximately 80% of respondents were ≥25 years old. In the fully-adjusted model, the odds of ≥35 hr/wk of sedentary behavior were 80% higher for heavy cannabis users versus never users (OR = 1.8, 95% CI: 1.4-2.3); in occasional cannabis users, the odds were 30% higher (OR = 1.3, 95% CI: 1.1-1.5). In stratified analyses, odds ratios were statistically significant among adults age 25-44 years and people living in nonrural settings. Conclusions/Importance: Our findings support dual lifestyle interventions targeting heavy cannabis use and excessive sedentary behavior simultaneously. Moreover, leisure-time sedentary behavior should be considered as a covariate in future epidemiologic models relating cannabis to health.

Regional differences in type 2 diabetes treatment and outcomes in Germany-An analysis of the German DPV and DIVE registries

AIMS

On the basis of the Diabetes Versorgungs-Evaluation (DIVE) and Diabetes-Patienten-Verlaufsdokumentation (DPV) datasets, we aimed to explore the impact of differences in treatment modalities on outcomes in Germany and put these into a global context.

METHODS

The 2014 to 2016 DIVE and DPV databases were combined, and a total of 127 838 patients 18 years and older was analysed with respect to demographics, cardiovascular risk factors, comorbidities, treatments, and outcomes, separately for each German state. Estimates were expressed as adjusted least squares means together with 95% confidence intervals.

RESULTS

Saarland dataset recorded the lowest mean HbA_1c (6.7%; 6.6%-6.8%; 50 mmol/mol, 49-51 mmol/mol), Saxony-Anhalt showed the highest (8.3%; 8.2%-8.3%; 67 mmol/mol, 66-67 mmol/mol). The highest percentage of hypoglycaemic events was reported in Mecklenburg-West Pomerania (MWP) (4.7%; 3.9%-5.7%), the lowest in Thuringia (0.9%; 0.2%-3.4%). Metformin and sulfonylurea accounted for 36.4% to 53.3% of anti-diabetic treatments across states; other antihyperglycaemic drugs such as DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 analogues were used most often in MWP (40.0%; 37.8%-42.1%) and least in Rhineland-Palatinate (13.6%; 13.0%-14.2%). Treatment with insulin (alone or in combination) was reported most often in MWP (78.2%; 76.4%-80.0%) and least in Thuringia (26.0%; 20.1%-32.9%).

CONCLUSIONS

Federal states in Germany are heterogeneous concerning diabetes treatment and associated outcomes. These data should stimulate further discussion about how optimal diabetes care can be implemented in all areas of Germany, to achieve good treatment outcomes in all federal states.

Sedentary Behavior at Work and Cognitive Functioning: A Systematic Review

Background: It is now well-established that sedentarity has a negative impact on the physiological functioning and health of humans, whereas very little is known about the psychological repercussions, especially in cognitive functioning. Yet, studying the cognitive effects of the sedentary lifestyle is particularly relevant in the short term for productivity and in the long term for cognitive health (accelerated aging). This systematic review therefore aims to make an inventory of the potential cognitive effects of sedentarity at the workplace. Methods: Pubmed, PsycINFO, Cochrane, Web of Science, and Scopus were searched for English-language peer-reviewed articles published between January 1, 2000 and December 31, 2017 to identify studies including sedentary behavior and objective measures from cognitive domains (cognitive inhibition, cognitive flexibility, working memory, etc.). To carry out this systematic review, the 3 keywords "Sedentary" and "Cognition" and "Work" (and their derivatives) had to appear in the title or in the summary of the paper. Results: Of the 13 papers that met the inclusion criteria, 9 were short-term interventions, 3 medium-term interventions, and 1 long-term intervention. Nine of them reported non-significant results. Two studies study reported deterioration in cognitive performance. Two reported an improvement in performance in cognitive tasks with one study with overweight adults and the only one study with a long-term intervention. However, these studies intend to reduce sedentary behavior, but do not allow answering the question of the potential cognitive effects of the sedentary lifestyle. Conclusion: These data suggest that sedentary behavior is not associated with changes in cognitive performance in interventions that intend to reduce sedentary behavior. Then, and given the trend toward increased time in sedentary behavior, long-term prospective studies of high methodological quality are recommended to clarify the relationships between sedentary behavior and the cognitive functioning. Our systematic review identifies also the need for retrospective, longitudinal, or epidemiologic studies. It also recognizes the need to standardize methodology for collecting, defining, and reporting sedentary behavior and the need to standardize the cognitive tests used. The relationship between sedentary behavior and cognitive functioning remaining uncertain, further studies are warranted for which 8 recommendations are proposed.

Improved General and Oral Health in Diabetic Patients by an Okinawan-Based Nordic Diet: A Pilot Study

Periodontal disease, periodontitis as well as the preceding gingivitis, has been associated with both obesity and diabetes. Studies have shown that diet changes can lead to a lower incidence of such inflammation. The aim of the present case series over four weeks was to study the effects on medical and dental conditions in patients with type 2 diabetes of the consumption of the Okinawan-based Nordic Diet (OBND^®). Medical and dental examinations were performed to estimate the general health and gingivitis/periodontitis. Serum cytokine levels were assessed using Luminex technology. Eight of ten study participants completed the study. All participants lost weight (p = 0.012). Six out of seven that were treated with insulin could reduce their insulin intake after two weeks with OBND^®. The reduction was about 16 units which corresponds to a 34% relative reduction compared to the starting point (range 15–63%). Fasting blood glucose values fell (p = 0.035). Hemoglobin A1c (HbA1c) (p = 0.01), triglycerides (p = 0.05), and low-density lipoprotein (LDL) (p = 0.05) were also reduced. Bleeding on probing changed from ~28% before any dietary changes to ~13% after two weeks with OBND^® (p = 0.01). The reduction in gingival bleeding was as substantial as might be expected from one session of professional tooth cleaning. Markers of inflammation were also reduced. The OBND^® thus showed significant promise in alleviating the impact of diabetes on dental as well as general health.

Glucose impairments and insulin resistance in prostate cancer: the role of obesity, nutrition and exercise

BACKGROUND

Hyperinsulinemia, obesity and related metabolic diseases are associated with prostate cancer development. Prostate cancer patients undergoing androgen deprivation therapy (ADT) are at increased risk for metabolic syndrome, cardiovascular disease and diabetes, while pre-existing metabolic conditions may be exacerbated.

PURPOSE

An integrative approach is used to describe the interactions between insulin, glucose metabolism, obesity and prostate cancer. The potential role of nutrition and exercise will also be examined.

FINDINGS

Hyperinsulinemia is associated with prostate cancer development, progression and aggressiveness. Prostate cancer patients who undergo ADT are at risk of diabetes in survivorship. It is unclear whether this is a direct result of treatment or related to pre-existing metabolic features (e.g. hyperinsulinemia and obesity). Obesity and metabolic syndrome are also associated with prostate cancer development and poorer outcomes for cancer survivors, which may be driven by hyperinsulinemia, pro-inflammation, hyperleptinemia and/or hypoadiponectinemia.

CONCLUSIONS

Independently evaluating changes in glucose metabolism near the time of prostate cancer diagnosis and during long-term ADT treatment is important to distinguish their unique contributions to the development of metabolic disturbances. Integrative approaches, including metabolic, clinical and body composition measures, are needed to understand the role of adiposity and insulin resistance in prostate cancer and to develop effective nutrition and exercise interventions to improve secondary diseases in survivorship.

Impaired endocrine-metabolic homeostasis: underlying mechanism of its induction by unbalanced diet

To characterize the intrinsic mechanism by which sucrose induces β-cell dysfunction. Normal rats received for 3 weeks a standard diet supplemented with 10% sucrose in the drinking water (high sucrose (HS)) with/out an antioxidant agent (R/S α-lipoic acid). We measured plasma glucose, insulin, triglyceride, leptin, and lipid peroxidation levels; homeostasis model assessment (HOMA)-insulin resistance (HOMA-IR) and HOMA for β-cell function (HOMA-β) indexes were also determined. Insulin secretion, β-cell apoptosis, intracellular insulin and leptin mediators, and oxidative stress (OS) markers were also measured in islets isolated from each experimental group. HS rats had increased plasma triglyceride, insulin, leptin, and lipid peroxidation (OS marker) levels associated with an insulin-resistant state. Their islets developed an initial compensatory increase in glucose-induced insulin secretion and mRNA and protein levels of β-cell apoptotic markers. They also showed a significant decrease in mRNA and protein levels of insulin and leptin signaling pathway mediators. Uncoupling protein 2 (UCP2), peroxisome proliferator-activated receptor (PPAR)-α and -δ mRNA and protein levels were increased whereas mRNA levels of Sirtuin-1 (Sirt-1), glutathione peroxidase, and catalase were significantly lower in these animals. Development of all these endocrine-metabolic abnormalities was prevented by co-administration of R/S α-lipoic acid together with sucrose. OS may be actively involved in the mechanism by which unbalanced/unhealthy diet induces β-cell dysfunction. Since metabolic-endocrine dysfunctions recorded in HS rats resembled those measured in human pre-diabetes, knowledge of its molecular mechanism could help to develop appropriate strategies to prevent the progression of this metabolic state toward type 2 diabetes (T2D).

Variability and reliability study of overall physical activity and activity intensity levels using 24 h-accelerometry-assessed data

Background

24 h-accelerometry is now used to objectively assess physical activity (PA) in many observational studies like the German National Cohort; however, PA variability, observational time needed to estimate habitual PA, and reliability are unclear.

Methods

We assessed 24 h-PA of 50 participants using triaxial accelerometers (ActiGraph GT3X+) over 2 weeks. Variability of overall PA and different PA intensities (time in inactivity and in low intensity, moderate, vigorous, and very vigorous PA) between days of assessment or days of the week was quantified using linear mixed-effects and random effects models. We calculated the required number of days to estimate PA, and calculated PA reliability using intraclass correlation coefficients.

Results

Between- and within-person variance accounted for 34.4–45.5% and 54.5–65.6%, respectively, of total variance in overall PA and PA intensities over the 2 weeks. Overall PA and times in low intensity, moderate, and vigorous PA decreased slightly over the first 3 days of assessment. Overall PA (p = 0.03), time in inactivity (p = 0.003), in low intensity PA (p = 0.001), in moderate PA (p = 0.02), and in vigorous PA (p = 0.04) slightly differed between days of the week, being highest on Wednesday and Friday and lowest on Sunday and Monday, with apparent differences between Saturday and Sunday. In nested random models, the day of the week accounted for < 19% of total variance in the PA parameters. On average, the required number of days to estimate habitual PA was around 1 week, being 7 for overall PA and ranging from 6 to 9 for the PA intensities. Week-to-week reliability was good (intraclass correlation coefficients, range, 0.68–0.82).

Conclusions

Individual PA, as assessed using 24 h-accelerometry, is highly variable between days, but the day of assessment or the day of the week explain only small parts of this variance. Our data indicate that 1 week of assessment is necessary for reliable estimation of habitual PA.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5415-8) contains supplementary material, which is available to authorized users.

Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes

OBJECTIVES

The aims of this study were to describe the volume and patterns of objectively assessed sedentary behaviour, light intensity physical activity (LPA) and moderate-vigorous physical activity (MVPA), and to examine socio-demographic correlates, among adults living with type 2 diabetes.

METHODS

Participants (n = 166) wore an accelerometer (Actigraph® GT3X+) for seven consecutive days during waking hours and completed a questionnaire. Physical activity (PA) and sedentary time were described, and multivariable linear regression was used to estimate associations between socio-demographic characteristics and sedentary time and PA.

RESULTS

Participants, 46% of whom were female, had a mean age of 65.4 years (standard deviation (SD) = 9.5), body mass index (BMI) of 31.5 (6.6) kg/m2 and had been living with diabetes for an average of 13.1 (7.6) years. Participants were sedentary for 543.6 minutes/day, spent 273.4 minutes/day and 22.4 minutes/day in LPA and MVPA respectively. BMI was associated with increased sedentary time and reduced LPA (-2.5 minutes/day, 95% CI: -4.33 to -0.70) and MVPA (-0.62 minutes/day, 95% CI: -1.05 to -0.18) time. Compared with males, females had more LPA (34.4 minutes/day, 95% CI: 10.21-58.49) and less MVPA (-6.2 minutes/day, 95% CI: -12.04 to -0.41) time. Unemployed participants had 30.05 minutes more MVPA (95% CI: 3.35-56.75) than those who were employed or homemakers, and those not reporting income had 13 minutes/day more MVPA time than participants in the lowest income category (95% CI: 3.46-22.40).

CONCLUSION

Adults living with type 2 diabetes were not sufficiently active and were highly sedentary. Our results emphasize the need for more research exploring the diabetes-related health outcomes of sedentary behaviour and physical inactivity among people living with type 2 diabetes.

Physical Exercise Improves Heart Rate Variability in Patients with Type 2 Diabetes: A Systematic Review

PURPOSE OF REVIEW

The aim of the present systematic review is to provide an up-to-date analysis of the research on the effects of exercise programs on heart rate variability (HRV) in individuals with type 2 diabetes mellitus (T2DM). An electronic search of the literature (PubMed, PEDro and Web of Science) was performed. "HRV", "heart rate variability", "exercise", "physical" and "diabetes" were the terms used for article retrieval. Lastly, 15 articles were selected. PRISMA methodology was employed and data were extracted according to the PICOS approach.

RECENT FINDINGS

Although HRV is not routinely measured in the management of T2DM, it is an important measure due to its relation with mortality and diabetic neuropathy. Physical exercise has become a therapy for T2DM, because it improves physical fitness and functional capacity, enhances metabolic control and insulin sensitivity, reduces inflammatory markers and neuropathy symptoms and can increase the regenerative capacity of cutaneous axons, slowing or preventing neuropathy progression. However, it is not clear to what extent physical exercise can improve HRV in this population. Participation in the 15 selected studies was similar in men and women (48.01% men and 51.99% women). All the intervention programs included aerobic training, and it was complemented by strength training in four studies. Duration of physical exercise sessions ranged between 30 and 75 min, the frequency being between 2 and 7 days/week. Statistically significant improvements in groups with diabetes, relative to baseline, were observed in nine studies. More than 3 days per week of aerobic training, complemented by strength training, during at least 3 months seems to improve HRV in T2DM. Weekly frequency might be the most important factor to improve HRV. These aspects could help to design better programs based in scientific evidence, incorporating HRV as an important variable associated with diabetic neuropathy and mortality.

Relations of Arterial Stiffness With Postural Change in Mean Arterial Pressure in Middle-Aged Adults: The Framingham Heart Study

Impaired regulation of blood pressure on standing can lead to adverse outcomes, including falls, syncope, and disorientation. Mean arterial pressure (MAP) typically increases on standing; however, an insufficient increase or a decline in MAP on standing may result in decreased cerebral perfusion. Orthostatic hypotension has been reported in older people with increased arterial stiffness, whereas the association between orthostatic change in MAP and arterial stiffness in young- to middle-aged individuals has not been examined. We analyzed orthostatic blood pressure response and comprehensive hemodynamic data in 3205 participants (1693 [53%] women) in the Framingham Heart Study Third Generation cohort. Participants were predominantly middle aged (mean age: 46±9 years). Arterial stiffness was assessed using carotid-femoral pulse wave velocity, forward pressure wave amplitude, and characteristic impedance of the aorta. Adjusting for standard cardiovascular disease risk factors, orthostatic change in MAP (6.9±7.7 mm Hg) was inversely associated with carotid-femoral pulse wave velocity (partial correlation, r_p=-0.084; P<0.0001), forward wave amplitude (r_p=-0.129; P<0.0001), and characteristic impedance (r_p=-0.094; P<0.0001). The negative relation between forward wave amplitude and change in MAP on standing was accentuated in women (P=0.002 for sex interaction). Thus, higher aortic stiffness was associated with a blunted orthostatic increase in MAP, even in middle age. The clinical implications of these findings warrant further study.

Reallocating bouted sedentary time to non-bouted sedentary time, light activity and moderate-vigorous physical activity in adults with prediabetes and type 2 diabetes

Aim

The aim of this study was to investigate the potential associations of reallocating 30 minutes sedentary time in long bouts (>60 min) to sedentary time in non-bouts, light intensity physical activity (LPA) and moderate- to vigorous physical activity (MVPA) with cardiometabolic risk factors in a population diagnosed with prediabetes or type 2 diabetes.

Methods

Participants diagnosed with prediabetes and type 2 diabetes (n = 124, 50% men, mean [SD] age = 63.8 [7.5] years) were recruited to the physical activity intervention Sophia Step Study. For this study baseline data was used with a cross-sectional design. Time spent in sedentary behaviors in bouts (>60 min) and non-bouts (accrued in <60 min bouts) and physical activity was measured using the ActiGraph GT1M. Associations of reallocating bouted sedentary time to non-bouted sedentary time, LPA and MVPA with cardiometabolic risk factors were examined using an isotemporal substitution framework with linear regression models.

Results

Reallocating 30 minutes sedentary time in bouts to MVPA was associated with lower waist circumference (b = -4.30 95% CI:-7.23, -1.38 cm), lower BMI (b = -1.46 95% CI:-2.60, -0.33 kg/m2) and higher HDL cholesterol levels (b = 0.11 95% CI: 0.02, 0.21 kg/m². Similar associations were seen for reallocation of sedentary time in non-bouts to MVPA. Reallocating sedentary time in bouts to LPA was associated only with lower waist circumference.

Conclusion

Reallocation of sedentary time in bouts as well as non-bouts to MVPA, but not to LPA, was beneficially associated with waist circumference, BMI and HDL cholesterol in individuals with prediabetes and type 2 diabetes. The results of this study confirm the importance of reallocation sedentary time to MVPA.

Posture Allocation Revisited: Breaking the Sedentary Threshold of Energy Expenditure for Obesity Management

There is increasing recognition that low-intensity physical activities of daily life play an important role in achieving energy balance and that their societal erosion through substitution with sedentary (mostly sitting) behaviors, whether occupational or for leisure, impact importantly on the obesity epidemic. This has generated considerable interest for better monitoring, characterizing, and promoting countermeasures to sedentariness through a plethora of low-level physical activities (e.g., active workstations, standing desks, sitting breaks), amid the contention that altering posture allocation (lying, sitting, standing) can modify energy expenditure to impact upon body weight regulation and health. In addressing this contention, this paper first revisits the past and more recent literature on postural energetics, with particular emphasis on potential determinants of the large inter-individual variability in the energy cost of standing and the impact of posture on fat oxidation. It subsequently analyses the available data pertaining to various strategies by which posture allocations, coupled with light physical activity, may increase energy expenditure beyond the sedentary threshold, and their relevance as potential targets for obesity management.

Prolonged sitting may increase diabetes risk in physically inactive individuals: an 11 year follow-up of the HUNT Study, Norway

AIMS/HYPOTHESIS

We examined the association between sitting time and diabetes incidence, overall and by strata of leisure-time physical activity and BMI.

METHODS

We followed 28,051 adult participants of the Nord-Trøndelag Health Study (the HUNT Study), a population-based study, for diabetes incidence from 1995-1997 to 2006-2008 and estimated HRs of any diabetes by categories of self-reported total daily sitting time at baseline.

RESULTS

Of 28,051 participants, 1253 (4.5%) developed diabetes during 11 years of follow-up. Overall, sitting ≥8 h/day was associated with a 17% (95% CI 2, 34) higher risk of developing diabetes compared with sitting ≤4 h/day, adjusted for age, sex and education. However, the association was attenuated to a non-significant 9% (95% CI -5, 26) increase in risk after adjustment for leisure-time physical activity and BMI. The association between sitting time and diabetes risk differed by leisure-time physical activity (p _Interaction = 0.01). Among participants with low leisure-time physical activity (≤2 h light activity per week and no vigorous activity), sitting 5-7 h/day and ≥8 h/day were associated with a 26% (95% CI 2, 57) and 30% (95% CI 5, 61) higher risk of diabetes, respectively, compared with sitting ≤4 h/day. There was no corresponding association among participants with high leisure-time physical activity (≥3 h light activity or >0 h vigorous activity per week). There was no statistical evidence that the association between sitting time and diabetes risk differed by obesity (p _Interaction = 0.65).

CONCLUSIONS/INTERPRETATION

Our findings suggest that total sitting time has little association with diabetes risk in the population as a whole, but prolonged sitting may contribute to an increased diabetes risk among physically inactive people.