Leisure-Time Running Reduces the Risk of Incident Type 2 Diabetes

Isotemporal Substitution Modeling on Sedentary Behaviors and Physical Activity With Mortality Among People With Different Diabetes Statuses: A Prospective Cohort Study From the National Health and Nutrition Examination Survey Analysis 2007-2018

BACKGROUND

To assess the associations of replacing sedentary behavior with different types of physical activity with mortality among the US adults of varying diabetes statuses.

METHODS

This prospective cohort study included 21,637 participants (mean age, 48.5 y) from the National Health and Nutrition Examination Survey 2007-2018. Physical activity including leisure-time moderate-vigorous-intensity activity (MVPA), walking/bicycling, worktime MVPA, and sedentary behavior. We conducted an isotemporal substitution analysis using Cox regression to estimate the associations between replacements and mortality risks.

RESULTS

We found significant protective associations between replacing 30 minutes per day sedentary behavior with 3 types of physical activity and all-cause, cardiovascular disease (CVD) mortality risk (except worktime MVPA for CVD mortality) among total participants, with hazard ratio (HR; 95% confidence interval [CI]) ranging from 0.86 (0.77-0.95) to 0.96 (0.94-0.98). Among participants with diagnosed diabetes, replacing sedentary behavior with leisure-time MVPA was associated with a lower all-cause mortality risk (HR 0.81, 95% CI, 0.70-0.94), which was also observed in other subgroups, with HRs (95% CI) ranging from 0.87 (0.80-0.94) to 0.89 (0.81-0.99). Among those with prediabetes/undiagnosed diabetes, replacing sedentary behavior with walking/bicycling was associated with lower CVD mortality risk, and replacement to work-time MVPA was associated with lower all-cause and CVD mortality risk, with HRs (95% CI) ranging from 0.72 (0.63-0.83) to 0.96 (0.92-0.99).

CONCLUSIONS

Replacing sedentary behaviors with 30 minutes per day leisure-time MVPA was associated with lower all-cause mortality, regardless of diabetes statuses. Among people with prediabetes/undiagnosed diabetes, walking/bicycling was additionally associated with lower CVD mortality, and worktime MVPA was associated with lower all-cause and CVD mortality.

Health Benefits of Different Sports: a Systematic Review and Meta-Analysis of Longitudinal and Intervention Studies Including 2.6 Million Adult Participants

BACKGROUND

Several reviews have examined the health benefits of participation in specific sports, such as baseball, cricket, cross-country skiing, cycling, downhill skiing, football, golf, judo, rugby, running and swimming. However, new primary studies on the topic have recently been published, and the respective meta-analytic evidence needs to be updated.

OBJECTIVES

To systematically review, summarise and appraise evidence on physical health benefits of participation in different recreational sports.

METHODS

Searches for journal articles were conducted in PubMed/MEDLINE, Scopus, SpoLit, SPORTDiscus, Sports Medicine & Education Index and Web of Science. We included longitudinal and intervention studies investigating physical health outcomes associated with participation in a given sport among generally healthy adults without disability.

RESULTS

A total of 136 papers from 76 studies conducted among 2.6 million participants were included in the review. Our meta-analyses of available evidence found that: (1) cycling reduces the risk of coronary heart disease by 16% (pooled hazard ratio [HR] = 0.84; 95% confidence interval [CI]: 0.80, 0.89), all-cause mortality by 21% (HR = 0.79; 95% CI: 0.73, 0.84), cancer mortality by 10% (HR = 0.90; 95% CI: 0.85, 0.96) and cardiovascular mortality by 20% (HR = 0.80; 95% CI: 0.74, 0.86); (2) football has favourable effects on body composition, blood lipids, fasting blood glucose, blood pressure, cardiovascular function at rest, cardiorespiratory fitness and bone strength (p < 0.050); (3) handball has favourable effects on body composition and cardiorespiratory fitness (p < 0.050); (4) running reduces the risk of all-cause mortality by 23% (HR = 0.77; 95% CI: 0.70, 0.85), cancer mortality by 20% (HR = 0.80; 95% CI: 0.72, 0.89) and cardiovascular mortality by 27% (HR = 0.73; 95% CI: 0.57, 0.94) and improves body composition, cardiovascular function at rest and cardiorespiratory fitness (p < 0.010); and (5) swimming reduces the risk of all-cause mortality by 24% (HR = 0.76; 95% CI: 0.63, 0.92) and improves body composition and blood lipids (p < 0.010).

CONCLUSIONS

A range of physical health benefits are associated with participation in recreational cycling, football, handball, running and swimming. More studies are needed to enable meta-analyses of health benefits of participation in other sports. PROSPERO registration number CRD42021234839.

Environmental Preferences and Concerns of Recreational Trail Runners

Trail running is a fast-growing sport, linked to improvements in both physical and psychological well-being. Despite its popularity, the preferences of trail runners are not well known. The objective of this study was to examine the environmental preferences and concerns of trail runners with respect to age and gender. We conducted a cross-sectional survey of recreational trail runners. A total of 548 people responded, of which 50.1% of respondents were women and 44.2% were men. The sample was distributed relatively evenly across age groups, up to 54 years; respondents over 55 represented only 9.4% of the sample. Comparisons of runner characteristics by gender indicated significant differences (p < 0.05) according to age, distance run per week, and number of days run per week. Certain runner preferences also differed significantly by gender, including importance of running around others, the type of trail races they seek, and whether or not they like to seek "vert" or elevation in their runs. Major concerns for both genders while running included lack of cell reception (Men: 33.8%; Women: 50.8%) and getting lost (Men: 26.8%; Women: 35.5%). Comparisons of the results of this study help to strengthen our understanding of trail runners' environmental preferences and concerns and can be used to guide future design and maintenance of trail environments to encourage greater participation in the sport.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Time Spent Jogging/Running and Biological Aging in 4458 U.S. Adults: An NHANES Investigation

Telomere length is a good index of cellular aging. Longer telomeres are predictive of longer life, and healthy lifestyles are associated with longer telomeres. This study explored the relationship between time spent jogging or running each week and leukocyte telomere length (LTL) in 4458 randomly selected U.S. adults. The association was studied using data collected by the National Health and Nutrition Examination Survey (NHANES), and a cross-sectional design. Total weekly jog/run time was calculated from survey responses. From the minute totals, three categories were formed: <10 min/week, 10-74 min/week, and ≥75 min/week. Adults in the third category met the U.S. guidelines. Data were analyzed using one-way ANOVA. Partial correlation was used to adjust for differences in potential mediating factors, including demographic and lifestyle/medical factors. In the total sample, after adjusting for all the potential covariates, mean LTL significantly differed across the three jog/run categories (F = 4.1, p = 0.0272). Specifically, adults who met the guidelines via jogging and/or running had significantly longer telomeres than adults who performed no jogging/running. Adults in the middle category did not differ from the other two categories. A minimum of 75 min of jogging/running weekly is predictive of longer telomeres when compared to adults who do not jog or run regularly.

Lifestyle Patterns in Patients with Type 2 Diabetes

Modern lifestyles have led to sedentary behavior, lower participation in active movement and physical activities during leisure time, unhealthy diets, and increased exposure to stress. It is important to examine the interaction of several lifestyle risk factors instead of focusing on one alone. The purpose of this study was to identify lifestyle patterns in a group of patients with type 2 diabetes and the associations of its components with certain metabolic parameters. Using principal component analysis, we identified three dietary patterns: the prudent pattern (fat, oil, cereals, potatoes, vegetables, fish, nuts, seeds and fruits), the Western pattern (meat and meat products, eggs and soft drinks) and the traditional pattern (milk and its derivatives, soups and sauces, with a low intake of sugar/snacks). In addition, using the same method of analysis, we identified two lifestyle patterns: the inadequate lifestyle pattern (Western dietary pattern, increased hours of sleep and lower levels of stress) and the traditional lifestyle pattern (traditional dietary pattern, increased physical activity (PA) and non-smoking status). The inadequate lifestyle pattern was associated with younger age, hypertension and diabetic neuropathy. The traditional lifestyle pattern was related to lower postprandial blood glucose levels. Sedentary individuals were more likely to be over 65 years old and to have higher glycated hemoglobin (HbA1c). Smokers were also more likely to have inadequate glycemic and lipid profile control.

Training patterns associated with injury in New York City Marathon runners

OBJECTIVE

Training patterns are commonly implicated in running injuries. The purpose of this study was to measure the incidence of injury and illness among marathon runners and the association of injuries with training patterns and workload.

METHODS

Runners registered for the New York City Marathon were eligible to enrol and prospectively monitored during the 16 weeks before the marathon, divided into 4-week 'training quarters' (TQ) numbered TQ1-TQ4. Training runs were tracked using Strava, a web and mobile platform for tracking exercise. Runners were surveyed at the end of each TQ on injury and illness, and to verify all training runs were recorded. Acute:chronic workload ratio (ACWR) was calculated by dividing the running distance in the past 7 days by the running distance in the past 28 days and analysed using ratio thresholds of 1.3 and 1.5.

RESULTS

A total of 735 runners participated, mean age 41.0 (SD 10.7) and 46.0% female. Runners tracked 49 195 training runs. The incidence of injury during training was 40.0% (294/735), and the incidence of injury during or immediately after the marathon was 16.0% (112/699). The incidence of illness during training was 27.2% (200/735). Those reporting an initial injury during TQ3 averaged less distance/week during TQ2 compared with uninjured runners, 27.7 vs 31.9 miles/week (p=0.018). Runners reporting an initial injury during TQ1 had more days when the ACWR during TQ1 was ≥1.5 compared with uninjured runners (injured IQR (0-3) days vs uninjured (0-1) days, p=0.009). Multivariable logistic regression for training injuries found an association with the number of days when the ACWR was ≥1.5 (OR 1.06, 95% CI (1.02 to 1.10), p=0.002).

CONCLUSION

Increases in training volume ≥1.5 ACWR were associated with more injuries among runners training for a marathon. These findings can inform training recommendations and injury prevention programmes for distance runners.

Physical Activity Types, Physical Activity Levels and Risk of Diabetes in General Adults: The NHANES 2007-2018

BACKGROUND

Recreational activities show benefits for diabetes prevention, but work-related activity and the total amount of individual physical activity is rarely discussed.

PURPOSE

The purpose of this study was to evaluate the participation in five typical physical activities (vigorous work activity, vigorous recreational activities, moderate work activity, moderate recreational activities, and walk/bicycle for transportation), as well as the weekly distribution of total physical activity intensity, and to explore the relationships between physical activity types, physical activity levels, and risk of diabetes.

STUDY DESIGN

Cross-sectional study.

METHODS

The self-reported physical activity data on specific domains of physical activity were acquired from individuals in the 2007-2018 National Health and Nutrition Examination Survey (NHANES) using the Physical Activity Questionnaire (PAQ). Diabetes status was assessed by self-reported medical diagnosis or medication usage, or a fasting glucose concentration ≥ 126 mg/dL (fasting is defined as no caloric intake for at least 8 h) or HbA1c ≥ 6.5%. Weighted logistic regression was used to investigate the associations between physical activity types, physical activity levels, and risk of diabetes.

RESULTS

Diabetes was less prevalent in people who participated in physical activity and the risk of diabetes reduced progressively as total physical activity levels increased. Younger adults (20-44 years) and males reported a higher proportion of high-intensity physical activity participation.

CONCLUSIONS

Our findings highlight the importance of a physically active lifestyle for preventing diabetes. Distinct types of physical activity had different effects on the risk of diabetes. A greater total physical activity level was related to a substantial reduction in diabetes risk.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update

OBJECTIVE

The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers.

METHODS

The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development.

RESULTS

This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes.

CONCLUSIONS

This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.

Correlation between Cardiopulmonary Indices and Running Performance in a 14.5 km Endurance Running Event

BACKGROUND

Running is a common recreational activity, and the number of long-distance-race participants is continuously growing. It is well-established that regular physical activity can prevent and manage non-communicable diseases and benefit public health. Training for a long-distance race requires development of specific aerobic abilities and should generate the desired race performance. The purpose of this study was to support the training design and motivation of recreational endurance runners, by investigating whether a 14.5 km race performance of long-distance runners correlates with their cardiopulmonary indices measured in the laboratory.

METHODS

To examine the relationships of a 14.5 km running performance with the cardiopulmonary parameters of amateur runners, a cross-sectional study design was applied. Fifteen (eleven men and four women) recreational long-distance runners (aged 41.3 ± 9.2 years) from Northern Greece were included in the study and were evaluated in the laboratory within one week before an endurance running race-the 14.5 km Philip Road race, in Greece. The laboratory-based examinations of the athletes consisted of a comprehensive medical pre-participation screening and maximal cardiopulmonary exercise testing.

RESULTS

The results showed that the 14.5 km race performance time (73.8 ± 9.7 min) significantly correlated with the cardiopulmonary-exercise-testing speed-related indices at specific submaximal and maximal workloads (p < 0.01, p < 0.05), while the cardiopulmonary indices of oxygen uptake did not reliably predict race running time (p > 0.05).

CONCLUSIONS

There is a better correlation of the 14.5 km running performance of recreational long-distance runners with the cardiopulmonary-exercise-testing speed-related indices at specific workloads than with the indices of oxygen uptake, running economy or respiratory economy. When preparing a training strategy, amateur long-distance runners should mostly rely on specific running-speed-related laboratory data rather than on oxygen-uptake values.

Comparative Effectiveness of Lifestyle Intervention on Fasting Plasma Glucose in Normal Weight Versus Overweight and Obese Adults With Prediabetes

Background. It is hypothesized that normal weight individuals develop diabetes through different pathophysiological mechanisms and that methods of prevention may differ in the absence of overweight/obesity. In this study, we compared the effect of lifestyle health coaching (LHC) on fasting plasma glucose (FPG) in normal weight, overweight, and obese US adults with prediabetes. Methods. Subjects were 1358 individuals who completed baseline and follow-up evaluations as part of an LHC program (follow-up = ~6 months). Participants were stratified, based on baseline body mass index (BMI), into normal weight (n = 129), overweight (n = 345), and obese (n = 884) cohorts. LHC included counseling, predominantly via telehealth, on exercise and nutrition. Results. BMI decreased ( P < .001) in the overweight and obese participants but was unchanged in the normal weight participants. FPG decreased ( P < .001) in all 3 cohorts, and the magnitude of decrease did not differ significantly among cohorts. FPG decreased to <5.6 mmol/L in 58.1%, 49.3%, and 41.4% of the normal weight, overweight, and obese participants, respectively. Conclusions. To our knowledge, this study is the first outside of Asia to show that LHC is as effective in managing FPG in normal weight adults with prediabetes versus those who are overweight/obese.

5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Time-varying association between physical activity and risk of diabetes in the early and late adulthood: A longitudinal study in a West-Asian country

BACKGROUND

The time-varying association between physical activity (PA) and incidence of type 2 diabetes (T2DM) is still unclear. The present study aimed to investigate this association in the early- and late-adulthood during a 9-year follow-up.

METHODS

This study was conducted on 3905 participants in early and late adulthood, using the Tehran Lipid and Glucose Study (TLGS) dataset. PA was assessed via the Iranian version of Modified Activity Questionnaire (MAQ). The association between trend of PA and incident T2DM was investigated using time-varying Cox's proportional hazard model. Variables including job, education, smoking and body mass index (BMI) were adjusted in the final model.

RESULTS

The distribution of sex- and age-specific levels of PA changed significantly over time. Compared with physically inactive women, for older women with high level of PA, the risk of T2DM was 0.64 (95% CI: 0.43-0.95, P = 0.02) in adjusted model. Moreover, hazard for low PA group was significantly higher than the moderate group, and for these two groups were significantly higher than high PA level (P < 0.05).

CONCLUSION

High PA level can postpone the incident T2DM in early-aged and elderly women, over time. Therefore, gender and age are of great importance in designing the PA modifying programs to prevent T2DM.

Association Between Relative Quadriceps Strength and Type 2 Diabetes Mellitus in Older Adults: The Yangpyeong Cohort of the Korean Genome and Epidemiology Study

BACKGROUND

To examine the independent and combined association between relative quadriceps strength and the prevalence of type 2 diabetes mellitus (T2DM) in older adults.

METHODS

Among 1441 Korean older adults aged ≥65 years (71 [4.7] y) recruited between 2007 and 2016, 1055 older adults with no history of myocardial infarction, stroke, or cancer were included in the analysis. Cases of T2DM were identified by self-reported physician diagnosis, use antihyperglycemic medication or insulin, or fasting blood glucose ≥126 mg/dL. Logistic regression was used to calculate the odds ratios and 95% confidence intervals of T2DM by quartiles of relative quadriceps strength.

RESULTS

There were 162 T2DM cases (15%). Compared with the lowest quartile (weakest), the odds ratios (95% confidence intervals) of T2DM were 0.56 (0.34-0.90), 0.60 (0.37-0.96), and 0.47 (0.28-0.80) in the second, third, and fourth quartiles, respectively, after adjusting for possible confounders, including body mass index. In the joint analysis, compared with the "weak and overweight/obese" group, the odds (odds ratios [95% confidence intervals]) of T2DM was only lower in the "strong and normal weight" group (0.36 [0.22-0.60]) after adjusting for possible confounders.

CONCLUSIONS

Greater relative quadriceps strength is associated with reduced odds of T2DM in older adults after adjusting for potential confounders including body mass index.

Development and validation of the type 2 diabetes mellitus 10-year risk score prediction models from survey data

AIMS

In this paper, we demonstrate the development and validation of the 10-years type 2 diabetes mellitus (T2DM) risk prediction models based on large survey data.

METHODS

The Survey of Health, Ageing and Retirement in Europe (SHARE) data collected in 12 European countries using 53 variables representing behavioural as well as physical and mental health characteristics of the participants aged 50 or older was used to build and validate prediction models. To account for strongly unbalanced outcome variables, each instance was assigned a weight according to the inverse proportion of the outcome label when the regularized logistic regression model was built.

RESULTS

A pooled sample of 16,363 individuals was used to build and validate a global regularized logistic regression model that achieved an area under the receiver operating characteristic curve of 0.702 (95% CI: 0.698-0.706). Additionally, we measured performance of local country-specific models where AUROC ranged from 0.578 (0.565-0.592) to 0.768 (0.749-0.787).

CONCLUSIONS

We have developed and validated a survey-based 10-year T2DM risk prediction model for use across 12 European countries. Our results demonstrate the importance of re-calibration of the models as well as strengths of pooling the data from multiple countries to reduce the variance and consequently increase the precision of the results.

Two weeks of moderate intensity locomotor training increased corticosterone concentrations but did not alter the number of adropin-immunoreactive cells in the hippocampus of diabetic type 2 and control rats

Adropin (ADR) plays a role in metabolism regulation and its alterations in obesity and diabetes have been found. Treatment with ADR was beneficial in metabolic diseases, and physical exercise increased ADR concentrations in obese patients. However, data on the distribution of ADR in the brain are sparse. The role of metabolic status and physical exercise on its expression in the brain is undiscovered. We hypothesized that diabetes type 2 (DM2) and/or exercise will alter number of ADR-immunoractive (-ir) cells in the rat brain. Animals were divided into groups: diabetes type 2 (receiving high-fat diet and injections of streptozotocin) and control (fed laboratory chow diet; C). Rats were further divided into: running group (2 weeks of forced exercise on a treadmill) and non-running group. Body mass, metabolic and hormonal profiles were assessed. Immunohistochemistry was run to study ADR-ir cells in the brain. We found that: 1) in DM2 animals, running decreased insulin and increased glucose concentrations; 2) in C rats, running decreased insulin concentrations and had no effect on glucose concentration in blood; 3) running increased corticosterone (CORT) concentrations in DM2 and C rats; 4) ADR-ir cells were detected in the hippocampus and ADR-ir fibers in the arcuate nucleus of the hypothalamus, which is a novel location; 5) metabolic status and running, however, did not change number of these cells. We concluded that 2 weeks of forced moderate intensity locomotor training induced stress response present as increased concentration of CORT and did not influence number of ADR-ir cells in the brain.

5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2021

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Physical Activity Dimensions and Its Association with Risk of Diabetes in Middle and Older Aged Chinese People

Background: Diabetes and physical inactivity are prevalent worldwide. Risk of diabetes is known to be related with insufficient physical activity (PA), but associations with the respective dimensions of PA is unclear. Objective: To describe the patterns of physical activity among Chinese middle- and older-aged individuals and figure out their associations with diabetes risk in different dimensions. Methods: Extracting self-reported data from China Health and Retirement Longitudinal Study (CHARLS, 2015), this study included 6196 participants. Multivariate logistic regression was conducted to determine the association between diabetes risk and PA dimensions such as intensity, frequency, duration, and volume. Results: Concerning frequency, lower diabetes risk was associated with performing vigorous PA at any frequency overall. For duration, smaller odds of diabetes were observed in performing vigorous PA 2-4 h/day (OR 0.46, 95%CI 0.30 to 0.71), moderate PA ≥4 h/day (OR 0.59, 95%CI 0.42 to 0.82) and light PA ≥4 h/day (OR 0.59, 95%CI 0.41 to 0.85) overall. For volume, lower diabetes risk was associated with performing moderate-to-vigorous PA (MVPA) ≥2250 METs/week (OR 0.58, 95%CI 0.42 to 0.81) in middle-aged group (45-64 years), whereas no significant associations between MVPA and diabetes risk were found in older aged group (≥65 years). Conclusions: Our results revealed that physical inactivity is prevalent in China, with a greater proportion in the diabetes group. Lower risk of diabetes was associated with higher frequency, longer duration and longer volume of PA at higher intensity in middle-aged respondents and similar associations at lower intensity for the older adults. Additionally, further well-designed prospective studies are needed to confirm our findings.

Exercise and metabolic health: beyond skeletal muscle

Regular exercise is a formidable regulator of insulin sensitivity and overall systemic metabolism through both acute events driven by each exercise bout and through chronic adaptations. As a result, regular exercise significantly reduces the risks for chronic metabolic disease states, including type 2 diabetes and non-alcoholic fatty liver disease. Many of the metabolic health benefits of exercise depend on skeletal muscle adaptations; however, there is plenty of evidence that exercise exerts many of its metabolic benefit through the liver, adipose tissue, vasculature and pancreas. This review will highlight how exercise reduces metabolic disease risk by activating metabolic changes in non-skeletal-muscle tissues. We provide an overview of exercise-induced adaptations within each tissue and discuss emerging work on the exercise-induced integration of inter-tissue communication by a variety of signalling molecules, hormones and cytokines collectively named 'exerkines'. Overall, the evidence clearly indicates that exercise is a robust modulator of metabolism and a powerful protective agent against metabolic disease, and this is likely to be because it robustly improves metabolic function in multiple organs. Graphical abstract.