Greater Adherence to Recommended Morning Physical Activity is Associated With Greater Total Intervention-Related Physical Activity Changes in Bariatric Surgery Patients

Evaluating the impact of individuals' morningness-eveningness on the effectiveness of a habit-formation intervention for a simple and a complex behavior

Planning-based interventions are often used to help individuals form habits. Existing literature suggests a one-size-fits all approach to habit formation, but planning interventions may be optimized if tailored to individual differences and/or behavioral complexity. We test the hypothesis that planning to do a relatively complex behaviour (exercise) at a time that matches an individuals' diurnal preference will facilitate behavioral engagement; whereas for a simpler behaviour (calcium supplementation), the optimal time-of-day for a new behavior will occur in the morning. Young, women volunteers (N = 317) were randomly assigned to take calcium supplements or to exercise for 4 weeks and to control (no planning) or to one of three planning interventions (morning plan; evening plan; unassigned-time plan). Participants reported diurnal preference at baseline and habit strength and behavioral frequency weekly. Fitbit Zips and Medication Event Monitoring System Caps (MEMS) were used to objectively assess behavioral engagement. Multilevel modelling found that calcium-supplementation was greatest for morning-types in the morning-cue condition, whereas exercise was greatest for morning-types with morning cues and evening-types with evening cues. Habit-formation strategies may depend on diurnal preference and behavioral complexity. Future research can evaluate the role of other individual differences.

An ecological momentary assessment study of affectively-charged motivational states and physical activity

The physical activity (PA) intention-behavior gap has prompted researchers to explore other explanatory factors such as affective mechanisms which might better explain PA engagement. Affectively-charged motivations (e.g., desire, dread) are thought to influence the pursuit or avoidance of future behavior. This study examined whether affectively-charged motivations for PA changed across the day and were differentially associated with PA intensity. Participants (N = 60) wore ActiGraph GT3X accelerometers and answered EMA (M = 134.7 prompts/person) about affectively-charged motivations for upcoming PA using a 0-to-100-point scale (dread-excitement) in the morning, pre-activity, at-random, and evening for 14 days. Affectively-charged motivations for PA were lower in the morning and at-random compared to pre-activity (p = .004) and evening (p < .001). On average, individuals who rated morning affectively-charged motivations for PA 10-points higher engaged in 28 additional min/week of moderate-to-vigorous PA (p = .048). These findings suggest that affectively-charged motivations occurring in the morning may have greater salience for PA.

Association of Time-of-Day Physical Activity With Incident Cardiovascular Disease: The UK Biobank Study

INTRODUCTION

Early morning is characterized by an increased risk of cardiovascular events, a sudden rise in blood pressure, impaired endothelial function, and exacerbated hemodynamic changes during physical activity. The study aims to examine whether the time of day of physical activity is associated with incident cardiovascular disease (CVD).

METHODS

We prospectively analyzed 83,053 participants in the UK Biobank with objectively measured physical activity and initially free of CVD. Based on the diurnal patterns of physical activity, participants were categorized into 4 groups: early morning (n = 15,908), late morning (n = 22,371), midday (n = 24,764), and evening (n = 20,010). Incident CVD was defined as the first diagnosis of coronary heart disease or stroke.

RESULTS

During 197.4 million person-years of follow-up, we identified 3454 CVD cases. After adjusting for the overall acceleration average, the hazard ratios and 95% confidence intervals were 0.95 (0.86-1.07) for late morning, 1.15 (1.03-1.27) for midday, and 1.03 (0.92-1.15) for evening, as compared with the early morning group. In the joint analyses, higher levels of physical activity were associated with a lower risk of incident CVD in a similar manner across the early morning, late morning, and evening groups. However, the beneficial association was attenuated in the midday group.

CONCLUSION

In conclusion, early morning, late morning, and evening are all favorable times of day to engage in physical activity for the primary prevention of CVD, while midday physical activity is associated with an increased risk of CVD compared with early morning physical activity after controlling for the levels of physical activity.

When should I run-the role of exercise timing in metabolic health

The prevalence of type 2 diabetes is reaching epidemic proportions. First line therapy approaches are lifestyle interventions including exercise. Although a vast amount of studies reports on beneficial effects of exercise on metabolism in humans per se, overall data are contradictory which makes it difficult to optimize interventions. Innovative exercise strategies and its underlying mechanism are needed to elucidate in order to close this therapeutic gap. The skeletal muscle produces and secretes myokines and microRNAs in response to exercise and both are discussed as mechanisms linking exercise and metabolic adaptation. Aspects of chronophysiology such as diurnal variation in insulin sensitivity or exercise as a signal to reset dysregulated peripheral clocks are of growing interest in the context of impaired metabolism. Deep insight of how exercise timing determines metabolic adaptations is required to optimize exercise interventions. This review aims to summarize the current state of research on the interaction between timing of exercise and metabolism in humans, providing insights into proposed mechanistic concepts focusing on myokines and microRNAs. First evidence points to an impact of timing of exercise on health outcome, although data are inconclusive. Underlying mechanisms remain elusive. It is currently unknown if the timed release of mykokines depends on time of day when exercise is performed. microRNAs have been found as an important mediator of processes associated with exercise adaptation. Further research is needed to evaluate their full relevance. In conclusion, it seems to be too early to provide concrete recommendations on timing of exercise to maximize beneficial effects.

Effectiveness of the perioperative encounter in promoting regular exercise and physical activity: a systematic review and meta-analysis

BACKGROUND

Low levels of physical activity (PA) are associated with poorer health outcomes. The perioperative encounter (extending from initial contact in primary care to beyond discharge from hospital) is potentially a good time to intervene, but data regarding the effectiveness of interventions are scarce. To address this, we systematically reviewed existing literature to evaluate the effectiveness of interventions applied perioperatively to facilitate PA in the medium to long-term (at least six months after the intervention).

METHODS

In this systematic review and meta-analysis, we searched Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, CINAHL, Embase, PsycInfo, and SPORTDiscus from database inception to October 22nd 2020, with an updated search done on August 4th 2022. We searched clinical trials registers, and conducted forward- and backward-citation searches. We included randomised controlled trials and quasi-randomised trials comparing PA interventions with usual care, or another PA intervention, in adults who were scheduled for, or had recently undergone, surgery. We included trials which reported our primary outcomes: amount of PA or whether participants were engaged in PA at least six months after the intervention. A random effects meta-analysis was used to pool data across studies as risk ratios (RR), or standardised mean differences (SMDs), which we interpreted using Cohen. We used the Cochrane risk of bias tool and used GRADE to assess the certainty of the evidence. This study is registered with PROSPERO, CRD42019139008.

FINDINGS

We found 57 trials including 8548 adults and compared 71 interventions facilitating PA. Most interventions were started postoperatively and included multiple components. Compared with usual care, interventions may slightly increase the number of minutes of PA per day or week (SMD 0.17, 95% CI 0.09-0.26; 14 studies, 2172 participants; I² = 0%), and people's engagement in PA at the study's end (RR 1.19, 95% CI 0.96-1.47; 9 studies, 882 participants; I² = 25%); this was moderate-certainty evidence. Some studies compared two different types of interventions but it was often not feasible to combine data in analysis. The effect estimates generally indicated little difference between intervention designs and we judged all the evidence for these comparisons to be very low certainty. Thirty-six studies (63%) had low risk of selection bias for sequence generation, 27 studies (47%) had low risk of bias for allocation concealment, and 56 studies (98%) had a high risk of performance bias. For detection bias for PA outcomes, we judged 30 studies (53%) that used subjective measurement tools to have a high risk of detection bias.

INTERPRETATION

Interventions delivered in the perioperative setting, aimed at enhancing PA in the medium to long-term, may have overall benefit. However, because of imprecision in some of the findings, we could not rule out the possibility of no change in PA.

FUNDING

National Institute for Health Research Health Services and Delivery Research programme (NIHR127879).

How do previously inactive individuals restructure their time to ‘fit in’ morning or evening exercise: a randomized controlled trial

The objective of this study was to investigate changes in sedentary and active behaviors when previously inactive adults start exercising in the morning or evening. One-hundred adults with overweight or obesity (BMI ≥ 25 kg/m2) were recruited for a 12-week intervention and randomized to one of three groups: (i) morning exercise (AMEx; 0600–0900); (ii) evening exercise (PMEx; 1600–1900); or (iii) waitlist control. AMEx and PMEx were prescribed self-paced aerobic exercise to achieve a weekly total of 250 min via a combination of supervised and unsupervised training. Sedentary and active behavior times were measured at baseline, mid- and post-intervention using the multimedia activity recall for children and adults. Time spent engaging in physical activity was significantly increased from baseline at both mid- (+ 14–22 min·day−1) and post-intervention (+ 12–19 min·day−1), for AMEx and PMEx. At 12-weeks, participants in both morning and evening exercise groups reported increased time spent Sleeping (+ 36 and + 20 min·day−1, respecitively), and reduced time spent watching TV/playing videogames (− 32 and − 25 min·day−1, respectively). In response to an exercise stimulus, previously inactive adults make encouraging modifications in how they use their time, and the patterns of change are similar with morning and evening exercise.

Examining the Role of Exercise Timing in Weight Management: A Review

Many adults cite exercise as a primary strategy for losing weight, yet exercise alone is modestly effective for weight loss and results in variable weight loss responses. It is possible that some of the variability in weight loss may be explained by the time of day that exercise is performed. Few studies have directly compared the effects of exercise performed at different times of the day (i. e., morning versus evening exercise). Results from these existing studies are mixed with some studies demonstrating superior weight and fat mass loss from morning exercise, while other studies have found that evening exercise may be better for weight management. Exercise timing may alter modifiable lifestyle behaviors involved in weight management, such as non-exercise physical activity, energy intake, and sleep. The purpose of this review is to summarize evidence for and against time-of-day dependent effects of exercise on weight management. Although limited, we also review studies that have examined the effect of exercise timing on other lifestyle behaviors linked to body weight regulation. While exercise at any time of day is beneficial for health, understanding whether there is an optimal time of day to exercise may advance personalized treatment paradigms for weight management.

Does the Time-of-Day of Exercise Influence the Total Volume of Exercise? A Cross-Sectional Analysis of Objectively Monitored Physical Activity Among Active Individuals

BACKGROUND

To improve compliance and adherence to exercise, the concept of temporal consistency has been proposed. Before- and after-work are periods when most working adults may reasonably incorporate exercise into their schedule. However, it is unknown if there is an association between the time-of-day that exercise is performed and overall physical activity levels.

METHODS

Activity was assessed over 1 week in a sample of 69 active adults (n = 41 females; mean age = 34.9 [12.3] y). At the end of the study, participants completed an interviewer-assisted questionnaire detailing their motivation to exercise and their exercise time-of-day preferences.

RESULTS

Participants were classified as "temporally consistent" (n = 37) or "temporally inconsistent" (n = 32) exercisers based on their accelerometry data. The "temporally consistent" group was further analyzed to compare exercise volume between "morning-exercisers" (n = 16) and "evening-exercisers" (n = 21). "Morning-exercisers" performed a greater volume of exercise than "evening-exercisers" (419 [178] vs 330 [233] min by self-report; 368 [224] vs 325 [156] min actigraph-derived moderate to vigorous physical activity, respectively).

CONCLUSIONS

Our findings suggest that active individuals use a mixture of temporal patterns to meet PA guidelines. Time-of-day of exercise should be reported in intervention studies so the relationship between exercise time-of-day, exercise behavior, and associated outcomes can be better understood.

Sustaining Regular Exercise During Weight Loss Maintenance: The Role of Consistent Exercise Timing

BACKGROUND

Exercising at a consistent versus variable time of day cross-sectionally relates to greater moderate to vigorous physical activity (MVPA) among weight loss maintainers. This study evaluated the relationships between exercise timing and both MVPA levels and habit strength, as well as stability in exercise timing, over 1 year among maintainers in the National Weight Control Registry.

METHODS

Participants (n = 709) completed questionnaires assessing exercise timing, MVPA, and exercise automaticity (a measure of habit) at baseline and 1-year follow-up. At each assessment, participants were labeled temporally consistent exercisers if >50% of their exercise sessions per week occurred in one time window: early morning, late morning, afternoon, or evening. Participants exercising consistently during the same window at both assessments were labeled as having stable patterns.

RESULTS

Temporally consistent exercise at baseline, regardless of its specific time, related to greater MVPA over time (Ps< .05). Approximately half of temporally consistent exercisers at baseline exhibited stable patterns. Early morning exercise and greater exercise automaticity at baseline predicted stable patterns (Ps< .005). Temporally consistent exercise, especially during the early morning, related to greater automaticity across time (Ps< .01).

CONCLUSIONS

Consistent exercise timing may help maintainers accrue more MVPA. Consistent early morning exercise was most strongly related to exercise automaticity and routine stability.

Association of Objectively Measured Timing of Physical Activity Bouts With Cardiovascular Health in Type 2 Diabetes

OBJECTIVE

Moderate- to vigorous-intensity physical activity (MVPA) improves cardiovascular health. Few studies have examined MVPA timing. We examined the associations of timing of bout-related MVPA with cardiorespiratory fitness and cardiovascular risk in adults with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Baseline 7-day hip-worn accelerometry data from Look AHEAD participants (n = 2,153, 57% women) were analyzed to identify bout-related MVPA (≥3 METs/min for ≥10 min). Cardiorespiratory fitness was assessed by maximal graded exercise test. Participants were categorized into six groups on the basis of the time of day with the majority of bout-related MVPA (METs × min): ≥50% of bout-related MVPA during the same time window (morning, midday, afternoon, or evening), <50% of bout-related MVPA in any time category (mixed; the reference group), and ≤1 day with bout-related MVPA per week (inactive).

RESULTS

Cardiorespiratory fitness was highly associated with timing of bout-related MVPA (P = 0.0005), independent of weekly bout-related MVPA volume and intensity. Importantly, this association varied by sex (P = 0.02). In men, the midday group had the lowest fitness (β = -0.46 [95% CI -0.87, -0.06]), while the mixed group in women was the least fit. Framingham risk score (FRS) was associated with timing of bout-related MVPA (P = 0.02), which also differed by sex (P = 0.0007). The male morning group had the highest 4-year FRS (2.18% [0.70, 3.65]), but no association was observed in women.

CONCLUSIONS

Timing of bout-related MVPA is associated with cardiorespiratory fitness and cardiovascular risk in men with type 2 diabetes, independent of bout-related MVPA volume and intensity. Prospective studies are needed to determine the impacts of MVPA timing on cardiovascular health.

Consistent Morning Exercise May Be Beneficial for Individuals With Obesity

This review explores the hypothesis that a consistent exercise time, especially consistent morning exercise, improves exercise adherence and weight management for individuals with overweight or obesity. We discuss data supporting this premise, identify limitations of current research, and outline directions for future research on exercise timing to more robustly evaluate our thesis.

Does intensive multidisciplinary intervention for adults who elect bariatric surgery improve post-operative weight loss, co-morbidities, and quality of life? A systematic review and meta-analysis

This systematic review and meta-analysis of intervention studies aims to evaluate the effect of preoperative and/or post-operative support for adults who elect bariatric surgery delivered by a multidisciplinary team (MDT) on post-operative body composition, mental health, co-morbidities, quality of life, and side effects. Six electronic databases were searched. Revman and GRADE were used to assess confidence in pooled effects. Included interventions (N = 1533 participants in total) focused on lifestyle counselling (n = 4 studies), psychology (n = 4 studies), or exercise (n = 10 studies); comparator groups were less intensive usual care. Intensive MDT interventions increased post-operative weight loss (SMD: -0.94; 95% CI: -1.27 to -0.61) if delivered post-operatively. Preoperative and post-operative intensive interventions improved symptoms of depression and anxiety, quality of life, diastolic blood pressure, and resting heart rate but not lipids or glycaemic measures. Whilst usual MDT care is important preoperatively, this review conditionally recommends intensive MDT interventions for enhanced post-operative weight loss if delivered in the post-operative period, led by any health professional, based on moderate evidence. This review also conditionally recommends preoperative and/or post-operative lifestyle, nutrition, or psychology counselling and/or physical activity for improved mental and physical health. Further randomized controlled trials are required, which aim to specifically evaluate the best use of MDT resources.

Relationship of Consistency in Timing of Exercise Performance and Exercise Levels Among Successful Weight Loss Maintainers

OBJECTIVE

This study aimed to evaluate whether consistency in time of day that moderate- to vigorous-intensity physical activity (MVPA) is performed relates to MVPA levels among successful weight loss maintainers in the National Weight Control Registry.

METHODS

Participants (n = 375) reporting MVPA on ≥ 2 d/wk completed measures of temporal consistency in physical activity (PA) (> 50% of MVPA sessions per week occurring during the same time window: early/late morning, afternoon, or evening), PA levels, PA automaticity, and consistency in cues underlying PA habit formation (e.g., location).

RESULTS

Most (68.0%) participants reported temporally consistent MVPA. These individuals reported higher MVPA frequency (4.8 ± 1.6 vs. 4.4 ± 1.5 d/wk; P = 0.007) and duration (median [IQR]: 350.0 [200.0-510.0] vs. 285.0 [140.0-460.0] min/wk; P = 0.03), and they were more likely to achieve the national MVPA guideline (≥ 150 min/wk) than temporally inconsistent exercisers (86.3% vs. 74.2%, P = 0.004). Among temporally consistent exercisers, 47.8% were early-morning exercisers; MVPA levels did not differ by time of day of routine MVPA performance (P > 0.05). Greater automaticity and consistency in several cues were related to greater MVPA among all participants.

CONCLUSIONS

Most participants reported consistent timing of MVPA. Temporal consistency was associated with greater MVPA, regardless of the specific time of day of routine MVPA performance. Consistency in exercise timing and other cues might help explain characteristic high PA levels among successful maintainers.

The effects of exercise session timing on weight loss and components of energy balance: midwest exercise trial 2

Background/objectives

Circadian physiology has been linked to body weight regulation and obesity. To date, few studies have assessed the association between exercise timing and weight related outcomes. The aim of this secondary analysis was to explore the impact of exercise timing (i.e., 24 h clock time of exercise session) on weight loss and components of energy balance.

Subjects/methods

Overweight/obese (BMI 25.0–39.9 kg/m²), physically inactive, young adults (~51% female) completed a 10-month supervised exercise program (400 or 600 kcal/session for 5 days/week) or served as non-exercise controls (CON). Participants were categorized based on the time of day in which they completed exercise sessions (Early-Ex: >50% of sessions completed between 7:00 and 11:59 am; (n = 21), Late-Ex: >50% of sessions completed between 3:00 and 7:00 pm; (n = 25), Sporadic-Ex: <50% of sessions completed in any time category; (n = 24), and CON; (n = 18)). Body weight, energy intake (EI; digital photography), and non-exercise physical activity (NEPA; accelerometer) were assessed at baseline, 3.5, 7, and 10 months. Total daily energy expenditure (TDEE; doubly labeled water), was assessed at baseline and 10 months.

Results

At month 10, weight loss was significantly greater in both Early-EX (−7.2 ± 1.2%; p < 0.001) and Sporadic-EX (− 5.5 ± 1.2%; p = 0.01) vs CON (+0.5 ± 1.0%), and Early-EX vs Late-EX (−2.1 ± 1.0%; p < 0.001). There were no between group differences for change in TDEE, EI, and non-exercise energy expenditure (P > 0.05). A significant group × time interaction (p = 0.02) was observed for NEPA (counts/min), however, after adjusting for multiple comparisons, group effects were no longer significant.

Conclusions

Despite minimal differences in components of energy balance, Early-EX lost significantly more weight compared with Late-Ex. Although the mechanisms are unclear, the timing of exercise may be important for body weight regulation.

Evaluation of an exercise programme for post-bariatric surgery patients: views of participants

OBJECTIVE

Exercise programmes typically are evaluated with fitness assessments and psychological survey measures but seldom include participants' insights. The purpose of this study was to evaluate the benefits, facilitators and barriers of a 12-week exercise programme for post-bariatric surgery patients from the participants' perspective.

METHOD

Over a 2-year period, 20 patients recently having undergone bariatric surgery completed a 12-week programme that included participation in structured exercise and in focus groups designed to supplement standard evaluation data and provide insight into participants' views.

RESULTS

Participants were highly adherent to the programme, and focus group results reflected a clear positive evaluations. Benefits included helpful information, developing commitment, physical fitness and social support; notably, weight was seldom mentioned. Participants cited structure, accountability and group support as facilitators of exercise. Participants cited few barriers, although very few had set plans for continuing exercise after programme completion.

CONCLUSION

Participants saw many benefits to the exercise programme, and those benefits reflected lifestyle changes rather than a focus on weight. Programme structure, accountability and the support of the group were facilitators to exercise. Participants cited few barriers. However, the lack of plans for continued exercise suggested the need for a transition phase to help participants continue an active lifestyle after the 12-week structured programme.