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Liu M, Zhang Y, Zhang Y, He P, Zhou C, Ye Z, Yang S, Gan X, Hou FF, Qin X. Association of accelerometer-measured physical activity and its change with progression to chronic kidney disease in adults with type 2 diabetes and overweight/obesity. Br J Sports Med 2024; 58:313-319. [PMID: 38320851 DOI: 10.1136/bjsports-2023-107564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/16/2024]
Abstract
OBJECTIVE To examine the long-term association of objectively measured moderate-to-vigorous physical activity (MVPA) and its longitudinal changes with progression to chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and overweight/obesity. METHODS This study included 1746 participants in the Look AHEAD trial with baseline estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m2. MVPA was measured at baseline, year 1, year 4 and year 8 using an RT3 accelerometer. The outcome was progression to CKD, defined as eGFR<60 mL/min per 1.73 m2 with a drop of ≥30% or end-stage kidney disease. Cox hazards models were fitted to examine the association between MVPA and outcomes. RESULTS Over a median follow-up of 12.0 years, 567 participants experienced progression to CKD. Overall, there was a linear inverse association of cumulative average total MVPA (per 100 min/week higher amount, HR: 0.91; 95% CI: 0.86 to 0.96) and MVPA accumulated in bouts of ≥10 min (per 100 minutes/week higher amount, HR: 0.81; 95% CI: 0.72 to 0.91) with progression to CKD. Moreover, an increase in total MVPA from baseline to year 4 (the fourth quartile, ≥63.2 min/week) was associated with a 33% lower risk of progression to CKD compared with the largest MVPA reduction (the first quartile, <-198.3 min/week). A lower risk of progression to CKD was also observed for increases in MVPA accumulated in bouts of both <10 min and ≥10 min. CONCLUSIONS Longer MVPA time and increases in MVPA was associated with a reduced risk of progression to CKD in adults with overweight/obesity and T2D.
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Affiliation(s)
- Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Yanjun Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Sisi Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Xiaoqin Gan
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
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Papamargaritis D, le Roux CW, Holst JJ, Davies MJ. New therapies for obesity. Cardiovasc Res 2024; 119:2825-2842. [PMID: 36448672 PMCID: PMC10874276 DOI: 10.1093/cvr/cvac176] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 02/17/2024] Open
Abstract
Obesity is a chronic disease associated with serious complications and increased mortality. Weight loss (WL) through lifestyle changes results in modest WL long-term possibly due to compensatory biological adaptations (increased appetite and reduced energy expenditure) promoting weight gain. Bariatric surgery was until recently the only intervention that consistently resulted in ≥ 15% WL and maintenance. Our better understanding of the endocrine regulation of appetite has led to the development of new medications over the last decade for the treatment of obesity with main target the reduction of appetite. The efficacy of semaglutide 2.4 mg/week-the latest glucagon-like peptide-1 (GLP-1) receptor analogue-on WL for people with obesity suggests that we are entering a new era in obesity pharmacotherapy where ≥15% WL is feasible. Moreover, the WL achieved with the dual agonist tirzepatide (GLP-1/glucose-dependent insulinotropic polypeptide) for people with type 2 diabetes and most recently also obesity, indicate that combining the GLP-1 with other gut hormones may lead to additional WL compared with GLP-1 receptor analogues alone and in the future, multi-agonist molecules may offer the potential to bridge further the efficacy gap between bariatric surgery and the currently available pharmacotherapies.
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Affiliation(s)
- Dimitris Papamargaritis
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester LE5 4PW, UK
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin 4, Ireland
- Diabetes Research Centre, Ulster University, Coleraine BT52 1SA, UK
| | - Jens J Holst
- Department of Biomedical Sciences and the NNF Center for Basic Metabolic Research, University of Copenhagen Panum Institute, Copenhagen 2200, Denmark
| | - Melanie J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester LE5 4PW, UK
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3
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Gasana J, O'Keeffe T, Withers TM, Greaves CJ. A systematic review and meta-analysis of the long-term effects of physical activity interventions on objectively measured outcomes. BMC Public Health 2023; 23:1697. [PMID: 37660119 PMCID: PMC10474717 DOI: 10.1186/s12889-023-16541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/16/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Although physical activity interventions are frequently reported to be effective, long-term changes are needed to generate meaningful health benefits. There are criticisms that evaluations of physical activity interventions mostly report short-term outcomes and that these are often self-reported rather than measured objectively. This study therefore aimed to assess the long-term (at least 24 month) effectiveness of behavioural interventions on objectively measured physical activity. METHODS We conducted a systematic review with a meta-analysis of effects on objectively measured physical activity. We searched: Cochrane CENTRAL, EMBASE, PsychInfo, CINAHL and Pubmed up to 10th January 2022. Studies were included if they were in English and included a physical intervention that assessed physical activity in the long-term (defined as at least 24 months). RESULTS Eight studies with 8480 participants were identified with data suitable for meta-analysis. There was a significant effect of interventions on daily steps 24 months post baseline (four studies, SMD: 0.15, 95% CI: 0.02 to 0.28) with similar results at 36 to 48 months of follow up (four studies, SMD: 0.17, 95% CI: 0.07 to 0.27). There was a significant effect of interventions on moderate-to-vigorous physical activity 24 months post baseline (four studies, SMD: 0.18 95% CI: 0.07 to 0.29) and at 36 to 48 months (three studies, SMD: 0.16 95% CI: 0.09 to 0.23). The mean effect size was small. However, the changes in moderate-to-vigorous physical activity and steps per day were clinically meaningful in the best-performing studies. CONCLUSION This review suggests that behavioural interventions can be effective in promoting small, but clinically meaningful increases in objectively measured physical activity for up to 48 months. There is therefore a need to develop interventions that can achieve greater increases in long-term physical activity with greater efficiency.
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Affiliation(s)
- J Gasana
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, P.O Box 3286, Kigali, Rwanda
| | - T O'Keeffe
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - T M Withers
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - C J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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Karstoft K, Ried-Larsen M, Bruhn L, Pilmark NS, Hansen KB, Persson F, Jørgensen ME, Blond MB, Færch K. The effect of metformin treatment on volumes of free-living physical activity and sedentary behaviour: A post-hoc analysis of the PRE-D trial. J Sports Sci 2023; 41:1687-1691. [PMID: 38053246 DOI: 10.1080/02640414.2023.2291737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
Perceived physical exertion is increased when exercise is performed on metformin treatment, but the clinical relevance of this is unknown. In this post hoc analysis of a randomized, controlled trial, we investigated whether metformin treatment was associated with lower levels of free-living physical activity. Ninety individuals with overweight/obesity (BMI>25 m2/kg) and HbA1c-defined prediabetes (39-47 mmol/mol) were randomized to treatment with dapagliflozin (SGLT2-inhibitor; 10 mg once daily, n=30), metformin (850 mg twice daily, n=30) or no treatment (control, n=30) for 13 weeks in a parallel-group, open-label trial. Before (baseline), during (6 weeks) and immediately after (13 weeks) cessation of treatment, a 6-day assessment of physical activity and sedentary behaviour was performed using accelerometer-based physical activity monitors. Intention-to-treat analyses revealed no within-group changes or differences in change between the groups for any measures of physical activity or sedentary behaviour at neither 6 nor 13 weeks. Short-term metformin treatment does not reduce free-living physical activity level in individuals with overweight/obesity and HbA1c-defined prediabetes.
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Affiliation(s)
- Kristian Karstoft
- Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lea Bruhn
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Nanna Skytt Pilmark
- Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Bagge Hansen
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Frederik Persson
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
- Steno Diabetes Center Greenland (SDCG), Nuuk, Greenland
| | - Martin Bæk Blond
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Kristine Færch
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Qian J, Xiao Q, Walkup MP, Coday M, Erickson ML, Unick J, Jakicic JM, Hu K, Scheer FA, Middelbeek RJ. Association of Timing of Moderate-to-Vigorous Physical Activity With Changes in Glycemic Control Over 4 Years in Adults With Type 2 Diabetes From the Look AHEAD Trial. Diabetes Care 2023; 46:1417-1424. [PMID: 37226675 PMCID: PMC10300518 DOI: 10.2337/dc22-2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/22/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE We aimed to determine the association of the time-of-day of bout-related moderate-to-vigorous physical activity (bMVPA) with changes in glycemic control across 4 years in adults with overweight/obesity and type 2 diabetes. RESEARCH DESIGN AND METHODS Among 2,416 participants (57% women; mean age, 59 years) with 7-day waist-worn accelerometry recording at year 1 or 4, we assigned bMVPA timing groups based on the participants' temporal distribution of bMVPA at year 1 and recategorized them at year 4. The time-varying exposure of bMVPA (≥10-min bout) timing was defined as ≥50% of bMVPA occurring during the same time period (morning, midday, afternoon, or evening), <50% of bMVPA in any time period (mixed), and ≤1 day with bMVPA per week (inactive). RESULTS HbA1c reduction at year 1 varied among bMVPA timing groups (P = 0.02), independent of weekly bMVPA volume and intensity. The afternoon group had the greatest HbA1c reduction versus inactive (-0.22% [95%CI -0.39%, -0.06%]), the magnitude of which was 30-50% larger than the other groups. The odds of discontinuation versus maintaining or initiating glucose-lowering medications at year 1 differed by bMVPA timing (P = 0.04). The afternoon group had the highest odds (odds ratio 2.13 [95% CI 1.29, 3.52]). For all the year-4 bMVPA timing groups, there were no significant changes in HbA1c between year 1 and 4. CONCLUSIONS bMVPA performed in the afternoon is associated with improvements in glycemic control in adults with diabetes, especially within the initial 12 months of an intervention. Experimental studies are needed to examine causality.
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Affiliation(s)
- Jingyi Qian
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | | | - Jessica Unick
- Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI
| | - John M. Jakicic
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Frank A.J.L. Scheer
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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Cassidy S, Trenell M, Stefanetti RJ, Charman SJ, Barnes AC, Brosnahan N, McCombie L, Thom G, Peters C, Zhyzhneuskaya S, Leslie WS, Catt C, Catt M, McConnachie A, Sattar N, Sniehotta FF, Lean MEJ, Taylor R. Physical activity, inactivity and sleep during the Diabetes Remission Clinical Trial (DiRECT). Diabet Med 2023; 40:e15010. [PMID: 36398460 PMCID: PMC10099825 DOI: 10.1111/dme.15010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
AIMS As sustained weight loss is vital for achieving remission of type 2 diabetes, we explored whether randomisation to weight loss plus maintenance in the DiRECT trial was associated with physical activity, inactivity or sleep. METHODS Participants were randomised to either a dietary weight management programme or best-practice care. The weight management group were encouraged to increase daily physical activity to their sustainable maximum. Objective measurement was achieved using a wrist-worn GENEActiv accelerometer for 7 days at baseline, 12 and 24 months in both groups. RESULTS Despite average weight loss of 10 kg at 12 months in the intervention (n = 66) group, there were no differences in total physical activity or inactivity compared with the control (n = 104) at any time point. However, in our exploratory analysis, those who lost more than 10% of their baseline body weight performed on average 11 mins/day more light activity than the <10% group at 24 months (p = 0.033) and had significantly lower bouts of Inactivity30min (interaction, p = 0.005) across 12 and 24 months. At 24 months, the ≥10% group had higher daily acceleration (38.5 ± 12.1 vs. 33.2 ± 11.1 mg, p = 0.020), and higher accelerations in the most active 5-hour period (59.4 ± 21.8 vs. 50.6 ± 18.3 mg, p = 0.023). Wakefulness after sleep onset decreased in the intervention group compared with the control group and also in the ≥10% weight loss group at 12 and 24 months. CONCLUSIONS Randomisation to a successful intensive weight loss intervention, including regular physical activity encouragement, was not associated with increased physical activity although sleep parameters improved. Physical activity was greater, and night-time waking reduced in those who maintained >10% weight loss at 12 and 24 months. TRIAL REGISTRATION ISRCTN03267836.
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Affiliation(s)
- Sophie Cassidy
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Michael Trenell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Renae J Stefanetti
- Wellcome Centre for Mitochondrial Research, Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah J Charman
- Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alison C Barnes
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Naomi Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - George Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Carl Peters
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sviatlana Zhyzhneuskaya
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Wilma S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Christopher Catt
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Catt
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Falko F Sniehotta
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, New Brunswick, The Netherlands
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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7
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Balducci S, Haxhi J, Vitale M, Mattia L, Bollanti L, Conti F, Cardelli P, Sacchetti M, Orlando G, Zanuso S, Nicolucci A, Pugliese G. Sustained decreases in sedentary time and increases in physical activity are associated with preservation of estimated β-cell function in individuals with type 2 diabetes. Diabetes Res Clin Pract 2022; 193:110140. [PMID: 36328211 DOI: 10.1016/j.diabres.2022.110140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/06/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022]
Abstract
AIMS In the Italian Diabetes and Exercise Study_2, a counselling intervention produced modest but sustained increments in moderate-to vigorous-intensity physical activity (MVPA), with reallocation of sedentary-time (SED-time) to light-intensity physical activity (LPA). This post hoc analysis evaluated the impact of intervention on estimated β-cell function and insulin sensitivity. METHODS Patients with type 2 diabetes were randomized to one-month counselling once-a-year or standard care for 3 years. The HOmeostatic Model Assessment-2 (HOMA-2) method was used for estimating indices of β-cell function (HOMA-B%), insulin sensitivity (HOMA-S%), and insulin resistance (HOMA-IR); the disposition index (DI) was estimated as HOMA-β%/HOMA-IR; MVPA, LPA, and SED-time were objectively measured by accelerometer. RESULTS HOMA-B% and DI decreased in control group, whereas HOMA-B% remained stable and DI increased in intervention group. Between-group differences were significant for almost all insulin secretion and sensitivity indices. Changes in HOMA-B% and DI correlated with SED-time, MVPA and LPA. Changes in HOMA-B%, DI, and all indices were independently predicted by changes in SED-time (or LPA), MVPA, and BMI (or waist circumference), respectively. CONCLUSIONS In individuals with type 2 diabetes, increasing MVPA, even without achieving the recommended target, is effective in maintaining estimated β-cell function if sufficient amounts of SED-time are reallocated to LPA.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Martina Vitale
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lorenza Mattia
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Conti
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, University of Rome 'Foro Italico', Rome, Italy
| | - Giorgio Orlando
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Silvano Zanuso
- Centre for Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Antonio Nicolucci
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.
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8
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Thorsen IK, Yang Y, Valentiner LS, Glümer C, Karstoft K, Brønd JC, Nielsen RO, Brøns C, Christensen R, Nielsen JS, Vaag AA, Pedersen BK, Langberg H, Ried-Larsen M. The Effects of a Lifestyle Intervention Supported by the InterWalk Smartphone App on Increasing Physical Activity Among Persons With Type 2 Diabetes: Parallel-Group, Randomized Trial. JMIR Mhealth Uhealth 2022; 10:e30602. [PMID: 36170002 PMCID: PMC9557767 DOI: 10.2196/30602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 02/08/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Effective and sustainable implementation of physical activity (PA) in type 2 diabetes (T2D) health care has in general not been successful. Efficacious and contemporary approaches to support PA adherence and adoption are required. Objective The primary objective of this study was to investigate the effectiveness of including an app-based (InterWalk) approach in municipality-based rehabilitation to increase moderate-and-vigorous PA (MVPA) across 52 weeks compared with standard care among individuals with T2D. Methods The study was designed as a parallel-group, randomized trial with 52 weeks’ intervention and subsequent follow-up for effectiveness (52 weeks from baseline). Participants were recruited between January 2015 and December 2016 and randomly allocated (2:1) into 12 weeks of (1) standard care + InterWalk app–based interval walking training (IWT; IWT group; n=140), or (2) standard care + the standard exercise program (StC group; n=74). Following 12 weeks, the IWT group was encouraged to maintain InterWalk app–based IWT (3 times per week for 30-60 minutes) and the StC group was encouraged to maintain exercise without structured support. Moreover, half of the IWT group (IWTsupport group, n=54) received additional motivational support following the 12-week program until 52-week follow-up. The primary outcome was change in objectively measured MVPA time (minutes/day) from baseline to 52-week follow-up. Key secondary outcomes included changes in self-rated physical and mental health–related quality of life (HRQoL), physical fitness, weight, and waist circumference. Results Participants had a mean age of 59.6 (SD 10.6) years and 128/214 (59.8%) were men. No changes in MVPA time were observed from baseline to 52-week follow-up in the StC and IWT groups (least squares means [95% CI] 0.6 [–4.6 to 5.8] and –0.2 [–3.8 to 3.3], respectively) and no differences were observed between the groups (mean difference [95% CI] –0.8 [–8.1 to 6.4] minutes/day; P=.82). Physical HRQoL increased by a mean of 4.3 (95% CI 1.8 to 6.9) 12-item Short-Form Health Survey (SF-12) points more in the IWT group compared with the StC group (Benjamini-Hochberg adjusted P=.007) and waist circumference apparently decreased a mean of –2.3 (95% CI –4.1 to –0.4) cm more in the IWT group compared with the StC group but with a Benjamini-Hochberg adjusted P=.06. No between-group differences were observed among the remaining key secondary outcomes. Conclusions Among individuals with T2D referred to municipality-based lifestyle programs, randomization to InterWalk app–based IWT did not increase objectively measured MVPA time over 52 weeks compared with standard health care, although apparent benefits were observed for physical HRQoL. Trial Registration ClinicalTrials.gov NCT02341690; https://clinicaltrials.gov/ct2/show/NCT02341690
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Affiliation(s)
- Ida Kær Thorsen
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Yanxiang Yang
- Chair of Sport and Health Management, Technical University of Munich, Munich, Germany
| | | | - Charlotte Glümer
- Centre for Diabetes, Municipality of Copenhagen, Copenhagen, Denmark
| | - Kristian Karstoft
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rasmus Oestergaard Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Charlotte Brøns
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Jens Steen Nielsen
- Danish Centre for Strategic Research in Type 2 Diabetes, Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | | | - Bente Klarlund Pedersen
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henning Langberg
- CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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9
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Moldovan IA, Bragg A, Nidhiry AS, De La Cruz BA, Mitchell SE. The Physical Activity Assessment of Adults With Type 2 Diabetes Using Accelerometer-Based Cut Points: Scoping Review. Interact J Med Res 2022; 11:e34433. [PMID: 36066937 PMCID: PMC9490541 DOI: 10.2196/34433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/25/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Incorporating physical activity into lifestyle routines is recommended for individuals with type 2 diabetes. Accelerometers offer a promising method for objectively measuring physical activity and for assessing interventions. However, the existing literature for accelerometer-measured physical activity among middle-aged and older adults with type 2 diabetes is lacking. Objective This study aims to identify research studies in which accelerometer-based cut points were used to classify the physical activity intensity of middle-aged to older adults with type 2 diabetes as sedentary, light, moderate, vigorous, and very vigorous, and to determine if validated accelerometer cut points specifically for this population exist. Methods We followed the Joanna Briggs Institute methodology for scoping reviews. Between June 23 and July 12, 2020, two reviewers independently screened records from four databases (PubMed, Web of Science, Embase, Engineering Village) and the ActiGraph Corp web site for eligible studies that included patients with type 2 diabetes with a sample mean age ≥50 years, used research-grade accelerometers, applied cut points to categorize objectively measured physical activity, and were available in English. We excluded studies reporting exclusively steps or step counts measured by accelerometers or pedometers and conference abstracts or other sources that did not have a full text available. Data extraction was completed using Microsoft Excel. Data for the following variables were tabulated based on frequency distributions: study design, accelerometer type, device placement, epoch length, total wear time, and cut points used. Study aims and participant demographic data were summarized. Results A total of 748 records were screened at the abstract level, and 88 full-text articles were assessed for eligibility. Ultimately, 46 articles were retained and analyzed. Participants’ mean ages ranged from 50 to 79.9 years. The ActiGraph accelerometer and the Freedson et al and Troiano et al counts-per-minute cut points were the most frequently used across the literature. Freedson et al and Troiano et al counts-per-minute cut points for light, moderate, and vigorous activity correspond to <1952, 1952-5724, and ≥5725, and 100-2019, 2020-5998, and ≥5999, respectively. The Lopes et al cut points were developed by calibrating the ActiGraph in middle-aged and older adults with overweight/obesity and type 2 diabetes. These counts-per-minute thresholds are ≥200 (light), ≥1240 (moderate), and ≥2400 (vigorous), and were applied in 1 interventional study. Conclusions An assortment of accelerometer cut points have been used by researchers to categorize physical activity intensity for middle-aged and older adults with diabetes. Only one set of cut points was validated and calibrated in our population of interest. Additional research is warranted to address the need for diabetes-specific cut points to inform public health recommendations. This includes confirmation that the Lopes et al cut points reflect clinically meaningful changes in physical activity for adults with diabetes who have comorbidities other than overweight/obesity and the development of relative intensity cut points that may be more suitable for those with suboptimal physical functioning.
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Affiliation(s)
- Ioana A Moldovan
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States
| | - Alexa Bragg
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Anna S Nidhiry
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States
| | | | - Suzanne E Mitchell
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States.,Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States.,Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
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10
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Stansbury ML, Harvey J, Krukowski RA, Pellegrini CA, Wang X, West DS. Describing Transitions in Adherence to Physical Activity Self-monitoring and Goal Attainment in an Online Behavioral Weight Loss Program: Secondary Analysis of a Randomized Controlled Trial. J Med Internet Res 2022; 24:e30673. [PMID: 35089159 PMCID: PMC8838543 DOI: 10.2196/30673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/17/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background Standard behavioral weight loss interventions often set uniform physical activity (PA) goals and promote PA self-monitoring; however, adherence remains a challenge, and recommendations may not accommodate all individuals. Identifying patterns of PA goal attainment and self-monitoring behavior will offer a deeper understanding of how individuals adhere to different types of commonly prescribed PA recommendations (ie, minutes of moderate-to-vigorous physical activity [MVPA] and daily steps) and guide future recommendations for improved intervention effectiveness. Objective This study examined weekly patterns of adherence to step-based and minute-based PA goals and self-monitoring behavior during a 6-month online behavioral weight loss intervention. Methods Participants were prescribed weekly PA goals for steps (7000-10,000 steps/day) and minutes of MVPA (50-200 minutes/week) as part of a lifestyle program. Goals gradually increased during the initial 2 months, followed by 4 months of fixed goals. PA was self-reported daily on the study website. For each week, participants were categorized as adherent if they self-monitored their PA and met the program PA goal, suboptimally adherent if they self-monitored but did not meet the program goal, or nonadherent if they did not self-monitor. The probability of transitioning into a less adherent status was examined using multinomial logistic regression. Results Participants (N=212) were predominantly middle-aged females with obesity, and 67 (31.6%) self-identified as a racial/ethnic minority. Initially, 73 (34.4%) participants were categorized as adherent to step-based goals, with 110 [51.9%] suboptimally adherent and 29 [13.7%] nonadherent, and there was a high probability of either remaining suboptimally adherent from week to week or transitioning to a nonadherent status. However, 149 (70.3%) participants started out adherent to minute-based goals (34 [16%] suboptimally adherent and 29 [13.7%] nonadherent), with suboptimally adherent seen as the most variable status. During the graded goal phase, participants were more likely to transition to a less adherent status for minute-based goals (odds ratio [OR] 1.39, 95% CI 1.31-1.48) compared to step-based goals (OR 1.24, 95% CI 1.17-1.30); however, no differences were seen during the fixed goal phase (minute-based goals: OR 1.06, 95% CI 1.05-1.08; step-based goals: OR 1.07, 95% CI 1.05-1.08). Conclusions States of vulnerability to poor PA adherence can emerge rapidly and early in obesity treatment. There is a window of opportunity within the initial 2 months to bring more people toward adherent behavior, especially those who fail to meet the prescribed goals but engage in self-monitoring. Although this study describes the probability of adhering to step- and minute-based targets, it will be prudent to determine how individual characteristics and contextual states relate to these behavioral patterns, which can inform how best to adapt interventions. Trial Registration ClinicalTrials.gov NCT02688621; https://clinicaltrials.gov/ct2/show/NCT02688621
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Affiliation(s)
- Melissa L Stansbury
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jean Harvey
- Department of Nutrition and Food Sciences, College of Agriculture and Life Sciences, University of Vermont, Burlington, VT, United States
| | - Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Christine A Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xuewen Wang
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Delia Smith West
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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11
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Khunti K, Griffin S, Brennan A, Dallosso H, Davies M, Eborall H, Edwardson C, Gray L, Hardeman W, Heathcote L, Henson J, Morton K, Pollard D, Sharp S, Sutton S, Troughton J, Yates T. Behavioural interventions to promote physical activity in a multiethnic population at high risk of diabetes: PROPELS three-arm RCT. Health Technol Assess 2022; 25:1-190. [PMID: 34995176 DOI: 10.3310/hta25770] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a leading cause of mortality globally and accounts for significant health resource expenditure. Increased physical activity can reduce the risk of diabetes. However, the longer-term clinical effectiveness and cost-effectiveness of physical activity interventions in those at high risk of type 2 diabetes is unknown. OBJECTIVES To investigate whether or not Walking Away from Diabetes (Walking Away) - a low-resource, 3-hour group-based behavioural intervention designed to promote physical activity through pedometer use in those with prediabetes - leads to sustained increases in physical activity when delivered with and without an integrated mobile health intervention compared with control. DESIGN Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with follow-up conducted at 12 and 48 months. SETTING Primary care and the community. PARTICIPANTS Adults whose primary care record included a prediabetic blood glucose measurement recorded within the past 5 years [HbA1c ≥ 42 mmol/mol (6.0%), < 48 mmol/mol (6.5%) mmol/mol; fasting glucose ≥ 5.5 mmol/l, < 7.0 mmol/l; or 2-hour post-challenge glucose ≥ 7.8 mmol/l, < 11.1 mmol/l] were recruited between December 2013 and February 2015. Data collection was completed in July 2019. INTERVENTIONS Participants were randomised (1 : 1 : 1) using a web-based tool to (1) control (information leaflet), (2) Walking Away with annual group-based support or (3) Walking Away Plus (comprising Walking Away, annual group-based support and a mobile health intervention that provided automated, individually tailored text messages to prompt pedometer use and goal-setting and provide feedback, in addition to biannual telephone calls). Participants and data collectors were not blinded; however, the staff who processed the accelerometer data were blinded to allocation. MAIN OUTCOME MEASURES The primary outcome was accelerometer-measured ambulatory activity (steps per day) at 48 months. Other objective and self-reported measures of physical activity were also assessed. RESULTS A total of 1366 individuals were randomised (median age 61 years, median body mass index 28.4 kg/m2, median ambulatory activity 6638 steps per day, women 49%, black and minority ethnicity 28%). Accelerometer data were available for 1017 (74%) and 993 (73%) individuals at 12 and 48 months, respectively. The primary outcome assessment at 48 months found no differences in ambulatory activity compared with control in either group (Walking Away Plus: 121 steps per day, 97.5% confidence interval -290 to 532 steps per day; Walking Away: 91 steps per day, 97.5% confidence interval -282 to 463). This was consistent across ethnic groups. At the intermediate 12-month assessment, the Walking Away Plus group had increased their ambulatory activity by 547 (97.5% confidence interval 211 to 882) steps per day compared with control and were 1.61 (97.5% confidence interval 1.05 to 2.45) times more likely to achieve 150 minutes per week of objectively assessed unbouted moderate to vigorous physical activity. In the Walking Away group, there were no differences compared with control at 12 months. Secondary anthropometric, biomechanical and mental health outcomes were unaltered in either intervention study arm compared with control at 12 or 48 months, with the exception of small, but sustained, reductions in body weight in the Walking Away study arm (≈ 1 kg) at the 12- and 48-month follow-ups. Lifetime cost-effectiveness modelling suggested that usual care had the highest probability of being cost-effective at a threshold of £20,000 per quality-adjusted life-year. Of 50 serious adverse events, only one (myocardial infarction) was deemed possibly related to the intervention and led to the withdrawal of the participant from the study. LIMITATIONS Loss to follow-up, although the results were unaltered when missing data were replaced using multiple imputation. CONCLUSIONS Combining a physical activity intervention with text messaging and telephone support resulted in modest, but clinically meaningful, changes in physical activity at 12 months, but the changes were not sustained at 48 months. FUTURE WORK Future research is needed to investigate which intervention types, components and features can help to maintain physical activity behaviour change over the longer term. TRIAL REGISTRATION Current Controlled Trials ISRCTN83465245. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 77. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Applied Research Collaboration, East Midlands, UK
| | - Simon Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Dallosso
- NIHR Applied Research Collaboration, East Midlands, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Davies
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Helen Eborall
- Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Charlotte Edwardson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Laura Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laura Heathcote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Joseph Henson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Katie Morton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Innovia Technology Limited, Cambridge, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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12
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Balducci S, Haxhi J, Sacchetti M, Orlando G, Cardelli P, Vitale M, Mattia L, Iacobini C, Bollanti L, Conti F, Zanuso S, Nicolucci A, Pugliese G, Pugliese G, Balducci S, Sacchetti M, Zanuso S, Cardelli P, Nicolucci A, Pugliese G, Ribaudo MC, Alessi E, Vitale M, Cirrito T, Bollanti L, Conti FG, Di Biase N, La Saracina F, Balducci S, Ranuzzi M, Haxhi J, D'Errico V, Sacchetti M, Orlando G, Milo L, Milo R, Balducci G, Spinelli E, Cardelli P, Cavallo S, Balducci S, Alessi E, Balducci G, Orlando G, Zanuso S, Cardelli P, Lucisano G. Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2). Diabetes Care 2022; 45:213-221. [PMID: 34728529 DOI: 10.2337/dc21-1505] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In the Italian Diabetes and Exercise Study_2 (IDES_2), behavioral counseling promoted a sustained increase in physical activity (PA) volume (+3.3 MET h ⋅ week-1), moderate- to vigorous-intensity PA (MVPA) (+6.4 min ⋅ day-1), and light-intensity PA (LPA) (+0.8 h ⋅ day-1) and decrease in sedentary time (SED-time) (-0.8 h ⋅ day-1). Here, we investigated the relationships of changes in PA/SED-time with changes in physical fitness and cardiometabolic risk profile in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS In this 3-year randomized clinical trial, 300 physically inactive and sedentary patients were randomized 1:1 to receive 1-month theoretical and practical counseling once a year or standard care. Changes in physical fitness and cardiovascular risk factors/scores according to quartiles of accelerometer-measured changes in PA/SED-time were assessed, together with univariate and multivariable associations between these parameters, in the whole cohort and by study arm. RESULTS Physical fitness increased and HbA1c and coronary heart disease 10-year risk scores decreased with quartiles of MVPA and SED-time change. In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL ⋅ min-1 ⋅ kg-1 and HbA1c decreased by 0.73 and 0.85%, respectively. Univariate correlations confirmed these relationships, and mean changes in both MPVA and SED-time predicted changes in physical fitness and cardiovascular risk factors/scores independently of one another and of other confounders. Similar findings were observed with LPA and PA volume and in each group separately. CONCLUSIONS Even modest increments in MVPA may have a clinically meaningful impact, and reallocating SED-time to LPA may also contribute to improved outcomes, possibly by increasing total energy expenditure.
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Affiliation(s)
- Stefano Balducci
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.,3Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.,3Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Massimo Sacchetti
- 4Department of Human Movement and Sport Sciences, University of Rome "Foro Italico," Rome, Italy
| | - Giorgio Orlando
- 4Department of Human Movement and Sport Sciences, University of Rome "Foro Italico," Rome, Italy.,5Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, U.K
| | - Patrizia Cardelli
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,6Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy
| | - Martina Vitale
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lorenza Mattia
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Carla Iacobini
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lucilla Bollanti
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Conti
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Silvano Zanuso
- 7Center for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, U.K.,8Centre for Human Performance and Sport, University of Greenwich, Chatham Maritime, U.K
| | - Antonio Nicolucci
- 9Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy.,10Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
| | - Giuseppe Pugliese
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
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13
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Lillis J, Schumacher LM, Bond DS. Preliminary Evaluation of a 1-Day Acceptance and Commitment Therapy Workshop for Increasing Moderate-to-Vigorous Physical Activity in Adults with Overweight or Obesity. Int J Behav Med 2021; 28:827-833. [PMID: 33598781 PMCID: PMC9917958 DOI: 10.1007/s12529-021-09965-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Novel strategies to help adults with overweight/obesity increase motivation for becoming active are needed. This single-arm trial aimed to test the feasibility, acceptability, and preliminary efficacy of a 4-h acceptance and commitment therapy (ACT)-based workshop intervention for increasing moderate-to-vigorous physical activity (MVPA) among insufficiently active adults with overweight/obesity. METHODS Participants (N = 41) received a 1-day 4-h ACT workshop followed by weekly e-mails and monthly phone calls for 3 months. The primary outcome was change in accelerometer-measured MVPA minutes/day at 3 and 6 months. Process variables (i.e., autonomous motivation, PA acceptance) through which the ACT intervention was hypothesized to increase MVPA were assessed via questionnaires. RESULTS Participants completed 91% of phone calls and 75% of e-mail surveys. Acceptability ratings were > 4.5 out of 5 for "understandable," "useful," and "intent-to-use" on all intervention components. Participants on average achieved significant increases in bouted and total MVPA at 3 months that were maintained at 6 months. Participants also reported significant increases in physical activity acceptance and autonomous motivation, the latter of which related to MVPA changes. CONCLUSION Results support the feasibility and acceptability of the ACT workshop intervention for promoting MVPA changes among insufficiently active adults with overweight/obesity. Rigorous testing of this approach as a low-intensity standalone or add-on intervention to increase MVPA is warranted.
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Affiliation(s)
- Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI, 02903, USA.
| | - Leah M. Schumacher
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI 02903, USA
| | - Dale S. Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI 02903, USA
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14
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MacDonald CS, Ried-Larsen M, Soleimani J, Alsawas M, Lieberman DE, Ismail AS, Serafim LP, Yang T, Prokop L, Joyner M, Murad MH, Barwise A. A systematic review of adherence to physical activity interventions in individuals with type 2 diabetes. Diabetes Metab Res Rev 2021; 37:e3444. [PMID: 33769660 DOI: 10.1002/dmrr.3444] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Lifestyle interventions are pivotal for successful management of type 2 diabetes (T2D), however, the proportion of people with T2D adhering to physical activity advice has not been thoroughly studied. The purpose of this systematic review was to summarise the evidence on adherence to exercise or physical activity components in lifestyle interventions in those with T2D. We searched MEDLINE EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus on 12 November 2019. Eligible studies enrolled adults with T2D and reported the proportion of adherence to lifestyle interventions as a primary or secondary outcome. We included 11 studies (nine randomised controlled trials (RCTs) enrolling 1717 patients and two nonrandomised studies enrolling 62 patients). Only one of the studies had low risk of bias. The proportion of participants adhering to physical activity varied from 32% to 100% with a median of 58%. Adherence was higher in interventions using supervised training and lowest in interventions using remote coaching and the adherence rate in observational studies was higher compared to RCTs (92% vs. 55%; p < 0.01). Study duration, risk of bias, or participants' sex, were not associated with adherence to physical activity. The proportion of those with T2D adhering to physical activity interventions for T2D varies widely and most of the included studies had a high risk of bias. These findings have important implications for planning and power analysis of future trials and when counselling patients about lifestyle interventions including physical activity or exercise components.
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Affiliation(s)
- Christopher S MacDonald
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jalal Soleimani
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mouaz Alsawas
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Abdalla S Ismail
- Canton Medical Education Foundation (CMEF), Aultman Hospital, Canton, Ohio, USA
| | - Laura P Serafim
- School of medicine, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ting Yang
- Pulmonary and Critical Care Medicine Department, West China Hospital, Si Chuan University, China
| | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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15
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Sustaining Regular Exercise During Weight Loss Maintenance: The Role of Consistent Exercise Timing. J Phys Act Health 2021; 18:1253-1260. [PMID: 34391207 DOI: 10.1123/jpah.2021-0135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022]
Abstract
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.
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16
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Khunti K, Griffin S, Brennan A, Dallosso H, Davies MJ, Eborall HC, Edwardson CL, Gray LJ, Hardeman W, Heathcote L, Henson J, Pollard D, Sharp SJ, Sutton S, Troughton J, Yates T. Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial. BMC Med 2021; 19:130. [PMID: 34078362 PMCID: PMC8173914 DOI: 10.1186/s12916-021-01997-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
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).
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK. .,NIHR Applied Research Collaboration - East Midlands, Leicester, UK.
| | - Simon Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Dallosso
- NIHR Applied Research Collaboration - East Midlands, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | | | - Charlotte L Edwardson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Laura J Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laura Heathcote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Joe Henson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
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17
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Qian J, Walkup MP, Chen SH, Brubaker PH, Bond DS, Richey PA, Jakicic JM, Hu K, Scheer FAJL, Middelbeek RJW. Association of Objectively Measured Timing of Physical Activity Bouts With Cardiovascular Health in Type 2 Diabetes. Diabetes Care 2021; 44:1046-1054. [PMID: 33597215 PMCID: PMC7985432 DOI: 10.2337/dc20-2178] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/17/2021] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Jingyi Qian
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA .,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
| | | | | | - Peter H Brubaker
- Wake Forest University Health & Exercise Science, Winston-Salem, NC
| | - Dale S Bond
- The Miriam Hospital/Brown Alpert Medical School, Providence, RI
| | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - John M Jakicic
- Healthy Lifestyle Institute, University of Pittsburgh, Pittsburgh, PA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
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18
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillan B, Bower P, Panagioti M. Notice of Retraction. Hodkinson et al. Accelerometer- and Pedometer-Based Physical Activity Interventions Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(10):e1912895. JAMA Netw Open 2020; 3:e2032700. [PMID: 33337497 DOI: 10.1001/jamanetworkopen.2020.32700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, United Kingdom
| | - Brian McMillan
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
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19
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Early Physical Activity Adoption Predicts Longer-Term Physical Activity Among Individuals Inactive at Baseline. J Phys Act Health 2020; 17:1205-1212. [PMID: 33152692 DOI: 10.1123/jpah.2020-0114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/25/2020] [Accepted: 08/31/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND To examine the relationship between early physical activity (PA) adoption (2, 3, and 4 mo) and longer-term PA adherence (1 y) among individuals who were inactive at baseline and received a lifestyle intervention. METHODS Participants (n = 637) received weekly behavioral weight loss sessions, calorie reduction, and PA goals (50-175 min/wk progression). PA was assessed via self-reported measures at baseline, months 2 to 4, and 1 year. RESULTS PA at months 2 to 4 was significantly correlated with PA at 1 year (rs = .29-.35, P < .01). At all early time points, those failing to meet the prescribed PA goal (early nonadopters) engaged in significantly less PA at 1 year than those meeting the early PA goal (initial adopters). For example, using 2-month criteria, initial adopters engaged in 108.3 minutes per week more at 1 year compared with early nonadopters (P < .01) and had 2.8 times the odds (95% confidence interval, 1.9-4.2) of meeting the 1-year PA goal (≥175 min/wk, P < .01). CONCLUSIONS Failure to achieve PA goals at 2, 3, or 4 months results in less overall PA at 1 year. Thus, PA observed as early as month 2 may be a useful indicator for identifying at-risk individuals who may benefit from more intensive PA intervention strategies.
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20
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Zheng Y, Weinger K, Greenberg J, Burke LE, Sereika SM, Patience N, Gregas MC, Li Z, Qi C, Yamasaki J, Munshi MN. Actual Use of Multiple Health Monitors Among Older Adults With Diabetes: Pilot Study. JMIR Aging 2020; 3:e15995. [PMID: 32202506 PMCID: PMC7138595 DOI: 10.2196/15995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022] Open
Abstract
Background Previous studies have reported older adults’ perceptions of using health monitors; however, no studies have examined the actual use of multiple health monitors for lifestyle changes over time among older adults with type 2 diabetes (T2D). Objective The primary aim of this study was to examine the actual use of multiple health monitors for lifestyle changes over 3 months among older adults with T2D. The secondary aim was to explore changes in caloric intake and physical activity (PA) over 3 months. Methods This was a single-group study lasting 3 months. The study sample included participants who were aged ≥65 years with a diagnosis of T2D. Participants were recruited through fliers posted at the Joslin Diabetes Center in Boston. Participants attended five 60-min, biweekly group sessions, which focused on self-monitoring, goal setting, self-regulation to achieve healthy eating and PA habits, and the development of problem-solving skills. Participants were provided with the Lose It! app to record daily food intake and devices such as a Fitbit Alta for monitoring PA, a Bluetooth-enabled blood glucose meter, and a Bluetooth-enabled digital scale. Descriptive statistics were used for analysis. Results Of the enrolled participants (N=9), the sample was white (8/9, 89%) and female (4/9, 44%), with a mean age of 76.4 years (SD 6.0; range 69-89 years), 15.7 years (SD 2.0) of education, 33.3 kg/m2 (SD 3.1) BMI, and 7.4% (SD 0.8) hemoglobin A1c. Over the 84 days of self-monitoring, the mean percentage of days using the Lose It!, Fitbit Alta, blood glucose meter, and scale were 82.7 (SD 17.6), 85.2 (SD 19.7), 65.3 (SD 30.1), and 53.0 (SD 34.5), respectively. From baseline to completion of the study, the mean daily calorie intake was 1459 (SD 661) at week 1, 1245 (SD 554) at week 11, and 1333 (SD 546) at week 12, whereas the mean daily step counts were 5618 (SD 3654) at week 1, 5792 (SD 3814) at week 11, and 4552 (SD 3616) at week 12. The mean percentage of weight loss from baseline was 4.92% (SD 0.25). The dose of oral hypoglycemic agents or insulin was reduced in 55.6% (5/9) of the participants. Conclusions The results from the pilot study are encouraging and suggest the need for a larger study to confirm the outcomes. In addition, a study design that includes a control group with educational sessions but without the integration of technology would offer additional insight to understand the value of mobile health in behavior changes and the health outcomes observed during this pilot study.
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Affiliation(s)
- Yaguang Zheng
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Lora E Burke
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Matt C Gregas
- Research Services, Boston College, Chestnut Hill, MA, United States
| | - Zhuoxin Li
- Carroll School of Management, Boston College, Chestnut Hill, MA, United States
| | - Chenfang Qi
- North Shore Medical Center, Salem Hospital, Salem, MA, United States
| | - Joy Yamasaki
- Hollywood Presbyterian Medical Center, Los Angeles, CA, United States
| | - Medha N Munshi
- Joslin Diabetes Center, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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21
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MacDonald CS, Johansen MY, Nielsen SM, Christensen R, Hansen KB, Langberg H, Vaag AA, Karstoft K, Lieberman DE, Pedersen BK, Ried-Larsen M. Dose-Response Effects of Exercise on Glucose-Lowering Medications for Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial. Mayo Clin Proc 2020; 95:488-503. [PMID: 32007295 DOI: 10.1016/j.mayocp.2019.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether a dose-response relationship exists between volume of exercise and discontinuation of glucose-lowering medication treatment in patients with type 2 diabetes. PATIENTS AND METHODS Secondary analyses of a randomized controlled exercise-based lifestyle intervention trial (April 29, 2015 to August 17, 2016). Patients with non-insulin-dependent type 2 diabetes were randomly assigned to an intensive lifestyle intervention (U-TURN) or standard-care group. Both groups received lifestyle advice and objective target-driven medical regulation. Additionally, the U-TURN group received supervised exercise and individualized dietary counseling. Of the 98 randomly assigned participants, 92 were included in the analysis (U-TURN, n=61, standard care, n=31). Participants in the U-TURN group were stratified into tertiles based on accumulated volumes of exercise completed during the 1-year intervention. RESULTS Median exercise levels of 178 (interquartile range [IQR], 121-213; lower tertile), 296 (IQR, 261-310; intermediate tertile), and 380 minutes per week (IQR, 355-446; upper tertile) were associated with higher odds of discontinuing treatment with glucose-lowering medication, with corresponding odds ratios of 12.1 (95% CI, 1.2-119; number needed to treat: 4), 30.2 (95% CI, 2.9-318.5; 3), and 34.4 (95% CI, 4.1-290.1; 2), respectively, when comparing with standard care. Cardiovascular risk factors such as glycated hemoglobin A1c levels, fitness, 2-hour glucose levels, and triglyceride levels were improved significantly in the intermediate and upper tertiles, but not the lower tertile, compared with the standard-care group. CONCLUSION Exercise volume is associated with discontinuation of glucose-lowering medication treatment in a dose-dependent manner, as are important cardiovascular risk factors in well-treated participants with type 2 diabetes and disease duration less than 10 years. Further studies are needed to support these findings. STUDY REGISTRATION ClinicalTrials.gov registration (NCT02417012).
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Affiliation(s)
- Christopher S MacDonald
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Mette Y Johansen
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina M Nielsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Robin Christensen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Katrine B Hansen
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henning Langberg
- CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Allan A Vaag
- AstraZeneca, Early Clinical Development, Cardiovascular, Renal and Metabolic Research, Mölndal, Sweden
| | - Kristian Karstoft
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA
| | - Bente K Pedersen
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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22
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillan B, Bower P, Panagioti M. Accelerometer- and Pedometer-Based Physical Activity Interventions Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1912895. [PMID: 31596494 PMCID: PMC6802237 DOI: 10.1001/jamanetworkopen.2019.12895] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 01/15/2023] Open
Abstract
Importance Accelerometers and pedometers are accessible technologies that could have a role in encouraging physical activity (PA) in line with current recommendations. However, there is no solid evidence of their association with PA in participants with 1 or more cardiometabolic conditions such as diabetes, prediabetes, obesity, and cardiovascular disease. Objectives To assess the association of accelerometer- and pedometer-based interventions with increased activity and other improved health outcomes in adults with cardiometabolic conditions and to examine characteristics of the studies that could influence the association of both interventions in improving PA. Data Sources Records from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and PsycINFO were searched from inception until August 2018 with no language restriction. Study Selection Randomized clinical trials or cluster randomized clinical trials evaluating the use of wearable technology devices such as pedometers and accelerometers as motivating and monitoring tools for increasing PA were included. After removing duplicates, the searches retrieved 5762 references. Following abstract and title screening of 1439 references and full-text screening of 107 studies, 36 studies met inclusion criteria. Data Extraction and Synthesis Mean difference in PA was assessed by random-effects meta-analysis. Where the scale was different across studies, the standardized mean difference was used instead. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. This study was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures The primary outcome was objectively measured PA in the short to medium term (postintervention to 8 months' follow-up). Results Thirty-six randomized clinical trials (20 using accelerometers and 16 using pedometers) involving 5208 participants were eligible for review. Meta-analysis involving 32 of these trials (4856 participants) showed medium improvements in PA: accelerometers and pedometers combined vs comparator showed a small significant increase in PA overall (standardized mean difference, 0.39 [95% CI, 0.28-0.51]; I2 = 60% [95% CI, 41%-73%]) in studies of short to medium follow-up over a mean (SD) of 32 (28.6) weeks. Multivariable metaregression showed improved association with PA for complex interventions that involved face-to-face consultation sessions with facilitators (β = 0.36; 95% CI, 0.17-0.55; P < .001) and pedometer-based interventions (β = 0.30; 95% CI, 0.08-0.52; P = .002). Conclusions and Relevance In this study, complex accelerometer- and pedometer-based interventions led to significant small to medium improvements in PA levels of people with cardiometabolic conditions. However, longer-term trials are needed to assess their performance over time. This study found no evidence that simple self-monitored interventions using either pedometers or accelerometers are associated with improvements in PA.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, United Kingdom
| | - Brian McMillan
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
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Ried‐Larsen M, Johansen MY, MacDonald CS, Hansen KB, Christensen R, Wedell‐Neergaard A, Pilmark NS, Langberg H, Vaag AA, Pedersen BK, Karstoft K. Type 2 diabetes remission 1 year after an intensive lifestyle intervention: A secondary analysis of a randomized clinical trial. Diabetes Obes Metab 2019; 21:2257-2266. [PMID: 31168922 PMCID: PMC6772176 DOI: 10.1111/dom.13802] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/23/2019] [Accepted: 06/02/2019] [Indexed: 01/07/2023]
Abstract
AIM To investigate whether an intensive lifestyle intervention induces partial or complete type 2 diabetes (T2D) remission. MATERIALS AND METHODS In a secondary analysis of a randomized, assessor-blinded, single-centre trial, people with non-insulin-dependent T2D (duration <10 years), were randomly assigned (2:1, stratified by sex, from April 2015 to August 2016) to a lifestyle intervention group (n = 64) or a standard care group (n = 34). The primary outcome was partial or complete T2D remission, defined as non-diabetic glycaemia with no glucose-lowering medication at the outcome assessments at both 12 and 24 months from baseline. All participants received standard care, with standardized, blinded, target-driven medical therapy during the initial 12 months. The lifestyle intervention included 5- to 6-weekly aerobic and combined aerobic and strength training sessions (30-60 minutes) and individual dietary plans aiming for body mass index ≤25 kg/m2 . No intervention was provided during the 12-month follow-up period. RESULTS Of the 98 randomized participants, 93 completed follow-up (mean [SD] age 54.6 [8.9] years; 46 women [43%], mean [SD] baseline glycated haemoglobin 49.3 [9.3] mmol/mol). At follow-up, 23% of participants (n = 14) in the intervention and 7% (n = 2) in the standard care group met the criteria for any T2D remission (odds ratio [OR] 4.4, 95% confidence interval [CI] 0.8-21.4]; P = 0.08). Assuming participants lost to follow-up (n = 5) had relapsed, the OR for T2D remission was 4.4 (95% CI 1.0-19.8; P = 0.048). CONCLUSIONS The statistically nonsignificant threefold increased remission rate of T2D in the lifestyle intervention group calls for further large-scale studies to understand how to implement sustainable lifestyle interventions among people with T2D.
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Affiliation(s)
- Mathias Ried‐Larsen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Mette Y. Johansen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Christopher S. MacDonald
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
- CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Katrine B. Hansen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Robin Christensen
- Musculoskeletal Statistics UnitParker Institute, Bispebjerg and Frederiksberg HospitalCopenhagenDenmark
- Research Unit of Rheumatology, Department of Clinical ResearchUniversity of Southern Denmark, Odense University HospitalOdenseDenmark
| | - Anne‐Sophie Wedell‐Neergaard
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Nanna Skytt Pilmark
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Henning Langberg
- CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Allan A. Vaag
- Cardiovascular and Metabolic Disease Translational Medicine Unit, Early Clinical Development, IMED Biotech UnitAstraZenecaGothenburgSweden
| | - Bente K. Pedersen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Kristian Karstoft
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical PharmacologyBispebjerg Hospital, University of CopenhagenCopenhagenDenmark
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24
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Poppe L, De Bourdeaudhuij I, Verloigne M, Shadid S, Van Cauwenberg J, Compernolle S, Crombez G. Efficacy of a Self-Regulation-Based Electronic and Mobile Health Intervention Targeting an Active Lifestyle in Adults Having Type 2 Diabetes and in Adults Aged 50 Years or Older: Two Randomized Controlled Trials. J Med Internet Res 2019; 21:e13363. [PMID: 31376274 PMCID: PMC6696857 DOI: 10.2196/13363] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/16/2023] Open
Abstract
Background Adopting an active lifestyle plays a key role in the prevention and management of chronic diseases such as type 2 diabetes mellitus (T2DM). Web-based interventions are able to alter health behaviors and show stronger effects when they are informed by a behavior change theory. MyPlan 2.0 is a fully automated electronic health (eHealth) and mobile health (mHealth) intervention targeting physical activity (PA) and sedentary behavior (SB) based on the Health Action Process Approach (HAPA). Objective This study aimed to test the short-term effect of MyPlan 2.0 in altering levels of PA and SB and in changing personal determinants of behavior in adults with T2DM and in adults aged ≥50 years. Methods The study comprised two randomized controlled trials (RCTs) with an identical design. RCT 1 was conducted with adults with T2DM. RCT 2 was performed in adults aged ≥50 years. Data were collected via face-to-face assessments. The participants decided either to increase their level of PA or to decrease their level of SB. The participants were randomly allocated with a 2:1 ratio to the intervention group or the waiting-list control group. They were not blinded for their group allocation. The participants in the intervention group were instructed to go through MyPlan 2.0, comprising 5 sessions with an interval of 1 week between each session. The primary outcomes were objectively measured and self-reported PA (ie, light PA, moderate-to-vigorous PA, total PA, number of steps, and domain-specific [eg, transport-related] PA) and SB (ie, sitting time, number of breaks from sitting time, and length of sitting bouts). Secondary outcomes were self-reported behavioral determinants for PA and SB (eg, self-efficacy). Separate linear mixed models were performed to analyze the effects of MyPlan 2.0 in the two samples. Results In RCT 1 (n=54), the PA intervention group showed, in contrast to the control group, a decrease in self-reported time spent sitting (P=.09) and an increase in accelerometer-measured moderate (P=.05) and moderate-to-vigorous PA (P=.049). The SB intervention group displayed an increase in accelerometer-assessed breaks from sedentary time in comparison with the control group (P=.005). A total of 14 participants of RCT 1 dropped out. In RCT 2 (n=63), the PA intervention group showed an increase for self-reported total PA in comparison with the control group (P=.003). Furthermore, in contrast to the control group, the SB intervention group decreased their self-reported time spent sitting (P=.08) and increased their accelerometer-assessed moderate (P=.06) and moderate-to-vigorous PA (P=.07). A total of 8 participants of RCT 2 dropped out. Conclusions For both the samples, the HAPA-based eHealth and mHealth intervention, MyPlan 2.0, was able to improve only some of the primary outcomes. Trial Registration ClinicalTrials.gov NCT03291171; http://clinicaltrials.gov/ct2/show/NCT03291171. ClinicalTrials.gov NCT03799146; http://clinicaltrials.gov/ct2/show/NCT03799146. International Registered Report Identifier (IRRID) RR2-10.2196/12413
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Affiliation(s)
- Louise Poppe
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Maïté Verloigne
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Samyah Shadid
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | | | - Sofie Compernolle
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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25
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Johnson JL, Slentz CA, Ross LM, Huffman KM, Kraus WE. Ten-Year Legacy Effects of Three Eight-Month Exercise Training Programs on Cardiometabolic Health Parameters. Front Physiol 2019; 10:452. [PMID: 31040797 PMCID: PMC6476955 DOI: 10.3389/fphys.2019.00452] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/01/2019] [Indexed: 11/13/2022] Open
Abstract
Background: STRRIDE (Studies Targeting Risk Reduction Interventions through Defined Exercise) was an eight-month exercise study conducted from 1998-2003. Subjects were randomized to control or one of three exercise groups differing in intensity and amount. To determine if there were legacy effects, we invited 161 individuals who completed the intervention phase to return for a 10-year Reunion study. Methods: Subjects completed medical history and physical activity questionnaires. Height, body weight, blood pressure, waist circumference, and peak VO2 were measured. Fasting blood samples were analyzed for glucose, insulin and lipids. Of 161 original subjects, 153 were within 10 years of STRRIDE completion. Of these, 28 were lost to follow-up and 21 declined to participate in the Reunion study. Overall, 104 subjects (83% eligible) participated. Change over time was computed as the 10-year Reunion value minus the pre-intervention value. Significant within group changes were calculated using two-tailed t-tests. ANCOVA determined differences among groups with pre-intervention values as covariates. Bonferroni corrections were applied to account for multiple comparisons. Results: Ten years after completing STRRIDE, there were a number of group-specific health and fitness legacy effects. Original participation in either the moderate intensity exercise or control group resulted in a 10.5% decrease in peak VO2 over the ensuing 10 years. Conversely, both vigorous intensity groups experienced only a 4.7% decrement in cardiorespiratory fitness over that time period. As compared to controls, all three exercise groups experienced smaller increases in waist circumference. Those who participated in moderate intensity exercise experienced the greatest 10-year reduction in fasting insulin. Compared to all other groups, the moderate intensity subjects had greater reductions in mean arterial pressure at the Reunion timepoint. Summary: Ten years after completing a randomized eight-month exercise training intervention, previously sedentary individuals exhibited group-specific differences consistent with an intervention-based legacy effect on cardiorespiratory fitness and cardiometabolic parameters. These findings highlight the critical need to better understand the sustained legacy health effects of exercise training interventions.
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Affiliation(s)
- Johanna L Johnson
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Cris A Slentz
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Leanna M Ross
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States.,Division of Cardiology and Urbaniak Sports Sciences Institute, Duke University Medical Center, Durham, NC, United States
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26
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Balducci S, D'Errico V, Haxhi J, Sacchetti M, Orlando G, Cardelli P, Vitale M, Bollanti L, Conti F, Zanuso S, Lucisano G, Nicolucci A, Pugliese G. Effect of a Behavioral Intervention Strategy on Sustained Change in Physical Activity and Sedentary Behavior in Patients With Type 2 Diabetes: The IDES_2 Randomized Clinical Trial. JAMA 2019; 321:880-890. [PMID: 30835309 DOI: 10.1001/jama.2019.0922] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE There is no definitive evidence that changes in physical activity/sedentary behavior can be maintained long term in individuals with type 2 diabetes. OBJECTIVE To investigate whether a behavioral intervention strategy can produce a sustained increase in physical activity and reduction in sedentary time among individuals with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS The Italian Diabetes and Exercise Study 2 was an open-label, assessor-blinded, randomized clinical superiority trial, with recruitment from October 2012 to February 2014 and follow-up until February 2017. In 3 outpatient diabetes clinics in Rome, 300 physically inactive and sedentary patients with type 2 diabetes were randomized 1:1 (stratified by center, age, and diabetes treatment) to receive a behavioral intervention or standard care for 3 years. INTERVENTIONS All participants received usual care targeted to meet American Diabetes Association guideline recommendations. Participants in the behavioral intervention group (n = 150) received 1 individual theoretical counseling session and 8 individual biweekly theoretical and practical counseling sessions each year. Participants in the standard care group (n = 150) received only general physician recommendations. MAIN OUTCOMES AND MEASURES Co-primary end points were sustained change in physical activity volume, time spent in light-intensity and moderate- to vigorous-intensity physical activity, and sedentary time, measured by an accelerometer. RESULTS Of the 300 randomized participants (mean [SD] age, 61.6 [8.5] years; 116 women [38.7%]), 267 completed the study (133 in the behavioral intervention group and 134 in the standard care group). Median follow-up was 3.0 years. Participants in the behavioral intervention and standard care groups accumulated, respectively, 13.8 vs 10.5 metabolic equivalent-h/wk of physical activity volume (difference, 3.3 [95% CI, 2.2-4.4]; P < .001), 18.9 vs 12.5 min/dof moderate- to vigorous-intensity physical activity (difference, 6.4 [95% CI, 5.0-7.8]; P < .001), 4.6 vs 3.8 h/d of light-intensity physical activity (difference, 0.8 [95% CI, 0.5-1.1]; P < .001), and 10.9 vs 11.7 h/d of sedentary time (difference, -0.8 [95% CI, -1.0 to -0.5]; P < .001). Significant between-group differences were maintained throughout the study, but the between-group difference in moderate- to vigorous-intensity physical activity decreased during the third year from 6.5 to 3.6 min/d. There were 41 adverse events in the behavioral intervention group and 59 in the standard care group outside of the sessions; participants in the behavioral intervention group experienced 30 adverse events during the sessions (most commonly musculoskeletal injury/discomfort and mild hypoglycemia). CONCLUSIONS AND RELEVANCE Among patients with type 2 diabetes at 3 diabetes clinics in Rome who were followed up for 3 years, a behavioral intervention strategy compared with standard care resulted in a sustained increase in physical activity and decrease in sedentary time. Further research is needed to assess the generalizability of these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01600937.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Valeria D'Errico
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, ''Foro Italico'' University, Rome, Italy
| | - Giorgio Orlando
- Department of Human Movement and Sport Sciences, ''Foro Italico'' University, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy
| | - Martina Vitale
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Conti
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Silvano Zanuso
- Centre for Human Performance and Sport, University of Greenwich, Chatham Maritime, United Kingdom
- Currently with Center for Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, United Kingdom
| | - Giuseppe Lucisano
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
- Currently with Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Antonio Nicolucci
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
- Currently with Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
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27
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Lillis J, Bond DS. Values-based and acceptance-based intervention to promote adoption and maintenance of habitual physical activity among inactive adults with overweight/obesity: a study protocol for an open trial. BMJ Open 2019; 9:e025115. [PMID: 30782749 PMCID: PMC6340065 DOI: 10.1136/bmjopen-2018-025115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Despite the importance of regular moderate-intensity to vigorous-intensity physical activity (MVPA) for health benefits and long-term weight management, current comprehensive lifestyle interventions have focused on providing MVPA prescriptions and goals but with only minimal and intermittent focus on psychosocial theoretical constructs and novel strategies, perhaps explaining the often modest impact on adoption and maintenance of higher levels of MVPA. An intervention based on acceptance and commitment therapy (ACT) targeting the increase of values-based autonomous motivation could improve the adoption and maintenance of habitual MVPA among insufficiently active overweight or obese adults in a brief intervention format. METHODS AND ANALYSIS The overall aim of this study is to develop and test the feasibility, acceptability and preliminary efficacy of an ACT-based brief workshop intervention for increasing bouted MVPA for inactive adults with overweight/obesity using a single-arm design. A total of 48 inactive adults with overweight/obesity will be recruited and attend a 4-hour, ACT-based workshop followed by weekly emails and monthly phone calls for 3 months. The workshop will teach values clarification and acceptance-based skills to increase values-based autonomous motivation and bouted MVPA. Participants will self-monitor minutes of MVPA and personal values and report on progress via weekly emails and monthly phone calls. Assessments will be conducted at baseline and at 3 and 6 months. ETHICS AND DISSEMINATION Study procedures have been approved by the Institutional Review Board. Consent is given in writing and in person. Data collection and storage separates study data from personally identifying information. Two safety officers who are not connected to the study monitor study progress and participant safety. TRIAL REGISTRATION NUMBER NCT03565731; Pre-results.
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Affiliation(s)
- Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
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28
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Ried-Larsen M, MacDonald CS, Johansen MY, Hansen KB, Christensen R, Almdal TP, Pedersen BK, Karstoft K. Why prescribe exercise as therapy in type 2 diabetes? We have a pill for that! Diabetes Metab Res Rev 2018; 34:e2999. [PMID: 29488311 DOI: 10.1002/dmrr.2999] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/16/2018] [Accepted: 02/19/2018] [Indexed: 12/20/2022]
Abstract
The majority of T2D cases are preventable through a healthy lifestyle, leaving little room for questions that lifestyle should be the first line of defence in the fight against the development of T2D. However, when it comes to the clinical care of T2D, the potential efficacy of lifestyle is much less clear-cut, both in terms of impacting the pathological metabolic biomarkers of the disease, and long-term complications. A healthy diet, high leisure-time physical activity, and exercise are considered to be cornerstones albeit adjunct to drug therapy in the management of T2D. The prescription and effective implementation of structured exercise and other lifestyle interventions in the treatment of T2D have not been routinely used. In this article, we critically appraise and debate our reflections as to why exercise and physical activity may not have reached the status of a viable and effective treatment in the clinical care of T2D to the same extent as pharmaceutical drugs. We argue that the reason why exercise therapy is not utilized to a satisfactory degree is multifaceted and primarily relates to a "vicious cycle" with lack of proven efficacy on T2D complications and a lack of proven effectiveness on risk factors in the primary care of T2D. Furthermore, there is a lack of experimental research establishing the optimal dose of exercise. This precludes widespread and sustained implementation of physical activity and exercise in the clinical treatment of T2D will not succeed.
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Affiliation(s)
- Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Christopher S MacDonald
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- CopenRehab, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Y Johansen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katrine B Hansen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Thomas P Almdal
- Department of Endocrinology PE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bente K Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Karstoft
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
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29
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Unick JL, Gaussoin SA, Hill JO, Jakicic JM, Bond DS, Hellgren M, Johnson KC, Peters AL, Coday M, Kitzman DW, Bossart S, Wing RR. Objectively Assessed Physical Activity and Weight Loss Maintenance among Individuals Enrolled in a Lifestyle Intervention. Obesity (Silver Spring) 2017; 25:1903-1909. [PMID: 28940967 PMCID: PMC5695666 DOI: 10.1002/oby.21971] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the relationship between objectively assessed moderate-to-vigorous intensity physical activity (MVPA) and 4-year weight loss (WL) and WL maintenance among individuals with diabetes enrolled in the Look AHEAD trial. METHODS MVPA was measured in a subgroup of lifestyle intervention participants with accelerometry data at baseline and at 1 and 4 years (n = 553; age: 59.7 ± 6.8 y; BMI: 35.5 ± 5.9 kg/m2 ). Minutes per week of bout-related MVPA were calculated (≥ 3 metabolic equivalents, ≥ 10-min bouts), and adherence to the national physical activity (PA) recommendation for WL maintenance (≥ 250 min/wk) was assessed. RESULTS Independent of 1-year WL, 4-year MVPA (β = -0.003, SE = 0.002, P = 0.006), but not 1-year MVPA (β = 0.0001, SE = 0.001, P = 0.50), was significantly associated with 4-year WL. Compared with "nonmaintainers" (≥ 10% WL at year 1, but < 10% at year 4; n = 132), WL maintainers (≥ 10% WL at years 1 and 4; n = 103) had higher MVPA at year 1 (253.4 ± 251.8 vs. 163.9 ± 158.2 min/wk, P = 0.002) and year 4 (155.3 ± 180.6 vs. 111.4 ± 154.5 min/wk, P = 0.046). Although 38.8% and 22.3% of WL maintainers engaged in ≥ 250 min/wk at years 1 and 4, respectively, many engaged in < 150 min/wk (year 1: 41%, year 4: 61%). CONCLUSIONS Higher weekly MVPA is associated with greater long-term WL and weight maintenance; however, many individuals are able to maintain ≥ 10% WL while engaging in little MVPA.
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Affiliation(s)
- Jessica L Unick
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Sarah A Gaussoin
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - James O Hill
- Center for Human Nutrition, School of Medicine, University of Colorado, Denver, Colorado
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dale S Bond
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
| | - Margareta Hellgren
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karen C Johnson
- Department of Preventive Medicine, Health Science Center, University of Tennessee, Memphis, Tennessee, USA
| | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mace Coday
- Department of Preventive Medicine, Health Science Center, University of Tennessee, Memphis, Tennessee, USA
| | - Dalane W Kitzman
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Suzette Bossart
- Center for Human Nutrition, School of Medicine, University of Colorado, Denver, Colorado
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
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30
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Bryan AD, Jakicic JM, Hunter CM, Evans ME, Yanovski SZ, Epstein LH. Behavioral and Psychological Phenotyping of Physical Activity and Sedentary Behavior: Implications for Weight Management. Obesity (Silver Spring) 2017; 25:1653-1659. [PMID: 28948719 PMCID: PMC5657446 DOI: 10.1002/oby.21924] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Risk for obesity is determined by a complex mix of genetics and lifetime exposures at multiple levels, from the metabolic milieu to psychosocial and environmental influences. These phenotypic differences underlie the variability in risk for obesity and response to weight management interventions, including differences in physical activity and sedentary behavior. METHODS As part of a broader effort focused on behavioral and psychological phenotyping in obesity research, the National Institutes of Health convened a multidisciplinary workshop to explore the state of the science in behavioral and psychological phenotyping in humans to explain individual differences in physical activity, both as a risk factor for obesity development and in response to activity-enhancing interventions. RESULTS Understanding the behavioral and psychological phenotypes that contribute to differences in physical activity and sedentary behavior could allow for improved treatment matching and inform new targets for tailored, innovative, and effective weight management interventions. CONCLUSIONS This summary provides the rationale for identifying psychological and behavioral phenotypes relevant to physical activity and identifies opportunities for future research to better understand, define, measure, and validate putative phenotypic factors and characterize emerging phenotypes that are empirically associated with initiation of physical activity, response to intervention, and sustained changes in physical activity.
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Affiliation(s)
| | | | - Christine M. Hunter
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Mary E. Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Leonard H. Epstein
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Reallocating bouted sedentary time to non-bouted sedentary time, light activity and moderate-vigorous physical activity in adults with prediabetes and type 2 diabetes. PLoS One 2017; 12:e0181053. [PMID: 28753626 PMCID: PMC5533318 DOI: 10.1371/journal.pone.0181053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/26/2017] [Indexed: 01/25/2023] Open
Abstract
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.
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