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Aryal S, Blankenship JM, Bachman SL, Hwang S, Zhai Y, Richards JC, Clay I, Lyden K. Patient-centricity in digital measure development: co-evolution of best practice and regulatory guidance. NPJ Digit Med 2024; 7:128. [PMID: 38755349 PMCID: PMC11099175 DOI: 10.1038/s41746-024-01110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Digital health technologies (DHTs) have the potential to modernize drug development and clinical trial operations by remotely, passively, and continuously collecting ecologically valid evidence that is meaningful to patients' lived experiences. Such evidence holds potential for all drug development stakeholders, including regulatory agencies, as it will help create a stronger evidentiary link between approval of new therapeutics and the ultimate aim of improving patient lives. However, only a very small number of novel digital measures have matured from exploratory usage into regulatory qualification or efficacy endpoints. This shows that despite the clear potential, actually gaining regulatory agreement that a new measure is both fit-for-purpose and delivers value remains a serious challenge. One of the key stumbling blocks for developers has been the requirement to demonstrate that a digital measure is meaningful to patients. This viewpoint aims to examine the co-evolution of regulatory guidance in the United States (U.S.) and best practice for integration of DHTs into the development of clinical outcome assessments. Contextualizing guidance on meaningfulness within the larger shift towards a patient-centric drug development approach, this paper reviews the U.S. Food and Drug Administration (FDA) guidance and existing literature surrounding the development of meaningful digital measures and patient engagement, including the recent examples of rejections by the FDA that further emphasize patient-centricity in digital measures. Finally, this paper highlights remaining hurdles and provides insights into the established frameworks for development and adoption of digital measures in clinical research.
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Affiliation(s)
| | | | | | | | - Yaya Zhai
- VivoSense Inc, Newport Coast, CA, USA
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2
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Bachman SL, Blankenship JM, Busa M, Serviente C, Lyden K, Clay I. Capturing Measures That Matter: The Potential Value of Digital Measures of Physical Behavior for Alzheimer's Disease Drug Development. J Alzheimers Dis 2023; 95:379-389. [PMID: 37545234 PMCID: PMC10578291 DOI: 10.3233/jad-230152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/08/2023]
Abstract
Alzheimer's disease (AD) is a devastating neurodegenerative disease and the primary cause of dementia worldwide. Despite the magnitude of AD's impact on patients, caregivers, and society, nearly all AD clinical trials fail. A potential contributor to this high rate of failure is that established clinical outcome assessments fail to capture subtle clinical changes, entail high burden for patients and their caregivers, and ineffectively address the aspects of health deemed important by patients and their caregivers. AD progression is associated with widespread changes in physical behavior that have impacts on the ability to function independently, which is a meaningful aspect of health for patients with AD and important for diagnosis. However, established assessments of functional independence remain underutilized in AD clinical trials and are limited by subjective biases and ceiling effects. Digital measures of real-world physical behavior assessed passively, continuously, and remotely using digital health technologies have the potential to address some of these limitations and to capture aspects of functional independence in patients with AD. In particular, measures of real-world gait, physical activity, and life-space mobility captured with wearable sensors may offer value. Additional research is needed to understand the validity, feasibility, and acceptability of these measures in AD clinical research.
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Affiliation(s)
| | | | - Michael Busa
- Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Corinna Serviente
- Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Peerenboom N, Aryal S, Blankenship JM, Swibas T, Zhai Y, Clay I, Lyden K. The Case for the Patient-Centric Development of Novel Digital Sleep Assessment Tools in Major Depressive Disorder. Digit Biomark 2023; 7:124-131. [PMID: 37901365 PMCID: PMC10601929 DOI: 10.1159/000533523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 10/31/2023] Open
Abstract
Background Depression imposes a major burden on public health as the leading cause of disability worldwide. Sleep disturbance is a core symptom of depression that affects the vast majority of patients. Nonetheless, it is frequently not resolved by depression treatment and may even be worsened through some pharmaceutical interventions. Disturbed sleep negatively impact patients' quality of life, and persistent sleep disturbance increases the risk of recurrence, relapse, and even suicide. However, the development of novel treatments that might improve sleep problems is hindered by the lack of reliable low-burden objective measures that can adequately assess disturbed sleep in this population. Summary Developing improved digital measurement tools that are fit for use in clinical trials for major depressive disorder could promote the inclusion of sleep as a focus for treatment, clinical drug development, and research. This perspective piece explores the path toward the development of novel digital measures, reviews the existing evidence on the meaningfulness of sleep in depression, and summarizes existing methods of sleep assessments, including the use of digital health technologies. Key Messages Our objective was to make a clear call to action and path forward for the qualification of new digital outcome measures which would enable assessment of sleep disturbance as an aspect of health that truly matters to patients, promoting sleep as an important outcome for clinical development, and ultimately ensure that disturbed sleep will not remain the forgotten symptom of depression.
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Affiliation(s)
| | | | | | | | - Yaya Zhai
- Vivosense Inc., Newport Coast, CA, USA
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4
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Purcell SA, Legget KT, Halliday TM, Pan Z, Creasy SA, Blankenship JM, Hild A, Tregellas JR, Melanson EL, Cornier MA. Appetitive and Metabolic Responses to an Exercise versus Dietary Intervention in Adults with Obesity. Transl J Am Coll Sports Med 2022; 7:e000211. [PMID: 36337848 PMCID: PMC9635267 DOI: 10.1249/tjx.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction/Purpose Dietary restriction (DIET) and aerobic exercise (AEX) interventions may impact energy balance differently. Our aim was to describe the effects of weight loss interventions via DIET or AEX on measures of energy balance. Methods Adults with overweight or obesity were randomized to 12 weeks of DIET or AEX with similar calorie deficit goals. A study day was conducted before and after the intervention to assess subjective and hormonal (ghrelin, peptide-YY, glucagon-like peptide-1) appetite responses to a control meal, ad libitum energy intake (EI) at a single meal, and over three days of free-living conditions and eating behavior traits. Resting metabolic rate (RMR) was measured with indirect calorimetry and adjusted for body composition measured by dual X-ray absorptiometry. Non-exercise activity was measured using accelerometers. Results Forty-four individuals were included (age: 37 ± 9 years, body mass index: 30.6 ± 3.1 kg/m2). Both interventions resulted in weight and fat mass loss. The DIET group lost fat-free mass, although differences between groups were not significant (DIET: -1.2 ± 1.7 kg, p<0.001; AEX: 0.4 ± 1.5 kg, p=0.186; p=0.095 interaction). There were no differences in RMR after body composition adjustment. Both interventions were associated with an increase in dietary restraint (DIET: 4.9 ± 1.2, AEX: 2.8 ± 0.7; p<0.001 in both groups). Hunger decreased with DIET (-1.4 ± 0.5, p=0.003), and disinhibition decreased with AEX (-1.5 ± 0.5, p<0.001), although these changes were not different between groups (i.e., no group × time interaction). No other differences in appetite, EI, or non-exercise physical activity were observed within or between groups. Conclusions AEX did not result in compensatory alterations in appetite, ad libitum EI, or physical activity, despite assumed increased energy expenditure. Modest evidence also suggested that disinhibition and hunger may be differentially impacted by weight loss modality.
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Affiliation(s)
- Sarah A. Purcell
- Division of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristina T. Legget
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Tanya M. Halliday
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Zhaoxing Pan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Seth A. Creasy
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer M. Blankenship
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison Hild
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jason R. Tregellas
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Edward L. Melanson
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marc-Andre Cornier
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Blankenship JM, Vetter C, Broussard JL. Impairments in glycemic control during Eastbound transatlantic travel in healthy adults. SLEEP Advances 2022; 3:zpac009. [PMID: 35601081 PMCID: PMC9112920 DOI: 10.1093/sleepadvances/zpac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/07/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Study Objectives
Repeated bouts of circadian misalignment impair glucose tolerance. However, whether circadian misalignment associated with travel and jet lag impair glucose homeostasis in a free-living population is not known. The goal of the present study was to examine glycemic control during one week of Eastbound transatlantic travel in healthy men and women.
Methods
Seven healthy participants (5 women; age: 35.6 ± 2.5 years, BMI: 23.9 ± 2.4 m/kg2) traveled from Colorado, USA (GMT-7) to Europe (GMT and GMT+1) and wore a continuous glucose monitor (Freestyle Libre Pro) for 8–14 days before, during, and after travel. Indices of glycemic control were summarized over 24-hour periods and by day and night.
Results
Mean glucose, peak glucose, and time spent in hyperglycemia increased linearly throughout the travel period relative to baseline levels. Mean glucose concentrations rose 1.03 mg/dL (95% CI: 0.34, 1.74) and duration of hyperglycemia increased by 17 min (95% CI: 5.5, 28.6) each 24-hour period. Increases in 24-hour glucose were primarily driven by increases in daytime parameters with rising mean glucose (0.72 mg/dL per day, [95% CI: −0.1, 1.5]) and duration of hyperglycemia (13.2 min per day [95% CI: 4.3, 22.1]). Mean glucose, but not peak glucose or time spent in hyperglycemia, increased each night (0.7 mg/dL per night [95% CI: 0.2, 1.2]).
Conclusions
Eastbound transatlantic travel induced a progressive worsening of glucose metrics during 24-hour, day, and night periods. Future research on managing glycemic control during jet lag in people with metabolic disorders is warranted.
Clinical Trial Registration
None
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Affiliation(s)
- Jennifer M Blankenship
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Josiane L Broussard
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
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Grau L, Arbet J, Ostendorf DM, Blankenship JM, Panter SL, Catenacci VA, Melanson EL, Creasy SA. Creating an algorithm to identify indices of sleep quantity and quality from a wearable armband in adults. Sleep Sci 2022; 15:279-287. [PMID: 36158722 PMCID: PMC9496495 DOI: 10.5935/1984-0063.20220052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/23/2021] [Indexed: 11/20/2022] Open
Abstract
Objective Material and Methods Results Conclusion
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Affiliation(s)
- Laura Grau
- University of Colorado Anschutz Medical Campus, Department of
Biostatistics and Informatics - Aurora - CO - United States
| | - Jaron Arbet
- University of Colorado Anschutz Medical Campus, Department of
Biostatistics and Informatics - Aurora - CO - United States
| | - Danielle M Ostendorf
- University of Colorado Anschutz Medical Campus, Division of
Endocrinology, Metabolism, and Diabetes - Aurora - CO - United States
- University of Colorado Anschutz Medical Campus, Anschutz Health and
Wellness Center - Aurora - CO - United States
| | - Jennifer M Blankenship
- University of Colorado Anschutz Medical Campus, Division of
Endocrinology, Metabolism, and Diabetes - Aurora - CO - United States
| | - Shelby L Panter
- University of Colorado Anschutz Medical Campus, Division of
Endocrinology, Metabolism, and Diabetes - Aurora - CO - United States
- University of Colorado Anschutz Medical Campus, Anschutz Health and
Wellness Center - Aurora - CO - United States
| | - Victoria A Catenacci
- University of Colorado Anschutz Medical Campus, Division of
Endocrinology, Metabolism, and Diabetes - Aurora - CO - United States
- University of Colorado Anschutz Medical Campus, Anschutz Health and
Wellness Center - Aurora - CO - United States
| | - Edward L Melanson
- University of Colorado Anschutz Medical Campus, Division of
Endocrinology, Metabolism, and Diabetes - Aurora - CO - United States
- Eastern Colorado VA, Geriatric Research, Education, and Clinical
Center - Aurora - CO - United States
- University of Colorado Anschutz Medical Campus, Division of
Geriatrics - Aurora - CO - United States
| | - Seth A Creasy
- University of Colorado Anschutz Medical Campus, Division of
Endocrinology, Metabolism, and Diabetes - Aurora - CO - United States
- University of Colorado Anschutz Medical Campus, Anschutz Health and
Wellness Center - Aurora - CO - United States
- Corresponding author: Seth A Creasy, E-mail:
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Ostendorf DM, Blankenship JM, Grau L, Arbet J, Mitchell NS, Creasy SA, Caldwell AE, Melanson EL, Phelan S, Bessesen DH, Catenacci VA. Predictors of long-term weight loss trajectories during a behavioral weight loss intervention: An exploratory analysis. Obes Sci Pract 2021; 7:569-582. [PMID: 34631135 PMCID: PMC8488452 DOI: 10.1002/osp4.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Substantial interindividual variability in response to behavioral weight loss interventions remains a critical challenge in obesity treatment. An improved understanding of the complex factors that contribute to this variability may improve obesity treatment outcomes. OBJECTIVE To identify weight change trajectories during a behavioral weight loss intervention and to explore differences between trajectory groups in sociodemographic, biologic, behavioral, and psychosocial factors. METHODS Adults (n = 170, 40 ± 9 years, BMI 34 ± 4 kg/m2, 84% female) participated in an 18-month behavioral weight loss intervention. Weight was measured at 0, 3, 6, 9, 12, 15, 18, and 24 months. Among participants with at least two weights after baseline (n = 140), clusters of longitudinal trajectories of changes in weight were identified using a latent class growth mixture model. The association between baseline factors or changes in factors over time and trajectory group was examined. RESULTS Two weight change trajectories were identified: "weight regainers" (n = 91) and "weight loss maintainers" (n = 49). Black participants (90%, 19/21) were more likely than non-Black participants to be regainers versus maintainers (p < 0.01). Maintainers demonstrated greater increases in device-measured physical activity, autonomous motivation for exercise, diet self-efficacy, cognitive restraint, and engagement in weight management behaviors and greater reductions in barriers for exercise, disinhibition, and depressive symptoms over 24 months versus regainers (p < 0.05). CONCLUSION Maintainers and regainers appear to be distinct trajectories that are associated with specific sociodemographic, behavioral, and psychosocial factors. Study results suggest potential targets for more tailored, multifaceted interventions to improve obesity treatment outcomes.
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Affiliation(s)
- Danielle M. Ostendorf
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Jennifer M. Blankenship
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Laura Grau
- Department of Biostatistics and InformaticsColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Jaron Arbet
- Department of Biostatistics and InformaticsColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Nia S. Mitchell
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Seth A. Creasy
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Ann E. Caldwell
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Edward L. Melanson
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Geriatric MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical CenterDenverColoradoUSA
| | - Suzanne Phelan
- Department of Kinesiology & Public HealthCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Daniel H. Bessesen
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Victoria A. Catenacci
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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Blankenship JM, Rosenberg RC, Rynders CA, Melanson EL, Catenacci VA, Creasy SA. Examining the Role of Exercise Timing in Weight Management: A Review. Int J Sports Med 2021; 42:967-978. [PMID: 34034354 PMCID: PMC8591839 DOI: 10.1055/a-1485-1293] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Many adults cite exercise as a primary strategy for losing weight, yet exercise alone is modestly effective for weight loss and results in variable weight loss responses. It is possible that some of the variability in weight loss may be explained by the time of day that exercise is performed. Few studies have directly compared the effects of exercise performed at different times of the day (i. e., morning versus evening exercise). Results from these existing studies are mixed with some studies demonstrating superior weight and fat mass loss from morning exercise, while other studies have found that evening exercise may be better for weight management. Exercise timing may alter modifiable lifestyle behaviors involved in weight management, such as non-exercise physical activity, energy intake, and sleep. The purpose of this review is to summarize evidence for and against time-of-day dependent effects of exercise on weight management. Although limited, we also review studies that have examined the effect of exercise timing on other lifestyle behaviors linked to body weight regulation. While exercise at any time of day is beneficial for health, understanding whether there is an optimal time of day to exercise may advance personalized treatment paradigms for weight management.
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Affiliation(s)
- Jennifer M. Blankenship
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Corey A. Rynders
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Edward L. Melanson
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Geriatrics, VA Eastern Colorado Health Care System, Aurora, CO
| | - Victoria A. Catenacci
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Seth A. Creasy
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
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9
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Miller MJ, Blankenship JM, Kline PW, Melanson EL, Christiansen CL. Patterns of Sitting, Standing, and Stepping After Lower Limb Amputation. Phys Ther 2020; 101:6039323. [PMID: 33336706 PMCID: PMC7921296 DOI: 10.1093/ptj/pzaa212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/10/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objectives of this study were to describe sitting, standing, and stepping patterns for people with lower limb amputation (LLA) and to compare sitting, standing, and stepping between people with dysvascular LLA and people with traumatic LLA. METHODS Participants with dysvascular or traumatic LLA were included if their most recent LLA was at least 1 year earlier, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Sitting, standing, and stepping were measured using accelerometry. Daily sitting, standing, and stepping times were expressed as percentages of waking time. Time spent in bouts of specified durations of sitting (<30, 30-60, 60-90, and >90 minutes), standing (0-1, 1-5, and >5 minutes), and stepping (0-1, 1-5, and >5 minutes) was also calculated. RESULTS Participants (N = 32; mean age = 62.6 [SD = 7.8] years; 84% men; 53% with dysvascular LLA) spent most of the day sitting (median = 77% [quartile 1 {Q1}-quartile 3 {Q3} = 67%-84%]), followed by standing (median = 16% [Q1-Q3 = 12%-27%]) and stepping (median = 6% [Q1-Q3 = 4%-9%]). One-quarter (median = 25% [Q1-Q3 = 16%-38%]) of sitting was accumulated in bouts of >90 minutes, and most standing and stepping was accrued in bouts of <1 minute (standing: median = 42% [Q1-Q3 = 34%-54%]; stepping: median = 98% [Q1-Q3 = 95%-99%]). Between-etiology differences included proportion of time sitting (traumatic: median = 70% [Q1-Q3 = 59%-78%]; dysvascular: median = 79% [Q1-Q3 = 73%-86%]) and standing (traumatic: median = 23% [Q1-Q3 = 16%-32%]; dysvascular: median = 15% [Q1-Q3 = 11%-20%]). CONCLUSION Participants had high daily volumes of long durations of sitting. Further, these individuals accumulated most physical activity in bouts of <1 minute. IMPACT High levels of sedentary behavior and physical inactivity patterns may place people with LLA at greater mortality risk relative to the general population. Interventions to minimize sedentary behaviors and increase physical activity are potential strategies for improving poor outcomes of physical therapy after LLA.
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Affiliation(s)
| | - Jennifer M Blankenship
- Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA
| | - Edward L Melanson
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA
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Babcock MC, Blankenship JM, Brubaker A, Witten TL, Hildreth KL, Moreau KL. The Association Between Physical Inactivity And Vascular Dysfunction May Be Related To Low Testosterone Concentrations. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000685332.19578.9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Blankenship JM, Shanbhag P, Winslow J, Meek P, Blatchford P, Melanson EL, Boxer R. Changing Physical Activity In Older Adults With Heart Failure By Increasing Exercise Or Reducing Sitting. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000683200.57919.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Creasy SA, Blankenship JM, Panter SL, Catenacci VA, Wright KP, Reusch JE, Hildreth KL, Melanson EL. Effects Of Moderate Versus Vigorous Intensity Exercise Training In Older Adults With Prediabetes. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000684568.29133.8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Purcell SA, Legget KT, Halliday TM, Creasy SA, Blankenship JM, Hild A, Tregellas JR, Melanson EL, Cornier MA. Non-exercise Activity During Dietary Restriction Or Aerobic Exercise Interventions In Individuals With Overweight Or Obesity. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000677492.41596.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Viskochil R, Blankenship JM, Makari-Judson G, Staudenmayer J, Freedson PS, Hankinson SE, Braun B. Metrics of Diabetes Risk Are Only Minimally Improved by Exercise Training in Postmenopausal Breast Cancer Survivors. J Clin Endocrinol Metab 2020; 105:5634043. [PMID: 31745553 DOI: 10.1210/clinem/dgz213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/18/2019] [Indexed: 01/05/2023]
Abstract
CONTEXT Insulin resistance is a risk factor for breast cancer recurrence. How exercise training changes fasting and postglucose insulin resistance in breast cancer survivors is unknown. OBJECTIVE To evaluate exercise-induced changes in postglucose ingestion insulin concentrations, insulin resistance, and their associations with cancer-relevant biomarkers in breast cancer survivors. SETTING The University of Massachusetts Kinesiology Department. PARTICIPANTS 15 postmenopausal breast cancer survivors not meeting the physical activity guidelines (150 min/week of exercise). INTERVENTION A supervised 12-week aerobic exercise program (60 min/day, 3-4 days/week). MAIN OUTCOME MEASURES Postglucose ingestion insulin was determined by peak insulin and area under the insulin curve (iAUC) during a 5-sample oral glucose tolerance test. Insulin sensitivity was estimated from the Matsuda composite insulin sensitivity index (C-ISI). Changes in fitness and body composition were determined from submaximal VO2peak and dual energy X-ray absorptiometry. RESULTS Participants averaged 156.8 ± 16.6 min/week of supervised exercise. Estimated VO2peak significantly increased (+2.8 ± 1.4 mL/kg/min, P < .05) and body weight significantly decreased (-1.1 ± 0.8 kg, P < .05) following the intervention. There were no differences in fasting insulin, iAUC, C-ISI, or peak insulin following the intervention. Insulin was only significantly lower 120 min following glucose consumption (68.8 ± 34.5 vs 56.2 ± 31.9 uU/mL, P < .05), and there was a significant interaction with past/present aromatase inhibitor (AI) use for peak insulin (-11.99 non-AI vs +13.91 AI uU/mL) and iAUC (-24.03 non-AI vs +32.73 AI uU/mL). CONCLUSIONS Exercise training had limited overall benefits on insulin concentrations following glucose ingestion in breast cancer survivors but was strongly influenced by AI use.
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Affiliation(s)
- Richard Viskochil
- Department of Kinesiology, University of Massachusetts, Amherst, MA, US
- Huntsman Cancer Institute, Salt Lake City, UT, US
| | - Jennifer M Blankenship
- Department of Kinesiology, University of Massachusetts, Amherst, MA, US
- Anschutz Medical Center, Denver CO, US
| | - Grace Makari-Judson
- Division of Hematology-Oncology, Baystate Medical Center, Springfield, MA, US
| | - John Staudenmayer
- Department of Mathematics and Statistics, University of Massachusetts, Amherst, MA, US
| | - Patty S Freedson
- Department of Kinesiology, University of Massachusetts, Amherst, MA, US
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst MA, US
| | - Barry Braun
- Department of Kinesiology, University of Massachusetts, Amherst, MA, US
- Department of Health and Exercise Science, Colorado State University, Ft. Collins, CO, US
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Blankenship JM, Chipkin SR, Freedson PS, Staudenmayer J, Lyden K, Braun B. Managing free-living hyperglycemia with exercise or interrupted sitting in type 2 diabetes. J Appl Physiol (1985) 2019; 126:616-625. [DOI: 10.1152/japplphysiol.00389.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Breaking up sitting with light physical activity (PA) is effective in reducing hyperglycemia in the laboratory. Whether the same effects are observed in the free-living environment remains unknown. We evaluated how daily and postprandial glycemia is impacted by 20, 40, or 60 min of activity performed as either breaks from sitting after each meal (BR) or as one continuous walk after breakfast (WALK). Thirty individuals with type 2 diabetes completed three experimental conditions [BR, WALK, and control (CON)] in a randomized crossover design. Conditions were performed in a free-living environment with strict dietary control over 7 days. Participants increased PA in BR and WALK by 20, 40, or 60 min ( n = 10 in each group) and maintained habitual levels of PA during CON. A continuous glucose monitor (iPro2) and activPAL activity monitor were worn to quantify glycemic control and PA. Using linear mixed models with repeated measures, we 1) compared postprandial glucose (PPG) across conditions and 2) assessed the relationship between activity volume and glucose responses. Whereas WALK tended to shorten the daily duration of hyperglycemia compared with CON ( P = 0.0875), BR was not different from CON. BR and WALK significantly attenuated the breakfast PPG versus CON ( P ≤ 0.05), but lunch and dinner PPG were unaffected by BR and WALK. In conclusion, continuous walking was more effective than breaks from sitting in lowering daily hyperglycemia for the group, but both conditions lowered breakfast PPG. In contrast to tightly controlled laboratory studies, breaks from sitting did not lower hyperglycemia in the free-living environment. NEW & NOTEWORTHY Our “ecolabical” approach is new and noteworthy. This approach combines the external validity of the free-living environment (ecological) with the control of key confounding variables in the laboratory and allows for highly translatable findings by minimizing confounding variables. We found that both postmeal continuous walking and short breaks from sitting similarly attenuated the postprandial glucose (PPG) response to breakfast. Unlike previous laboratory studies, neither condition (walk after breakfast or postmeal breaks) significantly impacted PPG at lunch or dinner.
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Affiliation(s)
| | - Stuart R. Chipkin
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Patty S. Freedson
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - John Staudenmayer
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Barry Braun
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
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Parr EB, Devlin BL, Callahan MJ, Radford BE, Blankenship JM, Dunstan DW, Hawley JA. Effects of Providing High-Fat versus High-Carbohydrate Meals on Daily and Postprandial Physical Activity and Glucose Patterns: a Randomised Controlled Trial. Nutrients 2018; 10:nu10050557. [PMID: 29710870 PMCID: PMC5986437 DOI: 10.3390/nu10050557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 01/16/2023] Open
Abstract
We determined the effects of altering meal timing and diet composition on temporal glucose homeostasis and physical activity measures. Eight sedentary, overweight/obese men (mean ± SD, age: 36 ± 4 years; BMI: 29.8 ± 1.8 kg/m2) completed two × 12-day (12-d) measurement periods, including a 7-d habitual period, and then 5 d of each diet (high-fat diet [HFD]: 67:15:18% fat:carbohydrate:protein versus high-carbohydrate diet [HCD]: 67:15:18% carbohydrate:fat:protein) of three meals/d at ±30 min of 0800 h, 1230 h, and 1800 h, in a randomised order with an 8-d washout. Energy intake (EI), the timing of meal consumption, blood glucose regulation (continuous glucose monitor system (CGMS)), and activity patterns (accelerometer and inclinometer) were assessed across each 12-d period. Meal provision did not alter the patterns of reduced physical activity, and increased sedentary behaviour following dinner, compared with following breakfast and lunch. The HCD increased peak (+1.6 mmol/L, p < 0.001), mean (+0.5 mmol/L, p = 0.001), and total area under the curve (+670 mmol/L/min, p = 0.001), as well as 3-h postprandial meal glucose concentrations (all p < 0.001) compared with the HFD. In overweight/obese males, the provision of meals did not alter physical activity patterns, but did affect glycaemic control. Greater emphasis on meal timing and composition is required in diet and/or behaviour intervention studies to ensure relevance to real-world behaviours.
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Affiliation(s)
- Evelyn B Parr
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3000 VIC, Australia.
| | - Brooke L Devlin
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3000 VIC, Australia.
| | - Marcus J Callahan
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3000 VIC, Australia.
| | - Bridget E Radford
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3000 VIC, Australia.
| | - Jennifer M Blankenship
- Anschutz Medical Campus, University of Colorado, Denver, CO 80204, USA.
- Baker Heart and Diabetes Institute, Melbourne, 3004 VIC, Australia.
| | - David W Dunstan
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3000 VIC, Australia.
- Baker Heart and Diabetes Institute, Melbourne, 3004 VIC, Australia.
| | - John A Hawley
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3000 VIC, Australia.
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Viskochil R, Malin SK, Blankenship JM, Braun B. Exercise training and metformin, but not exercise training alone, decreases insulin production and increases insulin clearance in adults with prediabetes. J Appl Physiol (1985) 2017; 123:243-248. [PMID: 28473613 DOI: 10.1152/japplphysiol.00790.2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 04/17/2017] [Accepted: 05/02/2017] [Indexed: 01/02/2023] Open
Abstract
Adding metformin to exercise does not augment the effect of training alone to boost whole body insulin sensitivity and lower circulating insulin concentrations. Although lower insulin concentrations (lower supply) following lifestyle and/or pharmacological interventions are primarily attributed to reductions in insulin secretion that match increases in peripheral insulin sensitivity (lower demand), it is unclear whether exercise and/or metformin exert direct effects on insulin production, extraction, or clearance. Thirty-six middle-aged, obese, sedentary adults with prediabetes were randomized to placebo (P), metformin (M), exercise and placebo (E+P), or exercise and metformin (E+M) for 12 wk. Fasting plasma proinsulin (an indicator of insulin production), C-peptide, insulin, and glucose were collected before and after the intervention. Peripheral insulin sensitivity (euglycemic clamp), hepatic insulin extraction, insulin clearance, body weight, and cardiorespiratory fitness were also measured. Fasting proinsulin was unchanged following P (19.4 ± 10.1 vs. 22.6 ± 15.0 pmol/l), E+P (15.1 ± 7.4 vs. 15.5 ± 7.4 pmol/l), or M (24.8 ± 18.9 vs. 16.7 ± 20.3 pmol/l) but was significantly reduced after E+M (18.6 ± 11.9 vs. 13.9 ± 6.7 pmol/l; P = 0.04). Insulin clearance was significantly greater following M (384.6 ± 19.4 vs. 477.4 ± 49.9; P = 0.03) and E+M (400.1 ± 32.0 vs. 482.9 ± 33.9; P = 0.02) but was unchanged in P or E+P. In this study, metformin combined with exercise training reduced circulating proinsulin, and both groups taking metformin increased insulin clearance. This suggests that adding metformin to exercise may augment or attenuate training effects depending on the outcome or organ system being assessed.NEW & NOTEWORTHY Exercise is increasingly viewed as medication, creating a need to understand its interactions with other common medications. Research suggests metformin, a widely prescribed diabetes medication, may diminish the benefits of exercise when used in combination. In this study, however, metformin combined with exercise training, but not exercise alone, lowered proinsulin concentrations and increased insulin clearance in adults with prediabetes. This may directly influence personalized prescriptions of lifestyle and/or pharmacology to reduce diabetes risk.
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Affiliation(s)
- Richard Viskochil
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts
| | - Steven K Malin
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia.,Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, Virginia; and
| | | | - Barry Braun
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts; .,Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
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Dempsey PC, Blankenship JM, Larsen RN, Sacre JW, Sethi P, Straznicky NE, Cohen ND, Cerin E, Lambert GW, Owen N, Kingwell BA, Dunstan DW. Interrupting prolonged sitting in type 2 diabetes: nocturnal persistence of improved glycaemic control. Diabetologia 2017; 60:499-507. [PMID: 27942799 DOI: 10.1007/s00125-016-4169-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023]
Abstract
AIMS/HYPOTHESIS We aimed to examine the effect of interrupting 7 h prolonged sitting with brief bouts of walking or resistance activities on 22 h glucose homeostasis (including nocturnal-to-following morning hyperglycaemia) in adults with type 2 diabetes. METHODS This study is an extension of a previously published randomised crossover trial, which included 24 inactive overweight/obese adults with type 2 diabetes (14 men; 62 ± 6 years) who completed three 7 h laboratory conditions, separated by 6-14 day washout periods: SIT: (1) prolonged sitting (control); (2) light-intensity walking (LW): sitting plus 3 min bouts of light-intensity walking at 3.2 km/h every 30 min; (3) simple resistance activities (SRA): sitting plus 3 min bouts of simple resistance activities (alternating half-squats, calf raises, brief gluteal contractions and knee raises) every 30 min. In the present study, continuous glucose monitoring was performed for 22 h, encompassing the 7 h laboratory trial, the evening free-living period after leaving the laboratory and sleeping periods. Meals and meal times were standardised across conditions for all participants. RESULTS Compared with SIT, both LW and SRA reduced 22 h glucose [SIT: 11.6 ± 0.3 mmol/l, LW: 8.9 ± 0.3 mmol/l, SRA: 8.7 ± 0.3 mmol/l; p < 0.001] and nocturnal mean glucose concentrations [SIT: 10.6 ± 0.4 mmol/l, LW: 8.1 ± 0.4 mmol/l, SRA: 8.3 ± 0.4 mmol/l; p < 0.001]. Furthermore, mean glucose concentrations were sustained nocturnally at a lower level until the morning following the intervention for both LW and SRA (waking glucose both -2.7 ± 0.4 mmol/l compared with SIT; p < 0.001). CONCLUSIONS/INTERPRETATION Interrupting 7 h prolonged sitting time with either LW or SRA reduced 22 h hyperglycaemia. The glycaemic improvements persisted after these laboratory conditions and nocturnally, until waking the following morning. These findings may have implications for adults with relatively well-controlled type 2 diabetes who engage in prolonged periods of sitting, for example, highly desk-bound workers. TRIAL REGISTRATION anzctr.org.au ACTRN12613000576729 FUNDING: : This research was supported by a National Health and Medical Research Council (NHMRC) project grant (no. 1081734) and the Victorian Government Operational Infrastructure Support scheme.
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Affiliation(s)
- Paddy C Dempsey
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | | | - Robyn N Larsen
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Julian W Sacre
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Parneet Sethi
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Nora E Straznicky
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Neale D Cohen
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Ester Cerin
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia
| | - Gavin W Lambert
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Neville Owen
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bronwyn A Kingwell
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - David W Dunstan
- Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Institute of Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, WA, Australia
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Blankenship JM, Dempsy PC, Staudenmayer J, Braun B, Owen N, Dunstan DW, Wennberg P. Delayed Changes in Postprandial Glucose in Response to Light-Walking Breaks from Prolonged Sitting. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478568.74949.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Viskochil R, Laurin J, Malin SK, Blankenship JM, Braun B. Metformin May Blunt Beneficial Effects Of Exercise Training On Cancer-related Biomarkers In Women With Prediabetes. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000477664.87543.6d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Blankenship JM, Granados K, Braun B. Effects of subtracting sitting versus adding exercise on glycemic control and variability in sedentary office workers. Appl Physiol Nutr Metab 2014; 39:1286-93. [PMID: 25166626 DOI: 10.1139/apnm-2014-0157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent evidence suggests that, like adding exercise, reducing sitting time may improve cardiometabolic health. There has not been a direct comparison of the 2 strategies with energy expenditure held constant. The purpose of this study was to compare fasting and postmeal glucose and insulin concentrations in response to a day with frequent breaks from sitting but no exercise versus considerable sitting plus moderate exercise. Ten sedentary overweight/obese office workers were tested in 3 conditions: (i) walking per activity guidelines (AGW): sitting for majority of workday with a 30 min pre-lunch walk; (ii) frequent long breaks (FLB): no structured exercise but frequent breaks from sitting during workday with energy expenditure matched to AGW; and (iii) frequent short breaks (FSB): number of breaks matched to FLB, but duration of breaks were shorter. Plasma glucose and insulin areas under the curve were measured in response to a meal tolerance test (MTT) at the end of the workday and interstitial glucose was evaluated throughout the day and overnight using continuous glucose monitoring. Using repeated-measures linear mixed models, area under the curve of plasma glucose or insulin after the MTT was not different between conditions. Glycemic variability was lower in FLB compared with AGW (p < 0.05), and nocturnal duration of elevated glucose (>7.8 mmol/L) was shorter after FLB (2.5 ± 2.5 min) than AGW (32.7 ± 16.4 min) or FSB (45.6 ± 29.6 min, p = 0.05). When energy expenditure was matched, breaks from sitting approximated the effects of moderate-intensity exercise on postmeal glucose and insulin responses and more effectively constrained glycemic variability.
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Affiliation(s)
- Jennifer M Blankenship
- Energy Metabolism Laboratory, Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA
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Blankenship JM, Granados K, Staudenmayer J, Braun B. Effect of Breaks from Sitting versus Exercise on Overnight Glycemia. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000495167.71155.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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