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

Objective: Moderate-to-vigorous 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. 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 metabolic equivalent tasks (MET)/min for ≥10mins). Cardiorespiratory fitness was assessed by maximal graded exercise test. Participants were categorized into six groups based on the time of day with the majority of bout-related MVPA (MET×min): ≥50% of bout-related MVPA during the same time window (Morning, Midday, Afternoon, or Evening), <50% 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 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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Physical behaviors and chronotype in people with type 2 diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001375 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001375

Author(s):

Joseph Henson ◽

Alex V Rowlands ◽

Emma Baldry ◽

Emer M Brady ◽

Melanie J Davies ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Reference Group ◽

Vigorous Physical Activity ◽

Sleep Onset ◽

Sedentary Behaviors ◽

Intensity Gradient ◽

Average Acceleration ◽

Design And Methods

IntroductionPrevious investigations have suggested that evening chronotypes may be more susceptible to obesity-related metabolic alterations. However, whether device-measured physical behaviors differ by chronotype in those with type 2 diabetes (T2DM) remains unknown.Research design and methodsThis analysis reports data from the ongoing Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Control (CODEC) observational study. Eligible participants were recruited from both primary and secondary care settings in the Midlands area, UK. Participants were asked to wear an accelerometer (GENEActiv, ActivInsights, Kimbolton, UK) on their non-dominant wrist for 7 days to quantify different physical behaviors (sleep, sedentary, light, moderate-to-vigorous physical activity (MVPA), intensity gradient, average acceleration and the acceleration above which the most active continuous 2, 10, 30 and 60 min are accumulated). Chronotype preference (morning, intermediate or evening) was assessed using the Morningness-Eveningness Questionnaire. Multiple linear regression analyses assessed whether chronotype preference was associated with physical behaviors and their timing. Evening chronotypes were considered as the reference group.Results635 participants were included (age=63.8±8.4 years, 34.6% female, body mass index=30.9±5.1 kg/m2). 25% (n=159) of the cohort were morning chronotypes, 52% (n=330) intermediate and 23% (n=146) evening chronotypes. Evening chronotypes had higher sedentary time (28.7 min/day, 95% CI 8.6 to 48.3) and lower MVPA levels (–9.7 min/day, –14.9 to –4.6) compared to morning chronotypes. The intensity of the most active continuous 2-60 min of the day, average acceleration and intensity gradient were lower in evening chronotypes. The timing of physical behaviors also differed across chronotypes, with evening chronotypes displaying a later sleep onset and consistently later physical activity time.ConclusionsPeople with T2DM lead a lifestyle characterized by sedentary behaviors and insufficient MVPA. This may be exacerbated in those with a preference for ‘eveningness’ (ie, go to bed late and get up late).

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Time-of-day moderate-to-vigorous physical activity and all-cause mortality in individuals with type 2 diabetes

Journal of Sports Sciences ◽

10.1080/02640414.2021.2009163 ◽

2021 ◽

pp. 1-7

Author(s):

Tongyu Ma ◽

Yao Jie Xie ◽

Thomas Bennett ◽

Chong-Do Lee

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Vigorous Physical Activity ◽

Time Of Day ◽

All Cause Mortality

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170-OR: Association of Timing of Physical Activity Bouts with Cardiorespiratory Fitness in Adults with Type 2 Diabetes in the Look AHEAD Study

Diabetes ◽

10.2337/db20-170-or ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 170-OR

Author(s):

JINGYI QIAN ◽

MICHAEL P. WALKUP ◽

SHYH-HUEI CHEN ◽

PETER H. BRUBAKER ◽

DALE BOND ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Cardiorespiratory Fitness ◽

Look Ahead ◽

The Look

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Walking Compared With Vigorous Physical Activity and Risk of Type 2 Diabetes in Women

JAMA ◽

10.1001/jama.282.15.1433 ◽

1999 ◽

Vol 282 (15) ◽

pp. 1433 ◽

Cited By ~ 495

Author(s):

Frank B. Hu ◽

Ronald J. Sigal ◽

Janet W. Rich-Edwards ◽

Graham A. Colditz ◽

Caren G. Solomon ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Vigorous Physical Activity

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Abstract P057: Clusters of Cardiovascular Risk Factors Predict Incidence of Type 2 Diabetes in Men and Women: A Swedish Population-based Study

Circulation ◽

10.1161/circ.133.suppl_1.p057 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Charlotte A Larsson ◽

Bledar Daka ◽

Margareta I Hellgren ◽

Maria C Eriksson ◽

Lennart Råstam ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Population Based ◽

Population Based Study ◽

Men And Women ◽

Self Rated Health

Introduction: Clusters of metabolic variables and their effects on incidence of type 2 diabetes have been studied previously; however, little is known about the effects on diabetes from risk factor clusters including lifestyle and self-rated health. Hypothesis: We assessed the hypothesis that clusters of common cardiovascular risk factors, including lifestyle and self-rated health, can predict development of type 2 diabetes in men and women, respectively. Methods: In 2002-2005, 2816 men and women, 30-74 years, were randomly selected from two municipalities in southwestern Sweden and assessed with regard to cardiovascular/metabolic risk factors within the Skaraborg Project (76% participation). Participants performed an OGTT, had blood samples drawn, had anthropometric measurements and blood pressure taken, and answered validated questionnaires about e.g. leisure-time physical activity (with four answer alternatives from intensive to sedentary) and self-rated health (with five alternatives from excellent to very poor). Using the same protocol, 1332 participants from the baseline survey where re-examined in 2011-2014. After excluding those with diabetes at baseline, 1268 participants were included in this prospective population-based study. Results: Factor analysis (using varimax rotation) identified significant loadings (≥0.40) on the following three identical factors in men and women: the metabolic factor , comprising HOMA-ir, WHR, systolic blood pressure, and apolipoprotein B-to-A1 ratio; the vitality factor , comprising physical activity and self-rated health; and the addiction factor , comprising smoking and alcohol consumption. After a mean follow-up of 9.7±1.4 years, 76 cases of diabetes were identified; 46 in men and 30 in women. In a logistic regression analysis adjusted for all principal components, age, and educational level, the metabolic factor significantly predicted type 2 diabetes in both men (OR: 3.3, CI: 2.3-5.0) and women (OR: 3.5, CI: 2.2-5.6). Furthermore, a predictive effect of the vitality factor was also seen in women (OR: 1.8, CI: 1.2-2.9), but not in men (OR: 1.1, CI: 0.8-1.6), whereas the addiction factor had no effect in either men or women. Conclusions: This is to our knowledge the first time principle components of cardiovascular risk factors, including both metabolic and lifestyle variables, have been used to predict incidence of type 2 diabetes. The gender difference observed with regard to the combined impact of self-rated health and physical activity are novel and indicates a mechanism beside the metabolic syndrome that warrants further gender-specific exploration in future studies.

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Effects of Physical Activity and Exercise Training on Cardiovascular Risk in Coronary Artery Disease Patients With and Without Type 2 Diabetes

Diabetes Care ◽

10.2337/dc14-2216 ◽

2015 ◽

pp. dc142216 ◽

Cited By ~ 9

Author(s):

Jaana J. Karjalainen ◽

Antti M. Kiviniemi ◽

Arto J. Hautala ◽

Olli-Pekka Piira ◽

E. Samuli Lepojärvi ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Exercise Training ◽

Physical Activity And Exercise ◽

Artery Disease

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Type 2 diabetes in youth: A phenotype of poor cardiorespiratory fitness and low physical activity

International Journal of Pediatric Obesity ◽

10.1080/17477160902923341 ◽

2009 ◽

pp. 1-6

Author(s):

Gabriel Shaibi ◽

Sara Michaliszyn ◽

Cynthia Fritschi ◽

Lauretta Quinn ◽

Melissa Spezia Faulkner

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Cardiorespiratory Fitness ◽

Diabetes In Youth

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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)

10.2337/figshare.16746262.v2 ◽

2021 ◽

Author(s):

Stefano Balducci ◽

Jonida Haxhi ◽

Massimo Sacchetti ◽

Giorgio Orlando ◽

Patrizia Cardelli ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Physical Fitness ◽

Cardiovascular Risk Factors ◽

Risk Profile ◽

Risk Scores ◽

Metabolic Equivalents

<a>Objective.</a> In the Italian Diabetes and Exercise Study_2, a behavioral counseling <a>promoted</a> a sustained increase in physical activity (PA) volume (+3.3 metabolic equivalents-hour·week-1), moderate-to-vigorous-intensity PA (MVPA, +6.4 min·day-1), and light-intensity PA (LPA, +0.8 hours·day-1) and decrease in sedentary time (SED-time, -0.8 hours·day-1). Here, we investigated <a>the relationships of changes in PA/SED-time with changes in physical fitness and cardio-metabolic risk profile in individuals with type 2 diabetes</a>. Research Design and Methods. <a>In this 3-year randomized clinical trial, 300 physically inactive and sedentary patients were randomized 1:1 to receive one-month theoretical and practical counseling once-a-year or standard care. </a>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<a>, in the whole cohort and by study arm</a>. 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 improve outcomes, possibly by increasing total energy expenditure.

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