Association between objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes

Abstract

Aims/hypothesis: The aim of our study was to examine the associations between sedentary time (SED-time), time spent in moderate-to-vigorous-intensity physical activity (MVPA), total physical activity energy expenditure (PAEE) and cardiorespiratory fitness with metabolic risk among individuals with recently diagnosed type 2 diabetes.

Methods: Individuals participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION)-Plus trial underwent measurement of SED-time, MVPA and PAEE using a combined activity and movement sensor (n = 394), and evaluation of cardiorespiratory fitness (n = 291) and anthropometric and metabolic status. Clustered metabolic risk was calculated by summing standardised values for waist circumference, triacylglycerol, HbA1c, systolic blood pressure and the inverse of HDL-cholesterol. Multivariate linear regression analyses were used to quantify the associations between SED-time, MVPA, PAEE and cardiorespiratory fitness with individual metabolic risk factors and clustered metabolic risk.

Results: Each additional 1 h of SED-time was positively associated with clustered metabolic risk, independently of sleep duration and MVPA (β = 0.16 [95% CI 0.03, 0.29]). After accounting for SED-time, MVPA was associated with systolic blood pressure (β = -2.07 [-4.03, -0.11]) but not with clustered metabolic risk (β = 0.01 [-0.28, 0.30]). PAEE and cardiorespiratory fitness were significantly and independently inversely associated with clustered metabolic risk (β = -0.03 [-0.05, -0.02] and β = -0.06 [-0.10, -0.03], respectively). Associations between SED-time and metabolic risk were generally stronger in the low compared with the high fitness group.

Conclusions/interpretation: PAEE was inversely associated with metabolic risk, whereas SED-time was positively associated with metabolic risk. MVPA was not associated with clustered metabolic risk after accounting for SED-time. Encouraging this high-risk group to decrease SED-time, particularly those with low cardiorespiratory fitness, and increase their overall physical activity may have beneficial effects on disease progression and reduction of cardiovascular risk.

Trial registration: ISRCTN99175498.

Fig. 1

Associations of SED-time, MVPA, PAEE and cardiorespiratory fitness with clustered metabolic risk. Mean SED-time in the lower (reference), middle and higher tertile groups was 6.4 (range 1.2–8.0), 9.1 (range 8.0–10.4) and 11.6 (range 10.4–16.4) h/day, respectively (a). Mean time spent in MVPA in the lower, middle and higher tertile groups was 0.4 (range 0.0–0.6), 1.0 (range 0.6–1.5) and 2.4 (range 1.5–6.1) h/day, respectively (b). Mean PAEE in the lower, middle and higher tertile groups was 18.9 (range 5.6–24.7), 31.2 (range 24.8–39.4) and 50.3 (range 39.6–98.8) kJ kg⁻¹ day⁻¹, respectively (c). Mean cardiorespiratory fitness in the lower (reference), middle and higher tertile groups was 21.0 (range 11.3–26.9), 31.0 (range 27.1–34.6) and 38.7 (range 34.8–58.6) ml O₂ kg⁻¹ min⁻¹, respectively (d). Data are the zMS for each group (95% CI), adjusted for age, sex, intervention group, occupational socioeconomic class, smoking status, sleep duration, total energy intake, percentage energy from fat, alcohol intake, and use of antihypertensive drugs, glucose-lowering drugs and lipid-lowering drugs. SED-time is additionally adjusted for MVPA, and MVPA is additionally adjusted for SED-time. p values for trend across categories for SED-time (a), MVPA (b), PAEE (c) and cardiorespiratory fitness (d) were p = 0.04, p = 0.72, p < 0.001 and p = 0.001, respectively