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Clinical Trial
. 2023 Jul 1;46(7):1417-1424.
doi: 10.2337/dc22-2413.

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

Jingyi Qian  1   2 , Qian Xiao  3 , Michael P Walkup  4 , Mace Coday  5 , Melissa L Erickson  6 , Jessica Unick  7 , John M Jakicic  8 , Kun Hu  1   2 , Frank A J L Scheer  1   2 , Roeland J W Middelbeek  9 ; Look AHEAD Research Group
Affiliations
Clinical Trial

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

Jingyi Qian et al. Diabetes Care. .

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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Conflict of interest statement

Duality of Interest. The following organizations have committed to make major contributions to Look AHEAD: Federal Express, Health Management Resources, Johnson & Johnson, LifeScan Inc., Optifast-Novartis Nutrition, Roche Pharmaceuticals, Ross Product Division of Abbott Laboratories, SlimFast Foods Company, and Unilever. J.M.J. is on the scientific advisory board for Wondr Health, Inc. F.A.J.L.S. serves on the Sleep Research Society Board of Directors and has received consulting fees from the University of Alabama at Birmingham. F.A.J.L.S. interests were reviewed and managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict-of-interest policies. F.A.J.L.S. consultancies are not related to the current work. R.J.W.M. has received research funding from Novo Nordisk unrelated to this work. No other potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
Figure 1
Figure 1
Changes in glycemic measurements by bMVPA timing groups. A: Least squared means of changes in HbA1c over 4 years. B: Least squared means of changes in odds of discontinuation vs. maintaining or initiation in glucose-lowering medications in noninsulin users over 4 years. Means are estimated using linear mixed-effect model for continuous measures and multinomial generalized estimated equation model for reported medication use. Model 3 is used here and adjusted as indicated in Table 2 and Supplementary Table 7. Since participants were categorized twice by bMVPA timing at years 1 and 4, the same timing bMVPA group included different participants at each year. To highlight this, changes from year 1 to year 4 are presented as a dashed line.
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References

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