Level and correlates of physical activity and sedentary behavior in patients with type 2 diabetes: A cross-sectional analysis of the Italian Diabetes and Exercise Study_2

Stefano Balducci, Valeria D'Errico, Jonida Haxhi, Massimo Sacchetti, Giorgio Orlando, Patrizia Cardelli, Nicolina Di Biase, Lucilla Bollanti, Francesco Conti, Silvano Zanuso, Antonio Nicolucci, Giuseppe Pugliese, Italian Diabetes and Exercise Study 2 (IDES_2) Investigators, Stefano Balducci, Valeria D'Errico, Jonida Haxhi, Massimo Sacchetti, Giorgio Orlando, Patrizia Cardelli, Nicolina Di Biase, Lucilla Bollanti, Francesco Conti, Silvano Zanuso, Antonio Nicolucci, Giuseppe Pugliese, Italian Diabetes and Exercise Study 2 (IDES_2) Investigators

Abstract

Objective: Patients with type 2 diabetes usually show reduced physical activity (PA) and increased sedentary (SED)-time, though to a varying extent, especially for low-intensity PA (LPA), a major determinant of daily energy expenditure that is not accurately captured by questionnaires. This study assessed the level and correlates of PA and SED-time in patients from the Italian Diabetes and Exercise Study_2 (IDES_2).

Methods: Three-hundred physically inactive and sedentary patients with type 2 diabetes were enrolled in the IDES_2 to be randomized to an intervention group, receiving theoretical and practical exercise counseling, and a control group, receiving standard care. At baseline, LPA, moderate-to-vigorous-intensity PA (MVPA), and SED-time were measured by accelerometer. Physical fitness and cardiovascular risk factors and scores were also assessed.

Results: LPA was 3.93±1.35 hours∙day-1, MVPA was 12.4±4.6 min∙day-1, and SED-time was 11.6±1.2 hours∙day-1, with a large range of values (0.89-7.11 hours∙day-1, 0.6-21.0 min∙day-1, and 9.14-15.28 hours∙day-1, respectively). At bivariate analysis, LPA and MVPA correlated with better cardiovascular risk profile and fitness parameters, whereas the opposite was observed for SED-time. Likewise, values of LPA, MVPA, and SED-time falling in the best tertile were associated with optimal or acceptable levels of cardiovascular risk factors and scores. At multivariate analysis, age, female gender, HbA1c, BMI or waist circumference, and high-sensitivity C reactive protein (for LPA and SED-time only) were negatively associated with LPA and MPA and positively associated with SED-time in an independent manner.

Conclusions: Physically inactive and sedentary patients with type 2 diabetes from the IDES_2 show a low level of PA, though values of LPA, MVPA, and SED-time vary largely. Furthermore, there is a strong correlation of these measures with glycemic control, adiposity and inflammation, thus suggesting that even small improvements in LPA, MVPA, and SED-time might be associated with significant improvement in cardiovascular risk profile.

Trial registration: ClinicalTrials.gov NCT01600937.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Distribution of LVPA, MVPA, and…
Fig 1. Distribution of LVPA, MVPA, and SED-time values in the study subjects.
Median (interquartile range) for each variable are reported on the right. LPA = light intensity physical activity; MVPA = moderate-to-vigorous intensity; SED-time = sedentary time.

References

    1. Ladabaum U, Mannalithara A, Myer PA, Singh G. Obesity, abdominal obesity, physical activity, and caloric intake in U.S. Adults: 1988–2010. Am J Med. 2014; 127:717–727. 10.1016/j.amjmed.2014.02.026
    1. Huffman MD, Capewell S, Ning H, Shay CM, Ford ES, Lloyd-Jones DM. Cardiovascular health behavior and health factor changes (1988–2008) and projections to 2020: results from the National Health and Nutrition Examination Surveys. Circulation. 2012; 125:2595–2602. 10.1161/CIRCULATIONAHA.111.070722
    1. Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Physical activity in U.S. adults with diabetes and at risk for developing diabetes. Diabetes Care. 2007; 30:203–209. 10.2337/dc06-1128
    1. Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN. Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with Type 2 diabetes. Ann Intern Med. 2000; 132:605–611.
    1. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002; 346:793–801. 10.1056/NEJMoa011858
    1. Church TS, Cheng YJ, Earnest CP, Barlow CE, Gibbons LW, Priest EL, et al. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care. 2004; 27:83–88.
    1. Cooper AR, Sebire S, Montgomery AA, Peters TJ, Sharp DJ, Jackson N, et al. Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes. Diabetologia. 2012; 55:589–599. 10.1007/s00125-011-2408-x
    1. Cooper AJ, Brage S, Ekelund U, Wareham NJ, Griffin SJ, Simmons RK. Association between objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes. Diabetologia. 2014; 57:73–82. 10.1007/s00125-013-3069-8
    1. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009; 41:998–1005. 10.1249/MSS.0b013e3181930355
    1. Dunstan DW, Barr EL, Healy GN, Salmon J, Shaw JE, Balkau B, et al. Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. 2010; 121:384–391. 10.1161/CIRCULATIONAHA.109.894824
    1. Thorp AA, Healy GN, Owen N, Salmon J, Ball K, Shaw JE, et al. Deleterious associations of sitting time and television viewing time with cardiometabolic risk biomarkers: Australian Diabetes, Obesity and Lifestyle (AusDiab) study 2004–2005. Diabetes Care. 2010; 33: 327–334. 10.2337/dc09-0493
    1. Healy GN, Matthews CE, Dunstan DW, Winkler EA, Owen N. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06. Eur Heart J. 2011; 32:590–597. 10.1093/eurheartj/ehq451
    1. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010; 33:e147–167. 10.2337/dc10-9990
    1. Katzmarzyk PT. Physical activity, sedentary behavior, and health: paradigm paralysis or paradigm shift? Diabetes. 2010; 59:2717–2725. 10.2337/db10-0822
    1. Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev. 2010; 38:105–113.
    1. Healy GN, Winkler EA, Owen N, Anuradha S, Dunstan DW. Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers. Eur Heart J. 2015; 36:2643–2649. 10.1093/eurheartj/ehv308
    1. Sigal RJ, Kenny GP, Wasserman DP, Castaneda-Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care. 2004; 27:2518–2539.
    1. Balducci S, Sacchetti M, Haxhi J, Orlando G, D'Errico V, Fallucca S, et al. Physical exercise as therapy for type 2 diabetes mellitus. Diabetes Metab Res Rev. 2014; 30 (Suppl 1):13–23.
    1. Korkiakangas EE, Alahuhta MA, Laitinen JH. Barriers to regular exercise among adults at high risk or diagnosed with type 2 diabetes: a systematic review. Health Promot Int. 2009; 24:416–427. 10.1093/heapro/dap031
    1. Balducci S, Zanuso S, Nicolucci A, De Feo P, Cavallo S, Cardelli P, et al. Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES). Arch Intern Med. 2010; 170:1794–1803.
    1. Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Parlanti N, et al. Validation of a counseling strategy to promote the adoption and the maintenance of physical activity by type 2 diabetic subjects. Diabetes Care. 2003; 26:404–408.
    1. Nicolucci A, Balducci S, Cardelli P, Cavallo S, Fallucca S, Bazuro A, et al. Relationship of exercise volume to improvements of quality of life with supervised exercise training in patients with type 2 diabetes in a randomised controlled trial: the Italian Diabetes and Exercise Study (IDES). Diabetologia. 2012; 55:579–588. 10.1007/s00125-011-2425-9
    1. Yates T, Davies M, Gorely T, Bull F, Khunti K. Effectiveness of a pragmatic education program designed to promote walking activity in individuals with impaired glucose tolerance: a randomized controlled trial. Diabetes Care. 2009; 32:1404–1410. 10.2337/dc09-0130
    1. Kokkinos P, Myers J, Nylen E, Panagiotakos DB, Manolis A, Pittaras A, et al. Exercise capacity and all-cause mortality in African American and Caucasian men with type 2 diabetes. Diabetes Care. 2009; 32:623–628. 10.2337/dc08-1876
    1. Ekelund U, Ward HA, Norat T, Luan J, May AM, Weiderpass E, et al. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). Am J Clin Nutr. 2015; 101: 613–621. 10.3945/ajcn.114.100065
    1. Shephard RJ. Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med. 2003; 37:197–206. 10.1136/bjsm.37.3.197
    1. Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw JE, Zimmet PZ, et al. Objectively measured light-intensity physical activity is independently associated with 2-h plasma glucose. Diabetes Care. 2007; 30:1384–1389. 10.2337/dc07-0114
    1. Balducci S, Sacchetti M, Haxhi J, Orlando G, Zanuso S, Cardelli P, et al. The Italian Diabetes and Exercise Study 2 (IDES-2): a long-term behavioral intervention for adoption and maintenance of a physically active lifestyle. Trials. 2015; 16:569 10.1186/s13063-015-1088-0
    1. Inoue M, Iso H, Yamamoto S, Kurahashi N, Iwasaki M, Sasazuki S, et al. Daily total physical activity level and premature death in men and women: results from a large-scale population-based cohort study in Japan (JPHC study). Ann Epidemiol. 2008; 18:522–530. 10.1016/j.annepidem.2008.03.008
    1. Sedentary Behaviour Research Network. Letter to the Editor: Standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab. 2012; 37:540–542. 10.1139/h2012-024
    1. Balducci S, Zanuso S, Massarini M, Corigliano G, Nicolucci A, Missori S, et al. The Italian Diabetes and Exercise Study (IDES): Design and methods for a prospective Italian multicentre trial of intensive lifestyle intervention in people with type 2 diabetic and the metabolic Syndrome. Nutr Metab Cardiovasc Dis. 2008; 18:585–595. 10.1016/j.numecd.2007.07.006
    1. Herrmann SD, Hart TL, Lee CD, Ainsworth BE. Evaluation of the MyWellness Key accelerometer. Br J Sports Med. 2011; 45:109–113. 10.1136/bjsm.2009.062182
    1. Bergamin M, Ermolao A, Sieverdes JC, Zaccaria M, Zanuso S. Validation of the MyWellness Key in walking and running speeds. J Sports Sci Med. 2012; 11:57–63.
    1. Sieverdes JC, Wickel EE, Hand GA, Bergamin M, Moran RR, Blair SN. Reliability and validity of the Mywellness Key physical activity monitor. Clin Epidemiol. 2013; 5:13–20. 10.2147/CLEP.S38370
    1. McGinley SK, Armstrong MJ, Khandwala F, Zanuso S, Sigal RJ. Assessment of the MyWellness Key accelerometer in people with type 2 diabetes. Appl Physiol Nutr Metab. 2015; 40:1193–1198. 10.1139/apnm-2015-0169
    1. Sacchetti M, Balducci S, Bazzucchi I, Carlucci F, Scotto di Palumbo A, Haxhi J, et al. Neuromuscular dysfunction in diabetes: role of nerve impairment and training status. Med Sci Sports Exerc. 2013; 45:52–59.
    1. Penno G, Solini A, Bonora E, Fondelli C, Orsi E, Zerbini G, et al. Gender differences in cardiovascular disease risk factors, treatments and complications in patients with type 2 diabetes: the RIACE Italian multicentre study. J Intern Med. 2013; 274:176–191. 10.1111/joim.12073
    1. Febbraio MA. Exercise and inflammation. J Appl Physiol (1985). 2007; 103:376–377.
    1. Balducci S, Zanuso S, Nicolucci A, Fernando F, Cavallo S, Cardelli P, et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis. 2010; 20:608–617. 10.1016/j.numecd.2009.04.015

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