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Effect of Changes in Physical Activity on Physical Fitness and Cardiometabolic Risk Profile in Type 2 Diabetes
In the Italian Diabetes and Exercise Study_2 (IDES_2), behavioral counseling promoted a sustained increase in physical activity (PA) volume (+3.3 MET h ⋅ week-1), moderate- to vigorous-intensity PA (MVPA) (+6.4 min ⋅ day-1), and light-intensity PA (LPA) (+0.8 h ⋅ day-1) and decrease in sedentary time (SED-time) (-0.8 h ⋅ day-1). Here, we investigated the relationships of changes in PA/SED-time with changes in physical fitness and cardiometabolic risk profile in individuals with type 2 diabetes.
RESEARCH DESIGN AND METHODS
In this 3-year randomized clinical trial, 300 physically inactive and sedentary patients were randomized 1:1 to receive 1-month theoretical and practical counseling once a year or standard care. 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, in the whole cohort and by study arm.
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.
Even modest increments in MVPA may have a clinically meaningful impact, and reallocating SED-time to LPA may also contribute to improved outcomes, possibly by increasing total energy expenditure.
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)Diabetes Care 2021 Nov 02;[EPub Ahead of Print], S Balducci, J Haxhi, M Sacchetti, G Orlando, P Cardelli, M Vitale, L Mattia, C Iacobini, L Bollanti, F Conti, S Zanuso, A Nicolucci, G Pugliese
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This prespecified ancillary analysis of data from the full IDES_2 study resulted in some important findings deriving from how it addressed physical activity (PA) and a sedentary lifestyle. In most studies (and even the main analyses of the IDES_2 study), either increasing PA to meet guidelines or decreasing sedentary time is considered, not both. To be included in this ancillary analysis, however, adults with type 2 diabetes, aged 40 to 80 years, had to be both physically inactive—failing to meet the minimal weekly aerobic guidelines of 150 minutes of moderate to vigorous physical activity (MVPA)—and have a sedentary lifestyle for the prior 6 months to be included. This is important because it is possible to increase MVPA to meet guidelines and still have a sedentary lifestyle and vice versa.
In this study, the researchers specifically investigated the ability of behavioral counseling to lead to increased MVPA and decreased sedentary time to determine the relative importance of each behavior in improving physical fitness (estimated with VO2 max) and cardiovascular disease (CVD) risk profiles over a 3-year period. Participants were randomized to either receive nine sessions (completed in a month) of theoretical and practical exercise counseling once per year during the study or general physician recommendations only, which served as the control. Both groups finished with 133 to 134 participants in each, making it a rather small subset of the full IDES_2. However, the study design allowed for the parsing out of the effects of not only more MVPA and decreased sedentary time independently but also a greater total PA volume and increased light PA (LPA).
Importantly, the authors reported that even modest increases in MVPA had a clinically meaningful impact on physical fitness and CVD risk in these participants. Furthermore, replacing sedentary time with LPA independently contributed to these improvements. These findings are significant because they open up a variety of avenues for clinicians to address fitness and CVD risk in inactive, sedentary populations with type 2 diabetes instead of simply recommending that people meet the MVPA guidelines. Replacing sedentary time with LPA (including increased daily steps and more daily movement) may be more attainable for many individuals who find it easier to simply move more, including taking more frequent activity breaks of any intensity during extended sedentary times.