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Timing of Moderate to Vigorous Physical Activity, Mortality, CVD, and Microvascular Disease in Adults With Obesity
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
To assess the association between timing of aerobic moderate to vigorous physical activity (MVPA) and risk of cardiovascular disease (CVD), microvascular disease (MVD), and all-cause mortality in adults with obesity and a subset with obesity and type 2 diabetes (T2D).
RESEARCH DESIGN AND METHODS
Participants included adults with obesity (BMI ≥30 kg/m2) and a subset of those with T2D from the UK Biobank accelerometry substudy. Aerobic MVPA was defined as bouts of MVPA lasting ≥3 continuous minutes. Participants were categorized into morning, afternoon, or evening MVPA based on when they undertook the majority of their aerobic MVPA. The reference group included participants with an average of less than one aerobic MVPA bout per day. Analyses were adjusted for established and potential confounders.
RESULTS
The core sample included 29,836 adults with obesity, with a mean age of 62.2 (SD 7.7) years. Over a mean follow-up period of 7.9 (SD 0.8) years, 1,425 deaths, 3,980 CVD events, and 2,162 MVD events occurred. Compared with activity in the reference group, evening MVPA was associated with the lowest risk of mortality (hazard ratio [HR] 0.39; 95% CI 0.27, 0.55), whereas afternoon (HR 0.60; 95% CI 0.51, 0.71) and morning MVPA (HR 0.67; 95% CI 0.56, 0.79) demonstrated significant but weaker associations. Similar patterns were observed for CVD and MVD incidence, with evening MVPA associated with the lowest risk of CVD (HR 0.64; 95% CI 0.54, 0.75) and MVD (HR 0.76; 95% CI 0.63, 0.92). Findings were similar in the T2D subset (n = 2,995).
CONCLUSIONS
Aerobic MVPA bouts undertaken in the evening were associated with the lowest risk of mortality, CVD, and MVD. Timing of physical activity may play a role in the future of obesity and T2D management.
Additional Info
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Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity
Diabetes Care 2024 May 01;47(5)890-897, A Sabag, MN Ahmadi, ME Francois, S Postnova, PA Cistulli, L Fontana, E StamatakisFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study assessed the association of the timing of moderate to vigorous physical activity in adults with obesity and a subset with type 2 diabetes and its association with the risk of developing cardiovascular disease, microvascular disease, and all-cause mortality. Patient data was obtained from the UK biobank accelerometry study. A total of 28,836 patients were followed for 7.9 years. Each subset of patients was randomized to morning, afternoon, or evening exercise program. The results show that evening exercise with aerobic moderate to vigorous physical activity was associated with the lowest risk for mortality and cardiovascular and microvascular diseases.
All the three exercise groups had a reduction in all-cause mortality; however, the greatest improvement seems to be with the evening group. Evening group exercise was defined as 6 PM to 12 AM. This timing may pose logistical challenges for busy families or personal schedules. However, if patients are seeking a time of the day with the potential for optimal outcomes, then evening exercise at moderate to vigorous levels may contribute additional benefits.
I continue to encourage patients to exercise and adhere to schedules that yield consistency rather than aiming for specific times of the day, which may become barriers for compliance. For example, advising a patient who has traditionally exercised in the morning for the past 30 years to switch to evenings may be counterproductive. It is also important to remember that exercise frequency and total volume do offer broad health benefits, including reductions in mortality and morbidity irrespective of timing.
Physical activity reduces cardiometabolic risks, and recent evidence indicates that lower cardiovascular morbidity and mortality is associated with moderate to vigorous physical activity (MVPA) bouts. Cardiovascular and metabolic processes have diurnal rhythms, and disturbances in the core clock are observed with insulin resistance and type 2 diabetes (T2D), particularly in the evening period. Therefore, temporal optimization of MVPA may offset these diurnal disturbances and improve cardiometabolic risk. Sabag and colleagues examined the association between the timing of MVPA on mortality and the incidence of cardiovascular disease (CVD) and microvascular disease (MVD). Data from the UK Biobank study were utilized from individuals with obesity with/without T2D between 2006 and 2010 (N = 29,836; mean age, 62.2 years). Physical activity data were recorded between 2013 and 2015 by the wrist Axivity AX3 accelerometer for 7 days. The timing of physical activity was categorized into morning (6 am to ≤12 pm), afternoon (12 pm to ≤6 pm), and evening MVPA (6 pm to ≤12 am) according to where the majority of their MVPA occurred, in bouts lasting ≥3 min. For all-cause mortality, participants were included with around 8 years of follow-up time.
Lower risk of morbidity and mortality was associated with evening MVPA in individuals with obesity with/without T2D, followed by afternoon MVPA. Likewise, the evening MVPA was associated with lower CVD incidence risk followed by afternoon MVPA, whereas in individuals with obesity and T2D, morning and afternoon MVPA had less association with CVD. Regardless of time of day, MVPA resulted in a similar magnitude of risk for MVD, whereas in those with obesity and T2D, risk was lower with evening activity. MVPA at different times of day was associated with the lowest incidence of MVD, and the frequency of aerobic MVPA bouts was a more important factor in the association with mortality and CVD and MVD incidence than duration of the MVPA. This study confirms that the timing of MVPA may be crucial to optimize cardiometabolic health, and clinical trials are needed to study this further.