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Interrupting sitting time with walking, standing improves glycemic control in type 2 diabetes
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For adults with type 2 diabetes, interrupting sitting time with short bouts of walking or standing time improved 24-hour glucose control and insulin resistance vs. a standard exercise regimen, according to findings from a randomized crossover study.
“Our results suggest that in addition to exercise, people should also reduce their sitting time,” Bernard Duvivier, MD, of the department of human movement sciences at Maastricht University Medical Centre in the Netherlands, told Endocrine Today. “For people with type 2 diabetes, light-intensity activities (light walking and standing) can be an alternative to exercise to improve glucose levels, triglycerides and insulin sensitivity. We need dose-response studies investigating the feasibility of replacing sitting time with light activities in the long term.”
Duvivier and colleagues analyzed data from 19 adults with type 2 diabetes aged 40 to 75 years who exercised no more than 2.5 hours per week (13 men; mean age, 63 years; mean BMI, 30.5 kg/m²; mean HbA1c, 6.7%). Between February and May 2015, researchers randomly assigned participants to one of three interventions lasting 4 days. During the “sitting” regimen, participants were instructed to restrict walking to 1 hour per day and standing to 1 hour per day, spending the remainder of the day sitting. For the “exercise” regimen, participants were instructed to replace 1 hour per day of sitting time with supervised cycling on an ergometer, performed at least 2 hours after breakfast. For the “sit less” regimen, participants were instructed to replace approximately 5 hours per day of sitting with 2 hours of walking and 3 hours of standing, preferably breaking up their sitting time every 30 minutes and dividing walking and standing activities throughout the day. All participants wore accelerometers and continuous glucose monitors (24-hour glucose levels were measured on day 4); meals were standardized during the interventions. There was a 10-day washout period between regimens.
When performing the sit-less regimen, participants saw glucose levels reduced by approximately 36% vs. when performing the sitting regimen; incremental area under the curve for 24-hour glucose fell from a mean of 1,974 min x mmol/L during sitting to a mean of 1,263 min x mmol/L during the sit-less regimen (P = .002). The mean 24-hour glucose excursion was similar between the sit-less and exercise regimens (exercise regimen, 1,383 min x mmol/L; P = .499).
The sit-less regimen also improved insulin resistance; mean insulin resistance via homeostatic model of insulin resistance-2 (HOMA2-IR) was 1.89 for sit-less vs. 2.16 for sitting; however, the exercise regimen failed to improve insulin resistance (mean HOMA2-IR, 2.06).
“This finding may seem surprising given the high dose of exercise (65 minutes per day cycling at an intensity of 5.9 [metabolic equivalents]),” the researchers wrote. “It is possible that HOMA-IR was not accurate enough to detect relatively small changes in insulin sensitivity after exercise. However, it should be noted that during the exercise regimen participants spent most of the day sitting.”
The researchers noted that the duration of nonsitting activities may be more important than the intensity level.
“Additionally, the more abrupt and prominent reduction in blood glucose in the structured exercise intervention is proposed to increase the risk of hypoglycemia,” the researchers wrote. – by Regina Schaffer
For more information:
Bernard Duvivier, MD, can be reached at the Department of Human Movement Sciences, Maastricht University Medical Centre, Postbox 616, 6200 MD Maastricht, the Netherlands; email: bernard.duvivier@maastrichtunivesity.nl.
Disclosure: Duvivier reports no relevant financial disclosures.
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