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Daily steps, measured by pedometer, may reduce risk for progression to diabetes
Pedometer-measured physical activity is a valuable approach for reducing risk for progression to diabetes in an at-risk population, according to study findings published in BMJ Open Diabetes Research & Care.
“All activity counts in measuring the beneficial effects of physical activity,” William E. Kraus, MD, distinguished professor of cardiovascular genomics and the director of clinical translation at the Duke Molecular Physiology Institute, told Endocrine Today. “We do not have to think about physical activity for health as being only exercising in a gym. Brisk walking and, in fact, some activities of daily living, such as walking across the parking lot to the entrance to our workplace, grocery store or even the coffee shops, counts toward improving our health.”
In the study, the researchers used data from the NAVIGATOR study, a double-blind, placebo-controlled clinical trial that assessed whether valsartan or nateglinide, in conjunction with lifestyle changes, could decrease diabetes and CV event risk in 9,306 patients with impaired glucose tolerance who either had CVD or were at risk for CVD. All study subjects participated in the lifestyle intervention, which was aimed at achieving and maintaining a 5% weight loss, a decrease in dietary saturated and total fats, and increase physical activity to 150 minutes per week. The study’s primary outcome, new onset of diabetes, was defined as the development of a fasting plasma glucose of at least 7.0 mmol/L and/or a 2-hour glucose measurement of at least 200 mg/dL as determined on an oral glucose tolerance test conducted within 12 weeks.
The researchers evaluated regular walking habits objectively through research-quality pedometers in all NAVIGATOR study centers. This equipment tracked steps taken through a horizontal, spring-suspended lever arm, which moved vertically with each step. Steps activated an electrical circuit, which documented the step. Patients were followed for a median of 6.4 years.
Participants also received instruction to write down daily step counts in a log book and return the log book to the study team.
The researchers used unadjusted and adjusted Cox proportional hazard models to evaluate associations between physical activity and clinical outcomes.
Researchers assessed baseline pedometer data for 7,118 of the 9,306 NAVIGATOR participants. At baseline, the mean daily steps by quarters were 1,831, 4,652, 7,096 and 11,240 steps per day.
Over the course of the study, incident diabetes occurred in 35% (3,254) of participants. In the unadjusted analysis, each 2,000 greater number of daily steps, up to 10,000, was associated with an average of 5.5% decreased risk for progression to diabetes (HR = 0.95; 95% CI, 0.92-0.97). In analyses adjusted for age, sex and region origin, findings persisted (HR = 0.95; 95% CI, 0.92-0.96), according to researchers. Researchers observed similar results in the fully adjusted model (HR = 0.96; 95% CI, 0.94-0.99).
“Counting steps may be a very effective way of measuring how much physical activity and exercise we get,” Kraus said. “As a physician, I personally recommend that my patients aim for 10,000 steps per day.” – by Jennifer Byrne
For more information:
William E. Kraus, MD, can be reached at the Duke Molecular Physiology Institute, 300 North Duke Street, Durham, NC 27701; email: william.kraus@duke.edu.
Disclosure: The Navigator study was supported by Novartis. Kraus reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.