Adults with type 2 diabetes who lost 10% or more body weight move more, sleep better
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Adults with type 2 diabetes who lost at least 10% of their body weight engaged in more physical activity and slept better at 12 and 24 months than those who lost less weight, according to a study published in Diabetic Medicine.
In data from the Diabetes Remission Clinical Trial (DiRECT) trial, adults participating in an evidence-based weight management intervention had similar physical activity levels as control participants at 12- and 24-month follow-up, and higher levels of physical activity were observed only among those who lost more weight during the trial.
“We had expected that the subjective reports of greater daily physical activity would be matched by at least some increase in activity in the intervention group of DiRECT,” Roy Taylor, MD, professor of medicine and metabolism at Newcastle University in the U.K., told Healio. “However, those who lost the most weight clearly increased their daily activity. The study was not designed to distinguish between the two possible explanations for this — those who had to carry around much less body weight found it easier to walk more, or that those who were most motivated to improve health followed more exactly both the dietary and the activity advice.”
Activity similar between groups
Taylor and colleagues analyzed data from DiRECT, a randomized controlled trial in which adults aged 20 to 65 years with type 2 diabetes and a BMI between 27 kg/m2 and 45 kg/m2 were randomly assigned to an evidence-based weight management intervention or a best-practice care control group. During the study’s first phase of a total diet replacement for the intervention group for 3 months, participants were advised not to change their physical activity habits.
Beginning with the second phase of stepped food reintroduction for the intervention group, participants were asked to increase their physical activity and were provided with a step counter. An individual goal-setting approach was used to increase activity. Adults wore an accelerometer for 7 consecutive days at baseline, 12 months and 24 months to measure physical activity and sleep changes. Acceleration thresholds were used to differentiate between inactivity, light physical activity and moderate to vigorous physical activity. Sleep duration and wakefulness after sleep onset were calculated. Participants were included in the study if they wore their accelerometer for at least 3 days.
The analysis included 170 participants:104 from the control group and 66 from the intervention group. No differences in physical activity variables were observed between intervention and control participants at 12 and 24 months. The intervention group had a longer sleep duration at 24 months than controls (402.8 minutes per night vs. 381.2 minutes per night; P = .045).
More weight loss linked to more physical activity
Researchers conducted an exploratory analysis in which the study cohort was subdivided into a group that lost 10% or more body weight and those who lost less than 10%. Adults who lost 10% or more weight performed 11 more minutes of physical activity per day (P = .033) and had 65.8 fewer minutes of inactivity per day (P = .078) at 24 months than those who lost less weight. The group that lost more weight had a longer time of wakefulness at sleep onset at baseline than the group losing less weight (75.5 minutes per day vs. 57.2 minutes per day; P = .014), but no differences were observed at follow-up. Sleep duration did not differ between the subgroups.
“We know that sleep apnea is more common in heavier people, and also we know that some of our research participants were able to discontinue use of continuous positive airways pressure devices after weight loss,” Taylor said. “So it is not surprising that 10% or more weight loss brought about a sounder night’s sleep, that is, more time asleep and less disturbances to sleep. This is likely to have contributed to the reported improvement in well-being.”
Taylor said the findings revealed that researchers need to find more effective ways for adults with type 2 diabetes to be more active in their daily lives.
“Our own body is the heaviest thing that we lift many times a day and duration of activity is important in determining how much energy we burn,” Taylor said. “Any program must be cost effective to be rolled out by health providers, so a dose-response study is also required to find the optimal balance.”
For more information:
Roy Taylor, MD, can be reached at roy.taylor@newcastle.ac.uk.
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