Sitting Less and Moving More: Improved Glycaemic Control for Type 2 Diabetes Prevention and Management
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Epidemiological evidence indicates that excessive time spent in sedentary behaviours (too much sitting) is associated with an increased risk of type 2 diabetes (T2D). Here, we highlight findings of experimental studies corroborating and extending the epidemiological evidence and showing the potential benefits for T2D of reducing and breaking up sitting time across the whole day. We also discuss future research opportunities and consider emerging implications for T2D prevention and management. This new evidence is stimulating an expansion of diabetes-related physical activity guidelines—suggesting that in addition to moderate-vigorous physical activity, reducing and regularly interrupting prolonged sitting time is likely to have important and varied benefits across the spectrum of diabetes risk.
KeywordsSitting Sedentary behaviour Breaks in sedentary time Physical activity Exercise Diabetes Insulin resistance Metabolic syndrome Prediabetes Glycaemic control Cardiovascular Cardiometabolic risk
Neville Owen is supported by a NHMRC Program Grant (#569940) and a NHMRC Senior Principal Research Fellowship (#1003960) and the Victorian Government’s Operational Infrastructure Support Program. Thomas E. Yates helped develop and validate a diabetes prevention programme, Let’s Prevent Diabetes, selected to be part of Healthier You: The NHS Diabetes Prevention Programme in collaboration with Ingeus UK Limited. Bronwyn A. Kingwell is supported by a NHMRC Program Grant (#1036352) and a NHMRC Senior Principal Research Fellowship (#1059454) and the Victorian Government’s Operational Infrastructure Support Program. David W. Dunstan is supported by an NHMRC Senior Research Fellowship (#1078360) and the Victorian Government’s Operational Infrastructure Support Program and was invited keynote presenter at the 2nd Annual JustStand Wellness Summit in July 2012. His travel and housing expenses were covered by Ergotron Pty Ltd. No honorarium was received.
Compliance with Ethical Standards
Conflict of Interest
Paddy C. Dempsey, Neville Owen, Thomas E. Yates, Bronwyn A. Kingwell and David W. Dunstan declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387:1513–30.Google Scholar
- 2.IDF diabetes atlas. 7th ed: International Diabetes Federation; 2016.Google Scholar
- 5.Barr EL, Zimmet PZ, Welborn TA, et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation. 2007;116:151–7.CrossRefPubMedGoogle Scholar
- 8.•Sedentary Behaviour Research Network. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab. 2012;37:540- 2. Provided a standardized definition of the term “sedentary behavior” and a rationale for its use in clinical and research settings.Google Scholar
- 14.••Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and metaanalysis. Ann Intern Med. 2015;162:123–32. Large meta-analysis using predominantly prospective studies. Observed significant associations between sedentary behavior and cardiovascular disease events/mortality, with associations somewhat attenuated by higher levels of physical activity. Strongest associations were for risk for type 2 diabetes.CrossRefPubMedGoogle Scholar
- 19.••Brocklebank LA, Falconer CL, Page AS, et al. Accelerometer-measured sedentary time and cardiometabolic biomarkers: a systematic review. Prev Med. 2015;76:92–102. Systematic review of studies utilizing accelerometer-measured sedentary time. Observed significant associations between high sedentary behavior with poor insulin sensitivity, and some evidence that total sedentary time was unfavorably associated with fasting insulin, insulin resistance and triglycerides.CrossRefPubMedGoogle Scholar
- 20.••Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016. Largest harmonized meta-analysis to date of 16 prospective studies examining associations of sitting and television time and physical activity with all-cause mortality. Observed that high levels of moderate intensity physical activity (60–75 min/day) eliminated the increased risk of death associated with high sitting time (>8 h/day, but not with high (≥5 h/day) television time.Google Scholar
- 24.•Chastin SF, Egerton T, Leask C, et al. Meta-analysis of the relationship between breaks in sedentary behavior and cardiometabolic health. Obesity (Silver Spring). 2015;23:1800–10. Systematic review and meta-analysis which investigated the relationship between breaks in sedentary behavior with adiposity and cardiometabolic health (including both observational and experimental studies). Showed that interrupting bouts of sedentary behavior with light-intensity activity may help control adiposity and postprandial glycemia.CrossRefGoogle Scholar
- 25.Brown WJ, Bauman AE, Bull FC, et al. Development of evidence-based physical activity recommendations for adults (18-64 years). Report prepared for the Australian Government Department of Health. 2012.Google Scholar
- 26.The Sedentary Behaviour & Obesity Expert Working Group. The Sedentary Behaviour & Obesity Expert Working Group. Sedentary behaviour and obesity: review of the current scientific evidence. Department of Health. 2010.Google Scholar
- 31.••Larsen RN, Kingwell BA, Robinson C, et al. Breaking up of prolonged sitting over three days sustains, but does not enhance, lowering of postprandial plasma glucose and insulin in overweight and obese adults. Clin Sci (Lond). 2015;129:117–27. Randomized acute cross-over study in overweight-obese adults which examined whether the impact of breaking up prolonged sitting with bouts of light-walking has cumulative metabolic effects when performed over 3 cumulative days. Showed acute benefit, but no temporal (cumulative) changes in relative hyperglycemia across the 3 day experimental period.CrossRefGoogle Scholar
- 37.••Henson J, Davies MJ, Bodicoat DH, et al. Breaking up prolonged sitting with standing or walking attenuates the postprandial metabolic response in postmenopausal women: a randomized acute study. Diabetes Care. 2016;39:130–8. Randomized acute cross-over study in post-menopausal women with dysglycemia which examined the impact of breaking up prolonged sitting with bouts of light-walking or static standing. Showed improvements in postprandial glucose, insulin (on both days 1 and 2) and NEFA responses, but not triglycerides.CrossRefPubMedGoogle Scholar
- 39.••Dempsey PC, Larsen RN, Sethi P, et al. Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care. 2016;39:964–72. Randomized acute cross-over study in men and women with type 2 diabetes which examined the impact of breaking up prolonged sitting with intermittent bouts of light walking or simple body-weight resistance activities. Showed improvements in postprandial glucose, insulin, c-peptide and triglyceride responses.CrossRefPubMedGoogle Scholar
- 42.Colberg SR. Physical activity: the forgotten tool for type 2 diabetes management. Front Endocrinol (Lausanne). 2012;3:70.Google Scholar
- 45.Knudsen SH, Karstoft K, Pedersen BK, et al. The immediate effects of a single bout of aerobic exercise on oral glucose tolerance across the glucose tolerance continuum. Physiol Rep. 2014;2.Google Scholar
- 48.••Healy GN, Winkler EA, Owen N, et al. Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers. Eur Heart J. 2015;36:2643–9. Objective-measurement data used to model the potential impacts of reducing sitting time; replacing sitting time with an equivalent time spent standing showed benefits for glucose/lipid metabolism; replacing sitting with walking showed benefits for BMI and waist circumference. Findings suggested that, while more time spent standing is beneficial for some markers, more active alternatives to sitting would be preferable.CrossRefPubMedGoogle Scholar
- 49.Duvivier BM, Schaper NC, Bremers MA, et al. Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable. PLoS One. 2013;8, e55542.CrossRefPubMedPubMedCentralGoogle Scholar
- 50.••Healy GN, Eakin EG, Owen N, et al. A cluster RCT to reduce office workers’ sitting time: impact on activity outcomes. Med Sci Sports Exerc. 2016. Cluster-randomized trial of a multi-component intervention for sitting time reduction in sedentary office workers. Reported a -99.1 min/8h reduction in sitting time during working hours following 3 months of the program, which was diminished at 12 months (-45.4 min/8h) but remained significantly different to the control condition.Google Scholar
- 51.•Lyden K, Keadle SK, Staudenmayer J, et al. Discrete features of sedentary behavior impact cardiometabolic risk factors. Med Sci Sports Exerc. 2015;47:1079–86. Experimental study that examined the effects of 7 days increased sitting on markers of cardiometabolic risk. Study was conducted in a free-living environment. 2-h plasma insulin and area under the insulin curve were significantly elevated following the sedentary intervention. Changes in insulin responses were correlated with sitting bouts longer than 30 min.CrossRefPubMedPubMedCentralGoogle Scholar
- 52.••Biddle SJ, Edwardson CL, Wilmot EG, et al. A randomised controlled trial to reduce sedentary time in young adults at risk of type 2 diabetes mellitus: Project STAND (Sedentary Time ANd Diabetes). PLoS One. 2015;10:e0143398. Randomized controlled trial that determined whether a group-based structured education workshop focused on sitting reduction, with self-monitoring, reduced sitting time in adults at risk for type 2 diabetes. Study was unsuccessful in changing behavior at 12 months.CrossRefPubMedPubMedCentralGoogle Scholar
- 55.Richter EA, Mikines KJ, Galbo H, et al. Effect of exercise on insulin action in human skeletal muscle. J Appl Physiol (1985). 1989;66:876–85.Google Scholar
- 62.•Buman MP, Winkler EA, Kurka JM, et al. Reallocating time to sleep, sedentary behaviors, or active behaviors: associations with cardiovascular disease risk biomarkers, NHANES 2005-2006. Am J Epidemiol. 2014;179:323–34. Cross-sectional study in participants from NHANES. Used iso-temporal substitution modelling to demonstrate the beneficial effects of replacing sedentary time with sleep, light activity, or moderate-vigorous physical activity on cardiovascular disease risk biomarkers.CrossRefPubMedGoogle Scholar
- 65.•Yates T, Henson J, Edwardson C, et al. Objectively measured sedentary time and associations with insulin sensitivity: importance of reallocating sedentary time to physical activity. Prev Med. 2015;76:79–83. Cross-sectional study in participants with an increased risk of impaired glucose regulation. Used iso-temporal substitution to quantify associations between objectively-measured sedentary time and markers of insulin sensitivity. Indicated potential improvements in insulin sensitivity of re-allocating 30 min of sedentary time to either light activity (5%) or moderate-vigorous (18%) physical activity.CrossRefPubMedGoogle Scholar
- 73.Bergouignan A, Latouche C, Heywood S, et al. Frequent interruptions of sedentary time modulates contraction- and insulin-stimulated glucose uptake pathways in muscle: ancillary analysis from randomized clinical trials. Sci Rep. 2016;6:32044. doi: 10.1038/srep32044.
- 84.Dempsey PC, Sacre JW, Larsen RN, et al. Interrupting prolonged sitting with brief bouts of light walking or simple resistance activities reduces resting blood pressure and plasma noradrenaline in type 2 diabetes. J Hypertens. 2016. doi: 10.4172/2155-6156.S10-004.
- 90.Reis RS, Salvo D, Ogilvie D, et al. Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving. Lancet. 2016.Google Scholar
- 91.Sallis JF, Bull F, Guthold R, et al. Progress in physical activity over the Olympic quadrennium. Lancet. 2016.Google Scholar
- 96.•Prince SA, Saunders TJ, Gresty K, et al. A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta-analysis of controlled trials. Obes Rev. 2014;15:905–19. Systematic review and meta-analysis of interventions with a focus on physical activity and/or sedentary behaviors. Found interventions that focus solely on sedentary behaviors resulted in greater reductions in sedentary time than those interventions focusing primarily on increasing physical activity. However, the quality of the studies were classified as “very low” and “moderate”.CrossRefPubMedPubMedCentralGoogle Scholar
- 97.••Martin A, Fitzsimons C, Jepson R, et al. Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis. Br J Sports Med. 2015;49:1056–63. Systematic review and meta-analysis which investigated the effect of interventions which included sedentary behavior as an outcome measure in adults, Showed that lifestyle interventions (moderate quality) reduced sedentary behavior by 24 min/day, but that interventions focusing on sedentary behavior only (low quality) reduced sedentary behavior by 42 min/day.CrossRefPubMedGoogle Scholar