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Associations of Daily Steps and Step Intensity With Incident Diabetes in a Prospective Cohort Study of Older Women: The OPACH Study

posted on 20.01.2022, 00:10 by Alexis C. Garduno, Andrea Z. LaCroix, Michael J. LaMonte, David W. Dunstan, Kelly R. Evenson, Guangxing Wang, Chongzhi Di, Benjamin T. Schumacher, John Bellettiere
Objective: The primary aim assesses associations between total steps/day and incident diabetes, whereas the secondary aim assesses whether the intensity and/or cadence of steps is associated with incident diabetes.

Research Design and Methods: Women without physician-diagnosed diabetes (n=4,838; mean age=78.9, sd=6.7) were followed up to 6.9 years; 395 developed diabetes. Hip-worn ActiGraph GT3X+ accelerometers worn for one week enabled measures of total, light intensity, and moderate-to-vigorous (MV) intensity steps/day. Cox proportional hazards analysis modeled adjusted change in the hazard rate for incident diabetes associated with total, light, and MV steps/day. We further estimated the proportion of the steps-diabetes association mediated by body mass index (BMI).

Results: On average, participants took 3,729 steps/day (sd=2,114), of which 1,875±791 were light-intensity steps and 1,854±1,762 were MV-intensity. Greater steps/day were associated with a lower hazard rate for incident diabetes. Confounder-adjusted models for a 2000-steps/day increment yielded hazard ratio (HR) (95%CI)=0.88 (0.78-1.00, p=0.046). After further adjustment for BMI, HR=0.90 (95%CI: 0.80-1.02; p=0.11). BMI did not significantly mediate the steps-diabetes association (proportion mediated = 17.7%, 95% CI=-55.0%-142.0%; p=0.09). The relationship between MV steps/day (HR=0.86; 95%CI=0.74-1.00, p=0.04) and incident diabetes was stronger than for light steps/day (HR=0.97; 95%CI=0.73-1.29; p=0.84).

Conclusion: These findings suggest that for older adults, more steps/day are associated with lower incident diabetes and MV-intensity steps are most strongly associated with a lower hazard of diabetes. This evidence supports that regular stepping is an important risk factor for T2D prevention in older adults.


The study was supported by the National Institutes of Health (NIH) contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C, and grant R01HL105065 (AL) and 5R01CA227122 (KE). JB was funded by National Institute on Aging (P01 AG052352), the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK114945), and TRDRP (T31KT1501). This work was also supported by an NIH-funded predoctoral fellowship to A.G. (T32MH122376). The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, 75N92021D00005. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.