American Diabetes Association
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Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2)

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Version 3 2021-11-08, 14:58
Version 2 2021-11-08, 14:57
Version 1 2021-11-02, 14:13
posted on 2021-11-08, 14:58 authored by Stefano Balducci, Jonida Haxhi, Massimo Sacchetti, Giorgio Orlando, Patrizia Cardelli, Martina Vitale, Lorenza Mattia, Carla Iacobini, Lucilla Bollanti, Francesco Conti, Silvano Zanuso, Antonio Nicolucci, Giuseppe Pugliese, the Italian Diabetes and Exercise Study 2 (IDES_2) Investigators
Objective. In the Italian Diabetes and Exercise Study_2, a behavioral counseling promoted a sustained increase in physical activity (PA) volume (+3.3 metabolic equivalents-hour·week-1), moderate-to-vigorous-intensity PA (MVPA, +6.4 min·day-1), and light-intensity PA (LPA, +0.8 hours·day-1) and decrease in sedentary time (SED-time, -0.8 hours·day-1). Here, we investigated the relationships of changes in PA/SED-time with changes in physical fitness and cardio-metabolic risk profile in individuals with type 2 diabetes.

Research Design and Methods. In this 3-year randomized clinical trial, 300 physically inactive and sedentary patients were randomized 1:1 to receive one-month theoretical and practical counseling once-a-year or standard care. Changes in physical fitness and cardiovascular risk factors/scores according to quartiles of accelerometer-measured changes in PA/SED-time were assessed, together with univariate and multivariable associations between these parameters, in the whole cohort and by study arm.

Results. Physical fitness increased and HbA1c and coronary heart disease 10-year risk scores decreased with quartiles of MVPA and SED-time change. In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 ml·min-1·kg-1 and HbA1c decreased by 0.73 and 0.85%, respectively. Univariate correlations confirmed these relationships and mean changes in both MPVA and SED-time predicted changes in physical fitness and cardiovascular risk factors/scores independently of one another and of other confounders. Similar findings were observed with LPA and PA volume and in each group separately.

Conclusions. Even modest increments in MVPA may have a clinically meaningful impact and reallocating SED-time to LPA may also contribute to improve outcomes, possibly by increasing total energy expenditure.


This work was supported by the Metabolic Fitness Association, Monterotondo, Rome, Italy. The sponsor had no role in design and conduct of the study; collection, management, and interpretation of the data; or preparation, review, and approval of the manuscript.


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