Adding exercise or subtracting sitting time for glycaemic control: where do we stand?

Abstract

While regular structured exercise is a wellestablished (though arguably under-utilised) cornerstone in the prevention and management of type 2 diabetes, population adherence to recommended exercise guidelines remains stubbornly low. Indeed, most adults are exposed to environmental settings (at work, in automobile travel and in the domestic environment) that may not only limit their physical activity, but also promote sitting for prolonged periods of time. However, recent experimental evidence indicates that reducing and breaking up sitting time may also be a useful strategy to improve glycaemic control. In this issue of Diabetologia, Duvivier and colleagues report findings which suggest that reducing sitting time with standing and light-intensity activity could be a potential alternative to structured exercise for improving glycaemic control in type 2 diabetes patients. We review and discuss the findings of this study, its potential clinical implications, and a number of knowledge gaps and opportunities that could be considered in the interest of future research. The findings from Duvivier and colleagues should encourage healthcare practitioners, researchers and type 2 diabetes patients to consider the whole spectrum of physical activity, from sedentary behaviour through to structured exercise.

Sedentary behavior as a risk factor for cognitive decline? A focus on the influence of glycemic control in brain health

“…The “Exercise” regimen also tended to improve these outcomes, albeit to a lesser magnitude than “Sit Less” despite a comparable energy expenditure. The results of this study have generated some important discussion around potential implications [49] . The implications pertaining to glycemic control are that: (1) exercise bouts performed in the morning may not fully compensate for the negative effects of prolonged sitting for the rest of the day; and (2) the duration and frequency of physical activity, aided by timing around meals, may be more important than the intensity of physical activity.…”

An Under-the-Table Leg-Movement Apparatus and Changes in Energy Expenditure

“…It is not surprising that energy expenditure increased significantly based on leg movements alone because gluteal-femoral muscular contractions contribute substantially to human energy expenditure (Westerterp et al, 1996; Westerterp and Bouten, 1997). What is important to note is that these types of movements may directly impact glycemic control and other health outcomes (Kadam and Chuan, 2016; Dempsey et al, 2017; Fanchamps et al, 2017; Larsen et al, 2017) although we did not measure these outcomes. The under-the-table dynamic-sitting apparatus we tested was exothermic but unlikely to contribute to aerobic fitness.…”

Health effects of reduced occupational sedentary behaviour in type 2 diabetes using a mobile health intervention: a study protocol for a 12-month randomized controlled trial—the ROSEBUD study

“…Comparator arm Participants in the comparator arm will only receive individual face-to-face counselling and telephone counselling with a diabetes specialist nurse who will use a patient-centred approach focused on occupational sitting [13,18].…”

“…Moreover, experimental evidence indicates that reducing and breaking up sitting time may be a useful strategy to improve glucose control [ 5 , 6 , 9 , 10 ] and quality of life [ 11 ], as well as reducing fatigue [ 12 ]. Therefore, interrupting prolonged sitting with more light-intensity activities has been suggested as a beneficial and pragmatic intervention for individuals with T2DM, particularly in those who are physically inactive, are obese or have reduced exercise tolerance [ 13 , 14 ]. Accordingly, the 2016 Position Statement on physical activity/exercise and diabetes from the American Diabetes Association (ADA) includes specific recommendations to reduce and interrupt prolonged sitting [ 3 ].…”