Breaking sitting with light activities vs structured exercise: a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes

Duvivier, Bernard M. F. M.; Schaper, Nicolaas C.; Hesselink, Matthijs K. C.; van Kan, Linh; Stienen, Nathalie; Winkens, Bjorn; Koster, Annemarie; Savelberg, Hans H. C. M.

doi:10.1007/s00125-016-4161-7

Cited by 212Physical Activity and HealthDiabetes Management and ResearchDiabetes Treatment and Management

Breaking sitting with light activities vs structured exercise: a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes

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Duvivier, Bernard M. F. M., Schaper, Nicolaas C., Hesselink, Matthijs K. C., van Kan, Linh, Stienen, Nathalie, Winkens, Bjorn, Koster, Annemarie, Savelberg, Hans H. C. M.·2017·Diabetologia

DOI 10.1007/s00125-016-4161-7PMC PMC6518091

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Abstract

AIMS/HYPOTHESIS: We aimed to examine the effects of breaking sitting with standing and light-intensity walking vs an energy-matched bout of structured exercise on 24 h glucose levels and insulin resistance in patients with type 2 diabetes. METHODS: In a randomised crossover study, 19 patients with type 2 diabetes (13 men/6 women, 63 ± 9 years old) who were not using insulin each followed three regimens under free-living conditions, each lasting 4 days: (1) Sitting: 4415 steps/day with 14 h sitting/day; (2) Exercise: 4823 steps/day with 1.1 h/day of sitting replaced by moderate- to vigorous-intensity cycling (at an intensity of 5.9 metabolic equivalents [METs]); and (3) Sit Less: 17,502 steps/day with 4.7 h/day of sitting replaced by standing and light-intensity walking (an additional 2.5 h and 2.2 h, respectively, compared with the hours spent doing these activities in the Sitting regimen). Blocked randomisation was performed using a block size of six regimen orders using sealed, non-translucent envelopes. Individuals who assessed the outcomes were blinded to group assignment. Meals were standardised during each intervention. Physical activity and glucose levels were assessed for 24 h/day by accelerometry (activPAL) and a glucose monitor (iPro2), respectively. The incremental AUC (iAUC) for 24 h glucose (primary outcome) and insulin resistance (HOMA2-IR) were assessed on days 4 and 5, respectively. RESULTS: The iAUC for 24 h glucose (mean ± SEM) was significantly lower during the Sit Less intervention than in Sitting (1263 ± 189 min × mmol/l vs 1974 ± 324 min × mmol/l; p = 0.002), and was similar between Sit Less and Exercise (Exercise: 1383 ± 194 min × mmol/l; p = 0.499). Exercise failed to improve HOMA2-IR compared with Sitting (2.06 ± 0.28 vs 2.16 ± 0.26; p = 0.177). In contrast, Sit Less (1.89 ± 0.26) significantly reduced HOMA2-IR compared with Exercise (p = 0.015) as well as Sitting (p = 0.001). CONCLUSIONS/INTERPRETATION: Breaking sitting with standing and light-intensity walking effectively improved 24 h glucose levels and improved insulin sensitivity in individuals with type 2 diabetes to a greater extent than structured exercise. Thus, our results suggest that breaking sitting with standing and light-intensity walking may be an alternative to structured exercise to promote glycaemic control in patients type 2 diabetes. TRIAL REGISTRATION: , and the Dutch Heart Foundation. Financial support was also provided by Novo Nordisk BV, and Medtronic and Roche made the equipment available for continuous glucose monitoring.

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Individuals with diabetes and prediabetes often have barriers to exercise due to being frail or functionally compromised, making it difficult for them to tolerate long-lasting moderate-to-vigorous intensity physical activity as recommended (at least 150 min/week).
“However, individuals with diabetes and prediabetes often have barriers to exercise due to being frail or functionally compromised;9 therefore, tolerating long-lasting moderate-to-vigorous intensity PA (MVPA) as recommended (at least 150 min/week) is difficult for them.8”
From Accelerometer-measured physical activity, sedentary behavior, and incidence of macrovascular and microvascular events in individuals with type 2 diabetes mellitus and prediabetes (2025) · cites this paper as [9]
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In one study, replacing sitting with light-intensity walking and standing for 4.5 hours a day or cycling for 65 minutes a day improved 24-hour glucose compared with control, but insulin resistance was only significantly reduced in the light-intensity group.
“One study compared patients sitting for 14 hours daily against those replacing some of the sitting time with cycling for 65 minutes a day or those performing a combination of light-intensity walking and standing for 4.5 hours a day.Glucose levels over 24 hours, measured as area under the curve, improved in both groups with light-intensity walking and standing (À711 min × mmol/L) and those who cycl”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [88]

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Interrupting Prolonged Sitting
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Benefits for Type 2 Diabetes of Interrupting Prolonged Sitting With Brief Bouts of Light Walking or Simple Resistance Activities
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Interrupting prolonged sitting in type 2 diabetes: nocturnal persistence of improved glycaemic control
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Authors: Duvivier, B. M. F. M., Schaper, N. C., Hesselink, M. K. C., van Kan, L., Stienen, N., Winkens, B., Koster, A., & Savelberg, H. H. C. M.
Affiliations: Maastricht University Medical Centre (NL)
Corresponding author: Duvivier, Bernard M. F. M.
ORCID: Duvivier, Bernard M. F. M.
Schaper, Nicolaas C.
Hesselink, Matthijs K. C.
Koster, Annemarie
Savelberg, Hans H. C. M.
Venue: Diabetologia
Publisher: Springer Science and Business Media LLC
Published: 2016-11-30
Volume: 60
Issue: 3
Pages: 490-498
ISSN: 0012-186X (ISSN-L)
1432-0428
DOI: 10.1007/s00125-016-4161-7
PMC: PMC6518091
OpenAlex: W2556532561
Cited by: 212
References: 32
Citations by year: 2026: 8 · 2025: 18 · 2024: 20 · 2023: 22 · 2022: 31 · 2021: 36 · 2020: 28 · 2019: 11 · 2018: 24 · 2017: 12 · 2016: 1
FWCI: 12.88
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
Locations: Diabetologia (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion, cc-by)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders: Novo Nordisk B.V.
Kootstra Talent Fellowship from the Centre for Research Innovation, Support and Policy of Maastricht University Medical Centre +
Roche
Maastricht University Medical Centre +
Medtronic
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: type 2 diabetes, sedentary behavior, standing, structured exercise, cycling, glycemic control, insulin resistance, HOMA2-IR, free-living physical activity, step count, accelerometry, glucose monitoring, energy expenditure, free-living conditions, non-pharmacological treatment
MeSH terms: Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Humans, Insulin, Insulin Resistance, Male, Middle Aged, Posture, Exercise, Walking, Cross-Over Studies, Lipid Metabolism, Sedentary Behavior

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Breaking sitting with light activities vs structured exercise: a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes

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