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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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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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Fig. 1 Study design. Each participant followed three activity regimens under free-living conditions, each lasting 4 days: (1) Sitting: 14 h sitting/day; (2) Exercise: 1.1 h/day of sitting replaced by moderate- to vigorous-intensity cycling; and (3) Sit Less: 4.7 h/day of sitting replaced by standing (2.5 h) and light-intensity walking (2.2 h), relative to time spent doing these activities in the Sitting regimen
Fig. 1 Study design. Each participant followed three activity regimens under free-living conditions, each lasting 4 days: (1) Sitting: 14 h sitting/day; (2) Exercise: 1.1 h/day of sitting replaced by moderate- to vigorous-intensity cycling; and (3) Sit Less: 4.7 h/day of sitting replaced by standing (2.5 h) and light-intensity walking (2.2 h), relative to time spent doing these activities in the Sitting regimenCC BY · PubMed Central
Fig. 2 Mean 24 h glucose profiles during the last day of each activity regimen (n = 19 individuals). Solid line, Sitting regimen; dashed line, Sit Less regimen; dotted line, Exercise regimen
Fig. 2 Mean 24 h glucose profiles during the last day of each activity regimen (n = 19 individuals). Solid line, Sitting regimen; dashed line, Sit Less regimen; dotted line, Exercise regimenCC BY · PubMed Central
Fig. 3 (a) Twenty-four hour glucose iAUC during the last day of each activity regimen, (b) insulin resistance expressed as HOMA2-IR on the morning after each activity regimen, (c) duration of hyperglycaemia, and (d) maximal reduction in glucose level at 30 min during the last day of each activity regimen. Data are estimated means ± SEM (n = 19 individuals). * p ≤ 0.05, **p < 0.01 vs Sitting regimen; †, p ≤ 0.05 vs Exercise regimen
Fig. 3 (a) Twenty-four hour glucose iAUC during the last day of each activity regimen, (b) insulin resistance expressed as HOMA2-IR on the morning after each activity regimen, (c) duration of hyperglycaemia, and (d) maximal reduction in glucose level at 30 min during the last day of each activity regimen. Data are estimated means ± SEM (n = 19 individuals). * p ≤ 0.05, **p < 0.01 vs Sitting regimen; †, p ≤ 0.05 vs Exercise regimenCC BY · PubMed Central

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  1. World Health Organization (2010) Global recommendations on physical activity for health. WHO Press, Geneva

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Metadata

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
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
Licence
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 › Public Health, Environmental and Occupational Health › 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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