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Cited by 23Physical Activity and HealthDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Accelerometer-measured physical activity, sedentary behavior, and incidence of macrovascular and microvascular events in individuals with type 2 diabetes mellitus and prediabetes

Open access
Liang, Yannis Yan, He, Yu, Huang, Piao, Feng, Hongliang, Li, Haiteng, Ai, Sizhi, Du, Jing, Xue, Huachen +4 more·2025·Journal of Sport and Health Science
DOI 10.1016/j.jshs.2024.100973PMC PMC11863271
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Abstract

BACKGROUND: Physical activity (PA) is considered beneficial for lowering cardiovascular risks following type 2 diabetes mellitus (T2DM) and prediabetes, but existing evidence relies mainly on self-reported measurements. We aimed to describe the intensity-specific dose-response associations of PA and sedentary behavior (SB) with macrovascular and microvascular events among individuals with T2DM and prediabetes. METHODS: This study included 11,474 individuals with T2DM and prediabetes from the UK Biobank. PA, including total PA, moderate-to-vigorous intensity PA (MVPA), light-intensity PA (LPA), and SB, were measured by accelerometers over 7 days. MVPA was categorized according to the American Diabetes Association guideline-recommended level (at least 150 min/week), and total PA, LPA, and SB were grouped by tertiles. The outcomes were incidences of macrovascular events, microvascular events, heart failure (HF), and their combination (composite events). The events were ascertained using the International Classification of Diseases-10 (ICD-10) codes on the hospital or death records. RESULTS: During a median follow-up of 6.8 years, 1680 cases were documented, including 969 macrovascular events, 839 microvascular events, and 284 incidents of HF. Accelerometer-measured PA, irrespective of intensity, was inversely associated with the risk of composite events and each outcome in the dose-response patterns. Regarding categorized PA, engagement in total PA (high vs. low) was associated with decreased risk of macrovascular events (hazard ratio (HR) = 0.80; 95% confidence interval (95%CI): 0.67-0.95), microvascular events (HR = 0.76; 95%CI: 0.63-0.93), and HF (HR = 0.46; 95%CI: 0.32-0.66). Adherence to MVPA, but not LPA, above the guideline-recommended level (at least 150 min/week) was associated with reduced risk of macrovascular events (HR = 0.80; 95%CI: 0.68-0.95), microvascular events (HR = 0.76; 95%CI: 0.63-0.92), and HF (HR = 0.65; 95%CI: 0.46-0.92). The minimum dose of MVPA for lowering the risk of composite events was approximately 59.0 min/week. More time spent in SB was associated with an increased risk of composite events (high vs. low, HR = 1.17; 95%CI: 1.02-1.35) and HF (high vs. low, HR = 1.54; 95%CI: 1.09-2.20). Replacement of 30 min of SB (HR = 0.73; 95%CI: 0.65-0.81) and LPA (HR = 0.74; 95%CI: 0.66-0.83) with MVPA dramatically reduced the risk of composite events. CONCLUSION: Adherence to a higher amount of accelerometer-measured PA, especially MVPA at least 59 min/week, is associated with reduced risks of macrovascular and microvascular events among individuals with T2DM and prediabetes. Replacement of SB and LPA with MVPA helped lower the risk of diabetic vascular events.

AI snapshot

Written from the paper’s full text.

TL;DR

In UK Biobank adults with type 2 diabetes or prediabetes, accelerometer-measured moderate-to-vigorous physical activity (MVPA) showed inverse, generally non-linear dose-response associations with incident macrovascular and microvascular events, while light-intensity physical activity (LPA) had minimal benefit and sedentary behavior (SB) was associated with higher risk. The minimum MVPA dose associated with lower composite vascular event risk was about 59 min/week, below the guideline-recommended 150 min/week, with larger benefit at higher doses.

Key findings

  • Among 11,474 participants with T2DM/prediabetes, over a median 6.8 years, 1680 cases occurred: 969 macrovascular events, 839 microvascular events, and 284 heart failure (HF) cases.
  • For composite events, MVPA showed a non-linear inverse association: minimum dose 59.0 min/week; optimal dose 188.6 min/week, corresponding to HR 0.61 (95%CI 0.52–0.72). Meeting guideline MVPA (≥150 min/week) was associated with lower composite event risk (recommended vs. not recommended: HR 0.79, 95%CI 0.69–0.89).
  • High total PA was associated with lower composite event risk (high vs. low: HR 0.75, 95%CI 0.66–0.86), but high LPA was not (high vs. low: HR 0.96, 95%CI 0.84–1.09). High SB was associated with higher composite event risk (high vs. low: HR 1.17, 95%CI 1.02–1.35).
  • In isotemporal substitution, replacing 30 min/day of SB with MVPA reduced composite event risk (HR 0.73, 95%CI 0.65–0.81), and replacing 30 min/day of LPA with MVPA also reduced risk (HR 0.74, 95%CI 0.66–0.83).

Methods

  • Prospective cohort study using UK Biobank data; participants wore an Axivity AX3 wrist-worn triaxial accelerometer on the dominant wrist for 7 consecutive days. The analytic sample included 11,474 participants with T2DM or prediabetes and no prevalent diabetic vascular events.
  • Exposures were accelerometer-measured total PA volume, MVPA, LPA, and SB. Outcomes were incident macrovascular events, microvascular events, HF, and composite events, defined from ICD-10 codes in hospital or death records.
  • Main analyses used multivariable-adjusted Cox proportional hazards regression, restricted cubic splines with 3 knots for dose-response, and isotemporal substitution models; sensitivity analyses included competing-risk regression, excluding missing covariate data, and excluding events within the first 2 years.

Limitations

  • Stated: the UK Biobank cohort consisted mainly of white participants, limiting generalizability; 7-day accelerometry may not capture long-term PA patterns and may overestimate PA due to monitoring awareness; wrist-worn accelerometers do not account for strength/type of exercise, have reduced accuracy for slow walking, and cannot record PA context.
  • Stated: most covariates were assessed at physical visits approximately 6 years before the accelerometer baseline, though the authors note prior evidence of stability over time; participants who agreed to wear accelerometers were generally healthier than average, so generalizability to people with worse health conditions should be cautious.
  • Evident from the text: the observational design limits causal inference, and despite extensive adjustment, residual confounding cannot be excluded.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jshs.2024.100973

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

26 of 33 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Undertaking accelerometer-measured light-intensity physical activity at intensity levels lower than 3.0 metabolic equivalents could be an easier choice than moderate-to-vigorous intensity physical activity for enhancing health.

    “Instead, undertaking accelerometer-measured light-intensity PA (LPA) at intensity levels lower than 3.0 metabolite equivalents (METs) could be an easier choice than MVPA for enhancing health.10, 11, 12”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [10] Chastin, 2019, How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies, Br J Sports Med source

      The Introduction defines light-intensity physical activity as below 3 METs, and the Discussion says it may be easier to initiate than moderate-to-vigorous activity for some groups while offering potential health benefits. But the Methods’ inclusion criteria cover both subjectively and objectively measured activity; the paper does not limit its feasibility conclusion to accelerometer-measured activity. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [11] Liang, 2023, Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: A population-based cohort study using accelerometry, Eur J Prev Cardiol source

      The Discussion (page not available in our copy) says that a higher volume of accelerometer-measured physical activity at any intensity could diminish mortality risks associated with short or long sleep. That includes light activity in principle, but the paper does not identify activity below 3.0 METs as an easier choice than MVPA or assess that comparison. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [12] Jin, 2024, Association of accelerometer-measured sleep duration and different intensities of physical activity with incident type 2 diabetes in a population-based cohort study, J Sport Health Sci source

      The Discussion (Joint association of accelerometer-measured sleep duration and PA with incident type 2 diabetes; page unavailable) describes LPA as an alternative for people who have difficulty performing MVPA and reports an association with lower type 2 diabetes risk. However, the Exposures section defines accelerometer-measured LPA as 30–100 mg, not as activity below 3.0 METs; the paper also addresses diabetes risk rather than health generally. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    Adults with metabolic syndromes are more likely to spend their time in light-intensity physical activity or sedentary behavior compared to the general population.

    “Adults with metabolic syndromes are more likely to spend their time in LPA or sedentary behavior (SB) compared to the general population.17”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [17] Morrato, 2007, Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003, Diabetes Care source

      The Results (Data analysis, p. 4) report less moderate-to-vigorous activity among adults with diabetes and among those with more type 2 diabetes risk factors. That supports a related activity difference, but not the claim about adults with metabolic syndromes spending more time in light activity or sedentary behavior: the paper measured neither light-activity time nor, as it explicitly notes (Physical activity in adults, p. 6), the extent of sedentary behavior. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Premisecitation

    Accelerometers are more sensitive than self-reports for capturing long-term change in physical activity levels among adults with overweight/obesity and type 2 diabetes mellitus.

    “Indeed, the results from the Look Action for health in Diabetes (AHEAD) Trial indicated that accelerometers are more sensitive than self-reports for capturing long-term change in PA levels among adults with overweight/obesity and T2DM.23”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [23] Group, 2022, Association between change in accelerometer-measured and self-reported physical activity and cardiovascular disease in the look ahead trial, Diabetes Care source

      The Results and Abstract report that accelerometer-measured change from baseline to year 4 was associated with CVD outcomes, while self-reported change was not. The Conclusions offer lower sensitivity of self-report to certain activities as one possible explanation, but say the reason cannot be determined. They do not establish that accelerometers are generally more sensitive for capturing long-term change in physical activity levels. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    The existing evidence regarding associations between light-intensity physical activity and risks for developing cardiovascular events in the general population is conflicting.

    “The existing evidence regarding associations between LPA and risks for developing cardiovascular events in the general population is conflicting.13, 14, 15, 16”
    Quote in the paperSubstantial claim4 of 4 sources checked
    • cites [13] LaCroix, 2019, Association of light physical activity measured by accelerometry and incidence of coronary heart disease and cardiovascular disease in older women, JAMA Netw Open source

      The Discussion reports inconsistent previous findings on light physical activity and cardiovascular mortality, which supports the claim that some cardiovascular evidence was conflicting. But the Introduction says no studies had yet evaluated light physical activity and incident CHD or CVD in adults overall. The paper therefore does not support describing evidence about *developing cardiovascular events* in the general population as conflicting. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [14] Peter-Marske, 2023, Association of accelerometer-measured physical activity and sedentary behavior with incident cardiovascular disease, myocardial infarction, and ischemic stroke: The women's health study, J Am Heart Assoc source
    • cites [15] Jefferis, 2019, Does total volume of physical activity matter more than pattern for onset of CVD? A prospective cohort study of older British men, Int J Cardiol source

      The Discussion (PA intensity and duration) reports mixed findings for light-intensity physical activity: this study and one NHANES analysis found no association, while other analyses found lower CVD mortality or less consistent associations. That supports the claim that evidence is conflicting, but the comparisons largely concern CVD mortality in older groups rather than the onset of cardiovascular events in the general population. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [16] Dohrn, 2019, Accelerometry-assessed physical activity and sedentary time and associations with chronic disease and hospital visits – a prospective cohort study with 15 years follow-up, Int J Behav Nutr Phys Act source
  • Premisecitation

    Overestimation of the physical activity level is possible with self-reported measurements.

    “Overestimation of the PA level is possible.20,21”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [20] Prince, 2008, A comparison of direct versus self-report measures for assessing physical activity in adults: A systematic review, Int J Behav Nutr Phys Act source
    • cites [21] Warren, 2010, Assessment of physical activity – a review of methodologies with reference to epidemiological research: A report of the exercise physiology section of the European association of cardiovascular prevention and rehabilitation, Eur J Cardiovasc Prev Rehabil source
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 10
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [9] Duvivier, 2017, Breaking sitting with light activities vs. structured exercise: A randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes, Diabetologia source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [8] Kelsey, 2022, Guidelines for cardiovascular risk reduction in patients with type 2 diabetes: JACC guideline comparison, J Am Coll Cardiol source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The evidence used to inform current guidelines has exclusively relied on self-reported measurements, which are largely susceptible to both recall and social desirability biases.

    “The evidence used to inform current guidelines has exclusively relied on self-reported measurements, which are largely susceptible to both recall and social desirability biases.18,19”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [18] Shephard, 2003, Limits to the measurement of habitual physical activity by questionnaires, Eur J Prev Cardiol source

      The Basic issues section says questionnaire responses can be influenced by social desirability, and the Reliability section identifies shortcomings of human memory as a problem for recall. The paper describes questionnaires as a feasible way to assess large populations, but does not establish that evidence informing current guidelines relied exclusively on self-reported measurements. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [19] Sallis, 2000, Assessment of physical activity by self-report: Status, limitations, and future directions, Res Q Exerc Sport source

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The study implemented stringent data quality criteria in accordance with the UK Biobank accelerometer expert working group's guidelines.

    “To ensure data quality, the study implemented stringent criteria in accordance with the UK Biobank accelerometer expert working group's guidelines.25”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] Doherty, 2017, Large scale population assessment of physical activity using wrist worn accelerometers: The UK Biobank study, PLoS One source

      The Methods > Data Analysis passage describes quality criteria, including excluding records with less than 72 hours of wear data or without data in every hour of the day. The paper says these criteria were defined using missing-data simulations; the passages do not establish that they followed guidelines from a UK Biobank accelerometer expert working group. Page numbers are unavailable in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The study repeated the analyses excluding events that occurred within the first 2 years to exclude participants potentially at the preclinical stage of any diabetic vascular event and to help address reverse causality.

    “To exclude participants who were potentially at the preclinical stage of any diabetic vascular event, and to help address reverse causality, we also repeated the analyses excluding events that occurred within the first 2 years.12,37”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [12] Jin, 2024, Association of accelerometer-measured sleep duration and different intensities of physical activity with incident type 2 diabetes in a population-based cohort study, J Sport Health Sci source

      The Statistical analyses section says the study repeated analyses after excluding type 2 diabetes events in the first two years of follow-up, and the Discussion reports that the findings remained robust. Our copy does not state that this exclusion was intended to address reverse causality or preclinical diabetic vascular events; its outcome was incident type 2 diabetes. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [37] Liang, 2023, Social isolation, loneliness and subsequent risk of major adverse cardiovascular events among individuals with type 2 diabetes mellitus, Gen Psychiatr source

  • May combine two claims.

    Premisecitation

    Self-reports poorly capture light-intensity physical activity, which is often scattered throughout the day, and underestimate sedentary behavior.

    “Another major limitation of self-reports is that they poorly capture LPA, which is often scattered throughout the day, and underestimate SB.18”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [18] Shephard, 2003, Limits to the measurement of habitual physical activity by questionnaires, Eur J Prev Cardiol source

  • May combine two claims.

    Premisecitation

    Self-reported questionnaires are subject to recall and social desirability biases and are prone to underestimate physical activity, especially intermittent moderate-to-vigorous physical activity or light-intensity physical activity.

    “self-reported questionnaires are subject to recall and social desirability biases; therefore, they are prone to underestimate PA, especially intermittent MVPA or LPA.18”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [18] Shephard, 2003, Limits to the measurement of habitual physical activity by questionnaires, Eur J Prev Cardiol source

      The Basic issues section describes memory-related limits on recall, and Types of activity and Duration explain that questionnaires can miss low-intensity activity and brief bouts. But the claim's general direction of bias is overstated: Basic issues says social desirability generally leads people to overreport physical activity, not underestimate it. No page numbers are available in our copy. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Engaging in intermittent moderate-to-vigorous physical activity accumulation in shorter bouts might be an easier option, as indicated by recent studies.

    “Engaging in intermittent MVPA accumulation in shorter bouts might be an easier option, as indicated by recent studies.50,51”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [50] Stamatakis, 2022, Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality, Nat Med source
    • cites [51] Ahmadi, 2023, Brief bouts of device-measured intermittent lifestyle physical activity and its association with major adverse cardiovascular events and mortality in people who do not exercise: A prospective cohort study, Lancet Public Health source
    • Rests on an assumption: Individuals with type 2 diabetes mellitus and prediabetes are often older, relatively frail, or functionally compromised and may not tolerate long-lasting or more vigorous physical activity.

  • May combine two claims.

    Premisecitation

    Physical activity could inhibit inflammation by reducing interleukin-6 and tumor necrosis factor-α, which could lead to atherosclerosis and elevated blood pressure.

    “PA could inhibit inflammation by inducing significant reductions in interleukin-6 and tumor necrosis factor-α, which could lead to atherosclerosis and elevated blood pressure.48”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [48] Welsh, 2017, Targeting inflammation to reduce cardiovascular disease risk: A realistic clinical prospect?, Br J Pharmacol source

      The ‘TNF-α and IL-6 in CVD > Experimental data’ section links these cytokines to inflammation and atherosclerosis, although it describes mixed effects for IL-6. The paper does not report that physical activity significantly reduces either cytokine or that these cytokines cause elevated blood pressure; searches for exercise, physical activity, and blood pressure found no such passage. Page numbers are unavailable in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Exercise training could help with diabetes management by improving beta cell function and insulin sensitivity.

    “abundant evidence suggests that exercise training could help with diabetes management by improving beta cell function and insulin sensitivity.47”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [47] Heiskanen, 2018, Exercise training decreases pancreatic fat content and improves beta cell function regardless of baseline glucose tolerance: A randomised controlled trial, Diabetologia source

  • The quote only partly states this claim.

    Findingown data

    Spending more time in sedentary behavior is associated with a higher risk of developing most vascular events.

    “Spending more time in SB was associated with a higher risk of developing most vascular events.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: There is no unmeasured confounding of the observed associations between physical activity/sedentary behavior and vascular events.

  • May combine two claims.

    Findingown data

    Total volume of physical activity and moderate-to-vigorous intensity physical activity showed potential inverse linear dose-response associations with microvascular events.

    “We observed potential inverse linear dose-response associations for total volume of PA (poverall < 0.001, pnonlinearity = 0.821) and MVPA (poverall = 0.002, pnonlinearity = 0.131; minimum dose = 200.3 min/week) but a positive linear association for SB (poverall = 0.021, pnonlinearity = 0.723) regarding microvascular events as the outcomes”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Missing covariate data are missing at random and can be validly imputed using multiple imputation.

  • May combine two claims.

    Findingown data

    The present study documented generally inverse dose-response associations of physical activity with risks of incident composite, macrovascular, microvascular events, and heart failure among individuals with type 2 diabetes mellitus and prediabetes.

    “the present study documented generally inverse dose–response associations of PA with the risks of incident vascular events, including composite events, macrovascular events, microvascular events, and HF among individuals with T2DM and prediabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The optimal dose of moderate-to-vigorous intensity physical activity for heart failure was 223.9 min/week (HR 0.26, 95%CI 0.17-0.40), and the minimum dose was 41.4 min/week.

    “The optimal dose of MVPA was 223.9 min/week, corresponding to an HR of 0.26 (95%CI: 0.17–0.40), and the minimum dose was 41.4 min/week.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Missing covariate data are missing at random and can be validly imputed using multiple imputation.

  • May combine two claims.

    Findingown data

    The minimum dose of moderate-to-vigorous physical activity to reduce risk of diabetic vascular events was about 59 min/week, which is lower than the current recommended level of at least 150 min/week.

    “The minimum dose (about 59 min/week) of MVPA to reduce the risk of diabetic vascular events was much lower than the current recommended level (at least 150 min/week)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    During a median follow-up of 6.8 years, 1680 cases were documented, including 969 macrovascular events, 839 microvascular events, and 284 cases of heart failure.

    “During a median follow-up of 6.8 years (IQR: 5.6–8.0), 1680 cases were documented, including 969 macrovascular events, 839 microvascular events, and 284 cases of HF.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study conducted several sensitivity analyses to examine the robustness of the current findings.

    “Moreover, to examine the robustness of the current findings, we conducted several sensitivity analyses by calculating Fine-Gray sub-distribution hazards and incorporated death as a competing risk for the incidence of macrovascular events, microvascular events, HF, and composite events, excluding the participants with any missing covariate data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Wearable accelerometers enable the capturing of all components (intensity, type, or duration) of physical activity spread throughout the day and more accurately measure sedentary behavior by offsetting recall and social desirability biases.

    “In contrast to self-reports, wearable accelerometers enable the capturing of all components (intensity, type, or duration) of PA spread throughout the day and more accurately measure SB by offsetting recall and social desirability biases.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Trost, 2014, Clinical use of objective measures of physical activity, Br J Sports Med source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Multiple imputations were performed to impute missing data using the mice R package.

    “To minimize the potential inferential, multiple imputations were performed to impute missing data using the “mice” R package.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Missing covariate data are missing at random and can be validly imputed using multiple imputation.

  • Classified as probably not a substantial claim.

    Premisereasoning

    The effects of intensity-specific physical activity on preventing microvascular events remained unexplored due to the limitation of self-reported data.

    “the effects of intensity-specific PA on preventing microvascular events remained unexplored due to the limitation of their usage of self-reported data.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Our observations implied that adherence to moderate-to-vigorous physical activity, but not light-intensity physical activity, at a level much lower than the current guideline-recommended level could be effective in preventing vascular events in individuals with diabetes and prediabetes.

    “our observations implied that adherence to MVPA, but not LPA, at a level much lower than the current guideline-recommended level could be effective in preventing vascular events in individuals with diabetes and prediabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The current study extended existing evidence by using accelerometer-measured physical activity data, offsetting recall and social desirability biases and delineating precise dose targets for physical activity in different intensities for prevention of diabetic cardiovascular risks.

    “the current study extended the existing evidence by using accelerometer-measured PA data, successfully offsetting recall and social desirability biases and delineating precise dose targets for PA in different intensities for the prevention of diabetic cardiovascular risks.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The usage of accelerometer-measured physical activity data outweighed self-reports by offsetting recall and social desirability biases and providing opportunities to estimate associations of light-intensity physical activity and sedentary behavior with diabetic vascular events.

    “the usage of accelerometer-measured PA data in our study outweighed the self-reports adopted by most existing studies in this field by offsetting recall and social desirability biases and providing opportunities to estimate the associations of LPA and SB with diabetic vascular events.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The current study had strengths including large sample size and prospective design.

    “The current study had several strengths, including its large sample size and prospective design.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Overall, engaging in higher doses of physical activity (especially moderate-to-vigorous physical activity) and reducing sedentary behavior are fundamental lifestyle strategies for diabetes management to prevent risks of incident macrovascular and microvascular events among individuals with type 2 diabetes mellitus and prediabetes.

    “Overall, our study highlight that engaging in higher doses of PA (especially MVPA) and reducing time spent in SB are fundamental lifestyle strategies for diabetes management to prevent risks of incident macrovascular and microvascular events among individuals with T2DM and prediabetes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The healthy volunteer selection bias is less likely to bias the estimation of exposure-disease relationships.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Wrist-worn accelerometer does not account for strength and type of exercising training, has reduced accuracy when recording slow walking, and is unable to record context of undertaking physical activity.

    “wrist-wear accelerometer does not account for the strength and type of excising training, has reduced accuracy when recording slow walking, and is unable to record the context of undertaking PA.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Oxidative stress and intestinal microbiome change are likely potential mechanisms for the protective effect of physical activity on diabetic vascular events.

    “oxidative stress and intestinal microbiome change are likely potential mechanisms.49”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Venkatasamy, 2013, Effect of physical activity on insulin resistance, inflammation and oxidative stress in diabetes mellitus, J Clin Diagn Res

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    A 7-day accelerometry measurement of physical activity failed to track long-term pattern of physical activity level, confining ability of causal reference in the study.

    “A 7-day accelerometry measurement of PA failed to track the long-term pattern of PA level, which has confined the ability of a causal reference in our study.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Sensitivity analyses showed all results remained largely robust using competing risk regression, excluding participants with missing data, and excluding events within first 2 years.

    “In the sensitivity analyses, all results remained largely robust by using competing risk regression (Supplementary Table 6), excluding participants with missing data on covariables (Supplementary Table 7), and excluding events occurring within the first 2 years (Supplementary Table 8).”
    Quote in the paperSubstantial claim
28 of 28

  • The paper relies on this without support.

    Missing covariate data are missing at random and can be validly imputed using multiple imputation.

    “To minimize the potential inferential, multiple imputations were performed to impute missing data using the “mice” R package.”

  • The paper relies on this without support.

    There is no unmeasured confounding of the observed associations between physical activity/sedentary behavior and vascular events.

    “Model 3 was additionally adjusted for cardiovascular risk factors (healthy diet score, sleep duration, smoking status, alcohol consumption, serum creatinine, family history of diabetes, history of cancers, history of depression, and use of blood glucose-lowering medications, blood pressure-lowering medications, and cholesterol-lowering medications).”

  • The paper relies on this without support.

    Individuals with type 2 diabetes mellitus and prediabetes are often older, relatively frail, or functionally compromised and may not tolerate long-lasting or more vigorous physical activity.

    “individuals with T2DM and prediabetes are often older, relatively frail, or functionally compromised and, therefore, may not tolerate long-lasting or more vigorous PA.”

  • The paper relies on this without support.

    The healthy volunteer selection bias is less likely to bias the estimation of exposure-disease relationships.

    “This “healthy volunteer” selection bias is less likely to bias the estimation of exposure-disease relationships”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Low-activity group size differs from Table 1

    Minor

    The results state that 3,822 participants had a low total volume of physical activity, but Table 1 assigns 3,828 to the low group. The table assigns 3,822 to the high group.

  • Ten-minute substitution uses conflicting time units

    Minor

    The results describe substituting 10 minutes per week of sedentary behavior with light activity, whereas Table 2 labels the corresponding substitution as 10 minutes per day.

  • Number of Cox models stated as three, but four are described

    Minor

    The statistical analysis says three multivariable-adjusted Cox models were used, then describes Models 1 through 4.

3 of 3

Cites

Flagged first, then by citations

Cited by

Still being checked.

Related

Authors
Liang, Y. Y., He, Y., Huang, P., Feng, H., Li, H., Ai, S., Du, J., Xue, H., Liu, Y., Zhang, J., Qi, L., & Zhang, J.
Affiliations
  • Guangzhou Medical University (CN)
  • Sun Yat-sen University (CN)
  • Guangdong Provincial People's Hospital (CN)
  • Tulane University (US)
Corresponding author
  • Qi, Lu
  • Zhang, Jihui
ORCID
Venue
Journal of Sport and Health Science
Publisher
Elsevier BV
Published
2025-12
Volume
14
Pages
100973
ISSN
  • 2213-2961 (ISSN-L)
  • 2095-2546
DOI
10.1016/j.jshs.2024.100973
PMC
PMC11863271
OpenAlex
W4402022960
Semantic Scholar
e0bd0ff88c68e7601a834fdacfa443de1d17bed2
Cited by
23
References
55
Citations by year
2026: 13 · 2025: 8 · 2024: 2
FWCI
5.76
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of sport and health science/Journal of Sport and Health Science (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Natural Science Foundation of China (32100880)
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, Cardiovascular Risks, and Lipoproteins
Keywords
physical activity, sedentary behavior, type 2 diabetes, prediabetes, macrovascular events, heart failure, moderate-to-vigorous physical activity, light physical activity, accelerometer-measured activity, dose-response relationship, cardiovascular risk, UK Biobank, diabetes complications
MeSH terms
Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, United Kingdom, Heart Failure, Humans, Male, Middle Aged, Prediabetic State, Exercise, Incidence, Sedentary Behavior, Accelerometry

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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