Accelerometer-derived physical activity and mortality in individuals with type 2 diabetes
Open accessAbstract
Physical activity (PA) has been shown to reduce diabetes mortality, but largely based on imprecise self-reported data, which may hinder the development of related recommendations. Here, we perform a prospective cohort study of 4003 individuals with type 2 diabetes (T2D) from the UK Biobank with a median follow-up of 6.9 years. Duration and intensity of PA are measured by wrist-worn accelerometers over a 7-day period. We observe L-shaped associations of longer duration of PA, regardless of PA intensity, with risks of all-cause and cancer mortality, as well as a negatively linear association with cardiovascular disease mortality. 18.8%, 28.0%, and 31.1% of deaths are attributable to the lowest level of light-intensity PA, moderate-intensity PA, and vigorous-intensity PA, respectively. Collectively, our findings provide insights for clinical guidelines that should highlight the potential value of adherence to greater intensity and duration of PA for patients with T2D.
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Written from the paper’s full text.
TL;DR
In 4003 UK Biobank adults with type 2 diabetes and wrist-accelerometer physical activity, longer duration at any intensity was associated with lower all-cause and cancer mortality in an L-shaped pattern and linearly lower CVD mortality over a median 6.9 years. Population-attributable fractions were substantial for the least active groups, especially MVPA.
Key findings
- Among 4003 participants with T2D, 339 deaths occurred over median 6.9 years. All-cause mortality showed L-shaped associations with PA duration regardless of intensity; at inflection points, risk reductions were ~60% at 1800 min/week LPA, 70% at 300 min/week MPA, 45% at 30 min/week VPA, and 70% at 300 min/week MVPA versus the least active 1st percentile.
- For all-cause mortality, compared with <150 min/week MPA, adjusted HRs (95% CI) were 0.61 (0.47–0.79) for 150–299, 0.41 (0.29–0.56) for 300–449, and 0.24 (0.15–0.36) for ≥450 min/week; for VPA ≥30 vs 0 min/week, HR was 0.43 (0.26–0.70); for MVPA ≥625 vs <275 min/week, HR was 0.30 (0.16–0.54).
- Cancer mortality (158 deaths) showed L-shaped associations, while CVD mortality (83 deaths) showed negative linear associations. Compared with <150 min/week MPA, ≥450 min/week MPA was associated with 63% lower cancer mortality and 68% lower CVD mortality; VPA ≥30 vs none had HRs of 0.61 (0.32–1.17) for cancer and 0.35 (0.10–1.15) for CVD.
- PAFs for all-cause mortality in the lowest activity groups were 18.8% for LPA, 28.0% for MPA, and 31.1% for VPA; for MVPA, PAFs were 47.1% for <275 min/week, 8.8% for 275–449, and 1.0% for 450–624. The discussion states up to 56.9% of deaths could potentially be associated with performing <625 min/week MVPA.
Methods
- Prospective cohort from the UK Biobank: 4003 participants with T2D at baseline and valid wrist-worn Axivity AX3 accelerometer data over 7 days; exclusions included insufficient wear time (<72 h), daylight saving shifts, and missing covariates. Mean age was 64.9 years and 63.0% were male.
- PA intensities were defined as 30–125 mg for LPA, >125–400 mg for MPA, and >400 mg for VPA; MVPA was the sum of MPA and VPA. Outcomes were all-cause, cancer, and CVD mortality ascertained from death certificates, with follow-up to November 12, 2021.
- Dose–response associations used restricted cubic splines in Cox proportional hazards models, with categorized four-level PA exposures and three adjustment models; analyses also included PAFs, joint risk matrices, stratified analyses, and multiple sensitivity analyses.
Limitations
- Stated: a 7-day accelerometer measurement may not represent habitual PA; wrist-worn devices may not fully capture activities with minimal arm movement (e.g., cycling); the study focused only on PA duration and intensity, not fragmentation, diurnal, or distributional patterns; intensity cut-points may introduce subjectivity.
- Stated: residual or unmeasured confounding and reverse causation cannot be fully excluded, and causal conclusions cannot be made; selection bias may limit generalizability because UK Biobank response rate was 5.5%, accelerometer data were available only for a subset, and included diabetic adults were generally healthier, more active, and had lower mortality than overall diabetic adults.
- Evident from the text: the analyzed sample was predominantly White (93.4%) and observational, so the findings may not generalize to other racial/ethnic or national populations and cannot establish causality; the paper itself acknowledges selection bias and the need for verification across diverse populations.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Cites
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Claims the paper makes
20 of 28 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured
- Premisecitation
These recommendations were primarily made based on evidence from self-reported PA.
“These recommendations were primarily made based on evidence from self-reported PA, which may be optimized by incorporating evidence from accelerometer-measured PA.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [23] ElSayed, N. A. et al. 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes – 2023. Diabetes Care 46, S68–S96 (2023). source
The Physical Activity recommendations appear in the passage indexed under Nonnutritive Sweeteners (page unavailable), but the passage does not say how the evidence underlying them was measured. The same section cites an accelerometer-measured study; searches for self-reported physical activity and the recommendations’ evidentiary basis found no statement that the evidence was primarily self-reported. (LLM, conf=0.73)
Experimental — accuracy not yet measured
- Premisecitation
Recent evidence suggests that any potential bias resulting from poor representativeness would have a minimal impact on the association of PA with mortality in the UK Biobank.
“Nonetheless, recent evidence suggests that any potential bias resulting from poor representativeness would have a minimal impact on the association of PA with mortality in the UK Biobank31.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [31] Stamatakis, E. et al. Is cohort representativeness passé? Poststratified associations of lifestyle risk factors with mortality in the UK Biobank. Epidemiology 32, 179–188 (2021). source
- Study design and conductcitation
We utilized wrist-worn accelerometers that are more accurate in discriminating different intensities compared to waist-worn accelerometers.
“Second, we utilized wrist-worn accelerometers that are more accurate in discriminating different intensities compared to waist-worn accelerometers30.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [30] Mielke, G. I. et al. Absolute intensity thresholds for tri-axial wrist and waist accelerometer-measured movement behaviors in adults. Scand. J. Med. Sci. Sports 33, 1752–1764 (2023). source
- Premisecitation
A harmonized meta-analysis of eight studies found that in the general population the maximal risk reduction in all-cause mortality for accelerometer-measured moderate-to-vigorous-intensity physical activity (about 60%) was about twice the magnitude as reported in studies relying on self-reported physical activity.
“A harmonized meta-analysis of eight studies found that in the general population the maximal risk reduction in all-cause mortality for accelerometer-measured MVPA (about 60%) was about twice the magnitude as reported in studies relying on self-reported PA14.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [14] Ekelund, U. et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ 366, l4570 (2019). 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
- Interpretationown data
The 11% lower risk of all-cause mortality per 600 MET-min/week increase in this study was much larger than the 4% reported by a meta-analysis of six prospective cohort studies (N = 32,221).
“Moreover, we found that every 600 MET-min/week increase of accelerometer-measured PA was associated with 11% lower risk of all-cause mortality in patients with T2D, much larger than 4% as reported by a meta-analysis of six prospective cohort studies (N = 32,221)22.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [22] Geidl, W., Schlesinger, S., Mino, E., Miranda, L. & Pfeifer, K. Dose-response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies. Int. J. Behav. Nutr. Phys. Act. 17, 109 (2020). source
- Premisecitation
A previous validation study showed a 7-day measurement was strongly associated with PA over a period of up to 3.7 years.
“A previous validation study showed a 7-day measurement was strongly associated with PA over a period of up to 3.7 years29.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [29] Dwyer, T. et al. Objectively measured daily steps and subsequent long term all-cause mortality: the Tasped Prospective Cohort Study. PLoS ONE 10, e0141274 (2015). source
The Discussion (page unavailable) reports that two days of pedometer recording captured 89% of the variance over a seven-day period. That supports short-term measurement agreement, not the claim that a seven-day measurement was strongly associated with physical activity for up to 3.7 years; no such longitudinal validation appears in the passages searched. (LLM, conf=0.82)
Experimental — accuracy not yet measured
- Premisecitation
Some prospective cohort studies reported that ≥150 min/week of moderate-to-vigorous-intensity physical activity or ≥75 min/week of vigorous-intensity physical activity was associated with 14%-37% lower risks of all-cause mortality in diabetic adults.
“Moreover, some prospective cohort studies reported that ≥150 min/week of moderate-to-vigorous-intensity PA (MVPA) or ≥75 min/week of vigorous-intensity PA (VPA) was associated with 14%–37% lower risks of all-cause mortality in diabetic adults8–10.”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [8] Yerramalla, M. S. et al. Association of moderate and vigorous physical activity with incidence of type 2 diabetes and subsequent mortality: 27 year follow-up of the Whitehall II study. Diabetologia 63, 537–548 (2020). source
- cites [9] Han, H. et al. Association of a healthy lifestyle with all-cause and cause-specific mortality among individuals with type 2 diabetes: a prospective study in UK Biobank. Diabetes Care 45, 319–329 (2022). source
- cites [10] Jung, I. et al. Association of physical activity with total and cause-specific mortality in patients with diabetes: a nationwide population-based cohort study. Diabetes Res. Clin. Pract. 202, 110819 (2023). source
- Findingown data
Compared with <150 min/week of moderate-intensity physical activity, the multivariable-adjusted hazard ratio for all-cause mortality was 0.61 (95% CI 0.47-0.79) for 150-299 min/week.
“For example, compared with <150 min/week of MPA, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 150–299, 300–449, and ≥450 min/week were 0.61 (0.47-0.79), 0.41 (0.29-0.56), and 0.24 (0.15-0.36), respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Beyond the inflection point, additional all-cause mortality risk reduction was significant for moderate-to-vigorous-intensity physical activity (20% by 1000 min/week).
“Additional associations of all-cause mortality risk reductions followed by a longer duration of PA were limited for VPA (additional 1% by as long as 100 min/week) but significant for LPA (15% by 3000 min/week), MPA (20% by 1000 min/week), and MVPA (20% by 1000 min/week).”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Compared with none of vigorous-intensity physical activity, ≥30 min/week of vigorous-intensity physical activity had a hazard ratio of 0.61 (95% CI 0.32-1.17) for cancer mortality.
“Meanwhile, the HRs with VPA ≥ 30 min/week were 0.61 (95% CI: 0.32–1.17) for cancer mortality, and 0.35 (95% CI: 0.10–1.15) for CVD-cause mortality, compared with none of VPA.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Compared with <150 min/week of moderate-intensity physical activity, the multivariable-adjusted hazard ratio for all-cause mortality was 0.41 (95% CI 0.29-0.56) for 300-449 min/week.
“For example, compared with <150 min/week of MPA, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 150–299, 300–449, and ≥450 min/week were 0.61 (0.47-0.79), 0.41 (0.29-0.56), and 0.24 (0.15-0.36), respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
At the inflection point, the all-cause mortality reduction associated with moderate-to-vigorous-intensity physical activity was approximately 70% at 300 min/week compared with the least active one percentile.
“At the inflection points, associations were observed with all-cause mortality reductions of ~60% at 1800 min/week for LPA, 70% at 300 min/week for moderate-intensity PA (MPA), 45% at 30 min/week for VPA, and 70% at 300 min/week for MVPA, compared with the least active one percentile.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Irrespective of physical activity intensity, L-shaped associations with physical activity duration were found for cancer mortality.
“Irrespective of PA intensity, L-shaped associations with PA duration were found for cancer mortality whereas negative linear associations were observed for CVD mortality (Fig. 2).”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
At the inflection point, the all-cause mortality reduction associated with light-intensity physical activity was approximately 60% at 1800 min/week compared with the least active one percentile.
“At the inflection points, associations were observed with all-cause mortality reductions of ~60% at 1800 min/week for LPA, 70% at 300 min/week for moderate-intensity PA (MPA), 45% at 30 min/week for VPA, and 70% at 300 min/week for MVPA, compared with the least active one percentile.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Different combinations of physical activity could associate with similar risk reductions in all-cause mortality, such as 300-449 min/week of moderate-intensity physical activity and 2100-2449 min/week of light-intensity physical activity (HR = 0.35; 95% CI 0.19-0.63).
“Different combinations of PA could associate with similar risk reductions in all-cause mortality, such as 300–449 min/week of MPA and 2100–2449 min/week of LPA (HR = 0.35; 95% CI: 0.19–0.63), 1–14 min/week of VPA and 2100–2449 min/week of LPA (HR = 0.33; 95% CI: 0.17–0.63), 1–14 min/week of VPA and 300–449 min/week of MPA (HR = 0.35; 95% CI: 0.22–0.54).”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Beyond the inflection point, additional all-cause mortality risk reduction was limited for vigorous-intensity physical activity (additional 1% by as long as 100 min/week).
“Additional associations of all-cause mortality risk reductions followed by a longer duration of PA were limited for VPA (additional 1% by as long as 100 min/week) but significant for LPA (15% by 3000 min/week), MPA (20% by 1000 min/week), and MVPA (20% by 1000 min/week).”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Regardless of physical activity intensity, the dose-response associations of accelerometer-measured physical activity duration with all-cause mortality were L-shaped in individuals with type 2 diabetes.
“Regardless of PA intensity, the dose–response associations of PA duration with all-cause mortality were L-shaped (Fig. 2).”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Almost all combinations of physical activity intensities were associated with lower risks of all-cause and cause-specific mortality.
“We found that almost all combinations of PA were associated with lower risks of all-cause and cause-specific mortality.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Compared with <150 min/week of moderate-intensity physical activity, ≥450 min/week of moderate-intensity physical activity was associated with a 68% lower risk of cardiovascular disease mortality.
“Compared with <150 min/week of MPA, ≥450 min/week of MPA was associated with a 63% (95% CI: 33%–80%) and 68% (95% CI: 21%–87%) lower risk of cancer and CVD mortality, respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Beyond the inflection point, additional all-cause mortality risk reduction was significant for light-intensity physical activity (15% by 3000 min/week).
“Additional associations of all-cause mortality risk reductions followed by a longer duration of PA were limited for VPA (additional 1% by as long as 100 min/week) but significant for LPA (15% by 3000 min/week), MPA (20% by 1000 min/week), and MVPA (20% by 1000 min/week).”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Compared with none of vigorous-intensity physical activity, ≥30 min/week of vigorous-intensity physical activity had a hazard ratio of 0.35 (95% CI 0.10-1.15) for cardiovascular disease mortality.
“Meanwhile, the HRs with VPA ≥ 30 min/week were 0.61 (95% CI: 0.32–1.17) for cancer mortality, and 0.35 (95% CI: 0.10–1.15) for CVD-cause mortality, compared with none of VPA.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
No statistically significant interactions were found between all physical activity intensities and age, sex, BMI, waist circumference, smoking status, alcohol intake, diet scores, sleep scores, and history of hypertension (p for interaction >0.05).
“No statistically significant interactions were found between all PA intensities and age, sex, BMI, waist circumference, smoking status, alcohol intake, diet scores, sleep scores, and history of hypertension (p value for interaction >0.05, Supplementary Tables 11–14).”
Quote in the paperNot a substantial claim - Findingown data
At the inflection point, the all-cause mortality reduction associated with vigorous-intensity physical activity was approximately 45% at 30 min/week compared with the least active one percentile.
“At the inflection points, associations were observed with all-cause mortality reductions of ~60% at 1800 min/week for LPA, 70% at 300 min/week for moderate-intensity PA (MPA), 45% at 30 min/week for VPA, and 70% at 300 min/week for MVPA, compared with the least active one percentile.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
When physical activity duration was classified into four levels, all-cause mortality risk gradually decreased as duration increased to a higher level, irrespective of physical activity intensity (p for trend <0.001).
“Accordingly, when the duration of PA was classified into four levels, the risk for all-cause mortality gradually decreased as the duration increased to a higher level, irrespective of PA intensity (p value for trend <0.001, Table 2 and Fig. 3).”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Beyond the inflection point, additional all-cause mortality risk reduction was significant for moderate-intensity physical activity (20% by 1000 min/week).
“Additional associations of all-cause mortality risk reductions followed by a longer duration of PA were limited for VPA (additional 1% by as long as 100 min/week) but significant for LPA (15% by 3000 min/week), MPA (20% by 1000 min/week), and MVPA (20% by 1000 min/week).”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
At the inflection point, the all-cause mortality reduction associated with moderate-intensity physical activity was approximately 70% at 300 min/week compared with the least active one percentile.
“At the inflection points, associations were observed with all-cause mortality reductions of ~60% at 1800 min/week for LPA, 70% at 300 min/week for moderate-intensity PA (MPA), 45% at 30 min/week for VPA, and 70% at 300 min/week for MVPA, compared with the least active one percentile.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Compared with <150 min/week of moderate-intensity physical activity, the multivariable-adjusted hazard ratio for all-cause mortality was 0.24 (95% CI 0.15-0.36) for ≥450 min/week.
“For example, compared with <150 min/week of MPA, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 150–299, 300–449, and ≥450 min/week were 0.61 (0.47-0.79), 0.41 (0.29-0.56), and 0.24 (0.15-0.36), respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
Negative linear associations with physical activity duration were observed for cardiovascular disease mortality.
“Irrespective of PA intensity, L-shaped associations with PA duration were found for cancer mortality whereas negative linear associations were observed for CVD mortality (Fig. 2).”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
In our study, the risk for all-cause mortality decreased sharply as the duration of MPA increased to 300 min/week with a less drastic magnitude thereafter.
“In our study, the risk for all-cause mortality decreased sharply as the duration of MPA increased to 300 min/week with a less drastic magnitude thereafter.”
Quote in the paperSubstantial claim - Findingown data
Every 600 MET-min/week increase of accelerometer-measured physical activity was associated with 11% lower risk of all-cause mortality in patients with type 2 diabetes.
“Moreover, we found that every 600 MET-min/week increase of accelerometer-measured PA was associated with 11% lower risk of all-cause mortality in patients with T2D, much larger than 4% as reported by a meta-analysis of six prospective cohort studies (N = 32,221)22.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
A 50% risk reduction of all-cause mortality was associated with ≥150 min/week of moderate-intensity physical activity in this study.
“Similarly, 50% risk reduction of all-cause mortality was associated with ≥150 min/week of MPA in our study,”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Findingown data
We found that any amount of PA, even in light intensity, was associated with lower mortality risks versus none among T2D patients.
“we found that any amount of PA, even in light intensity, was associated with lower mortality risks versus none among T2D patients.”
Quote in the paperSubstantial claim - Findingown data
In our study, 50% risk reduction of all-cause mortality was associated with ≥150 min/week of MPA.
“Similarly, 50% risk reduction of all-cause mortality was associated with ≥150 min/week of MPA in our study, much larger than 14% from another study using self-reported PA in the UK Biobank9.”
Quote in the paperSubstantial claim - Interpretationown data
Up to 56.9% of deaths among patients with type 2 diabetes could potentially be associated with performing <625 min/week of moderate-to-vigorous-intensity physical activity.
“Up to 56.9% deaths among T2D patients could potentially be associated with performing <625 min/week of MVPA.”
Quote in the paperSubstantial claim- Rests on an assumption: The findings from UK Biobank participants with type 2 diabetes and valid accelerometer data are representative enough of patients with type 2 diabetes to inform clinical guidelines.
- Rests on an assumption: The population-attributable fractions estimate the proportion of deaths that would be prevented by increasing physical activity, implying a causal effect of physical activity on mortality.
- Study design and conductown data
The associations between physical activity and mortality were independent of many potential confounders, including those related to diabetes severity.
“The associations were independent of many potential confounders, including those related to diabetes severity.”
Quote in the paperSubstantial claim- Rests on an assumption: The observed associations between physical activity and mortality are not due to unmeasured confounding.
- Interpretationown data
The effort required to increase the volume of MPA may not be proportional to the benefit after reaching 300 min/week.
“This finding suggests that the effort required to increase the volume of MPA may not be proportional to the benefit after reaching 300 min/week”
Quote in the paperSubstantial claim - Study design and conductreasoning
The possibility of reverse causation cannot be fully eliminated.
“the possibility of reverse causation cannot be fully eliminated.”
Quote in the paperNot a substantial claim - Study design and conductown data
The results were similar to the main analyses after excluding those with poor self-rated health status and those who died within the first 2 or 4 years of follow-up.
“Although the results were similar to the main analyses after excluding those with poor self-rated health status and those who died within the first 2 or 4 years of follow-up, the possibility of reverse causation cannot be fully eliminated.”
Quote in the paperNot a substantial claim - Interpretationreasoning
If the measurement error is random, the true association between PA and mortality may be underestimated in our study.
“If the measurement error is random, the true association between PA and mortality may be underestimated in our study.”
Quote in the paperNot a substantial claim - Interpretationreasoning
The selection bias may limit the generalizability of the current findings.
“The selection bias may limit the generalizability of the current findings.”
Quote in the paperNot a substantial claim - Premisecitation
A marked increase in cytokines, such as interleukin-6 and interleukin-10, provoked by PA can protect against chronic inflammation in T2D.
“In addition, a marked increase in cytokines, such as interleukin-6 and interleukin-10, provoked by PA can protect against chronic inflammation in T2D27.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] Pedersen, B. K. Anti-inflammatory effects of exercise: role in diabetes and cardiovascular disease. Eur. J. Clin. Investig. 47, 600–611 (2017). source
- May combine two claims. 24
- Classified as probably not a substantial claim. 7
- The quote only partly states this claim. 4
May combine two claims.
PremisecitationPrior accelerometry-based studies specific to patients with type 2 diabetes were scant but all demonstrated significant risk reductions in mortality-related outcomes with higher volumes of physical activity.
“Prior accelerometry-based studies specific to T2D patients were scant but all demonstrated significant risk reductions in mortality-related outcomes with higher volumes of PA, such as a 29% lower risk of premature all-cause mortality for every 60-min increase in daily ambulatory movement in the NHANES and a 2.6% lower risk of a composite CVD outcome including all-cause mortality for every 100 MET-”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [17] Loprinzi, P. D. The effects of objectively-measured, free-living daily ambulatory movement on mortality in a national sample of adults with diabetes. Physiol. Behav. 154, 126–128 (2016). source
- cites [18] Zhu, P. et al. Replacing of sedentary behavior with physical activity and the risk of mortality in people with prediabetes and diabetes: a prospective cohort study. Int. J. Behav. Nutr. Phys. Act. 20, 81 (2023). source
The Results (Isotemporal substitution analyses; page unavailable) report that replacing 30 minutes of sedentary time with light physical activity was associated with lower all-cause mortality among participants with diabetes. The same analysis did not show a statistically significant reduction for moderate-to-vigorous activity in that group. The paper does not establish that all prior accelerometry-based studies in type 2 diabetes found significant reductions, or report the cited 29% and 2.6% estimates. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [19] Look AHEAD Study Group. Association between change in accelerometer-measured and self-reported physical activity and cardiovascular disease in the Look AHEAD Trial. Diabetes Care 45, 742–749 (2022). source
The Results report that, among Look AHEAD participants with type 2 diabetes, each 100 MET-min/week increase in accelerometer-measured activity over four years was associated with a significantly lower risk of composite CVD outcomes; the CVD Outcomes section confirms that some composites include death. The paper does not establish that all prior accelerometry-based studies in this population found significant reductions, and our copy does not report the cited NHANES estimate of 29% lower all-cause mortality per 60 minutes of daily movement. (LLM, conf=0.85)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationThe magnitude of risk reduction was smaller in T2D patients than in the general from 1400 min/week to 2100 min/week of LPA (26% vs. 50%) and from around 0 to 140 min/week of MVPA (55% vs. 60%), but beyond this level, the risk continued to decrease in T2D patients while levelled off or even slightly increased in the general.
“The magnitude of risk reduction was smaller in T2D patients than in the general from 1400 min/week to 2100 min/week of LPA (26% vs. 50%) and from around 0 to 140 min/week of MVPA (55% vs. 60%), but beyond this level, the risk continued to decrease in T2D patients while levelled off or even slightly increased in the general.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [14] Ekelund, U. et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ 366, l4570 (2019). 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
May combine two claims.
PremisecitationTwo studies from NHANES, a study from the Look AHEAD Trial, and a study from the Walking Away from Type 2 Diabetes trial all demonstrated significant risk reductions related to all-cause mortality with higher volumes of physical activity.
“Two studies derived from the NHANES, a study from the Look AHEAD Trial and a study from the Walking Away from Type 2 Diabetes trial all demonstrated significant risk reductions in related to all-cause mortality with higher volumes of PA17–20.”
Quote in the paperSubstantial claim3 of 4 sources checked- cites [17] Loprinzi, P. D. The effects of objectively-measured, free-living daily ambulatory movement on mortality in a national sample of adults with diabetes. Physiol. Behav. 154, 126–128 (2016). source
- cites [18] Zhu, P. et al. Replacing of sedentary behavior with physical activity and the risk of mortality in people with prediabetes and diabetes: a prospective cohort study. Int. J. Behav. Nutr. Phys. Act. 20, 81 (2023). source
- cites [19] Look AHEAD Study Group. Association between change in accelerometer-measured and self-reported physical activity and cardiovascular disease in the Look AHEAD Trial. Diabetes Care 45, 742–749 (2022). source
The Results report significantly lower risk of cardiovascular outcomes with greater accelerometer-measured physical activity over four years. The CVD Outcomes section shows that two secondary composite outcomes included all-cause death, but the paper does not report a significant risk reduction for all-cause mortality as a separate outcome. The association also did not hold for one-year activity change or self-reported activity. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [20] Bakrania, K. et al. Associations of objectively measured moderate-to-vigorous-intensity physical activity and sedentary time with all-cause mortality in a population of adults at high risk of type 2 diabetes mellitus. Prev. Med. Rep. 5, 285–288 (2017). source
May combine two claims.
FindingcitationThe L-shaped dose-response associations of accelerometer-measured LPA and MVPA with all-cause mortality in T2D patients in our study mirrored those in the general population in a harmonized meta-analysis, with similar inflection points for LPA (around 2000 min/week) but different ones for MVPA (T2D: 300 min/week; general: 140 min/week).
“The L-shaped dose–response associations of accelerometer-measured LPA and MVPA with all-cause mortality in T2D patients in our study mirrored those in the general population in a harmonized meta-analysis, with similar inflection points for LPA (around 2000 min/week) but different ones for MVPA (T2D: 300 min/week; general: 140 min/week)14.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [14] Ekelund, U. et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ 366, l4570 (2019). 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
May combine two claims.
PremisecitationA meta-analysis of 12 cohorts indicated that the all-cause mortality risk in the highest physical activity category was 40% lower than in the lowest among diabetic adults, but the exact volume of physical activity cannot be specified because grouping rules are highly heterogeneous across cohorts.
“A meta-analysis of 12 cohorts has indicated that the all-cause mortality risk in the highest PA category was 40% lower than that in the lowest among diabetic adults, but the exact volume of PA cannot be specified because its grouping rules are highly heterogeneous across cohorts7.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [7] Kodama, S. et al. Association between physical activity and risk of all-cause mortality and cardiovascular disease in patients with diabetes: a meta-analysis. Diabetes Care 36, 471–479 (2013). source
Classified as probably not a substantial claim.
PremisecitationExisting studies have demonstrated that objectively measured physical activity could be a potential predictor for cardiovascular disease mortality and cancer mortality in the general population.
“In addition, existing studies have demonstrated that objectively measured PA could be a potential predicator for cardiovascular disease (CVD) mortality and cancer mortality in the general population15,16.”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [15] Leroux, A. et al. Quantifying the Predictive performance of objectively measured physical activity on mortality in the UK Biobank. J. Gerontol. A Biol. Sci. Med. Sci. 76, 1486–1494 (2021). source
The Abstract and Discussion (page not provided) report that objectively measured physical activity predicts all-cause mortality among UK Biobank participants over 50. They do not report separate predictions for cardiovascular-disease or cancer mortality, and the studied cohort does not establish the claim for the general population. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [16] Ledbetter, M. K., Tabacu, L., Leroux, A., Crainiceanu, C. M. & Smirnova, E. Cardiovascular mortality risk prediction using objectively measured physical activity phenotypes in NHANES 2003–2006. Prev. Med. 164, 107303 (2022). source
The Discussion reports that accelerometer-derived physical activity measures predicted CVD mortality in a US non-institutionalized sample, and the Abstract specifies participants aged 50–85. The paper does not report a finding about cancer mortality, and its study population is narrower than the general population claimed. (LLM, conf=0.89)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationAccelerometry data in 871 T2D patients showed that 55.8%, 57.4%, and 34.9% of White, African American, and Hispanic individuals did not meet the recommended threshold in guidelines.
“accelerometry data in 871 T2D patients showed that 55.8%, 57.4%, and 34.9% of White, African American, and Hispanic individuals did not meet the recommended threshold in guidelines24.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [24] Bazargan-Hejazi, S., Arroyo, J. S., Hsia, S., Brojeni, N. R. & Pan, D. A racial comparison of differences between self-reported and objectively measured physical activity among US adults with diabetes. Ethn. Dis. 27, 403–410, (2017). source
May combine two claims.
Study design and conductcitationPA was objectively measured by an accelerometer which can capture leisure and non-leisure PA across multiple domains and minimized the recall bias and reporting bias.
“Furthermore, PA was objectively measured by an accelerometer which can capture leisure and non-leisure PA across multiple domains28 and minimized the recall bias and reporting bias.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [28] Guo, W., Key, T. J. & Reeves, G. K. Accelerometer compared with questionnaire measures of physical activity in relation to body size and composition: a large cross-sectional analysis of UK Biobank. BMJ Open 9, e024206 (2019). source
Classified as probably not a substantial claim. May combine two claims.
PremisecitationThe latest guideline recommends ≥150 min/week of MPA to most T2D patients or ≥75 min/week of VPA to patients who are younger and more physically fit.
“The latest guideline recommends ≥150 min/week of MPA to most T2D patients or ≥75 min/week of VPA to patients who are younger and more physically fit23.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [23] ElSayed, N. A. et al. 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes – 2023. Diabetes Care 46, S68–S96 (2023). source
May combine two claims.
Findingown dataPopulation-attributable fractions for all-cause mortality for the lowest activity groups were 18.8% for light-intensity physical activity, 28.0% for moderate-intensity physical activity, and 31.1% for vigorous-intensity physical activity.
“Similar patterns to MVPA were observed for other PA intensities, with 18.8%, 28.0%, and 31.1% of PAFs for the lowest activity groups of LPA, MPA, and VPA, respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: The population-attributable fractions estimate the proportion of deaths that would be prevented by increasing physical activity, implying a causal effect of physical activity on mortality.
The quote only partly states this claim.
Findingown dataDuring a median follow-up of 6.9 years, 339 deaths were documented among the 4003 UK Biobank participants with type 2 diabetes included in the main analysis.
“During a median follow-up of 6.9 years (interquartile range 6.3–7.4 years), 339 death cases were documented.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataA total of 158 cancer deaths (46.6% of all deaths) and 83 cardiovascular disease deaths (24.5% of all deaths) were recorded.
“A total of 158 cancer deaths (46.6% of all deaths) and 83 CVD deaths (24.5% of all deaths) were recorded.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataPopulation-attributable fractions for all-cause mortality decreased with higher durations of moderate-to-vigorous-intensity physical activity: 47.1% for <275 min/week, 8.8% for 275-449 min/week, and 1.0% for 450-624 min/week.
“For example, the population-attributable fractions (PAFs) for mortality sequentially decreased with higher durations of MVPA, with PAFs of 47.1%, 8.8%, and 1.0% for those engaging <275 min/week, 275–449 min/week, and 450–624 min/week, respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: The population-attributable fractions estimate the proportion of deaths that would be prevented by increasing physical activity, implying a causal effect of physical activity on mortality.
The quote only partly states this claim.
Findingown dataCompared with <150 min/week of moderate-intensity physical activity, ≥450 min/week of moderate-intensity physical activity was associated with a 63% lower risk of cancer mortality.
“Compared with <150 min/week of MPA, ≥450 min/week of MPA was associated with a 63% (95% CI: 33%–80%) and 68% (95% CI: 21%–87%) lower risk of cancer and CVD mortality, respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
May combine two claims.
Findingnone givenAs short as 15 min/week of VPA have been linked to a 40% lower risk of mortality that needs to be achieved by 125 min/week of MPA.
“Another noteworthy point is that as short as 15 min/week of VPA have been linked to a 40% lower risk of mortality that needs to be achieved by 125 min/week of MPA.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataA dramatic risk reduction was also seen in VPA till 30 min/week and then became steady.
“A dramatic risk reduction was also seen in VPA till 30 min/week and then became steady.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataInverse associations previously observed between the duration of self-reported PA and the risk of mortality in individuals with T2D were verified in the UK Biobank using accelerometry data, but with a larger magnitude.
“In conclusion, inverse associations previously observed between the duration of self-reported PA and the risk of mortality in individuals with T2D were verified in the UK Biobank using accelerometry data, but with a larger magnitude”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataIn this prospective cohort study of 4003 adults with type 2 diabetes, longer duration of accelerometer-measured physical activity was significantly associated with a lower risk of all-cause, cancer, and cardiovascular disease mortality, without minimal or maximal threshold.
“In this prospective cohort study of 4003 adults with T2D, we found that irrespective of PA intensity, longer duration of accelerometer-measured PA was significantly associated with a lower risk of all-cause, cancer, and CVD mortality, without minimal or maximal threshold.”
Quote in the paperSubstantial claim- Rests on an assumption: The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
- Rests on an assumption: The findings from UK Biobank participants with type 2 diabetes and valid accelerometer data are representative enough of patients with type 2 diabetes to inform clinical guidelines.
May combine two claims. The quote only partly states this claim.
Study design and conductown dataThe main results were largely consistent across multiple sensitivity analyses, including exclusion of participants with poor self-rated health, further adjustment for or stratification by diabetes severity factors, additional adjustment for T2D-related complications, mutual adjustment of LPA, MPA, and VPA, imputation of missing data, competing risk regression, expressing PA volume in MET, and分组 by
“The results were largely consistent with the main analyses when participants with poor self-rated health status were excluded (Supplementary Table 15), when further adjusted for or stratified by diabetes severity factors (Supplementary Tables 16, 17), when we additionally adjusted for T2D-related complications (Supplementary Table 18), when LPA, MPA, and VPA were mutually adjusted in models (Suppl”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataIn this study, a 70% risk reduction in all-cause mortality was seen at the inflection point of moderate-to-vigorous-intensity physical activity (300 min/week), which was larger than the 55% at 500 min/week by self-report in a US study of 41,726 diabetic adults.
“In our study, a 70% of risk reduction in all-cause mortality was seen at the inflection point of MVPA (300 min/week), larger than the 55% at 500 min/week by self-report in a US study of 41,726 diabetic adults21.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] Beltran-Valls, M. R. et al. Physical activity and diabetes mortality in people with type 2 diabetes: a prospective cohort study of 0.5 million US people. Diabetes Metab. 49, 101410 (2023). source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningAs for any observational studies, we cannot exclude the role of residual/unmeasured confounding or make causal conclusions, even though we have adjusted for a wide range of potential confounders.
“Fifth, as for any observational studies, we cannot exclude the role of residual/unmeasured confounding or make causal conclusions, even though we have adjusted for a wide range of potential confounders.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenThe sample size of the UK Biobank was as large as 0.5 million, the response rate was only 5.5% and accelerometer-measured PA was only available for a subset of participants.
“though the sample size of the UK Biobank was as large as 0.5 million, the response rate was only 5.5% and accelerometer-measured PA was only available for a subset of participants.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenDiabetic adults in these analyses were generally healthier, more physically active, and had a lower mortality rate than the overall diabetic adults.
“Diabetic adults in these analyses were generally healthier, more physically active, and had a lower mortality rate than the overall diabetic adults.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningThe discrepancy suggests a longer duration of PA to achieve the same amount of risk reduction in mortality but a larger maximal risk reduction in T2D patients compared to general population.
“Such discrepancy suggests a longer duration of PA to achieve the same amount of risk reduction in mortality but a larger maximal risk reduction in T2D patients”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenThe major strengths of this study were its large-scale sample size and rich data sources that enabled us to accurately identify patients with T2D.
“The major strengths of this study were its large-scale sample size and rich data sources that enabled us to accurately identify patients with T2D.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenSeveral sensitivity analyses were carried out to assess the robustness of our results.
“Several sensitivity analyses were carried out to assess the robustness of our results.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe underlying biological mechanisms for the association between PA and mortality reduction in T2D patients can be summarized as PA-induced improvement on insulin sensitivity, glycose control, lipoprotein profile, blood pressure, and blood coagulability, which are likely to reduce the risk of diabetic complications and CVD.
“The underlying biological mechanisms for the association between PA and mortality reduction in T2D patients can be summarized as PA-induced improvement on insulin sensitivity, glycose control, lipoprotein profile, blood pressure, and blood coagulability, which are likely to reduce the risk of diabetic complications and CVD26.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] Tanasescu, M., Leitzmann, M. F., Rimm, E. B. & Hu, F. B. Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes. Circulation 107, 2435–2439 (2003). source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationreasoningThe between-study difference in risk reduction might be attributed to different background of study populations and different measurement methods of PA.
“The between-study difference might be attributed to the different background of the study populations and the different measurement methods of PA.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe algorithms for the capture and adjudication of prevalent T2D was consistent with previous research.
“The algorithms for the capture and adjudication of prevalent T2D was consistent with previous research9.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Han, H. et al. Association of a healthy lifestyle with all-cause and cause-specific mortality among individuals with type 2 diabetes: a prospective study in UK Biobank. Diabetes Care 45, 319–329 (2022). source
May combine two claims.
Study design and conductown dataThe proportional hazard assumption for Cox models was checked with Schoenfeld residuals and no violation was observed.
“The proportional hazard assumption for Cox models was checked with Schoenfeld residuals and no violation was observed (Supplementary Table 27).”
Quote in the paperSubstantial claim
The paper relies on this without support.
The 7-day wrist-worn accelerometer measurement reflects participants' usual physical activity duration and intensity.
“Duration and intensity of PA are measured by wrist-worn accelerometers over a 7-day period.”
The paper relies on this without support.
The observed associations between physical activity and mortality are not due to unmeasured confounding.
“The associations were independent of many potential confounders, including those related to diabetes severity.”
The paper relies on this without support.
The findings from UK Biobank participants with type 2 diabetes and valid accelerometer data are representative enough of patients with type 2 diabetes to inform clinical guidelines.
“Collectively, our findings provide insights for clinical guidelines that should highlight the potential value of adherence to greater intensity and duration of PA for patients with T2D.”
The paper relies on this without support.
The population-attributable fractions estimate the proportion of deaths that would be prevented by increasing physical activity, implying a causal effect of physical activity on mortality.
“18.8%, 28.0%, and 31.1% of deaths are attributable to the lowest level of light-intensity PA, moderate-intensity PA, and vigorous-intensity PA, respectively.”
The paper relies on this without support.
Accelerometry represents an improvement over self-report by reducing recall bias, misclassification of intensity, omission of fragmented PA, and insensitiveness in capturing LPA.
“Accelerometry represents an improvement over self-report by reducing recall bias, misclassification of intensity, omission of fragmented PA, and insensitiveness in capturing LPA.”
The paper relies on this without support.
There is currently a lack of robust evidence on whether a 7-day measurement is representative of habitual PA.
“First, there is currently a lack of robust evidence on whether a 7-day measurement is representative of habitual PA.”
The paper relies on this without support.
Wrist-worn accelerometers may not fully capture activities involving minimal arm movement, such as cycling, that ankle-worn accelerometers can quantify more accurately.
“However, they may not fully capture activities involving minimal arm movement, such as cycling, that ankle-worn accelerometers can quantify more accurately.”
The paper relies on this without support.
The cut-points for various PA intensities in this study may introduce a degree of subjectivity due to variability from device and demographic differences.
“However, it is important to note that these thresholds, which can be subject to variability due to device and demographic differences, may introduce a degree of subjectivity.”
The paper relies on this without support.
PA could be influenced by participants’ health status.
“Sixth, PA could be influenced by participants’ health status.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Wearable activity-tracking technologies have garnered growing attention as tools to encourage physical activity and support self-management in people with chronic conditions such as type 2 diabetes.
“In recent years, wearable activity-tracking technologies, including pedometers, accelerometers, fitness trackers, smartwatches, and smartphone-based applications, have garnered growing attention as tools to encourage physical activity and support self-management in people living with chronic conditions such as T2D.”
The majority of included studies were randomized controlled trials (n = 23), accompanied by seven observational studies and one quasi-experimental study.
“The majority were randomized controlled trials (n = 23), accompanied by seven observational studies, comprising four with a prospective or longitudinal design [9,10,14,15] and three that were cross-sectional [16,17,18], along with one quasi-experimental study with a pre–post design and no control group [19].”
Accelerometers provide continuous and accurate data, including the ability to detect low-intensity movements.
“They provide continuous and accurate data, including the ability to detect low-intensity movements [10,17].”
Wearable devices offer functionalities such as real-time feedback, step counting, heart rate monitoring, and behaviour-based prompts to foster sustained engagement in physical activity.
“These devices offer functionalities like real-time feedback, step counting, heart rate monitoring, and behaviour-based prompts to foster sustained engagement in physical activity.”
Wearable technologies are accessible and relatively affordable, representing promising complements to traditional care.
“owing to their accessibility and relative affordability, these technologies represent promising complements to traditional care [8,9,10].”
A minimum monitoring duration of seven consecutive days is appropriate to account for day-to-day variability and provide a reliable representation of habitual behaviour, including weekday/weekend differences.
“A minimum of seven days was considered appropriate, as this duration is commonly adopted in physical activity research to account for day-to-day variability and to provide a reliable representation of habitual behaviour, including differences between weekdays and weekends [10,12,13].”
Accelerometers record movement acceleration, enabling quantification of physical activity and sedentary time under real-life conditions.
“These devices record movement acceleration, enabling the quantification of physical activity and sedentary time under real-life conditions [10,24].”
Higher levels of daily physical activity were associated with lower all-cause, cardiovascular, and cancer-related mortality, with clear dose-response relationships observed.
“One large-scale observational analysis found that higher levels of daily physical activity were associated with lower all-cause, cardiovascular, and cancer-related mortality, with clear dose–response relationships observed [10].”
Cites
International physical activity questionnaire: 12-country reliability and validity
CRAIG, C. L., MARSHALL, A. L., SJ??STR??M, M., BAUMAN, A. E., BOOTH, M. L., AINSWORTH, B. E., PRATT, M., EKELUND, U., YNGVE, A., SALLIS, J. F., et al. (2003) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000078924.61453.fb · Cited by 21,619 · see citing works
Ong, K. L., Stafford, L. K., McLaughlin, S. A., Boyko, E. J., Vollset, S. E., Smith, A. E., Dalton, B. E., Duprey, J., Cruz, J. A., Hagins, H., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(23)01301-6 · Cited by 4,681 · see citing works
Fry, A., Littlejohns, T. J., Sudlow, C., Doherty, N., Adamska, L., Sprosen, T., Collins, R., & Allen, N. E. (2017) · American Journal of Epidemiology · doi:10.1093/aje/kwx246 · Cited by 3,979 · see citing works
Mozaffarian, D. (2016) · Circulation · doi:10.1161/circulationaha.115.018585 · Cited by 2,216 · see citing works
Ekelund, U., Tarp, J., Steene-Johannessen, J., Hansen, B. H., Jefferis, B., Fagerland, M. W., Whincup, P., Diaz, K. M., Hooker, S. P., Chernofsky, A., et al. (2019) · BMJ · doi:10.1136/bmj.l4570 · Cited by 1,769 · see citing works
Use and misuse of population attributable fractions
Rockhill, B., Newman, B., & Weinberg, C. (1998) · American Journal of Public Health · doi:10.2105/ajph.88.1.15 · Cited by 1,683 · see citing works
MIND diet associated with reduced incidence of Alzheimer's disease
Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Bennett, D. A., & Aggarwal, N. T. (2015) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2014.11.009 · Cited by 1,162 · see citing works
Anti-inflammatory effects of exercise: role in diabetes and cardiovascular disease
Pedersen, B. K. (2017) · European Journal of Clinical Investigation · doi:10.1111/eci.12781 · Cited by 617 · see citing works
Population attributable fraction
Mansournia, M. A., & Altman, D. G. (2018) · BMJ · doi:10.1136/bmj.k757 · Cited by 478 · see citing works
Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease
Biddinger, K. J., Emdin, C. A., Haas, M. E., Wang, M., Hindy, G., Ellinor, P. T., Kathiresan, S., Khera, A. V., & Aragam, K. G. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.3849 · Cited by 468 · see citing works
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s005 · Cited by 362 · see citing works
Wearable-device-measured physical activity and future health risk
Strain, T., Wijndaele, K., Dempsey, P. C., Sharp, S. J., Pearce, M., Jeon, J., Lindsay, T., Wareham, N., & Brage, S. (2020) · Nature Medicine · doi:10.1038/s41591-020-1012-3 · Cited by 355 · see citing works
Pearson-Stuttard, J., Bennett, J., Cheng, Y. J., Vamos, E. P., Cross, A. J., Ezzati, M., & Gregg, E. W. (2021) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(20)30431-9 · Cited by 335 · see citing works
Tanasescu, M., Leitzmann, M. F., Rimm, E. B., & Hu, F. B. (2003) · Circulation · doi:10.1161/01.cir.0000066906.11109.1f · Cited by 329 · see citing works
Han, H., Cao, Y., Feng, C., Zheng, Y., Dhana, K., Zhu, S., Shang, C., Yuan, C., & Zong, G. (2022) · Diabetes Care · doi:10.2337/dc21-1512 · Cited by 290 · see citing works
Dwyer, T., Pezic, A., Sun, C., Cochrane, J., Venn, A., Srikanth, V., Jones, G., Shook, R., Sui, X., Ortaglia, A., et al. (2015) · PLOS ONE · doi:10.1371/journal.pone.0141274 · Cited by 239 · see citing works
Are Self-report Measures Able to Define Individuals as Physically Active or Inactive?
Steene‐Johannessen, J., Anderssen, S. A., van der Ploeg, H. P., Hendriksen, I. J. M., Donnelly, A., Brage, S., & Ekelund, U. (2015) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000760 · Cited by 238 · see citing works
Kodama, S., Tanaka, S., Heianza, Y., Fujihara, K., Horikawa, C., Shimano, H., Saito, K., Yamada, N., Ohashi, Y., & Sone, H. (2013) · Diabetes Care · doi:10.2337/dc12-0783 · Cited by 212 · see citing works
Stamatakis, E., Owen, K. B., Shepherd, L., Drayton, B., Hamer, M., & Bauman, A. E. (2021) · Epidemiology · doi:10.1097/ede.0000000000001316 · Cited by 192 · see citing works
Geidl, W., Schlesinger, S., Mino, E., Miranda, L., & Pfeifer, K. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-01007-5 · Cited by 183 · see citing works
Nesti, L., Pugliese, N. R., Sciuto, P., & Natali, A. (2020) · Cardiovascular Diabetology · doi:10.1186/s12933-020-01109-1 · Cited by 146 · see citing works
Standardizing Analytic Methods and Reporting in Activity Monitor Validation Studies
Welk, G. J., Bai, Y., Lee, J. M., Godino, J., Saint‐Maurice, P. F., & Carr, L. J. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001966 · Cited by 139 · see citing works
Guo, W., Key, T. J., & Reeves, G. K. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-024206 · Cited by 82 · see citing works
Ho, F. K., Zhou, Z., Petermann-Rocha, F., Para-Soto, S., Boonpor, J., Welsh, P., Gill, J. M. R., Gray, S. R., Sattar, N., Pell, J. P., et al. (2022) · Circulation · doi:10.1161/circulationaha.122.059663 · Cited by 76 · see citing works
Leroux, A., Xu, S., Kundu, P., Muschelli, J., Smirnova, E., Chatterjee, N., & Crainiceanu, C. (2021) · The Journals of Gerontology: Series A · doi:10.1093/gerona/glaa250 · Cited by 66 · cited 12× · see citing works
“4 and Supplementary Table 5).”
InfluentialAbildso, C. G., Daily, S. M., Meyer, M. R. U., Perry, C. K., & Eyler, A. A. (2023) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7204a1 · Cited by 63 · see citing works
Yerramalla, M. S., Fayosse, A., Dugravot, A., Tabak, A. G., Kivimäki, M., Singh-Manoux, A., & Sabia, S. (2020) · Diabetologia · doi:10.1007/s00125-019-05050-1 · Cited by 45 · see citing works
Bazargan-Hejazi, S., Arroyo, J. S., Hsia, S., Brojeni, N. R., & Pan, D. (2017) · Ethnicity & Disease · doi:10.18865/ed.27.4.403 · Cited by 35 · see citing works
Cao, Z., Hou, Y., Yang, H., Huang, X., Wang, X., & Xu, C. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.048 · Cited by 31 · see citing works
Self-citationMielke, G. I., de Almeida Mendes, M., Ekelund, U., Rowlands, A. V., Reichert, F. F., & Crochemore‐Silva, I. (2023) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.14416 · Cited by 26 · cited 1× · see citing works
“However, they may not fully capture activities involving minimal arm movement, such as cycling, that ankle-worn accelerometers can quantify more accurately.”
Zhu, P., Lao, G., Li, H., Tan, R., Gu, J., & Ran, J. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01488-0 · Cited by 23 · see citing works
Beltran-Valls, M. R., Cabanas-Sánchez, V., Sadarangani, K. P., Rodríguez-Artalejo, F., Moliner-Urdiales, D., & Martínez-Gómez, D. (2023) · Diabetes & Metabolism · doi:10.1016/j.diabet.2022.101410 · Cited by 21 · see citing works
Shin, W. Y., Lee, T., Jeon, D.-H., & Kim, H. C. (2018) · Journal of Korean Medical Science · doi:10.3346/jkms.2018.33.e60 · Cited by 20 · see citing works
Look AHEAD Study Group (2022) · Diabetes Care · doi:10.2337/dc21-1206 · Cited by 20 · see citing works
Bakrania, K., Edwardson, C. L., Khunti, K., Henson, J., Stamatakis, E., Hamer, M., Davies, M. J., & Yates, T. (2017) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2017.01.013 · Cited by 19 · see citing works
Ledbetter, M. K., Tabacu, L., Leroux, A., Crainiceanu, C. M., & Smirnova, E. (2022) · Preventive Medicine · doi:10.1016/j.ypmed.2022.107303 · Cited by 16 · cited 1× · see citing works
“…15), when further adjusted for or strati fi ed by diabetes severity factors (Supplementary Tables 16, 17), when we additionally adjusted for T2D-related complications (Supplementary Table 18), when LPA, MPA, and VPA were mutually adjusted in models (Supplementary Table 19 and Supplementary Fig.”
Loprinzi, P. D. (2016) · Physiology & Behavior · doi:10.1016/j.physbeh.2015.11.022 · Cited by 7 · see citing works
Jung, I., Han, K.-D., Moon, S. J., Kwon, H., Park, S. E., Rhee, E.-J., & Lee, W.-Y. (2023) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2023.110819 · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Zahalka, S. J. et al. The Role of Exercise in Diabetes. https://www.ncbi.nlm.nih.gov/books/NBK549946/ (MDText.com, Inc., 2023).
Cited by
Sorted by citations
Laffi, A., Persiani, M., Piras, A., Meoni, A., & Raffi, M. (2025) · Healthcare · doi:10.3390/healthcare13192422 · Cited by 9 · see citing works
- Authors
- Cao, Z., Min, J., Chen, H., Hou, Y., Yang, H., Si, K., & Xu, C.
- Affiliations
- Hangzhou Normal University (CN)
- Capital Medical University (CN)
- Tianjin Medical University (CN)
- Shanghai Jiao Tong University (CN)
- Corresponding author
- Si, Keyi
- Xu, Chenjie
- Venue
- Nature Communications
- Published
- 2024-06-17
- Volume
- 15
- Issue
- 1
- Pages
- 5164-5164
- ISSN
- 2041-1723 (ISSN-L)
- PMC
- PMC11183112
- OpenAlex
- W4399731507
- Semantic Scholar
- fb9d96dc3fd45666ac537e53a1a3ac12f2b4c1e9
- Cited by
- 37
- References
- 38
- Citations by year
- 2026: 20 · 2025: 13 · 2024: 4
- FWCI
- 8.85
- Type
- journal article
- Language
- en
- Update notices
- correction (2024-11-18)
- Open access
- gold
- doi.org
- Locations
- Nature Communications (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Natural Science Foundation of China (72204071)
- Natural Science Foundation of Zhejiang Province (LY23G030005)
- Hangzhou Normal University (4265C50221204119)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
- Keywords
- type 2 diabetes, physical activity, accelerometer-measured activity, mortality, all-cause mortality, cancer mortality, cardiovascular mortality, light physical activity, moderate physical activity, high-intensity exercise, physical activity duration, physical activity intensity, attributable mortality
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, United Kingdom, Humans, Male, Middle Aged, Neoplasms, Prospective Studies, Exercise, 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.
What counts as a claim ›How we measure confidence ›How we check this ›
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