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Sedentary Behavior as a Mediator of Type 2 Diabetes
Open accessAbstract
Over the past 5 years, the fastest growing new area of physical activity research centered around the concept that the large amount of time people spend sitting inactive may have significant physiological consequences hazardous to human health, including risk for type 2 diabetes and poor metabolism of lipids and glucose. Meta-analysis (10 studies) suggests there is a 112% greater relative risk associated with a large duration of sedentary behavior for type 2 diabetes. Meta-analysis also indicates significantly greater odds for metabolic syndrome. We also summarize results for 7 studies using objective measures of total sedentary time and focusing on cardiometabolic risks in persons at high risk for type 2 diabetes or already diagnosed with type 2 diabetes. The underlying hypothesis introduced in 2004 by the inactivity physiology paradigm has been that frequent and abundant contractile activity by certain types of skeletal muscle can have a potent influence on key physiological processes, even when the intensity is below that achieved through exercise. We explain some of the mechanisms for why the metabolism in slow-twitch oxidative skeletal muscle is key for understanding the healthy responses to low-intensity physical activity (LIPA). Findings from objective measures from inclinometry indicated that the quartile range for weekly sedentary time is ∼29 h/week. The total daily time that people sit, stand, and accumulate nonexercise steps is independent of traditionally recommended moderate-vigorous physical activity. The large amount of sedentary time associated with risk for disease can only be reduced significantly with safe and nonfatiguing LIPA, especially in the most at-risk proportion of the population. Importantly, experimental studies are starting to indicate that it will be especially insightful to understand the acute dose-response effects of LIPA in order to understand why reducing sedentary time can improve lipid and glucose metabolism for the prevention and treatment of chronic disorders related to type 2 diabetes.
Overview
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Written from the paper’s full text.
TL;DR
This review argues that prolonged sedentary behavior is a distinct risk factor for type 2 diabetes and metabolic syndrome, independent of moderate-vigorous physical activity. It synthesizes epidemiological and acute physiological evidence to propose that replacing sitting with frequent, non-fatiguing low-intensity physical activity may improve glucose and lipid metabolism.
Key findings
- In a meta-analysis of 10 studies (6 prospective; 505,045 participants), large vs. small TV time was associated with a 112% greater pooled relative risk of type 2 diabetes, independent of self-reported physical activity.
- In a meta-analysis of 10 cross-sectional studies (21,393 participants), the most sedentary categories had 73% greater odds of metabolic syndrome, even after some studies adjusted for BMI and MVPA.
- Objective inclinometry indicated a ~29 hr/week difference between the most and least sedentary quartiles; people sat 50% to 75% of the waking day, and sedentary time was independent of recommended MVPA.
- Acute experimental evidence: one day of sitting reduced insulin-stimulated glucose uptake by 39% vs. LIPA; another study found ~20% differences in postprandial glucose and insulin between sedentary and active conditions, with similar responses across two walking intensities.
Methods
- Narrative review of inactivity physiology, contrasting sedentary behavior with exercise physiology and summarizing epidemiological, objective-monitoring, acute experimental, and animal/molecular studies.
- Data summarized include meta-analyses (10 studies, 505,045 participants; 10 cross-sectional studies, 21,393 participants), 7 studies using objective measures in people at high risk for or diagnosed with type 2 diabetes, and acute trials of sitting vs. low-intensity activity.
- Main analysis is qualitative synthesis of reported relative risks, odds ratios, and physiological mechanisms; no new primary data or meta-analysis is presented.
Limitations
- Stated: bedrest studies require cautious interpretation; datasets not designed for sedentary behavior may have unanticipated confounding; most objective studies do not report timing of sedentary assessment relative to blood sampling; accelerometry has error in the low-intensity range; no reports relate breaks in sedentary time to type 2 diabetes.
- Stated: evidence more strongly supports total sedentary time than pattern/breaks for disease risk; after adjustment for waist or BMI, some break associations were no longer significant.
- Evident: as a narrative review, it does not describe a systematic search strategy or formal quality appraisal, and many included epidemiological studies rely on self-reported TV/sedentary time, limiting causal inference.
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In the paper
“recent studies using inclinometers to quantify all of the non-sitting and total sedentary time (12) indicate that most people sit more than half of every day, or between 50% (1st quartile) to 75% (4th quartile) of the waking day (Fig 4A).”
§ Sedentary behavior as a mediator of type 2 diabetes > CONCLUSION
What the sources say
- Not checked yetcites [12] Craft LL Zderic TW Gapstur SM Vaniterson EH Thomas DM Siddique J Hamilton MT Evidence that women meeting physical activity guidelines do not sit less: an observational inclinometry study Int J Behav Nutr Phys Act 2012 10 4 9 122 23034100 PMC3490758
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Global gene profiling indicates diversity and potency of the responses potentially important for prevention of type 2 diabetes and related metabolic risks, including genes previously shown to modulate glucose metabolism (e.g., GLUT1, OGTase P110, SNAP-23, and Rad) and frequently associated processes such as inflammation and thrombosis (e.g. LPP1).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Molecular mechanisms potentially explaining why sitting too much is not the same as exercising too little
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“there was a large cluster of genes that had a significant increase in expression during a period of prolonged inactivity for 12 hours, yet unexpectedly did not reverse back to normal within several hours after regaining contractile activity (Fig 1B).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Molecular mechanisms potentially explaining why sitting too much is not the same as exercising too little
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Figure 4B also illustrates that even in the individuals who exercised at twice the 150 min/week level in the recommendations, sitting time and the total daily non-exercise activity was not different from those who almost never exercised.”
§ Sedentary behavior as a mediator of type 2 diabetes > CONCLUSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Quantitatively, we found there was a difference of ~29 hrs/week between the most and least sedentary quartiles (Figure 4A).”
§ Sedentary behavior as a mediator of type 2 diabetes > CONCLUSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Comparing relatively low and high categories of sedentary time, the most sedentary categories had 73% greater odds for metabolic syndrome, even after some of these studies apparently adjusted for BMI and MVPA.”
- Also stated in: § Abstract · hedged
“Meta-analysis also indicates significantly greater odds for metabolic syndrome.”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Sedentary time and metabolic syndrome (Table 1)
What the sources say
- Not checked yetcites [3] Edwardson CL Gorely T Davies MJ Gray LJ Khunti K Wilmot EG Yates T Biddle SJ Association of sedentary behaviour with metabolic syndrome: a meta-analysis PLoS One 2012 7 4 PMC3325927 22514690
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Abstract · hedged
In the paper
“the relationships between TV time and type 2 diabetes were independent of self-reported “physical activity” (meaning exercise-like behaviors).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes
What the sources say
- Not checked yetcites [10] Wilmot EG Edwardson CL Achana FA Davies MJ Gorely T Gray LJ Khunti K Yates T Biddle SJ Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis Diabetologia 2012 55 11 2895 905 22890825
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“the meta-analysis providing support for the current U.S. federal physical activity guidelines was associated with a 1.4 fold greater pooled relative risk of diabetes for people who did not meet the guideline-defined types of activity, such as brisk walking (2).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes
What the sources say
- Not checked yetcites [2] 2008 Physical Activity Guidelines for Americans US Department of Health and Human Services 2008 www.health.gov/paguidelines/
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“The total daily time that people sit, stand, and accumulate non-exercise steps is independent of traditionally recommended moderate-vigorous physical activity (MVPA).”
- Also stated in: § Associations between sedentary behaviors and type 2 diabetes · hedged
“This is likely relevant to the objective evidence that sedentary time is unrelated to the time that people engage in the activity profile currently recommended in the U.S. federal guidelines (12).”
§ Sedentary behavior as a mediator of type 2 diabetes > Abstract
What the sources say
- Not checked yetcites [12] Craft LL Zderic TW Gapstur SM Vaniterson EH Thomas DM Siddique J Hamilton MT Evidence that women meeting physical activity guidelines do not sit less: an observational inclinometry study Int J Behav Nutr Phys Act 2012 10 4 9 122 23034100 PMC3490758
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Associations between sedentary behaviors and type 2 diabetes · hedged
In the paper
“Meta-analysis (10 studies) suggest there is a 112% greater relative risk associated with a large duration of sedentary behavior for type 2 diabetes.”
- Also stated in: § Associations between sedentary behaviors and type 2 diabetes · plain
“One meta-analysis examined 10 studies (6 prospective) including 505,045 participants (10) and found that there was a 112% greater pooled relative risk of diabetes associated with large vs. small amounts of TV time (typically differing by a few hours per day as shown in Table 1, column 4).”
§ Sedentary behavior as a mediator of type 2 diabetes > Abstract
What the sources say
- Not checked yetcites [10] Wilmot EG Edwardson CL Achana FA Davies MJ Gorely T Gray LJ Khunti K Yates T Biddle SJ Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis Diabetologia 2012 55 11 2895 905 22890825
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Associations between sedentary behaviors and type 2 diabetes · plain
- Probably not a substantial claim. 6
- It may state two separate claims as one. 19
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Findings from objective measures from inclinometry indicated that the quartile range for weekly sedentary time is ~29 hours/week.”
§ Sedentary behavior as a mediator of type 2 diabetes > Abstract
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“They concluded that overall there were moderate to large unfavorable effects of high amounts of sedentary time on plasma triglyceride, glucose tolerance, and insulin sensitivity.”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Rapid and direct effects of time spent sitting versus performing low intensity physical activity
What the sources say
- Not checked yetcites [8] Saunders TJ Larouche R Colley RC Tremblay MS Acute sedentary behaviour and markers of cardiometabolic risk: a systematic review of intervention studies J Nutr Metab 2012 2012 712435 22754695 PMC3382951
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Authors also concluded from meta-analysis that sedentary time is associated with an increased risk of cardiovascular disease and all-cause mortality, while the strength of the association is most consistent for type 2 diabetes (10).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes
What the sources say
- Not checked yetcites [10] Wilmot EG Edwardson CL Achana FA Davies MJ Gorely T Gray LJ Khunti K Yates T Biddle SJ Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis Diabetologia 2012 55 11 2895 905 22890825
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“there is an inverse relationship between breaks in sedentary time with waist circumference (36,38,45,46) and BMI (45).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > The pattern or “breaks” in sedentary time
What the sources say
- Not checked yetcites [36] Cooper AR Sebire S Montgomery AA Peters TJ Sharp DJ Jackson N Fitzsimons K Dayan CM Andrews RC Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes Diabetologia 2012 55 3 589 99 22167127
- Not checked yetcites [38] Henson J Yates T Biddle SJ Edwardson CL Khunti K Wilmot EG Gray LJ Gorely T Nimmo MA Davies MJ Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health Diabetologia 2013 56 5 1012 20 23456209
- Not checked yetcites [45] Healy GN Dunstan DW Salmon J Cerin E Shaw JE Zimmet PZ Owen N Breaks in sedentary time: beneficial associations with metabolic risk Diabetes Care 2008 31 4 661 6 18252901
- Not checked yetcites [46] Healy GN Matthews CE Dunstan DW Winkler EA Owen N Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06 Eur Heart J 2011 32 5 590 7 21224291 PMC3634159
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“total sedentary time was significantly related to metabolic syndrome (30), insulin (36,46), HOMA-IR (36,46), 2 hr glucose (38,47), TG concentration (38,45,46), HDL (36,38,46), CRP (46), and IL-6 (41).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > The pattern or “breaks” in sedentary time
What the sources say
- Not checked yetcites [30] Bankoski A Harris TB McClain JJ Brychta RJ Caserotti P Chen KY Berrigan D Troiano RP Koster A Sedentary activity associated with metabolic syndrome independent of physical activity Diabetes Care 2011 34 2 497 503 21270206 PMC3024375
- Not checked yetcites [36] Cooper AR Sebire S Montgomery AA Peters TJ Sharp DJ Jackson N Fitzsimons K Dayan CM Andrews RC Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes Diabetologia 2012 55 3 589 99 22167127
- Not checked yetcites [46] Healy GN Matthews CE Dunstan DW Winkler EA Owen N Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06 Eur Heart J 2011 32 5 590 7 21224291 PMC3634159
- Not checked yetcites [38] Henson J Yates T Biddle SJ Edwardson CL Khunti K Wilmot EG Gray LJ Gorely T Nimmo MA Davies MJ Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health Diabetologia 2013 56 5 1012 20 23456209
- Not checked yetcites [47] Healy GN Dunstan DW Salmon J Cerin E Shaw JE Zimmet PZ Owen N Objectively measured light-intensity physical activity is independently associated with 2-hr plasma glucose Diabetes Care 2007 30 6 1384 9 17473059
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“A similar cross-sectional analysis using a heart rate method (35) reported that sedentary time was unfavorably related to plasma TG and HDL concentrations, waist circumference, and a clustered metabolic risk score (HbA1C, TG, inverse of HDL, waist).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Studies using devices to objectively estimate sedentary time in people identified as either high risk for type 2 diabetes or recently diagnosed with disease (Table 2)
What the sources say
- Not checked yetcites [35] Matthews CE George SM Moore SC Bowles HR Blair A Park Y Troiano RP Hollenbeck A Schatzkin A Amount of time spent in sedentary behaviors and cause-specific mortality in US adults Am J Clin Nutr 2012 95 2 437 45 22218159 PMC3260070
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“There was about 4 hr difference between the groups with the most and the least sedentary time and ~40% range in insulin-stimulated glucose uptake (43).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Insulin resistance relative to objectively determined sedentary time and total activity
What the sources say
- Not checked yetcites [43] Balkau B Mhamdi L Oppert JM Nolan J Golay A Porcellati F Laakso M Ferrannini E EGIR-RISC Study Group Physical activity and insulin sensitivity: the RISC study Diabetes 2008 57 10 2613 8 18591396 PMC2551669
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Insulin resistance is thought to be an underlying culprit in much of this condition (20).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Sedentary time and metabolic syndrome (Table 1)
What the sources say
- Not checked yetcites [20] Jornayvaz FR Samuel VT Shulman GI The role of muscle insulin resistance in the pathogenesis of atherogenic dyslipidemia and nonalcoholic fatty liver disease associated with the metabolic syndrome Annu Rev Nutr 2010 30 273 90 20645852 PMC3730129
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“breaks were related to 2 hr glucose (45), TG (45), CRP (46), and metabolic syndrome (30).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > The pattern or “breaks” in sedentary time
What the sources say
- Not checked yetcites [45] Healy GN Dunstan DW Salmon J Cerin E Shaw JE Zimmet PZ Owen N Breaks in sedentary time: beneficial associations with metabolic risk Diabetes Care 2008 31 4 661 6 18252901
- Not checked yetcites [46] Healy GN Matthews CE Dunstan DW Winkler EA Owen N Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06 Eur Heart J 2011 32 5 590 7 21224291 PMC3634159
- Not checked yetcites [30] Bankoski A Harris TB McClain JJ Brychta RJ Caserotti P Chen KY Berrigan D Troiano RP Koster A Sedentary activity associated with metabolic syndrome independent of physical activity Diabetes Care 2011 34 2 497 503 21270206 PMC3024375
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Sedentary time in this cohort was also directly associated with an insulin secretion index derived from an OGTT even after adjustment for clamp determined insulin sensitivity, and also with higher TG, and lower HDL-C independent of sustained MVPA but instead related to total daily activity (44).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Insulin resistance relative to objectively determined sedentary time and total activity
What the sources say
- Not checked yetcites [44] Lahjibi E Heude B Dekker JM Højlund K Laville M Nolan J Oppert JM Balkau B RISC Study Group Impact of objectively measured sedentary behaviour on changes in insulin resistance and secretion over 3 years in the RISC study: interaction with weight gain Diabetes Metab 2013 39 3 217 25 23541222
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“these relationships with disease rates remained significant in some of the studies additionally modeling for BMI (14–16) but not in all situations (17,18).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes
What the sources say
- Not checked yetcites [14] Hu FB Leitzmann MF Stampfer MJ Colditz GA Willett WC Rimm EB Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men Arch Intern Med 2001 161 12 1542 8 11427103
- Not checked yetcites [15] Krishnan S Rosenberg L Palmer JR Physical activity and television watching in relation to risk of type 2 diabetes: the Black Women’s Health Study Am J Epidemiol 2009 169 4 428 34 19056835 PMC2726641
- Not checked yetcites [16] Tonstad S Butler T Yan R Fraser GE Type of vegetarian diet, body weight, and prevalence of type 2 diabetes Diabetes Care 2009 32 5 791 6 19351712 PMC2671114
- Not checked yetcites [17] Ford ES Schulze MB Kröger J Pischon T Bergmann MM Boeing H Television watching and incident diabetes: Findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study J Diabetes 2010 2 1 23 7 20923471
- Not checked yetcites [18] Dunstan DW Salmon J Owen N Armstrong T Zimmet PZ Welborn TA Cameron AJ Dwyer T Jolley D Shaw JE AusDiab Steering Committee Physical activity and television viewing in relation to risk of undiagnosed abnormal glucose metabolism in adults Diabetes Care 2004 27 11 2603 9 15504993
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“the risk of too much sedentary time was independent of both the amount of accumulative MVPA and body composition indices (BMI, waist).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Studies using devices to objectively estimate sedentary time in people identified as either high risk for type 2 diabetes or recently diagnosed with disease (Table 2)
What the sources say
- Not checked yetcites [36] Cooper AR Sebire S Montgomery AA Peters TJ Sharp DJ Jackson N Fitzsimons K Dayan CM Andrews RC Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes Diabetologia 2012 55 3 589 99 22167127
- Not checked yetcites [37] Cooper AJ Brage S Ekelund U Wareham NJ Griffin SJ Simmons RK Association between objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes Diabetologia 2014 57 1 73 82 24196189 PMC3857880
- Not checked yetcites [38] Henson J Yates T Biddle SJ Edwardson CL Khunti K Wilmot EG Gray LJ Gorely T Nimmo MA Davies MJ Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health Diabetologia 2013 56 5 1012 20 23456209
- Not checked yetcites [39] Wijndaele K Orrow G Ekelund U Sharp SJ Brage S Griffin SJ Simmons RK Increasing objectively measured sedentary time increases clustered cardiometabolic risk: a 6 year analysis of the ProActive study Diabetologia 2014 57 2 305 12 24194101 PMC3889989
- Not checked yetcites [40] Ekelund U Griffin SJ Wareham NJ Physical activity and metabolic risk in individuals with a family history of type 2 diabetes Diabetes Care 2007 30 2 337 42 17259504
- Not checked yetcites [41] Henson J Yates T Edwardson CL Khunti K Talbot D Gray LJ Leigh TM Carter P Davies MJ Sedentary time and markers of chronic low-grade inflammation in a high risk population PLoS One 2013 8 10 e78350 24205208 PMC3812126
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“In a cross-sectional and prospective study of 528 people, sedentary time, as estimated from hip mounted accelerometry, was unfavorably related to fasting insulin, HOMA-IR, and HDL-C, both at baseline and after 6 months follow up (36).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Studies using devices to objectively estimate sedentary time in people identified as either high risk for type 2 diabetes or recently diagnosed with disease (Table 2)
What the sources say
- Not checked yetcites [36] Cooper AR Sebire S Montgomery AA Peters TJ Sharp DJ Jackson N Fitzsimons K Dayan CM Andrews RC Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes Diabetologia 2012 55 3 589 99 22167127
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The prescription for exercise is not only too brief but also too intense to be used as replacement for the vast amount of sedentary time currently linked with disease.”
§ Sedentary behavior as a mediator of type 2 diabetes > Introduction
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Skeletal muscle is a highly heterogeneous tissue and both the threshold for recruitment and the metabolic responses to contractile activity are very much dependent upon fiber type.”
§ Sedentary behavior as a mediator of type 2 diabetes > Metabolism in slow-twitch oxidative skeletal muscle is the key for metabolic responses during low intensity physical activity
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Notice that inactivity actually stimulated the rise in the expression of just as many genes as it did repress gene expression, invoking molecular processes turned on in response to sedentary behavior.”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Molecular mechanisms potentially explaining why sitting too much is not the same as exercising too little
What the sources say
- Not checked yetcites [58] Bey L Akunuri N Zhao P Hoffman EP Hamilton DG Hamilton MT Patterns of global gene expression in rat skeletal muscle during unloading and low-intensity ambulatory activity Physiol Genomics 2003 13 2 157 67 12582208
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Because of this, the energy demands of working fibers typically increase 50–100-fold greater in the working muscle mass, while other parts of the musculature can remain at resting levels (7).”
§ Sedentary behavior as a mediator of type 2 diabetes > Metabolism in slow-twitch oxidative skeletal muscle is the key for metabolic responses during low intensity physical activity
What the sources say
- Not checked yetcites [7] Hamilton MT Owen N Sedentary Behavior and Inactivity Physiology Physical Activity and Health 2 Bouchard C Blair SN Haskell WL Human Kinetics 2011 53 68
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Both experimental and epidemiological studies have recently been providing evidence that there may be unhealthy effects of large amounts of sedentary time (and inversely, small amounts of total non-exercise physical activity time, Fig 4A).”
§ Sedentary behavior as a mediator of type 2 diabetes > CONCLUSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Most importantly, there were ~20% differences for both the glucose and insulin responses in the sedentary vs. active condition, but the 2 active trials were similar.”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Rapid and direct effects of time spent sitting versus performing low intensity physical activity
What the sources say
- Not checked yetcites [53] Stephens BR Granados K Zderic TW Hamilton MT Braun B Effects of 1 day of inactivity on insulin action in healthy men and women: interaction with energy intake Metabolism 2011 60 7 941 9 21067784
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The large amount of sedentary time associated with risk for disease can only be reduced significantly with safe and non-fatiguing LIPA, especially in the most at risk proportion of the population.”
§ Sedentary behavior as a mediator of type 2 diabetes > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
- Rests on an assumption: Safe and non-fatiguing low-intensity physical activity can significantly reduce the large amount of sedentary time associated with disease risk in the most at-risk population.
In the paper
“In that intervention, the conclusion was the duration was more important than intensity because the caloric expenditure of exercise versus non-exercise activity was matched (54).”
§ Sedentary behavior as a mediator of type 2 diabetes > Associations between sedentary behaviors and type 2 diabetes > Rapid and direct effects of time spent sitting versus performing low intensity physical activity
What the sources say
- Not checked yetcites [54] Duvivier BM Schaper NC Bremers MA van Crombrugge G Menheere PP Kars M Savelberg HH Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable PLoS One 2013 8 2 e55542 23418444 PMC3572053
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“A fundamental point is that slow oxidative muscle can be heavily engaged during low intensity efforts, while at the same time the fast glycolytic type of muscle may remain inactive.”
§ Sedentary behavior as a mediator of type 2 diabetes > Metabolism in slow-twitch oxidative skeletal muscle is the key for metabolic responses during low intensity physical activity
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“During periods of acute contractile inactivity (59,60,64) and during reduced spontaneous ambulatory activity associated with aging (65,66), LPL activity decreases significantly, but primarily in the slow oxidative muscles where its actions are normally most important (Fig 3).”
§ Sedentary behavior as a mediator of type 2 diabetes > Metabolism in slow-twitch oxidative skeletal muscle is the key for metabolic responses during low intensity physical activity
What the sources say
- Not checked yetcites [59] Bey L Hamilton MT Suppression of skeletal muscle lipoprotein lipase activity during physical inactivity: a molecular reason to maintain daily low-intensity activity J Physiol 2003 551 Pt 2 673 82 12815182 PMC2343229
- Not checked yetcites [60] Zderic TW Hamilton MT Physical inactivity amplifies the sensitivity of skeletal muscle to the lipid-induced downregulation of lipoprotein lipase activity J Appl Physiol 2006 100 1 249 57 16195388
- Not checked yetcites [64] Hamilton MT Etienne J McClure WC Pavey BS Holloway AK Role of local contractile activity and muscle fiber type on LPL regulation during exercise Am J Physiol 1998 275 38 E1016 E1022 9843744
- Not checked yetcites [65] Bey L Areiqat E Sano A Hamilton MT Reduced lipoprotein lipase activity in postural skeletal muscle during aging J Appl Physiol 2001 91 687 692 11457782
- Not checked yetcites [66] Hamilton MT Areiqat E Hamilton DG Bey L Plasma triglyceride metabolism in humans and rats during aging and physical inactivity International Journal of Sports Nutrition and Exercise Metabolism 2001 11 95 102 11915936
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
Skeletal muscle insulin resistance is a key element in the development and progression of type 2 diabetes.
“Skeletal muscle insulin resistance is a key element in the development and progression of type 2 diabetes.”
The paper relies on this without support.
Acute contractile activity induces local signals stimulating glucose uptake independent of insulin signaling.
“First, independent of insulin signaling, acute contractile activity induces local signals stimulating glucose uptake.”
The paper relies on this without support.
Disease risks are associated with many hours per day of sitting idle, averaging approximately 10 hours per day or 70 hours each week.
“Disease risks are associated with many hours per day of sitting idle, averaging ~10 hrs/day or 70 hrs each week.”
The paper relies on this without support.
Safe and non-fatiguing low-intensity physical activity can significantly reduce the large amount of sedentary time associated with disease risk in the most at-risk population.
“The large amount of sedentary time associated with risk for disease can only be reduced significantly with safe and non-fatiguing LIPA, especially in the most at risk proportion of the population.”
The paper relies on this without support.
Muscle cells are constantly sensing and responding to their environment, so contractile activity and inactivity over the whole day counts.
“A remarkably fundamental concept that is useful for guiding inactivity physiology is simply that muscle cells are constantly sensing and responding to their environment, thus contractile activity and inactivity over the whole day counts.”
The paper relies on this without support.
Sitting at work and in leisure is ubiquitous in modern society.
“In conclusion, sitting at work and in leisure is ubiquitous in modern society.”
The paper relies on this without support.
LPL deficiencies are linked to lipoprotein parameters, inflammatory processes, and blood pressure.
“LPL deficiencies also have been linked to lipoprotein parameters, inflammatory processes, and blood pressure.”
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?
The cited source says what the claim attributes to it.
In the citing paper
“Modifying these characteristic sedentary patterns of adults with T2D could tackle a modifiable risk factor for T2D [12] that is scarcely addressed from clinical practice, which mainly focuses on increasing moderate and vigorous activity [13].”
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.
Newly diagnosed diabetes study is cited as a mortality study
MinorThe cited reference 35 is titled as a study of sedentary behavior and mortality in US adults, not a study of cardiometabolic measurements in people newly diagnosed with type 2 diabetes. Reference 37 is titled as a study of the latter population and outcomes.
“A similar cross-sectional analysis using a heart rate method (35) reported that sedentary time was unfavorably related to plasma TG and HDL concentrations, waist circumference, and a clustered metabolic risk score (HbA1C, TG, inverse of HDL, waist).”
“35. Matthews CE George SM Moore SC Bowles HR Blair A Park Y Troiano RP Hollenbeck A Schatzkin A Amount of time spent in sedentary behaviors and cause-specific mortality in US adults Am J Clin Nutr 2012 95 2 437 45 22218159 PMC3260070”
Two distinct acute studies are both identified as reference 53
MinorThe text identifies Stephens et al. (53) as one acute study, then calls a study in overweight or obese middle-aged adults the second acute study while also citing (53). These cannot be two distinct studies under the same reference number.
“The second of these acute studies was performed in overweight/obese middle age adults (53).”
“Stephens et al. (53) observed a 39% reduction in insulin stimulated glucose uptake (tracer determined plasma glucose uptake per unit insulin) after a day of sitting compared to a trial with LIPA when energy intake was held constant by controlled feedings.”
Citations
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Metadata
- Authors
- Hamilton, M. T., Hamilton, D. G., & Zderic, T. W.
- Affiliations
- Pennington Biomedical Research Center (US)
- ORCID
- Hamilton, Marc T.
- Venue
- Medicine and Sport Science
- Publisher
- S. Karger AG
- Published
- 2014
- Volume
- 60
- Pages
- 11-26
- ISSN
- 0076-6070 (ISSN-L)
- 0254-5020
- 1662-2812
- PMC
- PMC4364419
- OpenAlex
- W1538864188
- Semantic Scholar
- 1bc1a33006b6ec6419416d1babe77310bd0b049d
- Cited by
- 185
- References
- 72
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 18 · 2023: 19 · 2022: 30 · 2021: 18 · 2020: 11 · 2019: 12 · 2018: 11 · 2017: 19 · 2016: 6 · 2015: 10 · 2014: 1
- FWCI
- 31.05
- Type
- book chapter
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medicine and sport science/Medicine and sport (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (00119611)
- National Heart, Lung, and Blood Institute (HL-70482, HL-52490, R01HL057367, HL-57367, P01HL052490, F32HL070482)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (F32AR008455)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- sedentary behavior, type 2 diabetes, light physical activity, metabolic syndrome, cardiometabolic risk, slow-twitch muscle, glucose metabolism, lipid metabolism, inclinometry, sedentary time, dose-response relationship
- MeSH terms
- Animals, Diabetes Mellitus, Type 2, Glucose, Humans, Motor Activity, Risk Factors, Time Factors, Muscle, Skeletal, Metabolic Syndrome, Lipid Metabolism, Actigraphy, Sedentary Behavior
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.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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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