The association between sedentary behaviour, physical activity and type 2 diabetes markers: A systematic review of mixed analytic approaches
Open accessAbstract
The negative effect of sedentary behaviour on type 2 diabetes markers is established, but the interaction with measures of physical activity is still largely unknown. Previous studies have analysed associations with single-activity models, which ignore the interaction with other behaviours. By including results from various analytical approaches, this review critically summarises the effects of sedentary behaviour on diabetes markers and the benefits of substitutions and compositions of physical activity. Ovid Medline, Embase and Cochrane Library databases were systematically searched. Studies were selected if sedentary behaviour and physical activity were measured by accelerometer in the general population, and if associations were reported with glucose, insulin, HOMA-IR, insulin sensitivity, HbA1c, diabetes incidence, CRP and IL-6. Forty-five studies were included in the review. Conclusive detrimental associations with sedentary behaviour were determined for 2-h insulin (6/12 studies found associations), fasting insulin (15/19 studies), insulin sensitivity (4/6 studies), diabetes (3/4 studies) and IL-6 (2/3 studies). Reallocating sedentary behaviour to light or moderate-to-vigorous activity has a beneficial effect for 2-h glucose (1/1 studies), fasting insulin (3/3 studies), HOMA-IR (1/1 studies) and insulin sensitivity (1/1 studies). Compositional measures of sedentary behaviour were found to affect 2-h glucose (1/1 studies), fasting insulin (2/3 studies), 2-h insulin (1/1 studies), HOMA-IR (2/2 studies) and CRP (1/1 studies). Different analytical methods produced conflicting results for fasting glucose, 2-h glucose, 2-h insulin, insulin sensitivity, HOMA-IR, diabetes, hbA1c, CRP and IL-6. Studies analysing data by quartiles report independent associations between sedentary behaviour and fasting insulin, HOMA-IR and diabetes only for high duration of sedentary time (7–9 hours/day). However, this review could not provide sufficient evidence for a time-specific cut-off of sedentary behaviour for diabetes biomarkers. While substituting sedentary behaviour with moderate-to-vigorous activity brings greater improvements for health, light activity also benefits metabolic health. Future research should elucidate the effects of substituting and combining different activity durations and modalities.
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Fitness trackers motivate users to move more throughout the day, and increased physical activity levels mitigate the risk of various chronic diseases, particularly T2D.
“By providing real-time feedback and personalised goals, fitness trackers motivate users to move more throughout the day, and the increased physical activity levels mitigate the risk of various chronic diseases, particularly T2D, where a sedentary lifestyle is a significant risk factor [16].”
From Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population (2025) · cites this paper as [16]
The Results section (‘Diabetes incidence’) reports that three of four studies found higher odds of diabetes with more sedentary time, supporting the T2D-risk portion of the citation. The paper studies activity and diabetes markers, not whether fitness trackers’ real-time feedback or personalised goals motivate users to move more. It also does not establish that tracker-driven activity reduces the risk of various chronic diseases. (LLM, conf=0.88)
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- Authors
- Cavallo, F. R., Golden, C., Pearson-Stuttard, J., Falconer, C., & Toumazou, C.
- Affiliations
- Imperial College London (GB)
- UK Health Security Agency (GB)
- Corresponding author
- Cavallo, Francesca Romana
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2022-05-11
- Volume
- 17
- Issue
- 5
- Pages
- e0268289
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC9094551
- OpenAlex
- W4280492390
- Cited by
- 51
- References
- 79
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 10 · 2023: 22 · 2022: 3
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Engineering and Physical Sciences Research Council (Doctoral Training Partnership)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- sedentary behavior, physical activity, type 2 diabetes, insulin resistance, insulin sensitivity, HOMA-IR, fasting insulin, glucose, HbA1c, C-reactive protein, interleukin-6, moderate-to-vigorous physical activity, accelerometer-measured activity, diabetes incidence
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Glucose, Glycated Hemoglobin, Humans, Insulin, Insulin Resistance, Biomarkers, Exercise, Interleukin-6, Sedentary Behavior
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