Feasibility and Preliminary Efficacy of a “Sit Less” Program Leveraging Fitbit Tracking and Tailored Text Messages in Cardiometabolic Disease: Findings From 2 Parallel Randomized Controlled Trials in Coronary Artery Disease and Type 2 Diabetes

May combine two claims.

Physical activity attenuates cardiometabolic risk but does not eliminate the increased risk associated with high sedentary time.

“Emerging evidence suggests that physical activity attenuates cardiometabolic risk but does not eliminate the increased risk associated with high sedentary time [1,6].”

• cites [1] sourcePartly supported

  The Discussion reports that adjusting for moderate-to-vigorous physical activity attenuated the association between sedentary time and CVD risk, but the elevated risk remained significant in older women. This supports the persistence of risk with high sedentary time, but the study does not establish that physical activity itself reduces cardiometabolic risk more broadly. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [6] sourceDisputed

  The Findings and Interpretation passages (page not supplied) report that high physical activity seemed to eliminate the increased all-cause mortality risk associated with high sitting time—the opposite of the claim's unqualified statement. The paper distinguishes TV-viewing time, for which activity attenuated but did not eliminate increased mortality risk; it does not establish the stated cardiometabolic-risk outcome. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

May combine two claims.

Sedentary behavior involves a lack of leg muscle contractions and restricted blood flow behind the knee when sitting, which causes reduced insulin sensitivity, vascular dysfunction, activation of low-grade inflammatory responses, and an imbalance in energy expenditure.

“It involves a lack of leg muscle contractions and restricted blood flow behind the knee when sitting, which causes reduced insulin sensitivity, vascular dysfunction, activation of low-grade inflammatory responses, and an imbalance in energy expenditure [3].”

• cites [3] sourcePartly supported

  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.

The reason for prolonged sedentary time among these individuals may relate to fear of moderate-to-vigorous physical activity due to their heart condition among those with CVD or the perceived development of hypoglycemia among those with diabetes.

“The reason for this prolonged sedentary time among these individuals may relate to fear of moderate-to-vigorous levels of physical activity due to their heart condition among those with CVD or the perceived development of hypoglycemia among those with diabetes [10,11].”

• cites [10] sourceNot checked — no full text of the source
• cites [11] sourcePartly supported

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

  Experimental — accuracy not yet measured

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

Depressive symptoms were measured using the Patient Health Questionnaire-9.

“Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) [37].”

• cites [37] sourceSupported

Classified as probably not a substantial claim.

ActivPAL3 data were used for analysis if the participant wore the device for more than 10 hours on a given day, at least 3 days.

“ActivPAL3 data were used for analysis if the participant wore the device for more than 10 hours on a given day, at least 3 days [30].”

• cites [30] sourcePartly supported

  The Data processing section (“What constitutes a valid day?”; page unavailable) reports that some studies used a minimum of 10 hours of wear to define a valid day. It does not establish at least three such days as a requirement for including a participant’s activPAL3 data in analysis; the wear-period section instead says the number of days depends on the study and recommends a protocol of at least seven days. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Frequent standing or walking can reduce total sedentary time and disrupt prolonged sitting, changing physiological pathways and improving cardiometabolic outcomes.

“Frequent standing or walking can reduce total sedentary time and disrupt prolonged sitting, changing physiological pathways and improving cardiometabolic outcomes [12-14].”

• cites [12] sourcePartly supported

  The Discussion (page not available) reports that light-intensity activity breaks improve acute glycemic control, supporting the walking-related part of the claim. It also says standing breaks generally did not improve cardiometabolic markers and that the studies could not determine whether benefits came from less total sitting, added activity, or the interruption itself. The proposed physiological mechanism is therefore not established by this paper. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [13] sourceSupported
• cites [14] sourcePartly supported

  The Abstract reports that frequent two-minute walking breaks during prolonged sitting reduced postprandial glucose and insulin in overweight or obese adults. The Conclusions discuss a possible metabolic mechanism, but say whether brief standing alone protects metabolic health remains undetermined; the study did not establish a change in physiological pathways or broader cardiometabolic outcomes. Page numbers were not supplied in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

Data for analysis were extracted using PAL analysis with the validated CREA algorithm, which closely matches diary data in classifying wake time activities.

“Data for analysis were extracted from the device using PAL analysis (activPAL, version 8.11) with the validated CREA algorithm, which closely matches diary data in classifying wake time activities [31].”

• cites [31] sourceSupported

May combine two claims.

Reducing sedentary time with frequent breaks is safe in other chronic health conditions and applicable to patients with cardiometabolic diseases.

“Others have shown that reducing sedentary time with frequent breaks is safe in other chronic health conditions and applicable to patients with cardiometabolic diseases [15-17].”

• cites [15] sourceNot checked — no full text of the source
• cites [16] sourceNot checked — no full text of the source
• cites [17] sourcePartly supported

  The Results report no adverse events in the ACTIVATE Trial, and the results table reports reduced total and prolonged sitting time. However, the trial studied breast cancer survivors, not patients with cardiometabolic diseases, and it did not establish that frequent breaks were safe or effective in that population. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Experimental studies confirm that sedentary breaks can improve glucose levels by 2% to 17% and fasting insulin levels by 15%.

“Experimental studies confirm that sedentary breaks can improve glucose levels by 2% to 17% and fasting insulin levels by 15% [12,14].”

• cites [12] sourcePartly supported

  The experimental-results sections report significant reductions in postprandial glucose response with activity breaks (about 1.4% and 17.4%) and a roughly 15% reduction in insulin with light-activity breaks. They do not identify that insulin result as a reduction in fasting insulin; the Discussion also cautions that the studies cannot establish whether the benefit comes from breaking up sitting rather than adding activity. Standing breaks did not significantly reduce glucose. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [14] sourcePartly supported

  The Results (page not provided) show that activity breaks reduced postprandial glucose and insulin responses in overweight/obese adults. They report glucose reductions of 24.1%–29.6% and an insulin reduction of 23%, not the cited 2%–17% and 15%; the insulin result concerns the response after a test drink, not fasting insulin. (LLM, conf=0.91)

  Experimental — accuracy not yet measured

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

One possible explanation for the psychological outcomes is that participants in the Sit Less group may have become more aware of the challenges of replacing sedentary behavior with moderate levels of physical activity (response shift).

“One possible explanation is that participants in the Sit Less group may have become more aware of the challenges of replacing sedentary behavior with moderate levels of physical activity, a phenomenon known as response shift, which is commonly observed in self-reported outcomes in behavioral interventions [42].”

• cites [42] sourcePartly supported

  The Background (page not provided) defines response shift as a change in how a person evaluates their own quality of life, and the Results report that many reviewed studies detected it. The paper does not establish that becoming more aware of the difficulty of replacing sedentary behavior is itself a response shift, or that response shift is common specifically in behavioral interventions. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Sit Less participants showed greater reductions in total sedentary time than control (adjusted mean difference −17.3 min/d, 95% CI −63 to 28; P=.45), not statistically significant.

“Sit Less participants showed greater reductions in total sedentary time (adjusted mean difference −17.3 min/d, 95% CI −63 to 28; P=.45)”

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

Baseline sedentary time among completers was approximately 10.4 hours per day.

“their baseline sedentary time was approximately 10.4 hours per day.”

May combine two claims.

Other cardiometabolic biomarkers, physical activity, and psychological outcomes were not significantly different between groups.

“Other cardiometabolic biomarkers, physical activity, and psychological outcomes were not significantly different”

May combine two claims.

Sit Less participants showed increases in sit-to-stand transitions compared with control (4.2 per day, 95% CI −2 to 10; P=.13), not statistically significant.

“increases in sit-to-stand transitions (4.2 per day, 95% CI −2 to 10; P=.13)”

May combine two claims.

Sit Less participants showed greater reductions in prolonged sedentary time >60 min than control (−49.9 min/d, 95% CI −102 to 2; P=.06), not statistically significant.

“>60 minutes (−49.9 min/d, 95% CI −102 to 2; P=.06)”

May combine two claims.

Time in range was higher in Sit Less than control (2.1%, 95% CI −4.8 to 9.1; P=.54), not statistically significant.

“time in range (2.1%, 95% CI −4.8 to 9.1; P=.54)”

May combine two claims.

Mean glucose was lower in Sit Less than control (−6.0 mg/dL, 95% CI −14.9 to 2.8; P=.18), not statistically significant.

“mean glucose (−6.0 mg/dL, 95% CI −14.9 to 2.8; P=.18)”

May combine two claims.

Sit Less participants showed greater reductions in prolonged sedentary time >30 min than control (−39.5 min/d, 95% CI −100 to 21; P=.20), not statistically significant.

“prolonged sedentary time of >30 minutes (−39.5 min/d, 95% CI −100 to 21; P=.20)”

May combine two claims.

Until week 9, participants responded to goal-setting messages at rates ranging from 91% to 83%, but in the last 3 weeks response rates decreased to 58%-66%.

“Until week 9, participants consistently responded to goal-setting messages, with adherence rates ranging from 91% to 83%. However, in the last 3 weeks of the program, response rates decreased, ranging between 58% and 66%.”

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

Of the 37 randomized participants, 19 (51%) were assigned to Sit Less and 18 (49%) to control.

“Of the 37 randomized participants, 19 (51%) were randomly assigned to the Sit Less group, and 18 (49%) were assigned to the control group.”

May combine two claims.

Of 156 contacted, 128 (80%) met inclusion criteria, and 37 (30%) completed baseline assessments and were randomized.

“Of 156 participants who were contacted and assessed for eligibility, 128 (80%) met inclusion criteria, and of those, 37 (30%) completed all baseline assessments and were randomized (Figure 2).”

May combine two claims.

Adherence to Fitbit wear peaked at weeks 5 and 7 with 96% wearing the device, and dropped to 76% at week 12.

“Adherence to Fitbit wear peaked at weeks 5 and 7, with 96% wearing the device, and was maintained throughout the study period, except for week 12, when adherence dropped to 76%.”

May combine two claims.

The Sit Less intervention showed consistent directional improvements compared with the control group, although between-group differences were not statistically significant.

“Overall, the Sit Less intervention showed consistent directional improvements compared with the control group, although between-group differences were not statistically significant.”

May combine two claims.

By targeting prolonged sedentary time, the program has shown a trend to decrease in total sitting time, increase in sedentary breaks, and possible improvements in glycemic outcomes.

“By targeting prolonged sedentary time, the program has shown a trend to decrease in total sitting time, increase in sedentary breaks, and possible improvements in glycemic outcomes.”

May combine two claims.

Self-efficacy for increasing physical activity increased in the control group but decreased in the Sit Less group, with a significant between-group difference observed for moderate activity (adjusted mean difference −0.6, 95% CI −1.1 to −0.2; P=.003).

“Self-efficacy for increasing physical activity increased in the control group but decreased in the Sit Less group, with a significant between-group difference observed for moderate activity (adjusted mean difference −0.6, 95% CI −1.1 to −0.2; P=.003; Table 5).”

May combine two claims.

Sit-to-stand transitions were unchanged in the control group (36.2, SD 13.7 vs 36.8, SD 12.0) but increased in the Sit Less group (43.7, SD 9.9 vs 46.6, SD 8.9), with a nonsignificant adjusted mean difference of 4.2 transitions per day (95% CI −2 to 10; P=.13).

“Sit-to-stand transitions were unchanged in the control group (36.2, SD 13.7 vs 36.8, SD 12.0) but increased in the Sit Less group (43.7, SD 9.9 vs 46.6, SD 8.9), with a nonsignificant adjusted mean difference of 4.2 transitions per day (95% CI −2 to 10; P=.13).”

May combine two claims.

For sedentary bouts of >60 minutes, the control group showed minimal change (1.9 min/d; 95% CI −47 to 44), whereas the Sit Less group decreased by 52.0 minutes per day (95% CI −111 to 4), with an adjusted difference of −49.9 minutes per day (95% CI −102 to 2; P=.06).

“For sedentary bouts of >60 minutes, the control group showed minimal change (1.9 min/d; 95% CI −47 to 44), whereas the Sit Less group decreased by 52.0 minutes per day (95% CI −111 to 4), with an adjusted difference of −49.9 minutes per day (95% CI −102 to 2; P=.06).”

May combine two claims.

For standing time, the control group decreased from 170.5 (IQR 99‐255) to 158.1 (IQR 115‐256) minutes per day, whereas the Sit Less group increased from 182.9 (IQR 144‐228) to 193.4 (IQR 144‐239). The adjusted between-group difference was 9.7 minutes per day (95% CI −52 to 71; P=.76), but it was not significant.

“For standing time, the control group decreased from 170.5 (IQR 99‐255) to 158.1 (IQR 115‐256) minutes per day, whereas the Sit Less group increased from 182.9 (IQR 144‐228) to 193.4 (IQR 144‐239). The adjusted between-group difference was 9.7 minutes per day (95% CI −52 to 71; P=.76), but it was not significant.”

May combine two claims.

Although not statistically significant, participants in the Sit Less group increased both standing and stepping time by approximately 10 minutes more than those in the control group, despite variability in change scores.

“Although not statistically significant, participants in the Sit Less group increased both standing and stepping time by approximately 10 minutes more than those in the control group, despite variability in change scores.”

May combine two claims.

Although not statistically significant, CGM outcomes were directionally consistent with HbA1c. Adjusted mean differences indicated lower glucose management index (−0.1%, 95% CI −0.4 to 0.1; P=.16) and average glucose level (−6.0 mg/dL, 95% CI −14.9 to 2.8; P=.18) in the Sit Less group compared with the control group at postintervention.

“Although not statistically significant, CGM outcomes were directionally consistent with HbA1c. Adjusted mean differences indicated lower glucose management index (−0.1%, 95% CI −0.4 to 0.1; P=.16) and average glucose level (−6.0 mg/dL, 95% CI −14.9 to 2.8; P=.18) in the Sit Less group compared with the control group at postintervention (Table 4).”

May combine two claims.

The intervention demonstrated high feasibility, acceptability, and adherence within the patient with cardiometabolic diseases groups over a 12-week period, characterized by high engagement with text messaging and consistent use of Fitbits.

“The intervention demonstrated high feasibility, acceptability, and adherence within the patient with cardiometabolic diseases groups over a 12-week period, characterized by high engagement with text messaging and consistent use of Fitbits.”

May combine two claims.

Time spent in sedentary bouts of >30 minutes increased in the control group and decreased in the Sit Less group, with a nonsignificant adjusted between-group difference of −39.5 minutes per day (95% CI −100 to 21; P=.20).

“Time spent in sedentary bouts of >30 minutes increased in the control group and decreased in the Sit Less group (Table 2), with a nonsignificant adjusted between-group difference of −39.5 minutes per day (95% CI −100 to 21; P=.20).”

May combine two claims.

For stepping time, baseline values differed between groups (control: median 49.7 min/d, IQR 37‐75; Sit Less: median 80.8 min/d, IQR 52‐108; P=.01). Following the intervention, the control group and the Sit Less group both increased stepping time, but there was no statistically significant between-group difference following the intervention (adjusted mean difference 9.6 min/d, 95% CI −15 to 34; P=.

“For stepping time, baseline values differed between groups (control: median 49.7 min/d, IQR 37‐75; Sit Less: median 80.8 min/d, IQR 52‐108; P=.01). Following the intervention, the control group and the Sit Less group both increased stepping time, but there was no statistically significant between-group difference following the intervention (adjusted mean difference 9.6 min/d, 95% CI −15 to 34; P=.”

May combine two claims.

Step counts also increased in both groups; however, there was no statistically significant between-group difference following the intervention (adjusted mean difference 711.4 steps per day, 95% CI −983 to 2406; P=.41).

“Step counts also increased in both groups; however, there was no statistically significant between-group difference following the intervention (adjusted mean difference 711.4 steps per day, 95% CI −983 to 2406; P=.41).”

May combine two claims.

HbA1c levels were significantly lower in the Sit Less group compared with the control group at postintervention (adjusted mean difference −0.4%, 95% CI −0.8 to −0.1; P=.04), with a decrease observed in the Sit Less group (median change −0.4%, 95% CI −0.6 to −0.2) and minimal change in the control group (median change 0.1%, 95% CI −0.1 to 0.5).

“HbA1c levels were significantly lower in the Sit Less group compared with the control group at postintervention (adjusted mean difference −0.4%, 95% CI −0.8 to −0.1; P=.04), with a decrease observed in the Sit Less group (median change −0.4%, 95% CI −0.6 to −0.2) and minimal change in the control group (median change 0.1%, 95% CI −0.1 to 0.5).”

May combine two claims.

No statistically significant between-group differences were observed for other cardiometabolic outcomes, including weight, BMI, waist circumference, insulin, or blood pressure. Total cholesterol and low-density lipoprotein decreased and high-density lipoprotein increased, whereas triglycerides increased; however, none of these adjusted between-group differences were statistically significant.

“No statistically significant between-group differences were observed for other cardiometabolic outcomes, including weight, BMI, waist circumference, insulin, or blood pressure. Total cholesterol and low-density lipoprotein decreased and high-density lipoprotein increased, whereas triglycerides increased; however, none of these adjusted between-group differences were statistically significant (Mult”

Probably not a substantial claim: may not pass S2 (checkable).

These findings support evaluation in larger, adequately powered trials.

“these findings support evaluation in larger, adequately powered trials.”

Classified as probably not a substantial claim.

Generalized linear models estimated adjusted between-group differences, controlling for baseline values, cohort, cohort×group interaction, and leisure-time exercise.

“Generalized linear models estimated adjusted between-group differences, controlling for baseline values, cohort, cohort×group interaction, and leisure-time exercise.”

May combine two claims.

Greater total sedentary time is related to increased cardiometabolic risk, including decreased high-density lipoprotein levels and increased triglycerides, fasting glucose, BMI, and waist circumference.

“greater total sedentary time is related to increased cardiometabolic risk [2], including decreased high-density lipoprotein levels and increased triglycerides, fasting glucose [4], BMI, and waist circumference [5].”

• cites [2] sourceNot checked — no full text of the source
• cites [4] sourceNot checked — no full text of the source
• cites [5] sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Participants with cardiovascular disease or type 2 diabetes underwent separate randomization into the Sit Less intervention or the control group.

“Participants with cardiovascular disease or type 2 diabetes underwent separate randomization into the Sit Less intervention or the control group.”

May combine two claims.

The Sit Less intervention was feasible and acceptable and showed possible improvements in sedentary behavior and glycemic outcomes.

“The Sit Less intervention was feasible and acceptable and showed possible improvements in sedentary behavior and glycemic outcomes.”

Classified as probably not a substantial claim. May combine two claims.

This pilot study was designed to assess feasibility and acceptability rather than to conduct a fully powered hypothesis test.

“This pilot study was designed to assess the feasibility and acceptability of the Sit Less program rather than to conduct a fully powered hypothesis test.”

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

The Self-Report Habit Index measure has previously reported Cronbach α=0.91, 0.82, and 0.83.

“Habit strength for sedentary behavior was assessed using the validated Self-Report Habit Index measure (previously reported Cronbach α=0.91, 0.82, and 0.83) [36].”

• cites [36] sourceNot checked — no full text of the source

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

The study was conducted in accordance with the CONSORT guidelines.

“The study was conducted in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines (Checklist 1).”

May combine two claims.

No significant between-group differences were found in nonwear time and baseline activities except for stepping time.

“No significant between-group differences were found in nonwear time and baseline activities except for stepping time.”

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

All analyses were conducted using an intention-to-treat approach without data imputation.

“All analyses were conducted using an intention-to-treat approach without data imputation.”

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

Another Sit Less participant withdrew during the intervention due to a Fitbit data recording error.

“Another Sit Less group participant withdrew during the intervention due to a Fitbit data recording error.”

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

Dried blood spot testing has shown a strong correlation with conventional serum tests, making it a reliable and convenient tool for screening for cardiometabolic risk factors.

“Dried blood spot testing has shown a strong correlation with conventional serum tests, making it a reliable and convenient tool for screening for cardiometabolic risk factors [33,34].”

• cites [33] sourceNot checked — no full text of the source
• cites [34] sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Randomization occurred within each disease group, and a 1:1 randomization list was created by a statistician and uploaded into the REDCap randomization module.

“Randomization occurred within each disease group. A 1:1 randomization list was created by a statistician and uploaded into the REDCap randomization module.”

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

The Self-Efficacy Questionnaire for Physical Activity and Sedentary Behavior has previously reported Cronbach α=0.79 and 0.85.

“The Self-Efficacy Questionnaire for Physical Activity and Sedentary Behavior (previously reported Cronbach α=0.79 and 0.85) [35].”

• cites [35] AdamsMMOn our feet: feasibility trial of an intervention to reduce sedentary behavior and increase physical activity2012The University of North Carolina at GreensboroNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

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

Extreme outlier biomarker values were winsorized by replacing them with the next highest observed value.

“Given the small sample size, extreme values were winsorized by replacing them with the next highest observed value.”

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

Sensitivity analyses using transformed variables and the Gaussian distribution produced similar findings to the Gamma log link models.

“We also conducted the same analyses using transformed variables and the Gaussian distribution, with similar findings resulting from the models using the Gamma, log link function”

Classified as probably not a substantial claim.

Between-group models included baseline outcome value, cohort, cohort×group interaction, and leisure-time exercise as covariates.

“Each model included the corresponding baseline value of the outcome, cohort (CVD vs T2D), and the interaction between study group and cohort. Baseline outcome values were included to account for baseline variability, while the cohort and the cohort×group interaction term were included to account for known differences in cardiometabolic responses between the 2 clinical cohorts and to assess whether”

May combine two claims.

The activPAL3 accurately detects sitting and standing postures and has been validated against direct observation.

“The activPAL3, worn on the thigh, accurately detects sitting and standing postures and has been validated against direct observation [29].”

• cites [29] sourceNot checked — no full text of the source

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

Both groups wore the activPAL continuously with minimal nonwear time.

“Both the Sit Less and control groups wore the activPAL continuously (24 h/d), with minimal nonwear time (median 0 min/d, IQR 0‐0).”

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

Both studies were approved by the Vanderbilt Institutional Review Board and registered on ClinicalTrials.gov.

“Both studies were approved by the Vanderbilt Institutional Review Board and registered on ClinicalTrials.gov (CVD cohort: NCT05534256, August 24, 2022; T2D cohort: NCT05691452, January 5, 2023).”

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

Participants and the interventionist were not blinded to the allocation.

“Participants and the interventionist were not blinded to the allocation due to the nature of the intervention program.”

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

Outcome assessors and data analysts were blinded to the allocation.

“However, outcome assessors and data analysts were blinded to the allocation.”

May combine two claims.

The observed reductions in the Sit Less group may have clinical relevance for individuals with diabetes and/or CVD, considering that reducing and replacing 30 minutes of sedentary time yields significant cardiometabolic benefits and reduces the risk of developing CVD and mortality.

“Considering that reducing and replacing 30 minutes of sedentary time yields significant cardiometabolic benefits and reduces the risk of developing CVD and mortality [21], the observed reductions in the Sit Less group may have clinical relevance for individuals with diabetes and/or CVD.”

• cites [21] sourceNot checked — no full text of the source

May combine two claims.

Its multitechnology was well received by older adults, reinforcing its suitability for patients with cardiometabolic diseases.

“Its multitechnology was well received by older adults, reinforcing its suitability for patients with cardiometabolic diseases.”

Classified as probably not a substantial claim.

The significant finding for HbA1c should be interpreted with caution in light of the limited sample size and potential model instability.

“Accordingly, the significant finding for HbA1c should be interpreted with caution in light of the limited sample size and potential model instability.”

May combine two claims.

Frequent, short breaks (walking 5 min for every hour sitting) are practical, low-burden alternatives to exercise, proven to improve glucose and insulin levels.

“Frequent, short breaks (walking 5 min for every hour sitting) are practical, low-burden alternatives to exercise, proven to improve glucose and insulin levels [7,39].”

• cites [7] sourceNot checked — no full text of the source
• cites [39] sourceNot checked — no full text of the source

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

It is also possible that the measures used were not sufficiently sensitive to detect short-term changes in psychological constructs such as habit formation or that the pilot sample size was underpowered to detect modest psychological effects.

“However, it is also possible that the measures used were not sufficiently sensitive to detect short-term changes in psychological constructs such as habit formation or that the pilot sample size was underpowered to detect modest psychological effects.”

Classified as probably not a substantial claim.

Given the pilot nature of the study, small sample size, and multiple outcomes examined, the HbA1c finding should be interpreted cautiously.

“However, given the pilot nature of the study, small sample size, and multiple outcomes examined, the HbA1c finding should be interpreted cautiously.”

May combine two claims.

The study was underpowered to detect intervention effects on outcomes, and CIs are wide.

“In this randomized controlled pilot trial, we were underpowered to detect intervention effects on outcomes, and CIs are wide; however, we still detected some directional changes in outcomes of interest in the Sit Less group relative to the control group.”

• Also stated in: § Limitations · plain

  “The study was not powered to formally test hypotheses regarding intervention efficacy, and CIs were wide.”

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

To maintain model parsimony and reduce the risk of overfitting, no additional exploratory covariates were included in the final models beyond those considered clinically or methodologically essential.

“To maintain model parsimony and reduce the risk of overfitting, no additional exploratory covariates were included in the final models beyond those considered clinically or methodologically essential.”

May combine two claims.

Our findings suggest that the intervention was feasible for targeting prolonged sedentary time and provide preliminary suggestions for further investigation in adequately powered trials.

“Our findings suggest that the intervention was feasible for targeting prolonged sedentary time and provide preliminary suggestions for further investigation in adequately powered trials.”

May combine two claims.

Participants were recruited from a single hospital in Nashville, USA, and were predominantly White and highly educated, which limits generalizability.

“For instance, participants were recruited from a single hospital in Nashville, USA, and were predominantly White and highly educated. Although feasibility and acceptability were high in this sample, challenges such as varying comfort with technology and device usability may be more pronounced in other populations.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

The Sit Less program achieved these outcomes by integrating simple standing and walking breaks into daily routines, effectively overcoming common exercise barriers such as fear of hypoglycemia, cardiac discomfort, and time constraints.

“The Sit Less program achieved these outcomes by integrating simple standing and walking breaks into daily routines, effectively overcoming common exercise barriers such as fear of hypoglycemia, cardiac discomfort, and time constraints.”

May combine two claims.

Intervention studies on sedentary breaks in T2D or CVD are limited and mostly short-term laboratory studies.

“However, intervention studies on sedentary breaks in T2D or CVD are limited and mostly short-term laboratory studies [7,39].”

• cites [7] sourceNot checked — no full text of the source
• cites [39] sourceNot checked — no full text of the source

May combine two claims.

Baseline HbA1c levels (median, approximately 5.0%‐5.5%) were within the nondiabetic or well-controlled range for many participants, and no participants had baseline HbA1c levels >7.0%, further limiting generalizability.

“Moreover, baseline HbA1c levels (median, approximately 5.0%‐5.5%) were within the nondiabetic or well-controlled range for many participants, and no participants had baseline HbA1c levels >7.0%, further limiting generalizability.”

May combine two claims.

The Sit Less intervention effectively integrated multiple technologies to reduce sedentary behavior in patients with cardiometabolic diseases.

“In conclusion, the Sit Less intervention effectively integrated multiple technologies to reduce sedentary behavior in patients with cardiometabolic diseases.”

May combine two claims.

The positive outcomes were observed in a participant group with a median age of 67 years, indicating the potential of the multitechnology-based Sit Less program to reduce sedentary time and foster more active lifestyles among older adults with cardiometabolic conditions.

“Notably, these positive outcomes were observed in a participant group with a median age of 67 years, indicating the potential of our multitechnology-based Sit Less program to reduce sedentary time and foster more active lifestyles among older adults with cardiometabolic conditions.”

May combine two claims.

Our approach, which minimizes typical exercise barriers and promotes short active breaks, has demonstrated high feasibility and acceptance, suggesting its promise for future large-scale interventions.

“Our approach, which minimizes typical exercise barriers and promotes short active breaks, has demonstrated high feasibility and acceptance, suggesting its promise for future large-scale interventions.”

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

Participants wore the CGM device for a median of 9 days in both groups, with no between-group differences.

“Participants wore the CGM device for a median of 9 days in both groups, with no between-group differences.”