Association Between Change in Accelerometer-Measured and Self-Reported Physical Activity and Cardiovascular Disease in the Look AHEAD Trial
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Abstract
OBJECTIVE: To conduct post hoc secondary analysis examining the association between change in physical activity. Measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. RESEARCH DESIGN AND METHODS: Participants were adults with overweight/obesity and type 2 diabetes with physical activity. Data at baseline and year 1 or 4 (n = 1,978). Participants were randomized to diabetes support and education or intensive lifestyle intervention. Measures included accelerometry-measured moderate-to-vigorous physical activity (MVPA), self-reported physical activity, and composite (morbidity and mortality) CVD outcomes. RESULTS: In pooled analyses of all participants, using Cox proportional hazards models, each 100 MET-min/week increase in accelerometry-measured MVPA from baseline to 4 years was associated with decreased risk of the subsequent primary composite outcome of CVD. Results were consistent for changes in total MVPA (hazard ratio 0.97 [95% CI 0.95, 0.99]) and MVPA accumulated in ≥10-min bouts (hazard ratio 0.95 [95% CI 0.91, 0.98]), with a similar pattern for secondary CVD outcomes. Change in accelerometry-measured MVPA at 1 year and self-reported change in physical activity at 1 and 4 years were not associated with CVD outcomes. CONCLUSIONS: Increased accelerometry-measured MVPA from baseline to year 4 is associated with decreased risk of CVD outcomes. This suggests the need for long-term engagement in MVPA to reduce the risk of CVD in adults with overweight/obesity and type 2 diabetes.
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Prior 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-”
From Accelerometer-derived physical activity and mortality in individuals with type 2 diabetes (2024) · cites this paper as [19]
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 measuredTwo 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.”
From Accelerometer-derived physical activity and mortality in individuals with type 2 diabetes (2024) · cites this paper as [19]
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 measuredAccelerometers are more sensitive than self-reports for capturing long-term change in physical activity levels among adults with overweight/obesity and type 2 diabetes mellitus.
“Indeed, the results from the Look Action for health in Diabetes (AHEAD) Trial indicated that accelerometers are more sensitive than self-reports for capturing long-term change in PA levels among adults with overweight/obesity and T2DM.23”
From Accelerometer-measured physical activity, sedentary behavior, and incidence of macrovascular and microvascular events in individuals with type 2 diabetes mellitus and prediabetes (2025) · cites this paper as [23]
The Results and Abstract report that accelerometer-measured change from baseline to year 4 was associated with CVD outcomes, while self-reported change was not. The Conclusions offer lower sensitivity of self-report to certain activities as one possible explanation, but say the reason cannot be determined. They do not establish that accelerometers are generally more sensitive for capturing long-term change in physical activity levels. (LLM, conf=0.86)
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- Authors
- Look AHEAD Study Group
- Corresponding author
- Look AHEAD Study Group
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2022-01-12
- Volume
- 45
- Issue
- 3
- Pages
- 742-749
- ISSN
- 0149-5992 (ISSN-L)
- PMC
- PMC8918202
- OpenAlex
- W4206523504
- Cited by
- 20
- References
- 17
- Citations by year
- 2025: 3 · 2024: 8 · 2023: 5 · 2022: 4
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p30dk046204-15)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK057149, U01DK057151, U01DK057135, U01DK057131, U01DK056990, U01DK057136, U01DK057178, U01DK057182, U01DK057078, U01DK057154, U01DK057008, U01DK057171, U01DK057002, U01DK057219, U01DK056992, U01DK057177, P30DK048520, P30-DK046204)
- National Center for Research Resources (M01RR002719, M01RR000056, UL1RR025758, M01RR000051, M01RR001066, M01RR001346, UL1RR024153)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- physical activity, cardiovascular disease, moderate-to-vigorous physical activity, accelerometry, self-reported physical activity, type 2 diabetes, obesity, Look AHEAD trial, lifestyle intervention, diabetes support and education, exercise behavior change
- MeSH terms
- Adult, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Exercise, Self Report, Accelerometry
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