Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals with Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2)
Open accessPublished version of a preprint
Abstract
OBJECTIVE: In the Italian Diabetes and Exercise Study_2 (IDES_2), behavioral counseling promoted a sustained increase in physical activity (PA) volume (+3.3 MET h ⋅ week−1), moderate- to vigorous-intensity PA (MVPA) (+6.4 min ⋅ day−1), and light-intensity PA (LPA) (+0.8 h ⋅ day−1) and decrease in sedentary time (SED-time) (−0.8 h ⋅ day−1). Here, we investigated the relationships of changes in PA/SED-time with changes in physical fitness and cardiometabolic risk profile in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS: In this 3-year randomized clinical trial, 300 physically inactive and sedentary patients were randomized 1:1 to receive 1-month theoretical and practical counseling once a year or standard care. Changes in physical fitness and cardiovascular risk factors/scores according to quartiles of accelerometer-measured changes in PA/SED-time were assessed, together with univariate and multivariable associations between these parameters, in the whole cohort and by study arm. RESULTS: Physical fitness increased and HbA1c and coronary heart disease 10-year risk scores decreased with quartiles of MVPA and SED-time change. In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL ⋅ min−1 ⋅ kg−1 and HbA1c decreased by 0.73 and 0.85%, respectively. Univariate correlations confirmed these relationships, and mean changes in both MPVA and SED-time predicted changes in physical fitness and cardiovascular risk factors/scores independently of one another and of other confounders. Similar findings were observed with LPA and PA volume and in each group separately. CONCLUSIONS: Even modest increments in MVPA may have a clinically meaningful impact, and reallocating SED-time to LPA may also contribute to improved outcomes, possibly by increasing total energy expenditure.
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Written from the paper’s full text.
TL;DR
In a prespecified ancillary analysis of the 3-year IDES_2 randomized trial, both increases in moderate-to-vigorous physical activity (MVPA) and decreases in sedentary time (SED-time) were associated with improved physical fitness and cardiometabolic risk profile in adults with type 2 diabetes. Even modest MVPA increments appeared clinically meaningful, and reallocating SED-time to light-intensity physical activity (LPA) may also contribute to improved outcomes.
Key findings
- Physical fitness increased and HbA1c and coronary heart disease (CHD) 10-year risk scores decreased across quartiles of MVPA increase and SED-time decrease.
- In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL/min/kg, and HbA1c decreased by 0.73% and 0.85%, respectively.
- In multivariable models, changes in both MVPA and SED-time independently predicted changes in VO2max and HbA1c; MVPA change also predicted upper- and lower-body strength, waist circumference, triglycerides, and systolic blood pressure, while SED-time change predicted bending, fasting plasma glucose, diastolic blood pressure, HDL cholesterol, and CHD 10-year risk scores.
- Similar findings were observed for LPA and total PA volume and in each study arm separately.
Methods
- Prespecified ancillary analysis of IDES_2, an open-label, assessor-blinded, parallel, superiority randomized clinical trial; 300 physically inactive and sedentary patients with type 2 diabetes were randomized 1:1 to behavioral counseling or standard care, with 267 completing the 3-year study.
- PA/SED-time was measured by accelerometer and daily diary at baseline and every 4 months for 7 consecutive days; physical fitness was assessed yearly, and cardiovascular risk factors and UK Prospective Diabetes Study risk scores were measured.
- Analyses stratified participants by quartiles of changes in MVPA, SED-time, LPA, and PA volume; used one-way ANOVA and Spearman correlations; and applied multivariable linear regression models including age, sex, study arm, baseline dependent variable, and changes in MVPA/SED-time (model 1), with LPA substituted for SED-time (model 2) and PA volume substituted for MVPA/SED-time (model 3), in the whole cohort and by study arm.
Limitations
- The paper states that generalizability requires further investigation and validation in different cohorts or settings.
- The paper states that the trial was not designed to assess the impact of changes in MVPA and SED-time on physical fitness and CVD risk factors/scores, which were secondary end points, and that specific studies should be designed for this purpose.
- The paper states that results might have been affected by unmeasured confounders, e.g., diet, which were not considered in data analysis, though dietary prescriptions were given and adherence was verified at intermediate visits; evident from the text, analyses were limited to completers (267 of 300) and the open-label design did not blind participants or physicians, though assessors were blinded.
Model-written summary. Check it against the paper before relying on it.
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Cites
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Claims the paper makes
0 of 35 cited sources checked · 0 supported · 0 flagged
- Findingown data
Only change in SED-time was an independent predictor of change in bending, FPG, diastolic BP, and CHD 10-year risk scores.
“Only change in SED-time was an independent predictor of change in bending, FPG, diastolic BP, and CHD 10year risk scores and, inversely, of change in HDL cholesterol (Table 4)”
Quote in the paperSubstantial claim - Findingown data
Physical fitness improved with quartiles of mean change in MVPA.
“Improvements with quartiles of mean change over baseline in MVPA were observed for PA/SED-time and physical fitness parameters as well as for HbA 1c , FPG, BMI, triglycerides, and total and fatal CHD 10-year risk (Table 2).”
Quote in the paperSubstantial claim - Findingown data
HbA1c improved with quartiles of mean change in SED-time.
“Improvements with quartiles of mean change over baseline in SED-time were observed for PA and physical fitness parameters as well as for HbA 1c and total and fatal CHD 10-year risk (Table 3).”
Quote in the paperSubstantial claim - Findingown data
Similar findings were observed with LPA and PA volume.
“Similar findings were observed with LPA and PA volume and in each group separately.”
Quote in the paperSubstantial claim - Findingown data
In quartile IV of MVPA increase, cardiorespiratory fitness increased by 5.23 mL/min/kg.
“In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL Á min 21 Á kg 21 and HbA 1c decreased by 0.73 and 0.85%, respectively.”
Quote in the paperSubstantial claim
- Findingown data
Physical fitness improved with quartiles of mean change in SED-time.
“Improvements with quartiles of mean change over baseline in SED-time were observed for PA and physical fitness parameters as well as for HbA 1c and total and fatal CHD 10-year risk (Table 3).”
Quote in the paperSubstantial claim - Findingown data
Similar findings were observed in each study group separately.
“Similar findings were observed with LPA and PA volume and in each group separately.”
Quote in the paperNot a substantial claim - Findingown data
In quartile IV of SED-time decrease, cardiorespiratory fitness increased by 4.49 mL/min/kg.
“In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL Á min 21 Á kg 21 and HbA 1c decreased by 0.73 and 0.85%, respectively.”
Quote in the paperSubstantial claim - Findingown data
In model 2, LPA change was an independent predictor of changes in the same parameters as SED-time, except bending.
“In replacing of SED-time changes with LPA changes (model 2), the latter was an independent predictor of changes in the same parameters as for SED-time, except bending (Supplementary Table 5).”
Quote in the paperNot a substantial claim - Findingown data
Only change in MVPA was an independent predictor of change in upper and lower body strength.
“Only change in MVPA was an independent predictor of change in upper and lower body strength and inversely of change in waist circumference, triglycerides, and systolic BP (Table 4)”
Quote in the paperSubstantial claim - Findingown data
In model 3, PA volume change was an independent predictor of changes in the same variables as MVPA and/or SED-time.
“Likewise, in replacing of MVPA and LPA changes with PA volume changes (model 3), PA volume changes were an independent predictor of changes in the same variables as for MVPA and/or SED-time (Supplementary Table 6).”
Quote in the paperSubstantial claim - Findingown data
In model 1, changes in MVPA and SED-time were both independent predictors of change in HbA1c.
“In model 1, changes in MVPA and SED-time were both independent predictors of change in VO 2max (especially MVPA change) and HbA 1c (especially SED-time change) (Table 4).”
Quote in the paperSubstantial claim - Findingown data
Total and fatal CHD 10-year risk improved with quartiles of mean change in SED-time.
“Improvements with quartiles of mean change over baseline in SED-time were observed for PA and physical fitness parameters as well as for HbA 1c and total and fatal CHD 10-year risk (Table 3).”
Quote in the paperSubstantial claim - Findingown data
Only change in MVPA was inversely an independent predictor of change in waist circumference, triglycerides, and systolic BP.
“Only change in MVPA was an independent predictor of change in upper and lower body strength and inversely of change in waist circumference, triglycerides, and systolic BP (Table 4)”
Quote in the paperSubstantial claim - Findingown data
The baseline value of the dependent variable was always significantly associated with its change over the study follow-up, except for VO2max.
“The baseline value of the dependent variable was always significantly associated with its change over the study follow-up, except for VO 2max”
Quote in the paperNot a substantial claim - Findingown data
Total and fatal CHD 10-year risk improved with quartiles of mean change in MVPA.
“Improvements with quartiles of mean change over baseline in MVPA were observed for PA/SED-time and physical fitness parameters as well as for HbA 1c , FPG, BMI, triglycerides, and total and fatal CHD 10-year risk (Table 2).”
Quote in the paperSubstantial claim - Findingown data
Only change in SED-time was inversely an independent predictor of change in HDL cholesterol.
“Only change in SED-time was an independent predictor of change in bending, FPG, diastolic BP, and CHD 10year risk scores and, inversely, of change in HDL cholesterol (Table 4)”
Quote in the paperSubstantial claim - Findingown data
Mean changes in both MVPA and SED-time predicted changes in physical fitness and cardiovascular risk factors/scores independently of one another and of other confounders.
“mean changes in both MPVA and SED-time predicted changes in physical fitness and cardiovascular risk factors/scores independently of one another and of other confounders.”
Quote in the paperSubstantial claim - Findingown data
Results were similar when the multivariable linear regression analyses were conducted separately in CON and INT participants.
“Results were similar when the multivariable linear regression analyses were conducted separately in CON (Supplementary Table 7) and INT (Supplementary Table 8) participants.”
Quote in the paperNot a substantial claim - Findingown data
In model 1, changes in MVPA and SED-time were both independent predictors of change in VO2max.
“In model 1, changes in MVPA and SED-time were both independent predictors of change in VO 2max (especially MVPA change) and HbA 1c (especially SED-time change) (Table 4).”
Quote in the paperSubstantial claim - Findingown data
HbA1c improved with quartiles of mean change in MVPA.
“Improvements with quartiles of mean change over baseline in MVPA were observed for PA/SED-time and physical fitness parameters as well as for HbA 1c , FPG, BMI, triglycerides, and total and fatal CHD 10-year risk (Table 2).”
Quote in the paperSubstantial claim - Findingown data
In quartile IV of MVPA increase, HbA1c decreased by 0.73%.
“In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL Á min 21 Á kg 21 and HbA 1c decreased by 0.73 and 0.85%, respectively.”
Quote in the paperSubstantial claim - Findingown data
In quartile IV of SED-time decrease, HbA1c decreased by 0.85%.
“In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL Á min 21 Á kg 21 and HbA 1c decreased by 0.73 and 0.85%, respectively.”
Quote in the paperSubstantial claim - Findingown data
In this analysis of IDES_2, the relative importance of increases in MVPA and decreases in SED-time differed depending on the variable tested.
“This analysis of the IDES_2 also showed differences in the relative importance of increases in MVPA and decreases in SED-time depending on the variable tested.”
Quote in the paperSubstantial claim - Findingnone given
HDL cholesterol and diastolic BP were independently predicted by SED-time only.
“it is difficult to explain the findings that HDL cholesterol and diastolic BP were independently predicted by SED-time only, though they are in keeping with previous observations (30,40).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [30] German, 2021, Sleep, sedentary behavior, physical activity, and cardiovascular health: MESA, Med Sci Sports Exerc source
Not checked in the free run.
- cites [40] Mann, 2014, Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations, Sports Med source
Not checked in the free run.
- Findingown data
Change in LPA was independently associated with change in the same variables as change in SED-time.
“On the other hand, change in LPA was independently associated with change in the same variables as change in SED-time and change in PA volume was independently associated with change in the same variables as change in MVPA and LPA.”
Quote in the paperSubstantial claim - Findingown data
MVPA was the only independent predictor of muscle strength.
“which was the only independent predictor of muscle strength”
Quote in the paperSubstantial claim - Findingown data
Change in PA volume was independently associated with change in the same variables as change in MVPA and LPA.
“On the other hand, change in LPA was independently associated with change in the same variables as change in SED-time and change in PA volume was independently associated with change in the same variables as change in MVPA and LPA.”
Quote in the paperSubstantial claim - Premiseown data
In IDES_2, behavioral counseling promoted a sustained increase in moderate-to-vigorous-intensity physical activity of 6.4 min/day.
“moderate-to vigorous-intensity PA (MVPA) (+6.4 min Á day 21 )”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
- Premiseown data
In IDES_2, the reduction in SED-time and the reciprocal increment in LPA in comparisons with standard care were 0.8 h/day over time.
“the reduction in SED-time and the reciprocal increment in time spent in LPA in comparisons with individuals receiving standard care were 0.8 h Á day À1 over time”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
- Premiseown data
In IDES_2, behavioral counseling promoted a sustained increase in physical activity volume of 3.3 MET h/week.
“In the Italian Diabetes and Exercise Study_2 (IDES_2), behavioral counseling promoted a sustained increase in physical activity (PA) volume (+3.3 MET h Á week 21 )”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
- Premisecitation
In these studies, the intervention failed to produce sustained increases in cardiorespiratory fitness.
“or to produce sustained increases in cardiorespiratory fitness (12)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] ; Look AHEAD Research Group, 2010, Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial, Arch Intern Med
Not checked in the free run.
- Premiseown data
In IDES_2, behavioral counseling promoted a sustained increase in light-intensity physical activity of 0.8 h/day.
“and light-intensity PA (LPA) (+0.8 h Á day 21 )”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
- Premiseown data
In IDES_2, the increase in LPA substantially contributed to the 3.3 MET h/week increase in total PA volume.
“with the increase in LPA substantially contributing to the 3.3 MET h Á week À1 increase in total PA volume”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
- Premisecitation
In these walking intervention studies, the intervention failed to significantly improve CVD risk factors and other surrogate outcomes.
“However, in these studies, the intervention failed to significantly improve CVD risk factors and other surrogate outcomes (8)(9)(10)”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [8] Harris, 2018, Physical activity levels in adults and older adults 3-4 years after pedometer-based walking interventions: long-term follow-up of participants from two randomised controlled trials in UK primary care, PLoS Med source
Not checked in the free run.
- cites [9] Khunti, 2021, Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial, BMC Med source
Not checked in the free run.
- cites [10] Andrews, 2011, Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial, Lancet source
Not checked in the free run.
- Study design and conductreasoning
The trial was not designed to assess the impact of changes in MVPA and SED-time on physical fitness and CVD risk factors/scores, which were secondary end points.
“Second, this trial was not designed to assess the impact of changes in MVPA and SED-time on physical fitness and CVD risk factors/scores, which were secondary end points”
Quote in the paperSubstantial claim - Study design and conductreasoning
Results might have been affected by unmeasured confounders, e.g., diet, which were not considered in data analysis.
“Third, results might have been affected by unmeasured confounders, e.g., diet, which were not considered in data analysis”
Quote in the paperNot a substantial claim - Study design and conductnone given
PA/SED-time was measured objectively with accelerometers.
“Other strengths include the objective (accelerometer-based) measurement of PA/SEDtime”
Quote in the paperSubstantial claim - Interpretationown data
The association of bending with SED-time indicates a beneficial effect of reducing sitting (and increasing total PA) on flexibility.
“Conversely, the association of bending with SED-time indicates the beneficial effect of reducing sitting (and increasing the total amount of PA) on flexibility.”
Quote in the paperSubstantial claim - Interpretationown data
Even modest increments in MVPA may have a clinically meaningful impact for physically inactive and sedentary or unfit individuals, including most of those suffering from type 2 diabetes.
“In particular, our data suggest that even modest increments in MVPA may have a clinically meaningful impact for these people, provided that they are associated with larger decrements in SED-time and reciprocal increments in LPA resulting in substantial increases in total PA volume, which also contribute to improve outcomes.”
Quote in the paperSubstantial claim - Interpretationreasoning
The independent association of CHD 10-year risk scores with both MVPA and SED-time reflects their relationships with parameters used for calculating these scores.
“Finally, the independent association of CHD 10-year risk scores with both MVPA and SEDtime reflects their relationships with parameters used for calculating these scores”
Quote in the paperSubstantial claim - Interpretationreasoning
In physically inactive and sedentary patients with type 2 diabetes, the behavior change produced by counseling interventions targeting both MVPA and SED-time/LPA may be sufficient to ensure long-term benefits in terms of morbidity and mortality.
“This implies that, in these individuals, the behavior change produced by counseling interventions targeting both MVPA and SED-time/LPA may be sufficient to ensure long-term benefits in terms of morbidity and mortality.”
Quote in the paperSubstantial claim - Interpretationreasoning
The relative extent of increases over baseline in MVPA is as relevant as the absolute increase for the effect on clinical outcomes.
“Another plausible, not mutually exclusive explanation for the discrepancies between the IDES_2 and walking-based intervention studies is that the relative extent of increases over baseline in MVPA is as relevant as the absolute increase for the effect on clinical outcomes.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
- cites (8)(9)(10)(11)
Not checked in the free run.
- Interpretationown data
In physically inactive and sedentary patients with type 2 diabetes, even modest increments in MVPA may have a clinically meaningful impact on physical fitness and cardiovascular risk profile.
“in physically inactive and sedentary patients with type 2 diabetes, even modest increments in MVPA may have a clinically meaningful impact on physical fitness and cardiovascular risk profile”
Quote in the paperSubstantial claim - Interpretationreasoning
Reallocating SED-time to LPA may also contribute to improved outcomes, possibly by increasing total energy expenditure.
“Even modest increments in MVPA may have a clinically meaningful impact, and reallocating SED-time to LPA may also contribute to improved outcomes, possibly by increasing total energy expenditure.”
Quote in the paperSubstantial claim - Interpretationreasoning
The stronger relationship of CHD 10-year risk scores with SED-time likely depends on its higher strength of association with HbA1c compared with MVPA.
“with the stronger relationship with SED-time likely depending on its higher strength of association with HbA 1c compared with MVPA.”
Quote in the paperSubstantial claim - Premisecitation
Among sedentary, overweight postmenopausal women, one-half the currently recommended PA volume was sufficient to improve cardiorespiratory fitness.
“and, among sedentary, overweight postmenopausal women, one-half the currently recommended PA volume was sufficient to improve cardiorespiratory fitness (39).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [39] Church, 2007, Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: a randomized controlled trial, JAMA source
Not checked in the free run.
- Premisecitation
Among older women, as few as ~4,400 steps/day were significantly related to lower mortality rates compared with ~2,700 steps/day.
“Moreover, among older women, as few as $4,400 steps Á day À1 were significantly related to lower mortality rates compared with $2,700 steps Á day À1 (35)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [35] Lee, 2019, Association of step volume and intensity with all-cause mortality in older women, JAMA Intern Med source
Not checked in the free run.
- Interpretationcitation
A behavioral counseling targeting both MVPA and SED-time, such as in IDES_2, is more effective in promoting a sustained behavior change than interventions focusing only on PA.
“Taken together, these findings indicate that a behavioral counseling targeting both MVPA and SED-time, such as in the IDES_2, is more effective in promoting a sustained behavior change than interventions focusing only on PA (19)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] Prince, 2014, A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta-analysis of controlled trials, Obes Rev source
Not checked in the free run.
- Interpretationreasoning
Reallocating SED-time to LPA may also contribute to improve these outcomes, possibly by increasing total energy expenditure.
“and that reallocating SED-time to LPA may also contribute to improve these outcomes, possibly by increasing total energy expenditure.”
Quote in the paperSubstantial claim - Interpretationreasoning
The stronger association of glycemic control with SED-time than with MVPA may be related to the greater energy expenditure from the larger increase in LPA with reduction of SED-time compared with the modest increase in MVPA.
“The much stronger association of glycemic control with SED-time than with MVPA may be related to the greater amount of energy expenditure produced the associated larger increase in LPA with reduction of SED-time, compared with the modest increase in MVPA.”
Quote in the paperSubstantial claim
- May combine two claims. 13
- Classified as probably not a substantial claim. 9
- The quote only partly states this claim. 1
May combine two claims.
FindingcitationIn IDES_2, time spent in MVPA was only ~12 min/day at baseline and increased by >50% throughout the 3-year follow-up, remaining 30% over baseline at end of study.
“In fact, in the IDES_2, time spent in MVPA was only $12 min Á day À1 at baseline and, hence, increased by >50% throughout the 3-year follow-up and was still 30% over baseline at end of study (13).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
May combine two claims.
Findingown dataChanges in both MVPA and SED-time were independently associated with changes in VO2max, though the relationship was stronger for MVPA.
“Changes in both MVPA and SED-time were independently associated with changes in VO 2max , though the relationship was stronger for the former”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataUpon univariate analysis, changes in MVPA and SED-time correlated significantly with changes in physical fitness parameters as well as in HbA1c, FPG, hs-CRP, total and fatal CHD 10-risk, BMI and waist circumference (for MVPA changes only), and total stroke 10-risk score (for SED-time changes only).
“Upon univariate analysis, changes in MVPA and SED-time correlated significantly with those in physical fitness parameters as well as in HbA 1c , FPG, hs-CRP, total and fatal CHD 10-risk, BMI and waist circumference (for MVPA changes only), and total stroke 10-risk score (for SED-time changes only)”
Quote in the paperSubstantial claimMay combine two claims.
Premiseown dataIn IDES_2, the increase versus control in MVPA was only 6.4 min/day during the 3-year period and 3.6 min/day at the end of the study.
“However, while the increase versus control in MVPA was only 6.4 min Á day À1 during the 3-year period and 3.6 min Á day À1 at the end of the study”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationBoth physical inactivity and sedentary behavior are independently associated with increased mortality from any cause and cardiovascular disease in the general population.
“Both physical inactivity and sedentary behavior are independently associated with increased mortality from any cause and cardiovascular disease (CVD) in the general population (1,2)”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [1] Kraus, 2019, Physical activity, all-cause and cardiovascular mortality, and cardiovascular disease, Med Sci Sports Exerc source
Not checked in the free run.
- cites [2] Matthews, 2012, Amount of time spent in sedentary behaviors and cause-specific mortality in US adults, Am J Clin Nutr source
Not checked in the free run.
Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.
Premiseown dataIn IDES_2, behavioral counseling promoted a sustained decrease in sedentary time of 0.8 h/day.
“and decrease in sedentary time (SEDtime) (20.8 h Á day 21 )”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
May combine two claims.
PremisecitationCounseling interventions designed to promote walking through pedometers in the general population or in individuals with prediabetes or type 2 diabetes resulted in up to about 8 min/day increases in MVPA after 1 year and smaller (about 4 min/day), or even no, increments after longer follow-up, together with no change in SED-time.
“Counseling interventions designed to promote walking through the provision of pedometers in the general population (8) or in individuals with prediabetes (9) or type 2 diabetes (10,11) resulted in up to $8 min Á day À1 increases in MVPA after 1 year and smaller ($4 min Á day À1 ), or even no, increments after longer follow-up, together with no change in SED-time.”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [8] Harris, 2018, Physical activity levels in adults and older adults 3-4 years after pedometer-based walking interventions: long-term follow-up of participants from two randomised controlled trials in UK primary care, PLoS Med source
Not checked in the free run.
- cites [9] Khunti, 2021, Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial, BMC Med source
Not checked in the free run.
- cites [10] Andrews, 2011, Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial, Lancet source
Not checked in the free run.
- cites [11] Unick, 2016, Four-year physical activity levels among intervention participants with type 2 diabetes, Med Sci Sports Exerc source
Not checked in the free run.
May combine two claims.
Interpretationown dataThis prespecified ancillary analysis of IDES_2 showed that both increases in MVPA and decreases in SED-time contributed to the associated improvements in physical fitness and CVD risk profile.
“This prespecified ancillary analysis of the IDES_2 showed that both increases in MVPA and decreases in SED-time contributed to the associated improvements in physical fitness and CVD risk profile.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationBoth physical inactivity and sedentary behavior are independently associated with increased mortality from any cause and cardiovascular disease in people with type 2 diabetes.
“and also in people with type 2 diabetes (3,4)”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [3] Church, 2004, Exercise capacity and body composition as predictors of mortality among men with diabetes, Diabetes Care source
Not checked in the free run.
- cites [4] Loprinzi, 2016, The effects of objectively measured sedentary behavior on all-cause mortality in a national sample of adults with diabetes, Prev Med source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPeople with type 2 diabetes are usually well below the recommended level of physical activity and spend many daily hours as sedentary time.
“who are usually well below the recommended level of physical activity (PA) and spend many daily hours as sedentary time (SED-time) (5).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] Morrato, 2007, Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003, Diabetes Care source
Not checked in the free run.
May combine two claims.
PremisecitationIn IDES_2, a counseling intervention targeting both PA and sedentary behavior resulted in clinically meaningful improvements in physical fitness and, to a lesser extent, in CVD risk factors and scores over a 3-year follow-up.
“Conversely, in the Italian Diabetes and Exercise Study 2 (IDES_2), a counseling intervention targeting both PA and sedentary behavior, which was effective in promoting a sustained increase in PA and decrease in SED-time, resulted in clinically meaningful improvements in physical fitness and, to a lesser extent, in CVD risk factors and scores over a 3-year follow-up (13).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Balducci, 2019, Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial, JAMA source
Not checked in the free run.
Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).
PremisecitationWaist circumference, triglycerides, and systolic BP were preferentially associated with MVPA.
“while it is plausible that waist circumference, triglycerides, and systolic BP were preferentially associated with MVPA (28)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] LaMonte, 2017, Both light intensity and moderate-to-vigorous physical activity measured by accelerometry are favorably associated with cardiometabolic risk factors in older women: the Objective Physical Activity and Cardiovascular Health (OPACH) Study, J Am Heart Assoc source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe benefits of PA on CVD events and all-cause and CVD mortality start with very modest amounts (approximately one-third the amount recommended by guidelines).
“A pronouncement of the American College of Sports Medicine concluded that the benefits of PA on CVD events and all-cause and CVD mortality start with very modest amounts (approximately one-third the amount recommended by guidelines) (1).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1] Kraus, 2019, Physical activity, all-cause and cardiovascular mortality, and cardiovascular disease, Med Sci Sports Exerc source
Not checked in the free run.
May combine two claims.
PremisecitationIn adults at high risk for type 2 diabetes and CVD, every 2,000 steps/day increment in ambulatory activity at baseline was associated with a 10% lower risk of CVD events, and each 2,000 steps/day change from baseline to 12 months was associated with an additional 8% difference.
“Likewise, in adults at high risk for type 2 diabetes and CVD, every 2,000 step Á day À1 increment in ambulatory activity at baseline was associated with a 10% lower risk of CVD events and each 2,000 step Á day À1 change from baseline to 12 months was associated with an additional 8% difference (36).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [36] Yates, 2014, Association between change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance (NAVIGATOR trial): a cohort analysis, Lancet source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe study had a long duration and a large sample size.
“the long study duration, and the large sample size.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn inactive people, a 6 min/day difference in brisk walking (corresponding to ~500 steps in 5 min) was associated with significant health benefits (~4 life years gained).
“This interpretation is consistent with a recent UK Biobank longitudinal study showing that, in inactive people, a 6 min Á day À1 difference in brisk walking (corresponding to $500 steps in 5 min [37]) was associated with significant health benefits ($4 life years gained) (38).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [38] Chudasama, 2019, Physical activity, multimorbidity, and life expectancy: a UK Biobank longitudinal study, BMC Med source
Not checked in the free run.
- cites [37] Rowlands, 2021, Wrist-worn accelerometers: recommending ∼1.0 m g as the minimum clinically important difference (MCID) in daily average acceleration for inactive adults, Br J Sports Med source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationnone givenThe generalizability of the study's findings to different cohorts or settings requires further investigation and validation.
“First, generalizability requires further investigation and validation in different cohorts or settings.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationIn walking-based intervention studies, MVPA ranged from ~25 to ~45 min/day at baseline and increased by up to ~8 min/day after 1 year and by one-half or less after longer follow-up.
“Conversely, in walking-based intervention studies, percent increments were much smaller as MVPA ranged from $25 to $45 min Á day À1 at baseline and increased by up to $8 min Á day À1 after 1 year and by one-half or less after longer follow-up (8)(9)(10)(11).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites (8)(9)(10)(11)
Not checked in the free run.
The authors state this as an assumption.
The time patients were awake without wearing the accelerometer was spent in routine morning and evening sedentary activities, unless it was spent in activities that cannot be performed while wearing the accelerometer.
“In this way, it was possible to assume that the time patients were awake without wearing the accelerometer was spent in routine morning and evening sedentary activities, unless it was spent in activities that cannot be performed while wearing the accelerometer (e.g., swimming).”
The authors state this as an assumption.
SED-time was almost entirely reallocated to LPA.
“As SEDtime was almost entirely reallocated to LPA, which contributed significantly to the increase in total PA volume, LPA was substituted for SED-time in model 2”
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 behavioural scaffolding in supervised exercise interventions remains largely shaped by interpersonal support.
“However, the behavioural scaffolding remains largely shaped by interpersonal support [16,24,25,27].”
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.
CHD risk-score changes disagree between stratifications
MajorTables 2 and 3 stratify the same 267 completers, so their quartile results must yield the same overall mean change. The reported CHD risk-score values imply approximately −0.09% in Table 2 but +3.36% in Table 3, far beyond rounding.
“| CHD 10-year risk score, % | À0.04 ± 0.70 | À0.16 ± 0.90 | À0.04 ± 0.45 | À0.12 ± 0.53 | 0.002 |”
“| CHD 10-year risk score, % | 5.89 ± 6.54 | 4.09 ± 6.03 | 2.84 ± 4.89 | 0.59 ± 6.29 | <0.0001 |”
Identical Table 2 results have different ANOVA P values
MajorThe hs-CRP and CHD risk-score rows have identical means and SDs in every quartile and use the same quartile sizes, yet report P values of 0.654 and 0.002. Those identical inputs cannot produce different one-way ANOVA results.
“| hs-CRP, mg Á L À1 | À0.04 ± 0.70 | À0.16 ± 0.90 | À0.04 ± 0.45 | À0.12 ± 0.53 | 0.654 |”
“| CHD 10-year risk score, % | À0.04 ± 0.70 | À0.16 ± 0.90 | À0.04 ± 0.45 | À0.12 ± 0.53 | 0.002 |”
Fatal stroke risk-score changes disagree between stratifications
MajorThe fatal stroke risk-score quartile means imply an overall mean of about +3.16% in Table 2 and +0.41% in Table 3, although both tables cover the same 267 participants.
“| Fatal stroke 10-year risk score, % | 4.81 ± 6.30 | 3.77 ± 5.15 | 2.45 ± 4.51 | 1.57 ± 5.07 | 0.895 |”
“| Fatal stroke 10-year risk score, % | 0.30 ± 1.14 | 0.59 ± 1.09 | 0.50 ± 1.60 | 0.25 ± 1.07 | 0.364 |”
Quartile I MVPA mean differs from the table
MinorThe text describes the average MVPA change in quartile I as −10.8 min/day, but Tables 1 and 2 give its mean as −3.33 min/day. The stated −10.8 is approximately the lower endpoint of the quartile's range, not its mean.
“Patients falling in quartile I of MVPA and SED-time change showed a substantial decrease in MVPA and increase in SEDtime (on average, À10.8 min Á day À1 and 10.72 h Á day À1 , respectively)”
“| I: N = 67; mean À3.33 ± 2.17 (À10.81, À1.09) | 32 (47.8) | 19 (28.8) | 12 (17.6) | 4 (6.1) |”
Quartile II SED-time mean changes sign between tables
MinorTable 1 gives the quartile II mean SED-time change as positive 0.09 h/day, while Table 3 gives it as negative 0.09 h/day.
“mean 0.09 ± 0.17 (0.22, À0.33)”
“| SED time, h Á day À1 | 0.72 ± 0.39 | À0.09 ± 0.17 | À0.60 ± 0.18 | À1.53 ± 0.43 | |”
The citation lists haven’t been fetched yet
References 39 · Cited by 50
- Authors
- Balducci, S., Haxhi, J., Sacchetti, M., Orlando, G., Cardelli, P., Vitale, M., Mattia, L., Iacobini, C., Bollanti, L., Conti, F., Zanuso, S., Nicolucci, A., & Pugliese, G.
- Affiliations
- Azienda Ospedaliera Sant'Andrea (IT)
- Foro Italico University of Rome (IT)
- Manchester Metropolitan University (GB)
- University of Greenwich (GB)
- Mario Negri Sud Foundation (IT)
- Corresponding author
- Pugliese, Giuseppe
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2021-11-02
- Volume
- 45
- Issue
- 1
- Pages
- 213-221
- ISSN
- 0149-5992 (ISSN-L)
- OpenAlex
- W3209827762
- Cited by
- 50
- References
- 39
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 20 · 2023: 14 · 2022: 5
- FWCI
- 6.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- e-space (Manchester Metropolitan University) (acceptedVersion)
- Figshare (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Funders
- Eli Lilly and Company
- AstraZeneca
- Sanofi
- Sigma-Tau Pharmaceuticals
- Mylan
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, physical activity, sedentary behavior, physical fitness, cardiometabolic risk, behavioral counseling, moderate-to-vigorous physical activity, light physical activity, cardiorespiratory fitness, HbA1c, accelerometer-measured activity, energy expenditure
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Physical Fitness, Exercise, Sedentary Behavior, Accelerometry
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.
Statistics and arithmetic are recomputed, not judged.
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