Physical activity and diabetes mortality in people with type 2 diabetes: a prospective cohort study of 0.5 million US people

Aim To examine the association between physical activity and the cause of death with the greatest risk related to type 2 diabetes mellitus (T2DM) in a large population-based cohort representative of the general US adult population. Methods A total of 41,726 adults suffering from T2DM (age 62 ± 14 years) and 459,660 adults without diabetes (age 46 ± 18 years) who participated in the National Health Interview Survey from 1997 to 2014 were included in this prospective cohort study. Self-reported moderate-to-vigorous physical activity (MVPA) was categorized into inactive, insufficiently active, active and very active. Mortality data was obtained from the National Death Index. Cox regression models adjusted for potential confounders were performed to estimate hazard ratio (HR) and 95% confidence interval (CI). Results Diabetes mortality cause showed the highest relative risk of death among adults with T2DM compared to adults without diabetes (HR 5.72 [3.15;10.39]). There was a non-linear inverse dose-response association between MVPA and diabetes mortality among adults with T2DM, up to a plateau in risk reduction at approximately 500 min/week. Any level of activity was inversely associated with a significantly lower risk of diabetes mortality compared with being inactive (insufficiently active HR 0.71[0.54;0.97], active HR 0.68 [0.49;0.95], very active HR 0.44 [0.32;0.60]). Compared to adults without diabetes, the risk of diabetes mortality decreased from HR 7.38 [4.00;13.58] for inactive people with T2DM to HR 3.34 [1.76;6.32] for very active people with T2DM. Conclusions Higher levels of MVPA were associated with lower risk of diabetes mortality among adults with T2DM

Device-measured movement behaviors and cardiac biomarkers in older adults without major cardiovascular disease: the Seniors-ENRICA-2 study

Background: High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are biomarkers of myocardial infarction and heart failure, respectively, and indicate cardiovascular risk. Since low physical activity (PA) and sedentary behavior (SB) are also associated with higher cardiovascular risk, and this association could be a consequence of higher levels of cardiac biomarkers, we examined the association of device-measured movement behaviors with hs-cTnT and NT-proBNP in older men and women without major cardiovascular disease (CVD). Methods: We used data from 1939 older adults from the Seniors-ENRICA-2 study. Accelerometers were used to assess time spent in sleep, SB, light PA (LPA), and moderate-to-vigorous PA (MVPA). Linear regression models were fitted separately in eight strata defined by sex, by median total PA time, and by the presence of subclinical cardiac damage according to cardiac biomarkers levels. Results: In the less active men with subclinical cardiac damage, spending 30 min/day more of MVPA was associated with a mean percentage difference (MPD) (95% confidence interval) in hs-cTnT of - 13.1 (- 18.3, - 7.5); MPDs in NT-proBNP per 30 min/day increment were 5.8 (2.7, 8.9) for SB, - 19.3 (- 25.4, - 12.7) for LPA and - 23.1 (- 30.7, - 14.6) for MVPA. In women with subclinical cardiac damage who were less physically active, 30 min/day more of SB, LPA and MVPA were associated with MPDs in hs-cTnT of 2.1 (0.7, 3.6), - 5.1 (- 8.3, - 1.7) and - 17.5 (- 22.9, - 11.7), respectively, whereas in those more active, LPA and MVPA were associated with MPDs of 4.1 (1.2, 7.2) and - 5.4 (- 8.7, - 2.0), respectively. No associations were found with NT-proBNP in women. Conclusions: The relationship between movement behaviors and cardiac biomarkers in older adults without major CVD depends on sex, subclinical cardiac damage and PA level. More PA and less SB were generally related to lower cardiac biomarkers levels among less active individuals with subclinical cardiac damage, with greater benefits for hs-cTnT in women than men and no benefits for NT-proBNP in women.This work was supported by Instituto de Salud Carlos III, State Secretary of R+D+I and Fondo Europeo de Desarrollo Regional / Fondo Social Europeo (Fondo de Investigaciones Sanitarias grants 18/287, 19/319). DMG is supported by a Ramón y Cajal contract from the Ministry of Science, Innovation and Universities and Fondo Europeo de Desarrollo Regional / Fondo Social Europeo (RYC-2016-20546) and VCS by a Juan de la Cierva contract from the Ministry of Science, Innovation and Universities (IJC2018–038008-I). Reagents for measuring hs-cTnT and NT-proBNP have been provided by Roche Diagnostics International through a Research Agreement with the FUAM (Fundación de la Universidad Autónoma de Madrid). The funding agencies had no role in study design, data collection and analysis, interpretation of results, manuscript preparation or the decision to submit this manuscript for publication.S

Associations of physical activity type, volume, intensity, and changes over time with all-cause mortality in older adults: The Seniors-ENRICA cohorts

Objective: To assess the association of physical activity (PA) type, volume, intensity, and changes over time with all-cause mortality in older adults. Methods: We used data from 3518 and 3273 older adults recruited in the Seniors-ENRICA-1 and 2 cohorts. PA was assessed with the EPIC questionnaire. Participants reported how many hours they spent a week in walking, cycling, gardening, do-it-yourself (DIY), sports, and housework. Then, time at each intensity (moderate PA [MPA], vigorous PA [VPA], moderate-to-vigorous PA [MVPA] and total PA) was calculated. Changes in PA were calculated from the date of the baseline interview to Wave 1. All-cause mortality was ascertained up January 31, 2022. Analyses were performed with Cox regression models, adjusting for the main confounders. Results: Walking, gardening, sports, and housework was associated with lower mortality (ranged 20%–46%). Also, MPA, VPA, MVPA was associated with lower risk of mortality (ranged 28%–53%). Analyses of PA change showed that, compared no PA participation (at baseline nor Wave 1), maintain walking, sports, and housework (ranged 28%–53%) and maintaining MPA, VPA, and MVPA (ranged 32%–36%) levels was linked to decreased mortality risk. Those who increased, maintained, or even decreased total PA had lower mortality (57%, 52%, and 36%, respectively) than those with consistently very low PA. Conclusions: The lower mortality was observed in those with a high baseline level of total PA. Maintaining PA levels such as walking, gardening, and housework, or at all analyzed intensities, was related to lower mortalit

Cross-sectional and prospective associations of sleep, sedentary and active behaviors with mental health in older people: a compositional data analysis from the Seniors-ENRICA-2 study

Abstract Background Most studies on the effects of sleep, sedentary behavior (SB), and physical activity (PA) on mental health did not account for the intrinsically compositional nature of the time spent in several behaviors. Thus, we examined the cross-sectional and prospective associations of device-measured compositional time in sleep, SB, light PA (LPA) and moderate-to-vigorous PA (MVPA) with depression symptoms, loneliness, happiness, and global mental health in older people (≥ 65 years). Methods Data were taken from the Seniors-ENRICA-2 study, with assessments in 2015–2017 (wave 0) and 2018–2019 (wave 1). Time spent in sleep, SB, LPA and MVPA was assessed by wrist-worn accelerometers. Depression symptoms, loneliness, happiness, and global mental health were self-reported using validated questionnaires. Analyses were performed using a compositional data analysis (CoDA) paradigm and adjusted for potential confounders. Results In cross-sectional analyses at wave 0 (n = 2489), time-use composition as a whole was associated with depression and happiness (all p < 0.01). The time spent in MVPA relative to other behaviors was beneficially associated with depression (γ = -0.397, p < 0.001), loneliness (γ = -0.124, p = 0.017) and happiness (γ = 0.243, p < 0.001). Hypothetically, replacing 30-min of Sleep, SB or LPA with MVPA was beneficially cross-sectionally related with depression (effect size [ES] ranged -0.326 to -0.246), loneliness (ES ranged -0.118 to -0.073), and happiness (ES ranged 0.152 to 0.172). In prospective analyses (n = 1679), MVPA relative to other behaviors at baseline, was associated with favorable changes in global mental health (γ = 0.892, p = 0.049). We observed a beneficial prospective effect on global mental health when 30-min of sleep (ES = 0.521), SB (ES = 0.479) or LPA (ES = 0.755) were theoretically replaced for MVPA. Conclusions MVPA was cross-sectionally related with reduced depression symptoms and loneliness and elevated level of happiness, and prospectively related with enhanced global mental health. Compositional isotemporal analyses showed that hypothetically replacing sleep, SB or LPA with MVPA could result in modest but significantly improvements on mental health indicators. Our findings add evidence to the emerging body of research on 24-h time-use and health using CoDA and suggest an integrated role of daily behaviors on mental health in older people

Follow-up in healthy schoolchildren and in adolescents with DOWN syndrome: psycho-environmental and genetic determinants of physical activity and its impact on fitness, cardiovascular diseases, inflammatory biomarkers and mental health; the UP&DOWN Study

[Background] An objective diagnosis of sedentary behaviour as well as of the physical activity and fitness levels in youth and to better understand how lifestyle is associated with cardiovascular disease risk factors and other phenotypes is of clinical and public health interest, and might be informative for developing intervention studies focused on the promotion of physical activity in these population. The aim of this methodological paper is to describe the design and assessment in the UP&DOWN study. [Methods/Design] The UP&DOWN study is a multi-center follow-up design where 2225 Spanish primary and secondary schoolchildren from Cadiz and Madrid, respectively, as well as 110 Spanish adolescents with Down syndrome from Madrid and Toledo were recruited to be assessed. Nine main measurement categories are assessed: i) socio-demographic and early determinants; ii) environmental determinants; iii) physical activity and sedentary behaviour; iv) health-related fitness; v) blood pressure and resting heart rate; vi) mental health; vii) dietary patterns; viii) blood samples; and ix) genetic analysis. During the 3-yr follow-up study, socio-demographic and early determinants, and genetic analysis are only assessed in the first year. Blood sampling is assessed in the first year and the third year (2nd follow-up), and all the other measurements are assessed every year. [Discussion] The findings of the UP&DOWN study may help the Health Information Systems and policy makers to identify the target population for primary prevention and health promotion policies, and to develop and test preventive strategies. Moreover, these data will allow following the trends at population level, as well as to modify/adapt/create new evidence-based physical activity guidelines at national level. The findings will also serve as a scientific platform for interventional studies.This study was supported by the DEP 2010-21662-C04-00 (DEP 2010-21662-C04-01, DEP 2010-21662-C04-02, DEP 2010-21662-C04-03, DEP 2010-21662-C04-04) RYC-2010-05957 grants from the National Plan for Research, Development and Innovation (R + D + i) MICINN

Physical Activity, Sitting Time, and Mortality From Inflammatory Diseases in Older Adults

Objective: The aim of this study was to examine the independent and combined associations of physical activity (PA) and sitting time (ST) with long-term mortality attributed to inflammatory causes other than cardiovascular disease (CVD) and cancer in a national cohort of older adults in Spain.Design: Prospective study.Setting and Participants: A cohort of 3,677 individuals (1,626 men) aged ≥60 years was followed-up during 14.3 years.Measures: At baseline, individuals reported PA and ST. The study outcome was death from inflammatory diseases when CVD or cancer mortality was excluded. This outcome was classified into infectious and non-infectious conditions. Analyses were performed with Cox regression and adjusted for PA, ST, and other main confounders (age, sex, educational level, smoking, alcohol consumption, body mass index, and chronic conditions).Results: During follow-up, 286 deaths from inflammatory diseases (77 from infectious diseases) were identified. Compared to individuals who defined themselves as inactive/less active, mortality from inflammatory diseases was lower in those who were moderately active (hazard ratio [HR] = 0.67, 95% confidence interval [CI] = 0.50–0.90) or very active (HR = 0.48, 95%CI = 0.33–0.68), independently of ST. Also, being seated ≥7 h/d vs. &lt;7 h/d was linked to higher mortality (HR = 1.38, 95%CI = 1.02–1.87). The largest risk of mortality was observed in inactive/less active individuals with ST≥7 h/d (HR = 2.29, 95%CI = 1.59–3.29) compared to those with moderate/very PA and ST &lt;7 h/d. Low PA and high ST were consistently associated with a higher risk of mortality from non-infectious inflammatory causes. Associations of PA and ST with mortality from infectious inflammatory causes showed a similar trend, but most of them did not reach statistical significance.Conclusions: Low PA and high ST were independently associated with higher mortality from inflammatory diseases other than CVD or cancer in older adults. Interventions addressing simultaneously both behaviors could have greater benefits than those focusing on only one of them

Dose–response relationship between device-measured physical activity and incident type 2 diabetes: findings from the UK Biobank prospective cohort study

Background: Most studies investigating the association between physical activity (PA) and the risk of type 2 diabetes are derived from self-reported questionnaires, with limited evidence using device-based measurements. Therefore, this study aimed to investigate the dose–response relationship between device-measured PA and incident type 2 diabetes. Methods: This prospective cohort study included 40,431 participants of the UK Biobank. Wrist-worn accelerometers were used to estimate total, light, moderate, vigorous and moderate-to-vigorous PA. The associations between PA and incident type 2 diabetes were analysed using Cox-proportional hazard models. The mediating role of body mass index (BMI) was tested under a causal counterfactual framework. Results: The median follow-up period was 6.3 years (IQR: 5.7–6.8), with 591 participants developing type 2 diabetes. Compared to those achieving &lt; 150 min/week of moderate PA, people achieving 150–300, 300–600 and &gt; 600 min/week were at 49% (95% CI 62–32%), 62% (95% CI 71–50%) and 71% (95% CI 80–59%) lower risk of type 2 diabetes, respectively. For vigorous PA, compared to those achieving &lt; 25 min/week, individuals achieving 25–50, 50–75 and &gt; 75 min/week were at 38% (95% CI 48–33%), 48% (95% CI 64–23%) and 64% (95% CI 78–42%) lower type 2 diabetes risk, respectively. Twelve per cent and 20% of the associations between vigorous and moderate PA and type 2 diabetes were mediated by lower BMI, respectively. Conclusions: PA has clear dose-response relationship with a lower risk of type 2 diabetes. Our findings support the current aerobic PA recommendations but suggest that additional PA beyond the recommendations is associated with even greater risk reduction. Trial registration: The UK Biobank study was approved by the North West Multi-Centre Research Ethics Committee (Ref 11/NW/0382 on June 17, 2011)

Construcción y validación de una escala breve de percepción de barreras para la práctica deportiva en adolescentes

Fundamento: Hoy en dia, el descenso de la actividad fisica es un problema relevante de salud en el primer mundo. En consecuencia, una linea pertinente de investigacion es la adquisicion de conocimiento sobre los motivos por los que los adolescentes no practican actividad fisica. El objetivo de este estudio ha sido disenar y validar una escala que permita evaluar las barreras hacia la actividad fisico-deportiva desde la percepcion de los adolescentes. Metodos: El estudio se ha llevado a cabo con una muestra incidental de 160 adolescentes espanoles (84 mujeres), con edades comprendidas entre los 12 y los 18 anos. La muestra se dividio aleatoriamente en dos partes. Con una de las submuestras y a partir de un banco de 40 items, se procedio hasta alcanzar una escala breve y operativa de 12 items realizando un analisis factorial exploratorio. Con la segunda sub-muestra y mediante analisis factorial confirmatorio, se valido la estructura matricial. Asimismo, se analizo la consistencia interna de la escala obtenida mediante el coeficiente alpha de Cronbach. Resultados: La escala proporciono informacion sobre cuatro dimensiones: barreras por incompatibilidad (2 items), barreras vinculadas al autoconcepto (4 items), barreras por desmotivacion (4 items) y barreras sociales (2 items). El instrumento mostro suficiente validez de constructo (�Í2=60,78; grados de libertad=48; p=0,100; GFI=0,88; CFI=0,94; RMSEA=0,58) y alta consistencia interna (�Ì=0,80). Ademas, la escala tuvo capacidad para explicar el 67% de la varianza de los resultados. Conclusion: La Escala Breve de Percepcion de Barreras para la Practica Deportiva en Adolescentes es un instrumento valido y fiable

Lifestyle behaviors, social and economic disadvantages, and all-cause and cardiovascular mortality: results from the US National Health Interview Survey

AimTo examine the independent relationships of lifestyle and social and economic factors with all-cause and cardiovascular disease (CVD) mortality in a large representative sample of the US adult population. Furthermore, the association between the combination of lifestyle and social and economic factors with mortality was analyzed in detail.MethodsThe sample included 103,314 participants with valid records and eligible for mortality follow-up, and information on lifestyle factors and social and economic disadvantages (NHIS waves 2000, 2005, 2010, and 2015). An unhealthy lifestyle score was constructed using information on physical activity, alcohol consumption, diet, and smoking status. Social and economic disadvantages were assessed using information on education, receipt of dividends, employment, family's home, and access to private health. Information on mortality data was determined by the National Death Index records.ResultsCompared with favorable lifestyle, unfavorable lifestyle was associated with higher all-cause (HR 2.07; 95% CI 1.97–2.19) and CVD (HR 1.84; 95% CI 1.68–2.02) mortality. Higher social and economic disadvantages were also associated with higher all-cause (HR 2.44; 95% CI 2.30–2.59) and CVD mortality (HR 2.44; 95% CI 2.16–2.77), compared to low social and economic disadvantages. In joint associations, participants in the high social and economic disadvantage and unfavorable lifestyle showed a greater risk of all-cause (HR 4.06; 95% CI 3.69–4.47) and CVD mortality (HR 3.98; 95% CI 3.31–4.79).ConclusionLifestyle and social and economic disadvantages are associated with all-cause and CVD mortality. The risk of mortality increases as the number of social and economic disadvantages and unhealthy lifestyles increases