Step cadence and sedentary behaviour – developing the links to physical function and glucose control

Background Adults with type 2 diabetes, and those at high risk of developing it (prediabetes) typically have poorer cardiometabolic health profiles and are at higher risk of impaired physical function, placing them at greater risk of developing co-morbidities, increased hospital use, multiple medication use, and premature death than their counterparts without diabetes. Furthermore, evidence suggests that aside from the increased risk of cumulating poor cardiometabolic health markers, impaired physical function increases risk of mortality in people with type 2 diabetes. Fostering adaptations to physical activity and sedentary behaviour may elicit a plethora of benefits on physical function and cardiometabolic health in people with type 2 diabetes or prediabetes including reduced cardiovascular disease risk, better mobility and walking speed, heightened musculoskeletal function, and improved overall functional capacity. However, research investigating the benefits of adapting physical activity and sedentary behaviour habits to improve physical function has typically been limited to older adults. Aims 1: To investigate the association between activPAL-measured step cadence and physical function in older adults. 2: To explore associations between change in step cadence and change in markers of cardiometabolic health in people with prediabetes. 3: To assess a personalised home-based intervention to encourage adults with type 2 diabetes or prediabetes to reduce sitting time with the aim of improving cardiometabolic health and physical function. Methods 1: Post-hoc analysis was conducted in a cohort of 104 healthy older adults (age = 72 ± 5; 46% female). Generalised Linear Models were used to assess the associations between step cadence variables and performance in the sit-to-stand-60 test, stratified by ethnicity. 2: Post-hoc analysis was conducted in a cohort of 794 adults with a history of prediabetes (age = 60 ± 9 years, 49% female). Generalised Estimating Equations were used to assess the associations between change in step cadence variables and change in cardiometabolic health outcomes over four years, additionally stratified by ethnicity. 3: Nineteen adults with type 2 diabetes (age = 61 7, 47% female) completed a personalised intervention designed to use targeted physical activity and breaks in sedentary behaviour to improve glucose control and physical function. Healthy volunteers (age = 52 9, 64% female), free from type 2 diabetes were recruited for baseline case-control comparison. Key findings 1: Higher step cadence is associated with greater physical function in healthy older adults, with greater associations seen in White Europeans compared to South Asians. 2: Increase in step cadence over four years is associated with modest improvement in several markers of cardiometabolic health in people with prediabetes, with associations differing across White European and South Asian ethnicities. 3: A personalised intervention may reduce sitting time and improve physical function in people with type 2 diabetes over the short term. However, the intervention was not successful in improving glucose profiles. Conclusions The overall findings of this research help to bridge the gap in knowledge around the relationships between step cadence, sedentary behaviour, physical function, and cardiometabolic health in those with and without impaired glucose regulation. The research also offers some insight into potential ethnic differences in these relationships. Future large-scale randomised controlled trials are needed to establish the effectiveness and economic viability of a programme to increase step cadence and reduce sedentary behaviour in people with, and at high risk of developing, type 2 diabetes.</p

Four-Year Increase in Step Cadence Is Associated with Improved Cardiometabolic Health in People with a History of Prediabetes

Purpose  To investigate associations between 4-year change in step cadence and markers of cardiometabolic health in people with a history of prediabetes and to explore whether these associations are modified by demographic factors. Methods  In this prospective cohort study, adults, with a history of prediabetes, were assessed for markers of cardiometabolic health (body mass index (BMI), waist circumference, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and glycated haemoglobin (HbA1c) and free-living stepping activity (activPAL3™) at baseline, 1-year, and 4-years. Brisk steps/day were defined as the number of steps accumulated at ≥100 steps/minute and slow steps/day as those accumulated at Results  794 participants were included (age = 59.8 ± 8.9 years, 48.7% women, 27.1% ethnic minority, total steps/day = 8445 ± 3364, brisk steps/day = 4794 ± 2865, peak 10-minute step cadence = 128 ± 10 steps/minute. Beneficial associations were observed between change in brisk steps/day and change in BMI, waist circumference, HDL-C, and HbA1c. Similar associations were found between peak 10-minute step cadence and HDL-C and waist circumference. Interactions by ethnicity revealed change in brisk steps/day and change in peak 10-minute step cadence had a stronger association with HbA1c in White Europeans, whereas associations between change in 10-minute peak step cadence with measures of adiposity were stronger in South Asians. Conclusions  Change in the number of daily steps accumulated at a brisk pace was associated with beneficial change in adiposity, HDL-C, and HbA1c; however, potential benefits may be dependent on ethnicity for outcomes related to HbA1c and adiposity.</p

Ethnic differences in the relationship between step cadence and physical function in older adults.

This study investigated associations between step cadence and physical function in healthy South Asian (SA) and White European (WE) older adults, aged ≥60. Participants completed the 60-s Sit-to-Stand (STS-60) test of physical function. Free-living stepping was measured using the activPAL3™. Seventy-one WEs (age = 72 ± 5, 53% male) and 33 SAs (age = 71 ± 5, 55% male) were included. WEs scored higher than SAs in the STS-60 (23 vs 20 repetitions, p = 0.045). Compared to WEs, SAs had significantly lower total and brisk (≥100 steps/min) steps (total: 8971 vs 7780 steps/day, p = 0.041; brisk: 5515 vs 3723 steps/day, p = 0.001). In WEs, 1000 brisk steps and each decile higher proportion of steps spent brisk stepping were associated with STS-60 (β = 0.72 95% CI 0.05, 1.38 and β = 1.01 95% CI 0.19, 1.82, respectively), with associations persisting across mean peak 1 min (β = 1.42 95% CI 0.12, 2.71), 30 min (β = 1.71 95% CI 0.22, 3.20), and 60 min (β = 2.16 95% CI 0.62, 3.71) stepping periods. Associations were not observed in SAs. Ethnic differences in associations between ambulation and physical function may exist in older adults which warrant further investigation.</p