Short Orals: Physical activity for patients

Background: Type 2 diabetes (T2D) is a prevalent condition associated with cardiometabolic risk in which an unhealthy lifestyle (e.g. low physical activity (PA), high sedentary behavior (SB), insufficient sleep i.e., 24h-movement behaviors (24h-MBs)) plays an important role in disease management. However, it remains unclear whether 24h-MBs are associated with cardiometabolic health in people with T2D (PwT2D) and whether this association differs from that of healthy peers. Purpose: To compare 24h-MB compositions and associations with cardiometabolic variables between PwT2D and healthy controls. Methods: Cardiometabolic variables (i.e. Body Mass Index, waist-to-hip ratio, systolic- and diastolic blood pressure, advanced glycation end products) and accelerometer-derived 24-h MBs were collected in 75 healthy controls and 52 PwT2D. Blood parameters (i.e. HbA1c, cholesterol, triglycerides, glucose) were exclusively measured in PwT2D. A MANOVA, using compositional data analysis, was used to explore the differences in compositions between groups. Linear regression models analysed the associations between cardiometabolic variables and 24h-MB composition as the independent variable. Results: Significant differences (p<0.01) in 24h-MB compositions were observed between both groups with PwT2D spending less time in LPA (-34.13 min) and MVPA (-20.45 min) and more time in SB (+52.38 min) compared to healthy controls while sleep time did not differ. The composition of PwT2D was significantly associated with HDL-cholesterol (p<0.05), reallocating 20 minutes proportional from the other behaviors into MVPA was associated with a 3.53 mg/dl increase in HDL cholesterol. Preliminary results in a subsample of PwT2D (n=36) showed significant changes in 24h-MB compositions (more SB and less PA) after one year follow up. Conclusions: These findings underscore the importance of considering 24h-MBs in PwT2D. Further longitudinal research is necessary to explore the potential benefits of optimizing 24h-MB compositions on cardiometabolic health. Practical implications: These findings could be a first step towards an integrated approach in T2D management. Funding: Research Foundation Flanders

Background: Physical activity (PA) is associated with reduced risk of type 2 diabetes mellitus (T2DM). Existing research focuses on associations with average weekly PA time or volume, which ignores potential importance of the varying patterns in which PA is accumulated. Purpose: To examine associations of accelerometer-determined PA volume and pattern with incident T2DM Methods: Participants (n=4526, 40-75y, without preexisting T2DM) from The Maastricht Study and wore an activPAL accelerometer (> 5 days). Prospective associations of stepping volume (steps/day) with incident T2DM were assessed using Cox proportional hazards models with restricted cubic splines, adjusted for age, sex, education, smoking and diet. Four indicators of variation in between- and within-day stepping pattern were modelled alongside total steps/day. These were: proportion of steps accumulated on the 2 most active days (%Active-2days), between-day (BDV) and within-day steps/day variability (WDV), and inter-daily step count stability (IS: the extent that daily stepping patterns are uniform). Results: Over 34,130 person-years of follow-up (median 7.2y), 178 incident cases of T2DM were recorded. Average steps/day was associated with T2DM risk, (non-linearly, with steeper risk reduction earlier in the steps/day distribution). Compared to steps/day quintile one (lowest steps/day. Q1), adjusted HR were; Q2 0.70 (95%CI 0.46, 1.00), Q3 0.57 (0.37, 0.88), Q4 0.32 (0.19, 0.54), Q5 (highest steps/day) 0.41 (0.26, 0.67) (Ptrend <0.001). PA pattern metrics were associated with T2DM risk independently of PA volume. HRs for 10% increases in %Active-2days and IS were 0.72 (0.54, 0.97 p=0.02) and 1.83 (1.21, 3.02. p=0.002) respectively. Higher BDV but not WDV was also associated with lower T2DM risk. Conclusions: Greater variability in PA accumulation was associated with lower diabetes risk, independent of PA volume. Implications: Not all steps are equal. Alongside a higher overall volume, weekly PA patterns that are variable with some high ‘daily doses’ can additionally reduce T2DM risk.

Background: Rural cancer survivors are less likely to meet physical activity (PA) recommendations than urban cancer survivors. Purpose: To use a community-engaged approach to adapt an evidence-based intervention (EBI) for implementation in a rural community and test its effects on PA and psychosocial distress in rural breast cancer survivors. Methods: The Mind Your BEAT (MYB) intervention combined supervised aerobic exercise, provided through Kourage Health (KH, an EBI) with behavior change skills and mind-body strategies (e.g., mindfulness) delivered by trained research staff. Rural breast cancer survivors were recruited through KH and randomized to participate in KH as usual (control) or MYB. We assessed self-reported weekly leisure time PA (WLA) with the Godin Leisure-Time Exercise Questionnaire and psychosocial distress with the NCCN distress thermometer at baseline and post-intervention (3-months). Participants were categorized as meeting PA recommendations or not (WLA score ≥24 or <24) and reporting high or low psychosocial distress (NCCN score ≥4 or <4). Results: Rural breast cancer survivors (N=43, M age=66.3±10.0 years) were mostly non-Hispanic (95.1%), White (86.0%), diagnosed with stage 0 (14.3%) or I-II (66.6%) breast cancer, and roughly 5 years post-treatment (M=4.8±7.0 years). Of those randomized (MYB n=22, control n=21), 88.4% were retained post-intervention. MYB participants reported significant increases in WLA from baseline to post-intervention (Δ=24.6) compared to control participants (Δ=-3.9; F(1,36)=13.8, p=.001). The percent of MYB participants meeting PA recommendations increased from 45.5% to 77.8%, compared to the control group, which decreased from 42.9% to 40.0%. Although the percent of MYB participants reporting moderate-to-high distress decreased (63.6% to 33.3%), compared to the control group (61.9% to 55.0%), this was not statistically significant. Conclusions: MYB improved PA and may reduce distress among rural breast cancer survivors, an at-risk population. Practical implications: Findings fill a gap on the translation of EBIs into practice in rural community settings. Funding: NIH/NCI,K07CA222335

Background: Physical activity (PA) is an effective management strategy for type 2 diabetes (T2D) as it provides benefits for glycaemic control and weight management. However, it is unclear whether PA increases following T2D diagnosis. Purpose: To identify changes in PA levels following T2D diagnosis in mid-age Australian women. Methods: Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women’s Health (n=10,410). Surveys were mailed at three-year intervals from 1998 (age 47-52) to 2019 (age 68-73) to collect self-report data on PA and T2D diagnosis. PA change scores were calculated for each of the seven survey intervals. T2D diagnostic status at each survey was defined as not diagnosed, diagnosed (since the previous survey), or previously diagnosed (in any prior survey). Mixed modelling regression analysis was used to compare the average change in PA in the three groups. Results: Between 1998 and 2019, 14% of respondents (n=1,510) were diagnosed with T2D. Baseline PA level (median[IQR]) for the entire cohort was 599.4[199.8, 1282.1]MET.min/week. Over 21years, the mean(95% CI) change in PA across survey intervals was 5.5(-7.9,18.8)MET.min/week. Compared with those who were not diagnosed, the change in PA was 68.3(-16.9,153.5)MET.min/week (p=0.116) in those diagnosed with T2D since the previous survey, and -40.3(-110.6,30.0)MET.min/week (p=0.261) in those who were previously diagnosed. Conclusion: Around the time of their T2D diagnosis, Australian women tended to increase their PA levels. However, this increase was not maintained in the survey intervals following diagnosis. Practical Implications: Given long-term PA is important for T2D management, these findings should be considered when designing ongoing PA support for Australian women with T2D. Funding: The Australian Longitudinal Study on Women’s Health is funded by the Australian Government Department of Health and Aged Care. MJD is supported in part by The Commonwealth of Australia 2022 Effective Treatments and Therapies Grant (MRF2023434).

Background: Up to 50% of deaths related to cancer are considered to be preventable. Despite the existence of effective primary cancer prevention programmes (PCPs), impact often falls short due to poor adaptation and ineffective implementation strategies. Purpose: The PIECES project, a large multi-national project funded by Horizon Europe, aims to adapt and implement existing evidence-based interventions to improve implementation outcomes and by that, improve reach and effectiveness of PCP interventions in 10 countries. The project addresses six risk behaviors, including poor physical health, focusing on the specific behaviour change mechanisms that promote healthy behaviours. Methods: Through an adaptive co-creation process we developed an online Primary Cancer Prevention Implementation Toolkit (PCP-IT). The toolkit enables tailored implementation and is theory- and evidence-based. It underwent refinement through workability and technical piloting workshops. The toolkit focuses on tailored implementation and empowers local implementers to adapt evidence-based PCP programs and develop implementation strategies that are tailored to local needs. Results: The toolkit consists of structured yet flexible work processes to guide implementation teams, including evidence-informed repositories for PCP programs, determinants of practice and implementation strategies, a special module for stakeholder engagement throughout this process, and a community of practice. Conclusions: The project anticipates that the toolkit’s focus on adaptation and tailoring improves implementation outcomes of evidence-based interventions across diverse sites, associated with a reduction of cancer incidence in the European Union and beyond. The planned mixed-methods evaluation will provide insight into the toolkit’s applicability and inform future cancer prevention strategies. Practical implications: We will conduct a multi-site case comparison design, assessing key implementation outcomes (acceptability, feasibility, adoption, sustainability), guided by a realist evaluation approach to explore mechanisms of action. This positions the PCP-IT as a valuable resource for researchers and implementers to improve PCP implementation. Funding: Funded by the European Union. Project reference: 101104390.

Background: Physical activity plays a protective role in health, however, its distribution may vary depending on social determinants of health. Concurrently, racial disparity in physical activity among people with diabetes Brazil remains scarcely investigated. Purpose: We aimed to examine the association between physical activity and diabetes-related complications according to race in the Brazilian population. Methods: We analyzed cross-sectional data from the 2019 National Health Survey, a comprehensive population-based survey of Brazilian adults. Our assessment of physical activity encompassed commuting, leisure, domestic, and occupational activities, which collected through self-reported questionnaires. Diabetes-related complications included impairments in vision, kidney, and circulation, as well as foot ulcers, diabetic coma, and all-cause complications. To assess the association between physical activity and diabetes-related complications, we employed robust Poisson regression models with restricted cubic splines. Results: Our study involved 2,529 adults with diabetes (48.9% women; mean age: 53.5±11.9 years), with one-third experiencing complications. Black adults engaged less in leisure but more in occupational and commuting physical activity compared to whites. Blacks had higher risks of all-cause (1.61; 95%CI: 1.29, 2.02) and vision complications (1.58; 95%CI: 1.23, 2.04) irrespective of physical activity levels. Leisure-time activity reduced all-cause complications (PR: 0.78; 0.71, 0.86), while commuting and occupational activity showed no significant associations. Inactive browns had higher risks of kidney, circulatory, vision, and all-cause complications than active whites, but physical activity attenuated these risks. Conclusions: Our study unveils that the relationship between physical activity and diabetes-related complications is specific to activity domains and highlights racial disparities in physical activity among individuals with diabetes in Brazil. Practical implications: Culturally sensitive interventions are crucial to address racial disparities in physical activity and diabetes-related complications in Brazil. Healthcare strategies should consider the diverse needs of racial groups for effective diabetes management. Funding: CAPES, FAPERGS, and IATS-HCPA/UFRGS (Brazil).

Background: Multiple sclerosis (MS) is an immune-mediated neuroinflammatory disease with an early-onset. Previous studies on the relationship between physical activity (PA) and MS provided inconsistent results. However, no study used objective measures of PA, and little is known about the association with other movement behaviours such as sedentary time. Purpose: The objective of the study was to examine the theoretical association of reallocation of time between device-measured movement behaviours with MS risk. Methods: This study used data from the UK Biobank cohort, and included 96,253 participants followed between 2013-2022. Incident MS cases were ascertained based on self-report, primary care, hospital inpatient data and death data. Movement behaviour was measured with an Axivity AX3 wrist-worn triaxial accelerometer. Machine-learning models were used on accelerometer data to classify the movement behaviours (sleep, sedentary behaviour, light PA and moderate-to-vigorous PA [MVPA]). Cox proportional hazards models with age as the timescale and adjusted for confounders were used to investigate how reallocating time between movement behaviours composition, modelled using isometric log-ratio pivot coordinates, was associated with MS risk. Results: Reallocating 20 minute/day to MVPA from all other behaviours proportionally was associated with a 12% lower risk of MS (HR=0.88, 95%CI=0.81-0.95). Additionally, reallocating 20 min from any behaviour to MVPA was associated with a lower MS risk. Conversely, reallocating 20 minutes from MVPA to any other behaviour, was associated with an higher MS risk. Conclusions: Our findings showed that reallocating time to MVPA was associated with a reduced MS risk. These results are important for planning MS prevention programs and warrant further studies to understand which type and level of PA are the most beneficial. Practical implications: Our study provide prospective evidence in favour of the health benefits of PA and suggest that increasing time spent in MVPA would be beneficial in MS prevention. Funding: LIH funding

Background: Knee and hip osteoarthritis are among the largest contributors to years lived with disability, and this burden is expected to increase due to the aging population. The favorable health effects of physical activity are well known and are particularly important to people with osteoarthritis, as osteoarthritis predisposes to metabolic and functional deterioration. Walking is the predominant type of leisure-time physical activity for adults, but the amount and intensity of walking is poorly described in persons with knee/hip osteoarthritis.
Purpose: Describe the amount and intensity of walking speed across age groups according to knee/hip pain and osteoarthritis.
Methods: We included 10,936 persons ≥50 years from the Norwegian HUNT Study (mean age 65.7 years [SD 9.6]). Knee and hip osteoarthritis were assessed by self-reported physician-diagnosed osteoarthritis combined with information on chronic pain in knees or hips. Walking speed was assessed by accelerometers on the thigh and back and categorized as slow (≤4.0 km/h), moderate (4.1-5.4 km/h) or brisk (≥5.5 km/h) walking.
Results: In the age group 50-59 years, moderate/brisk walking constituted 22% of walking time for those with osteoarthritis, 23% for those with knee/hip pain, and 26% for people without pain. Corresponding numbers for the age group 60-69 was 25%, 21% and 19%, respectively. A similar pattern was observed also for the oldest age groups. The lower proportions in people with osteoarthritis and knee/hip pain where largely due to less brisk walking than people without pain.
Conclusions: People with knee/hip osteoarthritis have notably lower total walking time compared to pain free individuals. The proportion of moderate and brisk walking are considerably lower in people with osteoarthritis and gradually decrease in older age groups.
Practical implications: For people with osteoarthritis, facilitating to increase moderate and brisk walking can fulfill the first line treatment recommendation of increasing physical activity level.
Funding: N/A