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Sabag A, Ahmadi MN, Francois ME, Postnova S, Cistulli PA, Fontana L, Stamatakis E. Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity. Diabetes Care 2024; 47:890-897. [PMID: 38592034 PMCID: PMC11043226 DOI: 10.2337/dc23-2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To assess the association between timing of aerobic moderate to vigorous physical activity (MVPA) and risk of cardiovascular disease (CVD), microvascular disease (MVD), and all-cause mortality in adults with obesity and a subset with obesity and type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Participants included adults with obesity (BMI ≥30 kg/m2) and a subset of those with T2D from the UK Biobank accelerometry substudy. Aerobic MVPA was defined as bouts of MVPA lasting ≥3 continuous minutes. Participants were categorized into morning, afternoon, or evening MVPA based on when they undertook the majority of their aerobic MVPA. The reference group included participants with an average of less than one aerobic MVPA bout per day. Analyses were adjusted for established and potential confounders. RESULTS The core sample included 29,836 adults with obesity, with a mean age of 62.2 (SD 7.7) years. Over a mean follow-up period of 7.9 (SD 0.8) years, 1,425 deaths, 3,980 CVD events, and 2,162 MVD events occurred. Compared with activity in the reference group, evening MVPA was associated with the lowest risk of mortality (hazard ratio [HR] 0.39; 95% CI 0.27, 0.55), whereas afternoon (HR 0.60; 95% CI 0.51, 0.71) and morning MVPA (HR 0.67; 95% CI 0.56, 0.79) demonstrated significant but weaker associations. Similar patterns were observed for CVD and MVD incidence, with evening MVPA associated with the lowest risk of CVD (HR 0.64; 95% CI 0.54, 0.75) and MVD (HR 0.76; 95% CI 0.63, 0.92). Findings were similar in the T2D subset (n = 2,995). CONCLUSIONS Aerobic MVPA bouts undertaken in the evening were associated with the lowest risk of mortality, CVD, and MVD. Timing of physical activity may play a role in the future of obesity and T2D management.
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Affiliation(s)
- Angelo Sabag
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew N. Ahmadi
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Mackenzie Wearables Research Hub @ Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Monique E. Francois
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Svetlana Postnova
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Physics, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter A. Cistulli
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Luigi Fontana
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Mackenzie Wearables Research Hub @ Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Nemoto Y, Brown WJ, Mielke GI. Trajectories of physical activity from mid to older age in women: 21 years of data from the Australian Longitudinal Study on Women's Health. Int J Behav Nutr Phys Act 2024; 21:4. [PMID: 38191462 PMCID: PMC10773129 DOI: 10.1186/s12966-023-01540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/18/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Women's physical activity varies across the adult lifespan. However, changes in physical activity among mid-aged women are not well understood. We analysed 21 years of data from women born in 1946-51 to identify: (1) trajectories of physical activity in the transition from mid- to old-age and (2) determinants of different physical activity trajectories. METHODS Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (N = 10,371). Surveys were mailed at three-year intervals from 1998 (age 47-52) to 2019 (age 68-73) to collect data on physical activity, sociodemographic factors (country of birth, area of residence, educational attainment, marital status, income management, paid work hours, living with children age < 18, providing care), health indicators (menopause status, BMI, physical and mental health, chronic conditions), and health behaviours (smoking, alcohol status). Group-based trajectory modelling was used to identify trajectories of physical activity. Multinomial logistic regression models were used to examine the determinants of physical activity trajectories. RESULTS Five trajectories were identified: Low-stable (13.3% of participants), Moderate-stable (50.4%), Moderate-increasing (22.2%), High-declining (7.7%), and High-stable (6.6%). Sociodemographic characteristics (area of residence, education, income management, living with children, and providing care) were determinants of physical activity trajectories, but the strongest factors were BMI, physical and mental health. Women who were overweight/obese and had poor physical and mental health were less likely to be in the High-stable group than in any other group. Changes in these variables (increasing BMI, and declining physical and mental health) and in marital status (getting married) were positively associated with being in trajectories other than the High-stable group. CONCLUSIONS Although most women maintained physical activity at or above current guidelines, very low physical activity levels in the Low-stable group, and declining levels in the High-declining group are concerning. The data suggest that physical activity promotion strategies could be targeted to these groups, which are characterised by socioeconomic disadvantage, high (and increasing) BMI, and poor (and worsening) physical and mental health. Removing barriers to physical activity in these women, and increasing opportunities for activity, may reduce chronic disease risk in older age.
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Affiliation(s)
- Yuta Nemoto
- School of Public Health, The University of Queensland, Brisbane, QLD, 4006, Australia.
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, 160-8402, Japan.
- School of Health Innovation, Kanagawa University of Human Services, Kanagawa, 210-0821, Japan.
| | - Wendy J Brown
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4229, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, 4006, Australia
| | - Gregore Iven Mielke
- School of Public Health, The University of Queensland, Brisbane, QLD, 4006, Australia
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