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Final Report Summary - SEDIAB (The effect of a sedentary lifestyle on type 2 diabetes and its complications)

Low physical activity is a well-known risk factor of many healthy problems. It is, however, not clear whether the increased health risks are due to lack of moderate to vigorous physical activity or due to a more sedentary lifestyle. Sedentary behaviour cannot simply be defined as the lack of moderate to vigorous physical activity but is defined as engaging in activities which marginally increase energy expenditure above resting level such as sitting, using the computer, and watching television. Understanding the health consequences of sedentary behaviour independently and jointly associated with physical activity is essential in order to promote healthy behaviours and more effective guidelines.
In the present project we aim to disentangle the relation between objectively measured sedentary behaviour and physical activity with cardio-metabolic risk factors and type 2 diabetes and diabetic complications. Data from two well-defined cohort studies are used; the AGES-Reykjavik Study and the Maastricht Study in which high-quality objective physical activity data by accelerometry over multiple days have been collected.
In the first phase of the project, the determinants of sedentary behaviour came under scrutiny using data from the AGES-Reykjavik study. The results showed that certain midlife determinants including not being married; a lower educational level; poorer housing; obesity; and heart disease in midlife were associated with more sitting time in old age (Van der Berg et al. Med Sci Sports Excer 2014).
In the second phase the project, data from The Maastricht Study ( were used. In about 2500 participants, aged 40-75, the association between sedentary behaviour and diabetes status was examined. The Maastricht Study will only is the largest study worldwide on type 2 diabetes but also the largest study with ActivPal accelerometry data. The methodology for the accelerometry data processing had to still be developed. The data processing methodology was part of validation project for a methodological paper (Van der Berg et al. J Sports Sci 2016). Next, we examined the amount and pattern of sedentary with type 2 diabetes. We show that each additional hour of sedentary time was associated with a 22% increased risk of having type 2 diabetes independent of high-intensity physical activity (Van der Berg et al. Diabetologia 2016). Our findings suggest that sedentary behaviour may play a significant role in the development and prevention of type 2 diabetes.
As a next step we investigated the effect of replacing sedentary time with physical activity on metabolic risk factors. Interestingly, we found that replacing 30 minutes of sedentary time with standing or intensity physical activity improved cardiometabolic risk factors such as waist circumference, HDL cholesterol levels, and blood pressure. Further, we aimed to understand if sedentary behaviour is also associated with complications of type 2 diabetes. We therefore examined the association between sedentary behaviour and vascular stiffness and kidney function, two projects that are currently in progress.
This project greatly adds to the understanding of sedentary behaviour as an important health risk factor. Overall, very good progress on the research project has been made with 3 papers published in important international journals and 4 more papers in progress. Importantly this work also results in a PhD thesis.

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