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Physical Activity and Sedentary Behaviour of Adults with Type 2 Diabetes: a Systematic Review

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Physical Activity and Sedentary Behaviour of Adults with Type 2 Diabetes: a Systematic Review Review Physical activity and sedentary behaviour of adults with type 2 diabetes: a systematic review Ann-Marie Kennerly1 Abstract BSc (Hons), Student at University of Strathclyde Regular physical activity and low levels of prolonged sedentary behaviour are important lifestyle recommendations for the management of type 2 diabetes. This systematic review 1 Alison Kirk collates and summarises published research reporting on physical activity and sedentary BSc (Hons), PhD, Senior Lecturer in Physical Activity behaviour of adults with type 2 diabetes. for Health Systematic searches with three databases were conducted (Medline; PubMed; 1School of Psychological Sciences and Health, SportDiscus). Intervention studies were excluded. Studies were eligible if they: (i) were University of Strathclyde, Glasgow, UK published in English; (ii) were published between 1997 and January 2017; and (iii) objectively and/or subjectively measured physical activity and/or sedentary behaviour in adults with type 2 diabetes. Two reviewers independently cross-checked studies, conducted a Correspondence to: quality assessment and extracted data. Data were analysed using descriptive statistics and a Dr Alison Kirk, Room 532 Graham Hills Building, narrative synthesis. School of Psychological Sciences and Health, The search identified 349 studies; 29 eligible studies were included. All studies measured University of Strathclyde, Glasgow G1 1QX, UK; physical activity and 15 studies measured sedentary behaviour. Twenty studies used email: [email protected] subjective methods, six used objective methods and three used both subjective and objective methods. Most studies report low levels of physical activity and high levels of sedentary Received: 24 November 2017 Accepted in revised form: 13 March 2018 behaviour in adults with type 2 diabetes and note adults with type 2 diabetes to be less active and more sedentary than those without type 2 diabetes. Regardless of measurement method or study location, adults with type 2 diabetes report low levels of physical activity and high levels of sedentary behaviour and are less active and more sedentary than those without type 2 diabetes. There is a need for large-scale interventions which support active lifestyles to be implemented into diabetes care. Copyright © 2018 John Wiley & Sons. Practical Diabetes 2018; 35(3): 86–89 Key words physical activity; sedentary behaviour; type 2 diabetes Background to meet current PA guidelines of at There is substantial evidence docu- least 150 minutes a week of moderate menting the wide-ranging benefits PA or 75 minutes of vigorous intensity of frequent, regular physical activity exercise per week.6 Reducing the (PA) for management of type 2 dia- amount of time spent sedentary and betes (T2D) with improvements in breaking up prolonged SB of >30 min- glycaemic control, cardiovascular utes with light activity is also recom- risk factors and overall quality of life mended for management of T2D.1 being reported.1 Independent of PA Surveys using self-report meth- levels, time spent in sedentary ods have found adults with T2D are behaviour (SB) has also been shown less physically active than those with- to be deleterious for health.2 out the condition.7 Recently, data Sedentary behaviour is character- exploring this topic have been ised as any waking behaviour in a reported using objective methods. sitting or reclined posture with Both methods have advantages and energy expenditure of less than disadvantages. Objective methods 1.5 metabolic equivalents.3 A ran- can capture detailed information on domised crossover trial by Dempsey the pattern, for example intensity et al.4,5 concluded that interrupting and time of behaviour; however, prolonged SB with 3 minutes of they do not provide information light-intensity PA improves glucose about the type of activity and may metabolism in adults with T2D. not capture all physical activity such The American Diabetes Association as water-based activity. Subjective recommends that adults with T2D methods provide information on should exercise daily or at least every the type of activity but are often other day taking part in both aerobic criticised on issues related to robust- and anaerobic activities;1 the aim being ness of self-report data. 86 PRACTICAL DIABETES VOL. 35 NO. 3 COPYRIGHT © 2018 JOHN WILEY & SONS Review Physical activity and sedentary behaviour of adults with type 2 diabetes The objective of this systematic review was to review published evidence exploring PA and SB levels Records identified from in adults with T2D. database search (n=415): Additional studies identified PubMed (n=77) through other sources (n=0) Methods SportDiscus (n=198) The protocol for this systematic Medline (n=140) review can be accessed via www.crd. york.ac.uk registration number: CRD42017053717. A literature search was conducted in January Studies after duplicates 2017 to identify eligible studies. A removed (n=349) date restriction of 1997 was used to ensure findings were relevant to current practice. Only peer Studies removed after application Studies for title/abstract reviewed, published articles in of exclusion/inclusion criteria screening (n=349) English were included. Three data- (n=310) bases were searched using a Boolean search strategy: Medline, PubMed and SportDiscus. Search terms were: No full study available (n=3) Full-text articles assessed for • Population – over 18 years of age Intervention study (n=4) eligibility (n=39) with T2D. Participant selection bias (n=1) • Intervention – no intervention. • Comparison – no comparison or comparison with population with- out T2D or another relevant chronic Final studies eligible for Intervention studies (n=2) disease. qualitative synthesis (n=31) • Outcomes – SB or PA/inactivity as an outcome. • Study design – quantitative studies including cross-sectional Final studies included in and cohort design. systematic review (n=29) A Medical Subject Headings (MeSH) search of T2D was con- Figure 1. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow ducted to inform search terms. diagram illustrating the exclusion process and the final study selection into systematic review Definitions of PA and SB were used along with detailed guidance. measured, defined and analysed. to describe outcomes – for example: Differences in quality assessment Therefore, data were synthesised exercise; exercise habits; physical were resolved by discussion. Each and presented narratively. inactivity; sedentary time; sitting. question in the assessment tool was Additionally, reference lists and first rated either yes, no or other (can- Results authors of eligible studies were man- not determine [CD], not applicable Study selection ually searched. Intervention studies [NA], not reported [NR]). One Figure 1 illustrates the process of were excluded as PA behaviour point was available for each ques- article selection, including reasons could be non-representative of tion resulting in a possible 14-point for exclusion in accordance with participants’ usual patterns due to total for a high-quality study. Studies the Preferred Reporting Items for motivations during interventions. which scored below six points were Systematic reviews and Meta- Exclusion and inclusion criteria regarded to be of ‘poor’ quality, Analyses (PRISMA) statement. were applied to the titles and studies between 6–13 points were abstracts of studies and 100% of rated ‘fair’ and studies which scored Study characteristics the studies were cross-checked by 14 points were considered a ‘good’ The study characteristics and quality an independent researcher (AK). quality study. assessment are summarised in Disagreements were discussed and Alongside quality assessment, Appendix 1 (available online at www. agreed by consensus. relevant data were extracted. The practicaldiabetes.com) and are The quality of studies was extracted information included: grouped by methods of PA/SB meas- assessed individually based on year and location of publication; urement. The countries of included details reported by two reviewers sample characteristics and compar- studies were: America (n=8), Nigeria (AMK and AK) using the National ison group; measurement method; (n=3), the UK (n=3), Australia (n=2), Institute for Health assessment tool PA and/or SB results; and relevant Canada (n=2), Belgium (n=1), Brazil for observational, cohort and conclusions. There was incon- (n=1), Croatia (n=1), Denmark cross-sectional studies. This assess- sistency across eligible studies (n=1), Finland (n=1), France (n=1), ment tool consists of 14 questions regarding how PA and SB were Nepal (n=1), Netherlands (n=1), PRACTICAL DIABETES VOL. 35 NO. 3 COPYRIGHT © 2018 JOHN WILEY & SONS 87 Review Physical activity and sedentary behaviour of adults with type 2 diabetes Poland (n=1), South Africa (n=1) age appropriate comparison group 15–61% from studies using the and Turkey (n=1). of people without T2D report IPAQ with IPAQ scoring protocol Three studies used both subjec- lower PA levels using a variety of and between 25–75% for other tive and objective methods. None of subjective methods in people with self-report measures. Regardless of these studies included a comparison T2D.7,17–22 Two of the three stud- the measurement method, adults sample.8–10 Only one study meas- ies23,24 which report a comparison with diabetes report lower levels of ured subjective and objective PA with people with type 1 diabetes PA compared to adults without levels over the same time period.10 report people with
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