Physical Activity Offsets the Mortality Risk Associated with Excessive Sitting Time in Adults With Diabetes

Adults with diabetes who meet the recommended guidelines for physical activity may offset the risk of mortality that is associated with excessive sitting time, according to a new study by researchers at Columbia University Mailman School of Public Health. This is the first study to show that getting adequate exercise can counteract the elevated risk of mortality associated with sitting for long periods of time each day, even for people with diabetes. The findings are published in Diabetes Care.

“Managing the elevated mortality risk in this high-risk population is particularly pressing given the widespread diabetes epidemic and the tendency among adults with diabetes to sit more and move less,” said Wen Dai, MPH, first author of the study who was an MPH student in Epidemiology at Columbia Mailman School.

Excessive sedentary time is a significant public health issue with increased mortality risk for the general population.

The researchers analyzed data from the 2007-2018 National Health and Nutrition Examination Surveys (NHANES) for individuals 20 years of age or older with diabetes as defined by the American Diabetes Association. Individuals with diabetes were followed- through 2019 to determine mortality status. Sitting time and moderate-to-vigorous physical activity were self-reported. Data on sociodemographics, lifestyle factors, and medical conditions were collected through computer-assisted personal interviews. 

Physical activity was categorized as time spent in moderate to vigorous activity: inactive (<10 min/week), insufficiently active (10-149 min/week), and active (≥150 min/week). Thirty-eight percent of adults with diabetes reported being physically active for less than 10 minutes per week. Across the three physical activity categories (inactive, insufficiently active, active), a majority of adults with diabetes sat for 8 or more hours per day. Half of the respondents had diabetes for five years or less and 34 percent had diabetes for more than 10 years.

Over the approximately 6-year period, there were 1,278 deaths from all causes and 354 deaths from heart disease in a population with an average age of 60 years, 48 percent of whom were female and 61 percent of whom were non-Hispanic White.  When compared to sitting for less than 4 hours per day, sitting for 8 or more hours per day was associated with greater risk of mortality for inactive and insufficiently active adults, but not for active adults. This pattern was found for both all-cause mortality and for heart disease mortality.

“Our findings support an emphasis on encouraging and supporting patients in adhering to guideline-recommended physical activity levels, particularly for individuals whose life circumstances necessitate prolonged sitting in particular, such as drivers or office workers,” said Sandra Albrecht, PhD, assistant professor of Epidemiology at Columbia Mailman School of Public Health, and senior author.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grant number K01DK107791).