Physical activity levels by glycemia status: A population-based cross-sectional study in Peru

Highlights

• Physical activity levels were similar by glycemia status.

• Sitting time watching TV, a proxy of sedentarism, was similar by glycemia status.

• Subjects aware of T2DM diagnosis had low levels of physical activity.

• More than two thirds of individuals spent 2 or more hours sitting watching TV.

Abstract

Objective

To assess whether the prevalence of low physical activity levels and time spent watching TV differ depending on glycemia status.

Methods

A secondary analysis using data from a population-based study was conducted. Two were the outcomes: physical activity levels, derived from the International Physical Activity Questionnaire, and sitting time watching TV. The exposure was glycemia status, defined based on results of the oral glucose tolerance tests (OGTT): euglycemia, dysglycemia, and T2DM. The T2DM group was further split into: aware and unaware of T2DM diagnosis. Prevalence ratios (PR) and 95% CI were reported using Poisson regression models.

Results

Data of 1607 individuals, mean age 48.2 (SD: 10.6) years, 809 (50.3%) females, were analyzed. Dysglycemia and T2DM was present in 16.9% (95% CI: 15.1%–18.8%) and 11.0% (95% CI: 9.5%–12.6%) of participants, respectively. A total of 605 (37.6%; 95% CI: 35.2%–39.9%) participants had low levels of physical activity and 1019 (63.3%; 95% CI: 60.9%–65.7%) subjects spent ≥2 h per day sitting watching TV. In multivariable model, there was no significant association between glycemia status and physical activity levels (PR = 1.14; 95% CI: 0.95–1.36). Similar result was found between glycemia status and sitting time watching TV. However, those aware of T2DM diagnosis were more likely to have low levels of physical activity (PR = 1.31; 95% CI: 1.06–1.61) compared to the euglycemia group.

Conclusions

We found a no relationship between glycemia status and physical activity level or sitting time watching TV, pointing out similar levels of physical (in)activity among those with euglycemia, dysglycemia and T2DM. Individuals aware of having T2DM were 30% more likely to have low physical activity levels compared to the euglycemic group. There is a need to increase physical activity levels among T2DM individuals.

Introduction

Type 2 diabetes mellitus (T2DM) is a major cause of morbidity (i.e. complications) and mortality in the world [1]. The prevalence of T2DM has doubled over the past 30 years becoming a public health concern, especially in low- and middle-income countries [2]. Thus, in 2017, the International Diabetes Federation estimated the global prevalence of T2DM at 8.8% [3], whereas the prevalence in Peru has been estimated in 7% [4], varying from 3.5% in the jungle to 8.4% in Lima, the capital. However, the highest prevalence has been described in the north of Peru, reaching 11% [5]. In addition to such prevalence variation, a high proportion of individuals with T2DM are not aware of their diagnosis [6], which can be important to prevent further complications.

Patients with T2DM may require the individualization of specific therapy, including but not limited to pharmacological treatment, patient education, physical activity and nutritional recommendations, glycemic and blood pressure control, and psychological evaluation. For this, establishing specific goals is required in order to better manage lifestyle behaviors and improve quality of life by reducing long-term complications and slowing down disease progression [7]. Regarding lifestyle modifications, a low-calorie meal plan and physical activity levels with at least moderate intensity have been recommended [8]. In addition, patients should avoid being inactive or sedentary in order to stimulate musculoskeletal contractions, improving glycemic and metabolic control, reduce abdominal circumference, reduce triglyceride level, and further reduce postprandial glucose levels [9]. For example, television viewing, a sort of sedentary lifestyle, has been associated with overweight and obesity [10], but also with T2DM and poor glycemic control [11,12]. As a result, current physical activity guidelines include recommendations to improve physical activity levels and reduce and interrupt prolonged sitting.

Hyperglycemia may serve as an important marker for those who are at the greatest risk of developing T2DM, providing a potential window of opportunity to intervene as individuals with dysglycemia may benefit from timely lifestyle interventions. As physical activity patterns and sedentary lifestyles may vary according to the levels of glycemia (i.e. having dysglycemia or being aware of T2DM diagnosis), the present study aimed at evaluating whether the prevalence of low physical activity levels and sitting time watching TV, a proxy of sedentary lifestyle, differ depending on glycemia status.