Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity

Angelo Sabag; Matthew N Ahmadi; Monique E Francois; Svetlana Postnova; Peter A Cistulli; Luigi Fontana; Emmanuel Stamatakis

doi:10.2337/dc23-2448

Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity

Diabetes Care. 2024 May 1;47(5):890-897. doi: 10.2337/dc23-2448.

Authors

Angelo Sabag^{1

2}, Matthew N Ahmadi^{1

2

3}, Monique E Francois⁴, Svetlana Postnova^{1

5}, Peter A Cistulli^{1

6}, Luigi Fontana^{1

7

8}, Emmanuel Stamatakis^{1

2

3}

Affiliations

¹ Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
² Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
³ Mackenzie Wearables Research Hub @ Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁴ School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia.
⁵ School of Physics, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
⁷ Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁸ Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.

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.

MeSH terms

Accelerometry
Adult
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Diabetes Mellitus, Type 2* / complications
Exercise
Humans
Middle Aged
Obesity / complications

Grants and funding

This research was conducted using the UK Biobank resource under application 25813. This study was funded by an Australian National Health and Medical Research Council Investigator Grant (APP1194510) and the National Heart Foundation of Australia Postdoctoral Fellowship (APP107158).