Association between timing and consistency of physical activity and type 2 diabetes: a cohort study on participants of the UK Biobank

Diabetologia. 2023 Dec;66(12):2275-2282. doi: 10.1007/s00125-023-06001-7. Epub 2023 Sep 20.


Aims/hypothesis: We sought to quantify the relationship between morning, afternoon or evening physical activity and consistency (e.g. routine) and risk of type 2 diabetes.

Methods: A cohort of 93,095 UK Biobank participants (mean age 62 years) without a history of type 2 diabetes wore a wrist-worn accelerometer for 1 week. We converted accelerometer information to estimate metabolic equivalent of task (MET), summing MET h of total physical activity completed within three intra-day time segments (morning, afternoon and evening). We quantified physical activity consistency as the SD of participants' daily total physical activity. We ultimately associated each of the following with incident type 2 diabetes: (1) morning, afternoon or evening 'time-segmented' MET h per week; and (2) consistency. We also considered moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) in association with type 2 diabetes incidence.

Results: When considering MET as the physical activity measure, we observed protective associations of morning (HR 0.90 [95% CI 0.86, 0.93], p=7×10-8) and afternoon (HR 0.91 [95% CI 0.87, 0.95], p=1×10-5) but did not have evidence for evening physical activity (HR 0.95 [95% CI 0.90, 1.00], p=0.07) with type 2 diabetes. There was no difference between MET-measured morning and afternoon physical activity. Our substitution model highlighted the importance of adjusting for lifestyle factors (e.g. sleep time and diet); the effect of a substitution between afternoon and evening physical activity was attenuated after adjustment for lifestyle variables. Consistency of MET-measured physical activity was not associated with type 2 diabetes (p=0.07). MVPA and VPA were associated with decreased risk for type 2 diabetes at all times of the day.

Conclusions/interpretation: Total metabolic equivalents of physical activity in the morning and afternoon had a protective effect on diabetes risk and evening activity was not associated with diabetes. Consistency of physical activity did not play a role in decreasing risk for diabetes. Vigorous activity is associated with lower risk no matter the time of day of activity.

Keywords: Exercise routine; Lifestyle factors; Physical activity; Type 2 diabetes.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Accelerometry
  • Biological Specimen Banks
  • Cohort Studies
  • Diabetes Mellitus, Type 2* / epidemiology
  • Exercise
  • Humans
  • Middle Aged
  • United Kingdom / epidemiology