title: Daily Patterns of Physical Activity by Type 2 Diabetes Definition: Comparing Diabetes, Prediabetes, and Participants with Normal Glucose Levels in NHANES 2003-2006.
abstract: OBJECTIVE
  Diabetes is associated with low levels of physical activity (PA), but detailed objective information about how PA patterns vary by diabetes definition is lacking.
  
  
  METHODS
  PA was measured with Actigraph accelerometers in older (60+) adults from the 2003-2006 National Health and Nutrition Examination Survey (n= 1,043) and analyzed in 2014. Diabetes definition (normal glucose levels, prediabetes, diabetes) was assessed (fasting glucose, hemoglobin A1C, and self-report). Accelerometer data were used to characterize total activity counts (TAC) per day and hour-by-hour activity counts by diabetes definition. Multiple linear regression models explored the relationship between diabetes definition and TAC.
  
  
  RESULTS
  Despite similar patterns of PA, diabetes participants had significantly lower TAC compared to participants with normal glucose levels and prediabetes. Diabetes participants' activity counts per hour declined more rapidly after 12 pm, with the biggest differences between the groups occurring at 4 pm. Participants with normal glucose levels and prediabetes had similar TAC and daily PA profiles.
  
  
  CONCLUSIONS
  Our novel methodology provides information about PA patterns by diabetes definition. Significantly lower TAC in the diabetes group, their significant drop in afternoon PA, and the similarity of PA between participants with normal glucose levels and prediabetes provide insight into potential targets for intervention.
authors.affiliation: Cancer Prevention Fellowship Program Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Steeves
authors.affiliation: Laboratory of Epidemiology, and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Murphy
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Ciprian M
authors.initials: CM
authors.lastname: Crainiceanu
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Vadim
authors.initials: V
authors.lastname: Zipunnikov
authors.affiliation: Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
authors.forename: Dane R
authors.initials: DR
authors.lastname: Van Domelen
authors.affiliation: Laboratory of Epidemiology, and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA.
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
keywords: Diabetes; PA; cross sectional; patterns; prediabetes