title: Level and correlates of physical activity and sedentary behavior in patients with type 2 diabetes: A cross-sectional analysis of the Italian Diabetes and Exercise Study_2.
abstract: OBJECTIVE
  Patients with type 2 diabetes usually show reduced physical activity (PA) and increased sedentary (SED)-time, though to a varying extent, especially for low-intensity PA (LPA), a major determinant of daily energy expenditure that is not accurately captured by questionnaires. This study assessed the level and correlates of PA and SED-time in patients from the Italian Diabetes and Exercise Study_2 (IDES_2).
  
  
  METHODS
  Three-hundred physically inactive and sedentary patients with type 2 diabetes were enrolled in the IDES_2 to be randomized to an intervention group, receiving theoretical and practical exercise counseling, and a control group, receiving standard care. At baseline, LPA, moderate-to-vigorous-intensity PA (MVPA), and SED-time were measured by accelerometer. Physical fitness and cardiovascular risk factors and scores were also assessed.
  
  
  RESULTS
  LPA was 3.93±1.35 hours∙day-1, MVPA was 12.4±4.6 min∙day-1, and SED-time was 11.6±1.2 hours∙day-1, with a large range of values (0.89-7.11 hours∙day-1, 0.6-21.0 min∙day-1, and 9.14-15.28 hours∙day-1, respectively). At bivariate analysis, LPA and MVPA correlated with better cardiovascular risk profile and fitness parameters, whereas the opposite was observed for SED-time. Likewise, values of LPA, MVPA, and SED-time falling in the best tertile were associated with optimal or acceptable levels of cardiovascular risk factors and scores. At multivariate analysis, age, female gender, HbA1c, BMI or waist circumference, and high-sensitivity C reactive protein (for LPA and SED-time only) were negatively associated with LPA and MPA and positively associated with SED-time in an independent manner.
  
  
  CONCLUSIONS
  Physically inactive and sedentary patients with type 2 diabetes from the IDES_2 show a low level of PA, though values of LPA, MVPA, and SED-time vary largely. Furthermore, there is a strong correlation of these measures with glycemic control, adiposity and inflammation, thus suggesting that even small improvements in LPA, MVPA, and SED-time might be associated with significant improvement in cardiovascular risk profile.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01600937.
authors.affiliation: Department of Clinical and Molecular Medicine, ''La Sapienza" University, Rome, Italy.|Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.|Metabolic Fitness Association, Monterotondo, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Balducci
authors.affiliation: Department of Clinical and Molecular Medicine, ''La Sapienza" University, Rome, Italy.|Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.|Metabolic Fitness Association, Monterotondo, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: D'Errico
authors.affiliation: Department of Clinical and Molecular Medicine, ''La Sapienza" University, Rome, Italy.|Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.|Metabolic Fitness Association, Monterotondo, Rome, Italy.
authors.forename: Jonida
authors.initials: J
authors.lastname: Haxhi
authors.affiliation: Department of Human Movement and Sport Sciences, ''Foro Italico" University, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sacchetti
authors.affiliation: Department of Human Movement and Sport Sciences, ''Foro Italico" University, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Orlando
authors.affiliation: Department of Clinical and Molecular Medicine, ''La Sapienza" University, Rome, Italy.|Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Cardelli
authors.affiliation: Diabetes Unit, Fatebenefratelli San Pietro Hospital, Rome, Italy.
authors.forename: Nicolina
authors.initials: N
authors.lastname: Di Biase
authors.affiliation: Department of Clinical and Molecular Medicine, ''La Sapienza" University, Rome, Italy.|Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Lucilla
authors.initials: L
authors.lastname: Bollanti
authors.affiliation: Department of Clinical and Molecular Medicine, ''La Sapienza" University, Rome, Italy.|Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Conti
authors.affiliation: Centre for Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, United Kingdom.
authors.forename: Silvano
authors.initials: S
authors.lastname: Zanuso
authors.affiliation: Center for Outcomes Research and Clinical Epidemiology (CORE), Pescara, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.affiliation: Department of Clinical and Molecular Medicine, ''La Sapienza" University, Rome, Italy.|Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.identifier: http://orcid.org/0000-0003-1574-0397
authors.initials: G
authors.lastname: Pugliese
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D015444:Exercise; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D057185:Sedentary Behavior
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human