Dose-response associations of intermittent lifestyle physical activity micropatterns and incident type 2 diabetes

Objective: To examine dose-response associations of vigorous intermittent lifestyle physical activity micropatterns (VILPA; bouts ≤1 minute) and its moderate-to-vigorous equivalent (MV-ILPA; bouts ≤3 minutes) with incident type 2 diabetes. Research Design and Methods: Prospective data from UK Biobank accelerometry sub-study participants who reported no leisure-time exercise and had no type 2 diabetes at baseline were analysed. Daily duration and frequency of VILPA and MV-ILPA were derived from wrist-worn accelerometry. Incident type 2 diabetes was ascertained through linked primary care, hospital and death records. Dose-response associations were examined using multivariable-adjusted Fine-Gray subdistribution hazard models accounting for competing risks. Results: Among 22,706 participants (mean age 62.3 years; 56.4% female), 665 developed type 2 diabetes over an average follow-up of 7.9 years. Daily durations of VILPA and MV-ILPA showed inverse, non-linear L-shaped associations with incident type 2 diabetes. Median durations of 3.9 minutes/day of VILPA and 25.3 minutes/day of MV-ILPA were associated with 36% and 46% lower risk of type 2 diabetes, respectively, compared with those completing no VILPA or 3.9 minutes/day of MV-ILPA. Daily VILPA frequency showed a near-linear inverse association, with 10.4 bouts/day (median) corresponding to a hazard ratio (HR) of 0.64 (95% CI 0.51-0.81) compared with 0 bouts/day. Daily MV-ILPA frequency showed a U-shaped pattern, with risk reductions plateauing at approximately 56 bouts/day (HR 0.54, 95% CI 0.39−0.76). Conclusions: Among adults who do not do leisure-time exercise, accruing brief, intermittent bouts of moderate-to-vigorous intensity physical activity during day-to-day routines may be a promising strategy for prevention of type 2 diabetes.