Breaking sitting with light activities vs structured exercise: a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes

Bernard M F M Duvivier*, Nicolaas C Schaper, Matthijs K C Hesselink, Linh van Kan, Nathalie Stienen, Bjorn Winkens, Annemarie Koster, Hans H C M Savelberg

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


AIMS/HYPOTHESIS: We aimed to examine the effects of breaking sitting with standing and light-intensity walking vs an energy-matched bout of structured exercise on 24 h glucose levels and insulin resistance in patients with type 2 diabetes.

METHODS: In a randomised crossover study, 19 patients with type 2 diabetes (13 men/6 women, 63 ± 9 years old) who were not using insulin each followed three regimens under free-living conditions, each lasting 4 days: (1) Sitting: 4415 steps/day with 14 h sitting/day; (2) Exercise: 4823 steps/day with 1.1 h/day of sitting replaced by moderate- to vigorous-intensity cycling (at an intensity of 5.9 metabolic equivalents [METs]); and (3) Sit Less: 17,502 steps/day with 4.7 h/day of sitting replaced by standing and light-intensity walking (an additional 2.5 h and 2.2 h, respectively, compared with the hours spent doing these activities in the Sitting regimen). Blocked randomisation was performed using a block size of six regimen orders using sealed, non-translucent envelopes. Individuals who assessed the outcomes were blinded to group assignment. Meals were standardised during each intervention. Physical activity and glucose levels were assessed for 24 h/day by accelerometry (activPAL) and a glucose monitor (iPro2), respectively. The incremental AUC (iAUC) for 24 h glucose (primary outcome) and insulin resistance (HOMA2-IR) were assessed on days 4 and 5, respectively.

RESULTS: The iAUC for 24 h glucose (mean ± SEM) was significantly lower during the Sit Less intervention than in Sitting (1263 ± 189 min × mmol/l vs 1974 ± 324 min × mmol/l; p = 0.002), and was similar between Sit Less and Exercise (Exercise: 1383 ± 194 min × mmol/l; p = 0.499). Exercise failed to improve HOMA2-IR compared with Sitting (2.06 ± 0.28 vs 2.16 ± 0.26; p = 0.177). In contrast, Sit Less (1.89 ± 0.26) significantly reduced HOMA2-IR compared with Exercise (p = 0.015) as well as Sitting (p = 0.001).

CONCLUSIONS/INTERPRETATION: Breaking sitting with standing and light-intensity walking effectively improved 24 h glucose levels and improved insulin sensitivity in individuals with type 2 diabetes to a greater extent than structured exercise. Thus, our results suggest that breaking sitting with standing and light-intensity walking may be an alternative to structured exercise to promote glycaemic control in patients type 2 diabetes.

TRIAL REGISTRATION: NCT02371239 FUNDING: : The study was supported by a Kootstra grant from Maastricht University Medical Centre+, and the Dutch Heart Foundation. Financial support was also provided by Novo Nordisk BV, and Medtronic and Roche made the equipment available for continuous glucose monitoring.

Original languageEnglish
Pages (from-to)490-498
Number of pages9
Issue number3
Publication statusPublished - Mar 2017


  • Aged
  • Blood Glucose
  • Cross-Over Studies
  • Diabetes Mellitus, Type 2
  • Exercise
  • Female
  • Humans
  • Insulin
  • Insulin Resistance
  • Lipid Metabolism
  • Male
  • Middle Aged
  • Posture
  • Sedentary Lifestyle
  • Walking
  • Journal Article
  • Randomized Controlled Trial
  • Type 2 diabetes
  • Lipid metabolism
  • Sedentary breaks
  • Glycaemic control
  • Insulin sensitivity
  • Sedentary behaviour
  • Standing
  • Light-intensity physical activity

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