Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity

Apr 9, 2024Diabetes care

When adults with obesity do moderate to vigorous exercise and its links to death, heart disease, and small blood vessel disease

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Abstract

In a study of 29,836 adults with obesity, evening aerobic moderate to vigorous physical activity (MVPA) was associated with a 39% lower risk of mortality.

Evening MVPA showed the strongest association with reduced risk for all-cause mortality compared to reference activity levels.
Participants engaging in afternoon MVPA had a 40% lower risk of mortality, while morning MVPA was associated with a 33% reduction.
Evening MVPA was linked to a 36% lower risk of cardiovascular disease (CVD) events and a 24% lower risk of microvascular disease (MVD) events.
Similar protective associations were observed in the subset of participants with obesity and type 2 diabetes.
Findings suggest that the timing of physical activity may influence health outcomes in adults with obesity.

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OBJECTIVE: To assess the association between timing of aerobic moderate to vigorous physical activity (MVPA) and risk of cardiovascular disease (CVD), microvascular disease (MVD), and all-cause mortality in adults with obesity and a subset with obesity and type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS: Participants included adults with obesity (BMI ≥30 kg/m2) and a subset of those with T2D from the UK Biobank accelerometry substudy. Aerobic MVPA was defined as bouts of MVPA lasting ≥3 continuous minutes. Participants were categorized into morning, afternoon, or evening MVPA based on when they undertook the majority of their aerobic MVPA. The reference group included participants with an average of less than one aerobic MVPA bout per day. Analyses were adjusted for established and potential confounders.

RESULTS: The core sample included 29,836 adults with obesity, with a mean age of 62.2 (SD 7.7) years. Over a mean follow-up period of 7.9 (SD 0.8) years, 1,425 deaths, 3,980 CVD events, and 2,162 MVD events occurred. Compared with activity in the reference group, evening MVPA was associated with the lowest risk of mortality (hazard ratio [HR] 0.39; 95% CI 0.27, 0.55), whereas afternoon (HR 0.60; 95% CI 0.51, 0.71) and morning MVPA (HR 0.67; 95% CI 0.56, 0.79) demonstrated significant but weaker associations. Similar patterns were observed for CVD and MVD incidence, with evening MVPA associated with the lowest risk of CVD (HR 0.64; 95% CI 0.54, 0.75) and MVD (HR 0.76; 95% CI 0.63, 0.92). Findings were similar in the T2D subset (n = 2,995).

CONCLUSIONS: Aerobic MVPA bouts undertaken in the evening were associated with the lowest risk of mortality, CVD, and MVD. Timing of physical activity may play a role in the future of obesity and T2D management.

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Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity

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