Background: Waking time in sedentary behavior (SB), light physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) are interrelated. To consider this interrelationship of time in different behaviors it has become recognized that physical activity should be regarded from a time-use approach. We explored the associations of physical activity and SB with cardiometabolic risk factors in people with type 2 diabetes and prediabetes with two time-use approaches.

Methods: Cross-sectional data from individuals with prediabetes and type 2 diabetes was used. MVPA, LIPA and SB during the awake time were measured with ActiGraph GT1M accelerometer. Two time-used approaches, isotemporal substitution analysis, and compositional data analysis (CoDa) were applied to explore the associations of physical activity and SB with cardiometabolic risk factors such as anthropometrics, glucose metabolism and lipids.

Results: Data was provided for 124 participants in the isotemporal and 175 participants in the CoDa analyses. Of these 50 respectively 42% were female, mean age was 64 years in both samples. The findings showed strong positive associations with cardiometabolic risk factors for time spent in MVPA and negative associations of time spent in SB relative to time spent in the other behaviors. Theoretically, reallocating time from SB to MVPA was beneficially associated with BMI, waist circumference, and HDL cholesterol. When applying CoDa reallocation of 19 minutes MVPA to SB or to LIPA was associated with a 17% and 17% larger SAD, 39% and 36% larger HOMA-IR values, and 3% and 2% lower levels of HDL, respectively.  

Conclusions: In conclusion, our analyses from two different time-use perspectives showed similar results. The findings support the current evidence of device-measured physical activity and sedentary time. A high proportion of SB is devastating for cardiometabolic health. Maintaining or increasing time in MVPA are the most important features of the time-use behaviors in adults with prediabetes and type 2 diabetes.