Pulsford, Richard M;
Bakker, Esmée A;
Ahmadi, Matthew;
Blodgett, Joanna M;
Bosma, Hans;
Brocklebank, Laura;
Eussen, Simone JPM;
... Koster, Annemarie; + view all
(2025)
Not all steps are equal: independent prospective associations of stepping volume and patterns with incident type 2 diabetes mellitus in the Maastricht study.
International Journal of Behavioral Nutrition and Physical Activity
, 22
, Article 145. 10.1186/s12966-025-01839-z.
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Abstract
BACKGROUND: Stepping has been associated with reduced risk for type 2 diabetes (T2D), but existing prospective studies focus largely on average stepping volume (steps per day or week) and ignore important differences in how stepping is accumulated. Here, we examined independent associations of stepping volume and within and between day variability, with incident T2D. METHODS: Participants (n = 4594, 40-75y) without preexisting T2D from The Maastricht Study wore an activPAL3 accelerometer (6–7 days). Prospective associations of stepping volume (steps/day) with incident T2D were assessed using Cox proportional hazards models with restricted cubic splines, adjusted for age, sex, BMI, education, smoking, CVD, sedentary time and diet. Four indices of between-day (i-iii below) and within-day (iv below) stepping pattern were modelled alongside total steps/day. These were: (i) proportion of steps accumulated on the 2 most active days (%Active-2days), (ii) between-day step count variability (BDV) and (iii) inter-daily step count stability (IS), (iv) within-day variability in stepping (WDV) (variability in steps/hour). Higher values in %Active-2days, BDV and WDV indicate greater variation in stepping between or within days. Higher IS values indicate greater uniformity in hourly stepping pattern between days. RESULTS: Over 30,336 person-years of follow-up (mean 6.6y), 178 incident cases of T2D were recorded. A non-linear (p = 0.04) ‘L-shaped’ association was observed between stepping volume and T2D risk, with steeper risk reduction earlier in the steps/day distribution. Relative to accumulating ≤ 5000 steps/day, adjusted hazard ratios (95% CI) were 0.57 (0.34, 0.96) for 5000–7500 steps/day, 0.60 (0.65–0.94) for 7501–10,000 steps/day, 0.48 (0.25, 0.89) for 10,001–12,500 steps/day and 0.68 (0.37, 1.24) for > 12,501 steps/day. Higher %Active-2days, BDV, and lower IS, (cumulatively describing a stepping pattern which is variable between days and within days), were linearly associated with T2D risk independent of stepping volume. HRs per SD increase were: %Active-2days 0.70 (0.65, 0.97), BDV 0.69 (0.54, 0.89) and IS 1.32 (1.08, 1.63). CONCLUSIONS: Substantial reductions in T2D risk can be achieved by accumulating more steps during the day. Further, accumulating steps in a pattern possibly reflecting periodic larger doses of stepping may provide additional reductions in T2D risk. Future research regarding volume and optimum patterns of stepping could form the basis of the next generation of public health guidance and interventions to improve health through movement.
| Type: | Article |
|---|---|
| Title: | Not all steps are equal: independent prospective associations of stepping volume and patterns with incident type 2 diabetes mellitus in the Maastricht study |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1186/s12966-025-01839-z |
| Publisher version: | https://doi.org/10.1186/s12966-025-01839-z |
| Language: | English |
| Additional information: | This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
| Keywords: | Accelerometers, ActivPal, Daily steps, Physical activity, Activity patterns, Type 2 diabetes, Prospective study |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10217519 |
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