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Newly released guidelines recommend increased physical activity (PA) and reduced sedentary behaviors (SB) to improve glycemia and prevent the onset and progression of type 2 diabetes (T2D). Typically, 30-60 min bouts of PA are advocated per day. Although this approach increases PA, it does not decrease the length of the sedentary periods through the day. This is important because recent epidemiological data suggest that frequently interrupting sedentary time improves glucose control even in people who achieve the recommended levels of PA. Preliminary experimental data suggest that breaking up prolonged sedentary time by performing multiple short bouts (5 min) of PA throughout the day, may improve glycemia more than performing a single continuous bout of PA, and thereby potentially be a novel strategy to prevent T2D. The improvement in glycemia was observed even when the total amount of PA and total energy expenditure were matched, suggesting that how and when PA is performed over the day may matter more than how much PA is done. However, important gaps in knowledge remain including: (1) whether similar benefits on glucose control would be observed in adults with prediabetes, a clinically relevant population that is at high risk of developing T2D; (2) whether these effects are sustained or diluted over time, and (3) what are the mechanistic underpinnings. To address these gaps, the investigators propose to measure the acute and chronic effects of PA breaks on glucose control and the underlying mechanisms in individuals at risk of developing T2D. Sedentary men and women with prediabetes (n=66, 50% F) will be randomized to either an intervention designed to interrupt SB with 5-min bouts of brisk walking performed hourly for 9 hours/day, 5 days/week (BREAK) or a control condition consisting of 45-min of brisk walking performed as a single daily continuous bout, 5 days/week (ONE). The two 3-months interventions will be matched for total active time.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| BREAK Intervention | Experimental | Participants in the BREAK condition will perform 5-minute bouts of brisk walking hourly for 9 hours/day, 5 days/week for 3 months. |
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| ONE Intervention | Active Comparator | Participants in the ONE condition will perform 45 minutes of brisk walking as a single continuous bout, 5 days/week for 3 months. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| BREAK | Behavioral | The BREAK intervention is a physical activity regimen. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Glycemia | Plasma glucose concentration in mg/dL measured before and 30, 60, 90 and 120 min after an oral glucose tolerance test (OGTT, 75g glucose). | Glucose concentration in mg/dl, measured at fasting, during a 2 hour OGTT and after |
| Measure | Description | Time Frame |
|---|---|---|
| Insulinemia | Plasma insulin concentration in milli-international units per milliliter (mUI/mL) measured before and 30, 60, 90 and 120 min after an oral glucose tolerance test (OGTT, 75g glucose). | Plasma insulin concentration in mUI/mL, measured at fasting, during a 2 hour OGTT and after |
| Mean interstitial glucose concentration |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Patricia Smith, MS, RDN | Contact | 303.724.6821 | trish.smith@cuanschutz.edu | |
| Audrey Bergouignan, PhD | Contact | 303.724.9026 | audrey.bergouignan@cuanschutz.edu |
| Name | Affiliation | Role |
|---|---|---|
| Audrey Bergouignan, PhD | University of Colorado, Denver | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Colorado Anschutz Medical Campus | Recruiting | Aurora | Colorado | 80045 | United States |
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| ID | Term |
|---|---|
| D018149 | Glucose Intolerance |
| D057185 | Sedentary Behavior |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D006943 | Hyperglycemia |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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Participants will be randomized to either the BREAK condition (5-min bouts of brisk walking performed hourly for 9 hours/day, 5 days/wk) or the ONE condition (45-min of brisk walking performed as a single continuous bout, 5 days/wk) for 3 months. Participants will complete all study visits in only one group.
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A study research assistant that is not involved in the study participants' allocation process will create opaque, sealed envelopes with allocation sequences based on the randomization table created by the study statistician. The assignment of intervention to study participants will be based on the study allocation sequence generated by the statistician and the study team will enroll study participants and assign them to the interventions. The study team will be blinded until study participants' allocation (the day before visit G). After this, the study team will not be blinded to study participants' allocation as they will be responsible for assigning study participants, and for applying and monitoring the interventions. The study statistician will always be blinded.
| ONE |
| Behavioral |
The ONE intervention is a physical activity regimen. |
|
Mean interstitial glucose concentration measured continuously by a glucose monitor placed on the tricep for 24hours for 10 days. |
| Before and after 1 month and 3 months of intervention |
| Daily glycemia variability | Standard deviation (SD) of interstitial glucose concentration measured continuously by a glucose monitor placed on the tricep 24hours throughout 10 days. | Before and after 1 month and 3 months of intervention |
| Fasting A1c concentration | Fasting A1c concentration expressed in % | Time Frame: Before and after 1 month and 3 months of intervention |
| Fasting fructosamine concentration | Fasting fructosamine concentration in umol/L | Before and after 1 month and 3 months of intervention |
| 12-hour exogenous glucose oxidation | Rates of carbon-13 (13C) recovery (% of the dose) in expired carbon dioxide (CO2) following the ingestion of U-13C-glucose in both breakfast and lunch meals. | Before and after 1 month of intervention |
| 12-hour endogenous glucose oxidation | Rates of D2 recovery (% of the dose) in expired urines following the infusion of (2,2H2) glucose. | Before and after 1 month of intervention |
| 12 hour CO2 production | CO2 production measured by indirect calorimetry (ParvoMedics TrueOne® 2400, Salt Lake City) for 20 minutes every hour from 0800h to 1800h. | Before and after 1 month of intervention |
| 12 hour O2 production | O2 production measured by indirect calorimetry (ParvoMedics TrueOne 2400, Salt Lake City) for 20 minutes every hour from 0800h to 1800h. | Before and after 1 month of intervention |
| 12 Urine excretion | Urine will be measured every hour from 0730h to 1830h | Before and after 1 month of intervention |
| Glucose kinetics | Steele's equation for non-steady-state will be used to compute rate of appearance of total glucose (RaT) and rate of appearance of exogenous glucose (RaE), as well as the rates of disappearance (RdT and RdE) from the percentage of [6,6-2H2]glucose6 and of 13C-glucose in plasma glucose61. Endogenous glucose production (EGP) will be computed as RaT-RaE. Nonoxidative glucose disposal (NOGD) will be calculated by subtracting total carbohydrate oxidation from (RdT + RdE). Plasma glucose utilization will be assumed to be equivalent to RdT as has been confirmed previously. Muscle glycogen utilization during the active period will be calculated as total carbohydrate utilization during exercise minus plasma glucose utilization during exercise. | Before and after 1 month of intervention |
| Fasting and postprandial glucose | Fasting and postprandial glucose in mg/dl measured in response to standard lunch | Before and after 1 month of intervention |
| Fasting and postprandial insulin | Fasting and postprandial insulin in ml/iu measured in response to standard lunch | Before and after 1 month of intervention |
| Fasting and postprandial C-Peptide | Fasting and postprandial C-peptide nmol/mL measured in response to standard lunch | Before and after 1 month of intervention |
| Fasting and postprandial glucagon | Fasting and postprandial glucagon in pg/mL measured in response to standard lunch | Before and after 1 month of intervention |
| Fasting and postprandial catecholamines | Fasting and postprandial catecholamines in pg/mL measured in response to standard lunch | Before and after 1 month of intervention |
| Skeletal muscle content of protein kinase B (Akt) (Aktser473/total) | Vastus lateralis skeletal muscle biopsies will be collected from fasting participants by the Bergstrom technique. Biopsies will be used to measure protein kinase B (Akt) (Aktser473/total) using western blotting. | Before and after 1 month of intervention |
| Skeletal muscle content of ACC (ACCS79/ total) | Vastus lateralis skeletal muscle biopsies will be collected from fasting participants by the Bergstrom technique. Biopsies will be used to measure ACC (ACCS79/ total) using western blotting. | Before and after 1 month of intervention |
| Skeletal muscle content of TBC1D4 (AS160/ total) | Vastus lateralis skeletal muscle biopsies will be collected from fasting participants by the Bergstrom technique. Biopsies will be used to measure TBC1D4 (AS160/ total) using western blotting. | Before and after 1 month of intervention |
| Skeletal muscle content of COX4 | Vastus lateralis skeletal muscle biopsies will be collected from fasting participants by the Bergstrom technique. Biopsies will be used to measure citrate synthase (COX4) using western blotting. | Before and after 1 month of intervention |
| D001519 | Behavior |