Page 108 - 《运动与健康科学》(英文)2024年第2期

TaggedAPTARAEnd230 X. Jin et al.
prospective perspective. The weak but consistent trend in the individuals, and detailed epidemiological profiles allowed for
current study that short sleep duration was associated with a high-quality data analyses and valid estimates of exposure
higher risk of incident type 2 diabetes only when combined disease relationships. Second, as stated above, the adoption
with physical inactivity suggests that high or recommended of accelerometer-based measurements for sleep and PA could
levels of PA have the potential to protect and prevent short minimize the recall bias associated with self-reported measure-
sleepers from developing type 2 diabetes. This protective ments and allow for capturing poorly understood LPA.TaggedAPTARAEnd
effect of PA against short sleep from developing type 2 TaggedAPTARAPThere are several limitations that need to be addressed.
diabetes is generally consistent with existing studies. For First, in the UK Biobank, participants only began to wear the
example, an early experimental study with a small human accelerometer several years after baseline data were collected.
sample (n = 10) found that PA could partially protect sleep- This time gap led to difficulties excluding cases who deve-
deprived men from decreased insulin sensitivity. 35 Some loped type 2 diabetes during this period from the incident
cross-sectional studies have observed that among individuals dataset. However, the findings remained robust even after
with short sleep duration, those with a higher level of PA tend removing the cases occurring within the first 2 years. Second,
to have a lower prevalence of diabetes or insulin resistance prospective changes in accelerometer-measured sleep duration
than their peers. 16,36 In addition, a trial demonstrated that a and PA were unavailable in the UK Biobank cohort. While
lifestyle intervention that included increasing 30 min of MPA existing analyses of the UK Biobank have suggested that the
per day ameliorated the increased risk of type 2 diabetes asso- patterns of sleep and PA were relatively stable across time
43
ciated with self-reported long sleep duration; however, the overall, a dynamic association between sleep, PA, and the
independent contribution of MPA was inseparable from other development of type 2 diabetes could still exist without being
lifestyle modifications. 37 Compared with previous studies, by observable. Third, it is unclear from the current results whether
using a longitudinal design, objective sleep and PA measures, one PA intensity was more protective or whether they were all
and a large sample size, the current study provided direct and similar. HRs are calculated in the current study through
robust evidence supporting the hypothesis that PA reaching a comparisons within the same PA intensity category—to be
high or recommended level, regardless of intensity, may help specific, through comparisons between recommended and not
diminish the excessive risk of type 2 diabetes among short recommended MVPA, or high and low total volume of PA or
LPA. This prevented us from drawing any conclusions about
sleepers.TaggedAPTARAEnd
TaggedAPTARAPThe current findings highlight the importance of a public between-PA intensity category comparisons.TaggedAPTARAEnd
health strategy promoting PA of any intensity to combat the TaggedAPTARAPFourth, sedentary behavior, which is an important issue
risk of type 2 diabetes associated with lack of sleep. The high closely related to type 2 diabetes, is not included in the current
prevalence of chronic insufficient sleep is a constant health analyses. This is because sedentary behavior is closely associ-
concern. 38 Multiple factors may prevent adults from getting an ated with PA and sleep, which would not satisfy the premise of
adequate amount of sleep, such as chronic pain 39 or work Cox proportional hazards regression models. According to the
demands. 40 For these short sleepers, interventions that facili- consensus definition of sedentary behavior, 44 it refers to any
tate sufficient PA should be particularly valued and encour- waking behaviors characterized by an energy expenditure not
aged. It is worth noting that the relationship between sleep and reaching the threshold level of PA. Several existing studies
PA is bidirectional. Previous studies showed that PA improved have adopted this consensus definition to calculate the acceler-
sleep quantity and quality. 12 These sleep improvements, in ometer-measured sedentary time. 45,46 Under this definition, we
turn, protected individuals from PA-induced injuries and calculated sedentary time from the accelerometer data of the
12
diseases. The protective role of the WHO-recommended current study by defining sedentary as any epoch with a mean
MVPA level has been well validated up to now. In practical acceleration <30 mg outside the SPT-window, and we found
terms, people may achieve the recommended level by that sedentary time was significantly correlated with all intensi-
including at least 11 min of sports exercises or at least 21 min ties of PA (Spearman’s correlation: r total volume of PA = 0.727,
of walking, cycling, or shopping into their daily schedule. 25,41 r MVPA = 0.371, r LPA = 0.666). Therefore, we decided not to
Our study further demonstrated that LPA has a beneficial include sedentary time into the current analyses.TaggedAPTARAEnd
effect in lowering the risk of type 2 diabetes. This is particu- TaggedAPTARAPFinally, the lower incidence of type 2 diabetes in the UK
larly intriguing because a considerable number of people, Biobank sample (1.8%) compared to that in the general UK
usually those at a higher risk for type 2 diabetes, may have population (2.3%) 47 was consistent with the lower prevalence
difficulty performing MVPA or insist on performing MVPA of self-reported diabetes among UK Biobank participants, 48
instead of LPA. 42 In these cases, performing at least 45h of which probably reflects a selection bias favoring healthier
LPA per day, such as cleaning or slow walking, is considered participants in the UK Biobank cohort. 48 A similar selection
bias may also occur in the subgroup who agreed with and
good alternative protection.TaggedAPTARAEnd
complied with accelerometer wearing. Sensitivity analyses
found the excessive risks of type 2 diabetes for the short
TaggedAPTARAH24.3. Strengths and limitationsTaggedAPTARAEnd
sleepers with low or not recommended PA to be insignificant,
TaggedAPTARAPThis study had several strengths. First, the inclusion of a which likely reflected a floor effect resulting from healthier
prospective cohort design, a large sample size of 88,000 participants.TaggedAPTARAEnd