Association of physical activity metrics with indicators of cardiovascular function and control in children with and without type 1 diabetes

Abstract

Objective Little is known about the role of physical activity accumulation in cardiovascular disease risk for children with type 1 diabetes. Improved insight to identify factors of influence in key health outcomes could be provided by considering the entire physical activity profile. Methods Pulse wave velocity (PWV), augmentation index and heart rate variability (HRV) were assessed cross‐sectionally in children with (n = 29, 12.1 ± 2.1 years) and without (n = 19, 12.1 ± 2.1 years) type 1 diabetes. Time spent sedentary and in each physical activity intensity, intensity gradient and average acceleration were derived from seven consecutive days of monitoring with wrist‐worn accelerometry. Comparison between groups and influence of physical activity accumulation on cardiovascular metrics were explored with linear mixed models. Results Diabetic children demonstrated a higher PWV and a greater volume of light physical activity (p < 0.01), a more negative intensity gradient (p < 0.01), a lower average acceleration and less time in bouted moderate‐to‐vigorous physical activity (MVPA; p < 0.05). Overall, intensity gradient was strongly correlated with average acceleration, MVPA and bouted MVPA (r2 = 0.89, r2 = 0.80, r2 = 0.79, respectively; all p < 0.05), while average acceleration was correlated with MVPA and bouted MVPA (r2 = 0.85, r2 = 0.83, respectively; p < 0.05). Accounting for disease status, intensity gradient and average acceleration were significant predictors of HRV indices (p < 0.05) and PWV (p < 0.01, p < 0.05, respectively). Conclusion Overall, MVPA was most associated with central stiffness, highlighting the importance of meeting activity guidelines. Diabetic children demonstrated poorer cardiovascular health than their counterparts, likely attributable to a lower intensity and physical activity volume, identifying physical activity intensity as a key target for future interventions.

Arterial stiffness indices in children and adolescents with type 1 diabetes mellitus: A meta‐analysis

“…The studies originated from the United States, Australia, Croatia, Estonia, Finland, Greece, Italy, Norway, Poland, Taiwan, and the U.K. and were conducted between 2004 and 2021. In detail, 15 studies containing data on carotidfemoral PWV (cf-PWV) 14,15,17,18,20,[22][23][24]26,[28][29][30][31][32][33] (1698 T1DM patients and 1062 healthy controls), three studies measuring carotidradial PWV (cr-PWV) 17,23,30 (775 T1DM patients and 459 healthy controls), two studies reporting on brachial-ankle PWV (ba-PWV) 17,19 (622 T1DM patients and 262 healthy controls), three studies reporting PWV measured by means of MRI 21,25,27 (138 T1DM patients and 87 healthy controls), six studies with data on AIx 18,24,26,28,29,31,33 (263 T1DM patients and 270 healthy controls), and five studies reporting on augmentation index normalised to a heart rate of 75 (AIx75) 13,[15][16][17]22 (1104 T1DM patients and 576 healthy controls) were identified in the final review. The characteristics of all 21 studies included in the analysis are summarised in Table 1.…”

“…By omitting the study by Podgorski et al 29 . or the study by Marshall et al 33 . the difference became statistically significant (mean difference [d]: 0.54 CI: 0.03–1.06, P = 0.037 and mean difference [d]: 0.53 CI: 0.02–1.05, P = 0.044, respectively) but again with marked heterogeneity ( I 2 = 87%, P = <0.00001 and I 2 = 86%, P = <0.00001, respectively).…”

“…Sensitivity analysis was performed by repeating the randomeffects model after omitting one study at a time (Supporting Information S1: Figure 11). By omitting the study by Podgorski et al 29 or the study by Marshall et al 33 To assess publication bias, a funnel plot was employed and showed significant asymmetry confirmed by Egger's test (P = 0.41) and Begg's test (P = 0.30). The Duval's trim and fill method failed to adjust for publication bias (Supporting Information S1: Figure 12).…”

Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes

“…After all the conflicts were resolved, 130 articles were included for the full-article screen, and 54 studies were included for data extraction (eFigure 1 in Supplement 1). Details for each individual study are presented in eTables 2 to 5 in Supplement 1. For all 4 meta-analyses, cases and controls were similar in age and sex (Table 1), with limited data available for race and ethnicity across all studies (eTables 6 and 7 in Supplement 1).…”

Assessments of Perfusion, Blood Flow, and Vascular Structure in Ambulatory Subjects: Guidance for Translational Research Scientists

“…It is noted that the expected standard-of-practice is that reported PWV measurements are actually the average of two consecutive measurements or the median of three consecutive measurements if the difference between the first two exceeds 0.5 m/s [63]. [340,350,318,341,319,352,321,338,342,345,354,343,160,355,346,323,357,348,358,359,333,360,169,329,361,330,339,362,335,336,363,364] Peripheral arterial vasculature 16 [365, 349, 344, 351, 347, 337, 353, 322, 356, 324-327, 334, 328, 331] Carotid artery 2 [320,125] Aspect of vasculature assessed Arterial stiffness 49 [349, 340, 332, 350, 318, 344, 341, 351, 347, 319, 320, 352, 321, 337, 338, 353, 342, 322, 345, 354, 343, 160, 355, 346, 356, 125, 323, 324, 357, 348, 358, 325-327, 359, 333, 334, 360, 328, 169, 329, 361, 330, 339, 362, 335, 336, 363, 331, 364] Blood pressure 1 [349] Technique SphygmoCor device 12 [340,341,320,352,…”