Sex Differences in Step Count-Blood Pressure Association: A Preliminary Study in Type 2 Diabetes

Background Walking and cardiovascular mortality are inversely associated in type 2 diabetes, but few studies have objectively measured associations of walking with individual cardiovascular risk factors. Such information would be useful for “dosing” daily steps in clinical practice. This study aimed to quantify decrements in blood pressure and glycated hemoglobin (A1C) per 1,000 daily step increments. Methodology/Principal Findings Two hundred and one subjects with type 2 diabetes underwent assessments of step counts (pedometer-measured), blood pressure, A1C and anthropometric parameters. Due to missing data, the final analysis was conducted on 83 women and 102 men, with a mean age of 60 years. Associations of daily steps with blood pressure and A1C were evaluated using sex-specific multivariate linear regression models (adjusted for age, ethnicity, and BMI). Potential sex differences were confirmed in a combined model (women and men) with interaction terms. Mean values for daily steps, blood pressure, A1C and BMI were 5,357 steps/day; 137/80 mm Hg; 7.7% and 30.4 kg/m2 respectively. A 1,000 daily step increment among women was associated with a −2.6 (95% CI: −4.1 to −1.1) mm Hg change in systolic and a −1.4 (95% CI: −2.2 to −0.6) mm Hg change in diastolic blood pressure. Among men, corresponding changes were −0.7 (95% CI: −2.1 to 0.7) and −0.6 (95% CI: −1.4 to 0.3) mm Hg, respectively. Sex differences were confirmed in combined models. Step counts and A1C did not demonstrate clinically important associations. Conclusions/Significance A 1,000 steps/day increment is associated with important blood pressure decrements among women with type 2 diabetes but the data were inconclusive among men. Targeted “dose increments” of 1,000 steps/day in women may lead to measurable blood pressure reductions. This information may be of potential use in the titration or “dosing” of daily steps. No associations were found between step count increments and A1C.

[1]  C. Tudor-Locke,et al.  Accelerometer-determined steps/day and metabolic syndrome. , 2010, American journal of preventive medicine.

[2]  Terence Dwyer,et al.  Cardiometabolic risk in younger and older adults across an index of ambulatory activity. , 2009, American journal of preventive medicine.

[3]  Catrine Tudor-Locke,et al.  Accelerometer-determined steps per day in US adults. , 2009, Medicine and science in sports and exercise.

[4]  F. Harrell,et al.  Criteria for Evaluation of Novel Markers of Cardiovascular Risk: A Scientific Statement From the American Heart Association , 2009, Circulation.

[5]  B. Ainsworth,et al.  Translating physical activity recommendations into a pedometer-based step goal: 3000 steps in 30 minutes. , 2009, American journal of preventive medicine.

[6]  H Löllgen,et al.  Physical activity and all-cause mortality: an updated meta-analysis with different intensity categories. , 2009, International journal of sports medicine.

[7]  Catherine B. Chan,et al.  Preliminary analysis demonstrates winter reduction in daily steps and winter increase in blood pressure in type 2 diabetes , 2009 .

[8]  C. Tudor-Locke,et al.  Revisiting "how many steps are enough?". , 2008, Medicine and science in sports and exercise.

[9]  C. D. A. Stehouwer,et al.  Brisk walking compared with an individualised medical fitness programme for patients with type 2 diabetes: a randomised controlled trial , 2008, Diabetologia.

[10]  A. Swartz,et al.  Glucose Control and Walking in a Multiethnic Sample of Older Adults , 2008, Gerontology.

[11]  B. Balkau,et al.  A review of the metabolic syndrome. , 2007, Diabetes & metabolism.

[12]  I. Olkin,et al.  Using pedometers to increase physical activity and improve health: a systematic review. , 2007, JAMA.

[13]  Kaberi Dasgupta,et al.  Walking behaviour and glycemic control in type 2 diabetes: seasonal and gender differences-Study design and methods , 2007, Cardiovascular diabetology.

[14]  P. Engfeldt,et al.  Walking for exercise--does three times per week influence risk factors in type 2 diabetes? , 2005, Diabetes research and clinical practice.

[15]  B. Shatenstein,et al.  Development and validation of a food frequency questionnaire. , 2007, Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada.

[16]  D. Bassett,et al.  Pedometer measures of free-living physical activity: comparison of 13 models. , 2004, Medicine and science in sports and exercise.

[17]  C. Tudor-Locke,et al.  Pedometer accuracy in nursing home and community-dwelling older adults. , 2004, Medicine and science in sports and exercise.

[18]  Catrine Tudor-Locke,et al.  How Many Steps/Day Are Enough? Preliminary Pedometer Indices for Public Health , 2004 .

[19]  C. Tudor-Locke,et al.  Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes , 2004, International Journal of Obesity.

[20]  Catherine B. Chan,et al.  Cross-sectional relationship of pedometer-determined ambulatory activity to indicators of health. , 2003, Obesity research.

[21]  B. Ainsworth,et al.  International physical activity questionnaire: 12-country reliability and validity. , 2003, Medicine and science in sports and exercise.

[22]  Carl J Caspersen,et al.  Relationship of walking to mortality among US adults with diabetes. , 2003, Archives of internal medicine.

[23]  E. Rimm,et al.  Physical Activity in Relation to Cardiovascular Disease and Total Mortality Among Men With Type 2 Diabetes , 2003, Circulation.

[24]  J. Siègelovà,et al.  [The effect of walking exercise on aerobic capacity and serum lipids in type 2 diabetics]. , 2003, Vnitrni lekarstvi.

[25]  M. Sclavo [Physical activity and risk for cardiovascular events in diabetic women]. , 2001, Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology.

[26]  Andrew Thomas,et al.  WinBUGS - A Bayesian modelling framework: Concepts, structure, and extensibility , 2000, Stat. Comput..

[27]  Michael D. Brown,et al.  The Role of Exercise Training in the Treatment of Hypertension , 2000, Sports medicine.

[28]  John S Yudkin,et al.  Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study , 2000, BMJ : British Medical Journal.

[29]  T. Schmalzried,et al.  Step activity monitor: Increased accuracy in quantifying ambulatory activity , 1999, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[30]  B H Marcus,et al.  Six-month physical activity and fitness changes in Project Active, a randomized trial. , 1998, Medicine and science in sports and exercise.

[31]  S. Taimela,et al.  Exercise and the metabolic syndrome , 1997, Diabetologia.

[32]  Alvan R. Feinstein,et al.  Multivariable Analysis: An Introduction , 1996 .