Objectives: Fatigue and sleep disturbance are common in adults with T2D. The symptoms carry contextual variations and may influence physical activity (PA). This study examined the associations between these symptoms and PA measured by an accelerometer.

Methods: Fifty-three T2D adults completed a 7-day period during which they wore an ActiGraph-GT3X on the non-dominant wrist and completed a diary each morning. The diary assessed prior-night sleep and fatigue level (0-10) and feeling rested (1-5) upon awakening. Daytime PA data from the ActiGraph-GT3X were scored following the Freedson algorithm, including sedentary behavior, light- and moderate-intensity PA. The repeated 7-day data were analyzed using linear mixed models including both inter- and intra-individual sleep and fatigue variables as predictors of PA.

Results: Participants were 60.3 (range 50-76) years and 29 (54.7%) were females. The mean values for fatigue and feeling rested were 3.1 (range 0-8.6) and 3.3 (range 1.6-5.0), respectively. Controlling for age, sex, BMI, and diabetes duration (estimate=-2.4, p=0.021), inter-individual fatigue and feeling rested were not related to moderate-intensity PA; however, intra-individual fatigue (estimate=-4.0, p=0.029) and feeling rested (estimate=8.0, p=0.045) upon awakening were significantly associated with moderate-intensity PA. There were no significant associations between other sleep variables (e.g., sleep duration and efficiency) and PA variables.

Conclusions: At the inter-individual level, fatigue and feeling rested were not related to moderate-intensity PA. In contrast, at the individual level, lower fatigue and more restful sleep were associated with higher levels of moderate-intensity physical activity. These findings highlight the importance of addressing both inter- and intra-individual effects of symptoms commonly reported by T2D patients on physical activity in research and clinical practice.


B. Zhu: None. M. Kim: None. C. Fritschi: None.


University of Illinois at Chicago; National Institute on Aging (P30AG022849)

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