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Physical activity, inactivity and sleep during the Diabetes Remission Clinical Trial (DiRECT)

Lookup NU author(s): Professor Mike TrenellORCiD, Dr Renae StefanettiORCiD, Dr Sarah Charman, Alison Barnes, Dr Carl Peters, Dr Sviatlana Zhyzhneuskaya, Christopher Catt, Professor Mike Catt, Professor Falko Sniehotta, Professor Roy Taylor



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2022 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.Aims: As sustained weight loss is vital for achieving remission of type 2 diabetes, we explored whether randomisation to weight loss plus maintenance in the DiRECT trial was associated with physical activity, inactivity or sleep. Methods: Participants were randomised to either a dietary weight management programme or best-practice care. The weight management group were encouraged to increase daily physical activity to their sustainable maximum. Objective measurement was achieved using a wrist-worn GENEActiv accelerometer for 7 days at baseline, 12 and 24 months in both groups. Results: Despite average weight loss of 10 kg at 12 months in the intervention (n = 66) group, there were no differences in total physical activity or inactivity compared with the control (n = 104) at any time point. However, in our exploratory analysis, those who lost more than 10% of their baseline body weight performed on average 11 mins/day more light activity than the <10% group at 24 months (p = 0.033) and had significantly lower bouts of Inactivity30min (interaction, p = 0.005) across 12 and 24 months. At 24 months, the ≥10% group had higher daily acceleration (38.5 ± 12.1 vs. 33.2 ± 11.1 mg, p = 0.020), and higher accelerations in the most active 5-hour period (59.4 ± 21.8 vs. 50.6 ± 18.3 mg, p = 0.023). Wakefulness after sleep onset decreased in the intervention group compared with the control group and also in the ≥10% weight loss group at 12 and 24 months. Conclusions: Randomisation to a successful intensive weight loss intervention, including regular physical activity encouragement, was not associated with increased physical activity although sleep parameters improved. Physical activity was greater, and night-time waking reduced in those who maintained >10% weight loss at 12 and 24 months. TRIAL REGISTRATION ISRCTN03267836.

Publication metadata

Author(s): Cassidy S, Trenell M, Stefanetti RJ, Charman SJ, Barnes AC, Brosnahan N, McCombie L, Thom G, Peters C, Zhyzhneuskaya S, Leslie WS, Catt C, Catt M, McConnachie A, Sattar N, Sniehotta FF, Lean MEJ, Taylor R

Publication type: Article

Publication status: Published

Journal: Diabetic Medicine

Year: 2023

Volume: 40

Issue: 3

Print publication date: 01/03/2023

Online publication date: 18/11/2022

Acceptance date: 14/11/2022

Date deposited: 03/07/2023

ISSN (print): 0742-3071

ISSN (electronic): 1464-5491

Publisher: John Wiley and Sons Inc


DOI: 10.1111/dme.15010

PubMed id: 36398460


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Funder referenceFunder name
Diabetes UK