Objective: The aim of the present cross-sectional study was to examine the association among physical activity (PA), sedentary time (ST), and cardiometabolic risk in adults with prediabetes.

Research design and methods: Participants (n = 2,326; 25-70 years old, 67% female) from eight countries, with a BMI >25 kg ⋅ m(-2) and impaired fasting glucose (5.6-6.9 mmol ⋅ L(-1)) or impaired glucose tolerance (7.8-11.0 mmol ⋅ L(-1) at 2 h), participated. Seven-day accelerometry objectively assessed PA levels and ST.

Results: Multiple linear regression revealed that moderate-to-vigorous PA (MVPA) was negatively associated with HOMA of insulin resistance (HOMA-IR) (standardized β = -0.078 [95% CI -0.128, -0.027]), waist circumference (WC) (β = -0.177 [-0.122, -0.134]), fasting insulin (β = -0.115 [-0.158, -0.072]), 2-h glucose (β = -0.069 [-0.112, -0.025]), triglycerides (β = -0.091 [-0.138, -0.044]), and CRP (β = -0.086 [-0.127, -0.045]). ST was positively associated with HOMA-IR (β = 0.175 [0.114, 0.236]), WC (β = 0.215 [0.026, 0.131]), fasting insulin (β = 0.155 [0.092, 0.219]), triglycerides (β = 0.106 [0.052, 0.16]), CRP (β = 0.106 [0.39, 0.172]), systolic blood pressure (BP) (β = 0.078 [0.026, 0.131]), and diastolic BP (β = 0.106 [0.39, -0.172]). Associations reported between total PA (counts ⋅ min(-1)) and all risk factors were comparable or stronger than for MVPA: HOMA-IR (β = -0.151 [-0.194, -0.107]), WC (β = -0.179 [-0.224, -0.134]), fasting insulin (β = -0.139 [-0.183, -0.096]), 2-h glucose (β = -0.088 [-0.131, -0.045]), triglycerides (β = -0.117 [-0.162, -0.071]), and CRP (β = -0.104 [-0.146, -0.062]).

Conclusions: In adults with prediabetes, objectively measured PA and ST were associated with cardiometabolic risk markers. Total PA was at least as strongly associated with cardiometabolic risk markers as MVPA, which may imply that the accumulation of total PA over the day is as important as achieving the intensity of MVPA.