In this context, a 24-hr day comprises a sequence of movement behaviours distributed on a continuum ranging from limited/no movement to high-intensity activities. The five S’s (sleep, sitting, stepping, sweating and strengthening) encapsulate these physical behaviours and their inclusion represents an important milestone in bridging the gap between current knowledge around 24-hr behaviours and clinical care. These physical behaviours are all intrinsically linked and have the potential to impact glycaemic control and overall health.   

Of particular note, the importance of sleep as a key lifestyle component in the management of type 2 diabetes is promulgated, placing it on a pedestal, alongside physical activity. Historically, the sleep research in type 2 diabetes has focused on sleep disorders and deficiencies, but more recently the quantification of sleep has been characterised into a range of outcome measures. In particular, the three overarching constructs outlined in the latest ADA/EASD guidelines: quantity, quality and timing (i.e. chronotype) of sleep represent important and under-recognised components of type 2 diabetes management.

Beneficial effects on glycaemic control are evident across the spectrum of human movement (from breaking sitting with light activity through to sweating exercises). Even small, regular changes can make a difference to long term health (as little as 500 steps per day can reduce the risk of all-cause mortality). Strengthening exercises (i.e. any activity that uses your own body weight or works against a resistance) also improves glycaemic control and activities like tai chi and yoga also encompass elements of flexibility and balance. This is important as type 2 diabetes represents a model of accelerated biological ageing, leading to difficulties undertaking activities of daily living. As the frailty phenotype in type 2 diabetes is unique, often encompassing obesity at an earlier age, it is increasingly recognised as a major complication and an important target for management of type 2 diabetes.  

Ultimately, individual preferences, motivations and circumstances should inform choice, but by considering physical behaviour over the 24-hr day, it offers a broader spectrum of interventional opportunities to induce glycaemic and overall health benefits.