| Summary: | Type 2 diabetes is the fastest growing health threat to the UK, with prevalence rising 60% over the past decade. Those with Type 2 diabetes carry twice the risk of developing cardiovascular disease, a condition which claims the lives of the majority of adults in the UK. A significant proportion of cardio-metabolic disease could be prevented through improvements in lifestyle. Technological advancements, motorised transport and an increase in desk based work, have paved the way for physical inactivity to be norm in modern society. Clinical and government strategies to target unhealthy lifestyles are currently lacking. The aim of this thesis was to explore lifestyle related behaviours in cardio-metabolic disease, with a view to improving clinical care. A UK population based study (n=502,664) demonstrates that those with cardio-metabolic disease are characterised by low physical activity, sedentary behaviour and poor sleep. Combining all three behaviours exposes individuals to greater cardio-metabolic risk. A cross-sectional study (n=57) indicates that there are significant cardiac abnormalities in those with metabolic disease in the absence of overt heart disease. Finally, a randomised controlled trial (n=28) provides evidence that exercise can be used as a therapeutic strategy to improve cardiac structure and function in adults with Type 2 diabetes, and thereby moderate cardiac risk in this patient group. This thesis delivers two clear messages; 1) lifestyle behaviours remain significant unaddressed risk factors and 2) physical activity and exercise strategies should be used as therapies to reduce risk and improve cardio-metabolic health. Looking ahead, the results from the this study highlight the need for lifestyle behaviours to be part of the prevention and management strategies for cardio-metabolic health, and support the NHS’s 5 year plan to encourage healthier lifestyles as a priority.
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