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The beneficial effects of exercise, including reduction of cardiovascular risk, are especially important in children with type 1 diabetes (T1DM), in whom incidence of lifetime cardiovascular complications remains elevated despite good glycemic control. Being able to exercise safely is therefore a paramount concern. Dysregulated metabolism in T1DM however, causes frequent occurrence of both hypo- and hyperglycemia, the former typically associated with prolonged, moderate exercise, the latter with higher intensity, if shorter, challenges. While very few absolute contraindications to exercising exist in these children, exercise should not be started with glycemia outside the 80–250 mg/dl range. Within this glycemic range, careful adjustments in insulin administration (reduction or infusion rate via insulin pumps, or overall reduction of dosage of multiple injections) should be combined with carbohydrate ingestion before/during exercise, based on prior, individual experience with specific exercise formats. Unfamiliar exercise should always be tackled with exceeding caution, based on known responses to other exercise formats. Finally, gaining a deep understanding of other complex exercise responses, such as the modulation of inflammatory status, which is a major determinant of the cardio-protective effects of exercise, can help determine which exercise formats and which individual metabolic conditions can lead to maximally beneficial health effects.

Background: The purpose of the current study was to apply a more novel approach to systematically examine (1) associations of clustered cardiometabolic risk and cardiometabolic risk factors and (2) theoretical substitution of sedentary time with either sleep, light physical activity (LPA), or moderate to vigorous physical activity (MVPA) and substituting LPA with MVPA. Methods: Physical activity and sleep were objectively measured in 410 Flemish adults [55.5 (9.6) y, 64% men] with a SenseWear Pro 3 Armband. Cardiometabolic risk factors (obesity, hyperglycemia, dyslipidemia, and hypertension) and cardiorespiratory fitness were objectively measured. Isotemporal substitution analyses were performed to assess the associations between substituting time from a potentially negative behavior into another potentially positive behavior. Results: Theoretical substitution of sedentary time with MVPA was associated with decreased clustered cardiometabolic risk, b = −0.06 (−0.08 to −0.04), and substituting LPA with MVPA was associated with a decrease in clustered cardiometabolic risk, b = −0.08 (−0.11 to −0.04). Substituting sedentary time with LPA or sleep improved high-density lipoprotein-cholesterol, systolic and diastolic blood pressures, and waist circumference. Conclusion: Theoretical replacement of sedentary time with either sleep, LPA, or MVPA was positively associated with improved cardiometabolic risk factor status. Interventions for increasing cardiometabolic health can focus on replacing sedentary time with either sleep, LPA, or MVPA depending on the risk parameters that need to be targeted.