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The effect of time spent outdoors during summer on daily blood glucose and steps in women with type 2 diabetes

Journal of Behavioral Medicine
Molly B. Richardson, Courtney Chmielewski, Connor Y. H. Wu, Mary B. Evans, Leslie A. McClure, Kathryn W. Hosig, Julia M. Gohlke
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The online version of this article (https://​doi.​org/​10.​1007/​s10865-019-00113-5) contains supplementary material, which is available to authorized users.

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This study investigated changes in glycemic control following a small increase in time spent outdoors. Women participants with type 2 diabetes (N = 46) wore an iBUTTON temperature monitor and a pedometer for 1 week and recorded their morning fasting blood glucose (FBG) daily. They went about their normal activities for 2 days (baseline) and were asked to add 30 min of time outdoors during Days 3–7 (intervention). Linear mixed effects models were used to test whether morning FBG values were different on days following intervention versus baseline days, and whether steps and/or heat exposure changed. Results were stratified by indicators of good versus poor glycemic control prior to initiation of the study. On average, blood glucose was reduced by 6.1 mg/dL (95% CI − 11.5, − 0.6) on mornings after intervention days after adjusting for age, BMI, and ambient weather conditions. Participants in the poor glycemic control group (n = 16) experienced a 15.8 mg/dL decrease (95% CI − 27.1, − 4.5) in morning FBG on days following the intervention compared to a 1.6 mg/dL decrease (95%CI − 7.7, 4.5) for participants in the good glycemic control group (n = 30). Including daily steps or heat exposure did not attenuate the association between intervention and morning FBG. The present study suggests spending an additional 30 min outdoors may improve glycemic control; however, further examination with a larger sample over a longer duration and determination of mediators of this relationship is warranted.

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Extra materiaal
Supplementary Fig. 1. Flow diagram (adapted from the CONSORT flow diagram) (DOC 46 kb)
Supplementary material 2 (PDF 1233 kb)
Supplementary Fig. 2. Decision Tree for Inclusive and Restrictive Criteria for Pedometer Step Data. 1—“Day prior”–“day of” rule applied to all days (i.e. Day2–Day1); 2—Individually evaluate days identified with original daily log (322-48 = 14.9% of person-days modified in the Inclusive Dataset; n = 59, 18.3% in the Restrictive Dataset); 3—Baseline day 2 missing so repeated day 1 values; 4—Intervention days as last day or multiple intervention last days were missing so applied average of existing intervention days were imputed (i.e. Days 6 and 7 missing then used average of Days 3,4,5); 5—Days surrounding were reset so the average of intervention days was imputed; 6—Missing day was followed by the same type of day (i.e. intervention missing and intervention day following known) then the missing day was replaced with ½ of the following day and the day following was ½ as well (i.e. If Day 3 = Missing, Day 4 = 4818, then Day 3 = 2409, Day 4 = 2409) (PDF 49 kb)
Supplementary Table 1. Results of linear mixed effects models describing the relationship between the intervention and personal temperature (daily mean hourly) or steps (inclusive criteria) adjusting for weather variables (precipitation, weather station maximum and minimum temperatures). *0.047611 (DOCX 14 kb)
Supplementary Table 2. Results of linear mixed effects models testing to screen for partial mediation by steps day prior (inclusive and restrictive criteria) (DOCX 15 kb)
Supplementary Table 3. Results of linear mixed effects models testing to screen for partial mediation by personal temperature (daily mean average and daily max average) (DOCX 15 kb)
Supplementary Table 4. Model stratified by glycemic thresholds and adjusting for individual steps and/or personal temperature (Models 1-3 Poor Glycemic Control, Models 4-6 Good Glycemic Control). *0.05548 (DOCX 16 kb)
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