Diurnal Timing of Physical Activity in Relation to Obesity and Diabetes in the German National Cohort (NAKO)

Background: Physical activity supports weight regulation and metabolic health, but its timing in relation to obesity and diabetes remains unclear. We aimed to assess the diurnal timing of physical activity and its association with obesity and diabetes.

Methods: We cross-sectionally analyzed hip-worn accelerometry data from 61,116 participants aged 20-75 in the German National Cohort between 2015 and 2019. We divided physical activity into sex- and age-standardized quartiles of total morning (06:00-11:59), afternoon (12:00-17:59), evening (18:00-23:59), and nighttime (00:00-06:00) physical activity. Using multivariable logistic regression, we estimated associations of physical activity timing with obesity (BMI ≥ 30.0 kg/m) and diabetes (self-reported or HbA1c ≥ 6.5%). We accounted for sex, age, study region, education, employment, risky alcohol use, smoking, night shift work, and sleep duration.

Results: High afternoon (top vs. bottom quartile, OR: 0.36, 95% CI: 0.33-0.38) and evening physical activity (OR: 0.45, 95% CI: 0.42-0.48) showed lower obesity odds than high morning activity (OR: 0.71, 95% CI: 0.66-0.76), whereas nighttime activity increased obesity odds (OR: 1.58, 95% CI: 1.48-1.68). Associations were similar for diabetes, with the lowest odds for afternoon (OR: 0.47, 95% CI: 0.42-0.53), followed by evening (OR: 0.56, 95% CI: 0.50-0.62) and morning activity (OR: 0.80, 95% CI: 0.71-0.89), and higher odds for nighttime activity (OR: 1.43, 95% CI: 1.29-1.58). Findings were not modified by employment status, night shift work, and sleep duration.

Conclusions: Our cross-sectional findings require longitudinal corroboration but suggest afternoon and evening activity provide greater metabolic health benefits than morning activity, while nighttime activity is discouraged.