Lifestyle modifications are important components in the management of type 2 diabetes mellitus. However, national and international guidelines have tended to place the emphasis on diabetes medicine(s). For the first time, the latest American Diabetes Association/European Association for The Study of Diabetes (ADA/EASD) consensus guidelines on the management of hyperglycaemia have broken with tradition by incorporating a growing body of evidence linking health outcomes associated with type 2 diabetes to the movement behaviour composition over the whole, 24-hr day.

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 the management of diabetes and cardiovascular health. These physical behaviours are all linked and have the potential to impact glycaemic control and overall health.

Beneficial effects on glycaemic control are seen 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 also improves glycaemic control and activities like tai chi and yoga also encompass elements of flexibility and balance. 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 improve glycaemic control and improve various other health outcomes.

• 1.To provide an overview of the importance of physical activity in type 2 diabetes
• 2.To understand the role of physical activity on body composition and physical function
• 3.To provide an overview of the importance of the 24-hour physical behaviours for diabetes and cardiovascular health
• 4.To understand the role of digital tools for optimising the 24-hour physical behaviours in people living with type 2 diabetes and associated long term conditions