Previous studies have indicated an inverse relationship between aerobic physical activity (PA) and risk of diabetes-related mortality (DRM). Limitations of these previous studies include lack of a measure of PA duration, lack of a representative sample of the U.S. population, only consideration of leisure-time PA measures (LTPA), and no examination of the potential contribution of muscular strengthening activity (MSA) to risk reduction of DRM. The continuous National Health and Nutrition Examination Survey (NHANES) remedies these limitations as the PA questionnaires include data on a PA across different domains, MSA, and duration of all PA measures. PURPOSE: To examine the relationship between meeting the 2018 PA guidelines, for both total aerobic activity and MSA, and DRM. METHODS:The study sample (n=13,739), included adult (20-79 years of age) participants from the 1999-2006 NHANES. Using the 2018 aerobic and MSA guidelines, PA was categorized into 6 categories: category 1 (no aerobic PA and no MSA), category 2 (insufficient aerobic PA and no MSA), category 3 (meet aerobic PA and no MSA), category 4 (no aerobic PA and meet MSA), category 5 (insufficient aerobic PA and meet MSA), and category 6 (meeting both recommendations). The dependent variable in this study was DRM, which includes those who had diabetes as the primary cause of death as well as those with diabetes listed as an underlying cause of death. Cox-proportional hazard models were used for all analyses, adjusting for age, gender, race-ethnicity, education, self-reported smoking, self-reported physician diagnosed diabetes, HbA1c, and body mass index. Category 1 served as the reference group. RESULTS: Significant risk reductions for DRM were found in PA category 2 (HR = 0.62; 95% CI, 0.45-0.85), category 3 (HR = 0.48; 95% CI, 0.31-0.74) and category 6 (HR = 0.32; 95% CI, 0.15-0.69). CONCLUSIONS: Results suggest that aerobic PA has a significant, pronounced effect on reducing risk for DRM. MSA alone showed no effect on reducing DRM risk. However, meeting both recommendations led to greater risk reduction for DRM.

Introduction: Emerging evidence has suggested that those identifying as non-Hispanic white (NHW) or non-Hispanic black (NHB) have consistent and similar all-cause mortality risk reductions across dose of aerobic PA. In the same analyses, those identifying as Mexican American (MA) receive no protection from all-cause mortality across dose of aerobic PA. However, a single study has suggested that MAs meeting both the aerobic and muscular strengthening activity (MSA) recommendations have similar all-cause mortality risk reductions compared to NHW and NHB, highlighting the importance of MSA among MA. It is unknown, however, if these results translate to those who have diabetes. Hypothesis: NHW or NHB participants will have similar all-cause mortality risk reductions associated with aerobic PA independent of MSA participation. MA meeting both recommendations will have significant all-cause mortality risk reductions. Methods: The study sample (n=1,999) included adult (≥20 years of age) participants with diabetes from the 1999-2006 NHANES. Diabetes was defined as having one of the following: reported physician diagnosis, reported taking anti-hyperglycemic medication, or HbA1c ≥6.5%. PA was categorized into 6 categories based around the 2018 PA guidelines: category 1 (no aerobic PA and insufficient MSA), category 2 (insufficient aerobic PA and insufficient MSA), category 3 (active and insufficient MSA), category 4 (no aerobic PA and sufficient MSA), category 5 (insufficient aerobic PA and sufficient MSA), and category 6 (meeting both recommendations). Cox-proportional hazard models were used for all analyses. Results: A significant interaction (p<0.001) was found between categories of PA and race. Statistically significant risk reductions were found for categories 2,3 and 6 among NHW, and categories 2 and 3 among NHB; with a non-statistically significant risk reduction of 67% in category 6 (p=0.13) for NHB. A 45% reduction in risk was found among MA for category 6, however the estimate did not attain statistical significance (p=0.17). Conclusions: Similar to previous studies in those without diabetes, aerobic PA of any volume significantly reduced risk for all-cause mortality only among NHW and NHB with diabetes. While the risk reductions were clinically meaningful for both NHB and MA in category 6 compared to category 1, there was a lack of statistical significance. It is probable this may be, in part, influenced by a relatively low sample size within these two race-ethnic groups.

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