Association Between Physical Activity and Risk of All-Cause Mortality and Cardiovascular Disease in Patients With Diabetes

Abstract

OBJECTIVEThe association between habitual physical activity (PA) and lowered risk of all-cause mortality (ACM) and cardiovascular disease (CVD) has been suggested in patients with diabetes. This meta-analysis summarizes the risk reduction in relation to PA, focusing on clarifying dose-response associations.RESEARCH DESIGN AND METHODSElectronic literature searches were conducted for cohort studies that examined relative risk (RR) of ACM or CVD in relation to PA in patients with diabetes. For the qualitative assessment, RR for the highest versus the lowest PA category in each study was pooled with a random-effects model. We added linear and spline regression analyses to assess the quantitative relationship between increases in PA and ACM and CVD risk.RESULTSThere were 17 eligible studies. Qualitatively, the highest PA category had a lower RR [95% CI] for ACM (0.61 [0.52–0.70]) and CVD (0.71 [0.60–0.84]) than the lowest PA category. The linear regression model indicated a high goodness of fit for the risk of ACM (adjusted R2 = 0.44, P = 0.001) and CVD (adjusted R2 = 0.51, P = 0.001), with the result that a 1 MET-h/day incrementally higher PA was associated with 9.5% (5.0–13.8%) and 7.9% (4.3–11.4%) reductions in ACM and CVD risk, respectively. The spline regression model was not significantly different from the linear model in goodness of fit (P = 0.14 for ACM risk; P = 0.60 for CVD risk).CONCLUSIONSMore PA was associated with a larger reduction in future ACM and CVD risk in patients with diabetes. Nevertheless, any amount of habitual PA was better than inactivity.

The Association Between Patient-Reported Self-management Behavior, Intermediate Clinical Outcomes, and Mortality in Patients With Type 2 Diabetes: Results From the KORA-A Study

“…Despite a lack of evidence from randomized studies for the effect of SMB on long-term outcomes, there is some weak indication that specific dimensions of SMB are associated with prolonged life expectancy among diabetes patients. A recent meta-analysis (32) showed that 1-MET/h/day incrementally higher physical activity was associated with a 9.5% reduction in allcause mortality. Based on data from the multicenter ROSSO (Retrolective Study Self-Monitoring of Blood Glucose and Outcome) study, Martin et al (20) reported in their debatable study that SMBG reduces the mortality risk by 50% (33); however, in contrast no effect on all-cause mortality was found in the observational prospective Fremantle Diabetes Study (21).…”

Physical Activity for the Prevention of Cardiovascular Diseases

“…Heart disease and stroke account for approximately 65% of deaths among people with diabetes, and individuals classified as prediabetic are also at increased risk for CVD (34). Recent meta-analyses of diabetic cohorts report risk reductions of 29% for CVD incidence (48) and 37% for CVD mortality (49) for those in the highest versus lowest PA category. Walking 2 to 4.5 hours/week is associated with a 46% reduction in CVD mortality compared with walking less than 2 hours/week (49).…”

Short-Acting Insulin Reduction Strategies for Continuous Cycle Ergometer Exercises in Patients with Type 1 Diabetes Mellitus

“…In addition to standard insulin therapy, regular exercise has been suggested to lead to positive effects in patients with diabetes by lowering the risk of cardiovascular diseases and early all-cause mortality (1). Furthermore, it was recently shown that adopting a healthy lifestyle in patients with type 1 diabetes mellitus led to an improvement in body fat, body mass index (BMI) and lipid profiles as well as in blood pressure (2).…”