Dose-Response Relationship Between Physical Activity and the Morbidity and Mortality of Cardiovascular Disease Among Individuals With Diabetes: Meta-Analysis of Prospective Cohort Studies

Abstract

Background:The link between physical activity (PA) and cardiovascular disease (CVD) risk remains unclear.Objective: This study aimed to summarize the evidence from prospective studies on the association between PA and CVD morbidity and mortality. Methods:We systematically reviewed prospective cohort studies in PubMed, EMBASE, and Web of Science up to December 2022, with inclusion criteria specifying adult participants. To assess potential bias, we employed funnel plots and Egger's test. Our analysis utilized random-effects models for qualitative evaluation and applied linear and spline regression techniques to estimate dose-response associations. Results:The meta-analysis of 12 prospective cohort studies, involving a total of 109,820 participants, revealed that higher levels of PA were associated with a reduced risk of CVD. The RR of CVD for the highest compared with the lowest PA category was 0.62 (95% CI, 0.51-0.73). The linear regression model revealed 10 MET-h/week of incrementally higher PA was associated with a 19.0% (95% CI, 11.6%-25.7%) and a 6.9% (95% CI, 4.5%-9.3%) reductions in CVD morbidity and mortality. Additionally, the spline regression curves showed nonlinear relationships between PA levels and the risk of CVD, with a limited reduction in CVD risk and some further reduction in CVD mortality in PA levels above 20 MET-h per week.Conclusions: Increased PA correlated with decreased CVD morbidity and mortality in individuals with diabetes. The observed PA threshold aligns with general population recommendations. Gradual transition from inactivity to recommended PA levels could significantly alleviate CVD burden in diabetics.