Leisure-time physical activity is a significant predictor of stroke and total mortality in Japanese patients with type 2 diabetes: analysis from the Japan Diabetes Complications Study (JDCS)

Abstract

Aims/hypothesis Our aim was to clarify the association between leisure-time physical activity (LTPA) and cardiovascular events and total mortality in a nationwide cohort of Japanese diabetic patients.Methods Eligible patients (1,702) with type 2 diabetes (mean age, 58.5 years; 47% women) from 59 institutes were followed for a median of 8.05 years. A comprehensive lifestyle survey including LTPA and occupation was performed using standardised questionnaires. Outcome was A complete list of members of the JDCS group can be found in the electronic supplementary material (ESM). occurrence of coronary heart disease (CHD), stroke and total mortality. The adjusted HR and 95% CI were calculated by Cox regression analysis. Results A significant reduction in HR in patients in the top (≥15.4 metabolic equivalents [MET] h/week) vs the bottom tertile (≤3.7 MET h/week) of LTPA, adjusted by age, sex and diabetes duration, was observed in stroke (HR 0.55, 95% CI 0.32, 0.94) and total mortality (HR 0.49, 95% CI 0.26, 0.91) but not in CHD (HR 0.77, 95% CI 0.48, 1.25). The HR for stroke became borderline significant or nonsignificant after adjustment for lifestyle or clinical variables including diet or serum lipids. The significantly reduced total mortality by LTPA was independent of these variables and seemed not to be, at least mainly, attributed to reduced cardiovascular disease. Conclusions/interpretation In Japanese persons with type 2 diabetes, LTPA of 15.4 MET h/week or more was associated with a significantly lower risk of stroke partly through ameliorating combinations of cardiovascular risk factors. It was also associated with significantly reduced total mortality but independently of cardiovascular risk factors or events. These findings, implying differences from Western diabetic populations, should be considered in the clinical management of East Asians with diabetes. Electronic supplementary material

The Role of Lifestyle Change for Prevention of Cardiovascular Disease in Diabetes

“…In the Japan Diabetes Complications Study (JDCS), an analysis of leisure-time activity in 1702 participants with type 2 diabetes (based on HbA1c≥6.5 %) aged 40-70 years from 59 clinics and hospitals found that after a median of 8 years, leisure-time activity was associated with total mortality (HR 0.49, 95 % CI 0.26-0.91) but not fatal heart disease, when comparing the top tertile (≥15.4 metabolic equivalents [METs, hours/week]) versus the bottom tertile (≤3.7 MET [hours/week]), adjusted for age, sex, and diabetes duration. Also, no significant difference was found between tertiles 2 and 1 [30].…”

“…Similarly, leisure-time exercise METs in the JDCS study were not significantly associated with nonfatal coronary heart disease [30]. In JDCS, the hazard ratio for stroke was protective (HR 0.55, 95 % CI 0.32-0.94) after adjustment for age, sex, and diabetes duration but was not statistically significant after additional adjustments for lifestyle and clinical variables such as diet and serum lipids (HR 0.56, 95 % CI 0.26-1.20) [30].…”

“…The PREDIMED trial, along with other observational, prospective analyses, showed significant improvements in CVD risk among participants receiving lifestyle interventions or who had adopted or reported adopting improved lifestyle behaviors compared to individuals who did not [26][27][28][29][30][31][32]. However, notable results from the Look AHEAD trial suggest that intensive weight loss is not significantly associated with composite or individual CVD outcomes, even though intervention participants had significantly more weight loss, had better reductions in CVD risk factors, required fewer medications to manage blood pressure and lipid levels, experienced greater remission to normoglycemia, and had reduced incidence of physical disability compared to controls [24••, 33-35].…”

Physical Activity in Primary Stroke Prevention

“…8 A cohort study of individuals with newly diagnosed diabetes mellitus, followed up for 5 years, found that those who increased their PA had a relative risk of total cardiovascular disease (including stroke and myocardial infarction) of 0.53 compared with those who decreased their PA. 51 When considering the association between stroke and PA in people with diabetes mellitus, those who participated in at least 30 minutes/d of brisk walking, or the equivalent, had a 45% reduction in stroke risk compared with those who were inactive. 52 Several different variables are used in studies to classify excess weight: measurement of body mass index, waist circumference, waist:hip ratio, visceral adipose tissue, and overall body fat. Randomized controlled trials of PA interventions typically result in only modest weight loss (1-2 kg), 5 but they are often associated with improvements in body mass index, waist circumference, and body fat with PA interventions, 46 particularly in those with diabetes mellitus.…”

Actividad física en Diabetes Mellitus tipo II, un elemento terapéutico eficaz: revisión del impacto clínico

“…Otro estudio 52 analizó el beneficio de realizar altos niveles de actividad física sobre el riesgo de presentar un evento vascular cerebral, reportando que un volumen de actividad física mayor a 15.4 MET/Hora/semana de actividad física se asocia a una disminución del riesgo relativo del 45% (HR 0.55, IC95% 0.32 a 0.94) de presentar un evento vascular cerebral; sin embargo esta asociación no fue significativa para la enfermedad coronaria (HR 0.77, IC95% 0.48 a 1.25).…”