Physical Activity and Mortality in Individuals With Diabetes Mellitus

Abstract

BACKGROUND Physical activity (PA) is considered a cornerstone of diabetes mellitus management to prevent complications, but conclusive evidence is lacking. METHODS This prospective cohort study and meta-analysis of existing studies investigated the association between PA and mortality in individuals with diabetes. In the EPIC study (European Prospective Investigation Into Cancer and Nutrition), a cohort was defined of 5859 individuals with diabetes at baseline. Associations of leisure-time and total PA and walking with cardiovascular disease (CVD) and total mortality were studied using multivariable Cox proportional hazards regression models. Fixed- and random-effects meta-analyses of prospective studies published up to December 2010 were pooled with inverse variance weighting. RESULTS In the prospective analysis, total PA was associated with lower risk of CVD and total mortality. Compared with physically inactive persons, the lowest mortality risk was observed in moderately active persons: hazard ratios were 0.62 (95% CI, 0.49-0.78) for total mortality and 0.51 (95% CI, 0.32-0.81) for CVD mortality. Leisure-time PA was associated with lower total mortality risk, and walking was associated with lower CVD mortality risk. In the meta-analysis, the pooled random-effects hazard ratio from 5 studies for high vs low total PA and all-cause mortality was 0.60 (95% CI, 0.49-0.73). CONCLUSIONS Higher levels of PA were associated with lower mortality risk in individuals with diabetes. Even those undertaking moderate amounts of activity were at appreciably lower risk for early death compared with inactive persons. These findings provide empirical evidence supporting the widely shared view that persons with diabetes should engage in regular PA.

Physical activity, sedentary behavior and all-cause mortality among blacks and whites with diabetes

“…Studies that included both males and females had results ranging from 24 to 60% reductions in risk associated with high PA levels [16,17,19,20,22,24,26,28]. It is unclear whether the weaker associations observed in mixed-gender populations was a result of differences in study methodologies or an actual sex difference in the impact of PA on mortality among those with diabetes.…”

“…Sluik et al [24] used quartiles for the assessment of leisure-time PA, and their top quartile was more than 113 MET-h/wk (corresponds with approximately >16.1 MET-h/d). Mortality risk among their top quartile was reduced by almost 40% compared with the lowest quartile (HR, 0.62; 95% CI: 0.46–0.85).…”

“…Thus, occupational activity may be less strongly associated with decreased risk of mortality than leisure-time activity, and combining occupational activity and leisure-time activity may have biased the effect toward the null. Sluik et al [24] conducted a prospective study which stratified the association between activity and total mortality among individuals with diabetes by total PA and leisure-time activity. The estimates for the effect of total PA were weaker than that for leisure-time activity alone (active vs. inactive; total PA–HR: 0.81, 95% CI: 0.61–1.08; leisure-time-HR: 0.62, 95% CI: 0.45–0.85).…”

Physical activity and type 2 diabetes mellitus risk: population studies review

“…В результате метаанализа 5 ис-следований риск смерти при высокой ФА по сравнению с низкой ФА составил 0,60 (ДИ 0,49-0,73). Полученные результаты свидетельствуют о несомненном положитель-ном влиянии ФА на снижение риска преждевременной смерти у лиц с СД2 [38].…”

Promoting community readiness for physical activity among older adults in Germany – protocol of the ready to change intervention trial

“…Physical activity (PA) is a major contributor to healthy ageing [1, 2] that has been shown to reduce risks for many chronic diseases and injuries. Enhanced PA improves cardiometabolic markers, lowers resting blood pressure and decreases the risk for diabetes mellitus type II [3–5]. Positive mental health and cognitive effects of exercise have also been described [6].…”