Physical Activity and Mortality in Individuals With Diabetes Mellitus: A Prospective Study and Meta-Analysis

Study Questions:

Does physical activity (PA), which is considered a cornerstone of diabetes mellitus management to prevent complications, impact cardiovascular disease (CVD) and total mortality?


The authors used the prospective cohort study, EPIC (European Prospective Investigation Into Cancer and Nutrition), and a meta-analysis of existing studies to investigate the relationship between PA and mortality in diabetes. In the EPIC study, 5,859 individuals had 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.


Mean age in EPIC was approximately 57 years and >50% were men who were more active than women. After median follow-up of 9.4 years, 755 participants had died (13%). Death due to CVD accounted for 28% of all deaths (n = 212). 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% confidence interval [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. Risk estimates were not affected by additional adjustment for the intermediate factors glycated hemoglobin level, body mass index, and systolic blood pressure. In the meta-analysis, the pooled random effects hazard ratio from five studies for high versus low total PA and all-cause mortality was 0.60 (95% CI, 0.49-0.73).


Higher levels of PA were associated with lower mortality risk in individuals with diabetes. Moderate amounts of activity were associated with lower risk for early death compared with inactivity. These findings provide empirical evidence supporting the widely shared view that persons with diabetes should engage in regular PA.


The results in the diabetics in this analysis are in line with those found in the general population, where PA relates to a 33% lower risk of overall mortality and a 35% lower risk of CVD mortality compared with inactivity. I hope no one will ask for a large randomized controlled CV event-driven trial of exercise in diabetics. There are much better places to spend our health care research dollars.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Exercise

Keywords: Risk, Neoplasms, Follow-Up Studies, Exercise, Diabetes Mellitus, Type 2, Blood Pressure, Health Services Research, Hemoglobin A, Glycosylated, Incidence, Mitochondrial Diseases, Proportional Hazards Models, Body Mass Index, Cardiovascular Diseases, Motor Activity, Confidence Intervals, Diabetic Angiopathies, Diabetes Mellitus

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