Physical activity associated with lower risk of death in patients with diabetes

Increased physical activity (PA) has long been considered a key element in diabetes management. Patients with diabetes are at higher risk for cardiovascular disease (CVD) and premature death, so researchers note it is important to determine whether PA can produce similar beneficial effects in this high-risk population. While other studies have suggested that higher PA levels were associated with reduced CVD and total mortality rates, conclusive high-level evidence is lacking, according to the study background.

Diewertje Sluik, M.Sc., of the German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany, and colleagues sought to investigate whether PA (total, leisure time and walking) was associated with CVD and total mortality in a large group of patients with diabetes as part of a prospective cohort study and meta-analysis. The study included a group of 5,859 patients with diabetes at baseline defined in the EPIC (European Prospective Investigation Into Cancer and Nutrition) study. The meta-analysis included 12 studies.

"In this prospective analysis and meta-analysis of individuals with diabetes, higher levels of total PA, leisure-time PA and walking were associated with a lower risk of total and CVD mortality," the authors comment. "In the prospective analysis, people who reported being moderately physically active had lower mortality risk compared with those who reported being physically inactive."

Compared with patients who were physically inactive, the lowest mortality risk was seen in moderately active persons (hazard ratios [HR] were 0.62 for total mortality and 0.51 for CVD mortality). Leisure-time PA (including cycling, gardening and household work) was associated with lower total mortality risk, and walking was linked to lower CVD mortality risk, according to the study results.

"In conclusion, evidence from the present study and from previous studies summarized by meta-analyses supports the widely held view that PA is beneficially associated with lower mortality in people with diabetes," the authors comment. "Also, because not many patients with diabetes adhere to this advice, future research should elucidate the determinants of physical inactivity and design successful strategies to promote active lifestyles."

In an editorial, Mitchell H. Katz, M.D., of the Los Angeles County Department of Health Services, writes: "As physicians, it is important to understand the different physiologic effects and benefits of different forms of exercise so that we can guide our patients to the best regimen for them."

"A detailed guide for physicians on how to write an exercise prescription is available on the web. Some might question whether providing exercise prescriptions is really the job of the practicing physician, a fair question given that we are all trying to do more in our 15-minute visits," Katz continues.

"But having read the meta-analysis by Sluik at al, I cannot help but note that none of the time I spend trying to decide whether to increase the dose or add a new medication for my patients with type 2 diabetes is likely to result in a 38 percent reduction in all-cause mortality," Katz concludes.

More information:
Arch Intern Med. Published online August 6, 2012. doi:10.1001/archinternmed.2012.3130
Arch Intern Med. Published online August 6, 2012. doi:10.1001/archinternmed.2012.3196

Journal reference: JAMA Internal Medicine

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