The influence of physical activity on vascular complications and mortality in patients with type 2 diabetes mellitus

Diabetes Obes Metab. 2013 Nov;15(11):1008-12. doi: 10.1111/dom.12122. Epub 2013 Jun 11.

Abstract

Aims: There is limited evidence regarding the association between physical activity and vascular complications, particularly microvascular disease, in patients with type 2 diabetes.

Methods: From the 11 140 patients in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial, the effect of physical activity, categorized as none, mild, moderate or vigorous, and the number of sessions within a week, was examined in multivariable regression models adjusted for potential confounders. The study end-points were major cardiovascular events, microvascular complications and all-cause mortality.

Results: Forty-six percent of participants reported undertaking moderate to vigorous physical activity for >15 min at least once in the previous week. During a median of 5 years of follow-up, 1031 patients died, 1147 experienced a major cardiovascular event and 1136 a microvascular event. Compared to patients who undertook no or mild physical activity, those reporting moderate to vigorous activity had a decreased risk of cardiovascular events (HR: 0.78, 95% CI: 0.69-0.88, p < 0.0001), microvascular events (HR: 0.85, 95% CI: 0.76-0.96, p = 0.010) and all-cause mortality (HR: 0.83, 95% CI: 0.73-0.94, p = 0.0044).

Conclusions: Moderate to vigorous, but not mild, physical activity is associated with a reduced incidence of cardiovascular events, microvascular complications and all-cause mortality in patients with type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT00145925.

Keywords: cardiovascular disease; diabetes complications; exercise.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / prevention & control
  • Cohort Studies
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / mortality
  • Diabetes Mellitus, Type 2 / therapy*
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / etiology
  • Diabetic Angiopathies / physiopathology
  • Diabetic Angiopathies / prevention & control*
  • Exercise*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Incidence
  • Male
  • Microcirculation / drug effects
  • Middle Aged
  • Mortality
  • Motor Activity*
  • Proportional Hazards Models
  • Risk
  • Sedentary Behavior
  • Severity of Illness Index
  • Vascular Diseases / complications
  • Vascular Diseases / epidemiology
  • Vascular Diseases / physiopathology
  • Vascular Diseases / prevention & control*

Substances

  • Hypoglycemic Agents

Associated data

  • ClinicalTrials.gov/NCT00145925