Physical activity and mortality in individuals with diabetes mellitus: A prospective study and meta-analysis

Diewertje Sluik*, Brian Buijsse, Rebecca Muckelbauer, Rudolf Kaaks, Birgit Teucher, Nina Føns Johnsen, Anne Tjønneland, Kim Overvad, Jane Nautrup Østergaard, Pilar Amiano, Eva Ardanaz, Benedetta Bendinelli, Valeria Pala, Rosario Tumino, Fulvio Ricceri, Amalia Mattiello, Annemieke M.W. Spijkerman, Evelyn M. Monninkhof, Anne M. May, Paul W. FranksPeter M. Nilsson, Patrik Wennberg, Olov Rolandsson, Guy Fagherazzi, Marie Christine Boutron-Ruault, Françoise Clavel-Chapelon, José María Huerta Castaño, Valentina Gallo, Heiner Boeing, Ute Nöthlings

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

211 Citations (Scopus)


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 randomeffects 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.

Original languageEnglish
Pages (from-to)1285-1295
Number of pages11
JournalArchives of Internal Medicine
Issue number17
Publication statusPublished - 24 Sept 2012
Externally publishedYes


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