Published Online
on April 28, 2003

A more recent version of this article appeared on May 20, 2003

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Submitted on December 4, 2002
Revised on February 26, 2003
Accepted on February 27, 2003

Physical Activity in Relation to Cardiovascular Disease and Total Mortality Among Men With Type 2 Diabetes

Mihaela Tanasescu MD^*, Michael F. Leitzmann MD, Eric B. Rimm ScD, and Frank B. Hu MD

From the Departments of Nutrition (M.T., M.F.L., E.B.R., F.B.H.) and Epidemiology (M.F.L., E.B.R., F.B.H.), Harvard School of Public Health, and the Channing Laboratory (E.B.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.

^* To whom correspondence should be addressed. E-mail: mtanasescu{at}tourou.edu.

Background--The present study was conducted to examine the relationship of physical activity with risk of cardiovascular disease (CVD) and mortality among men with type 2 diabetes. CVD risk and mortality are increased in type 2 diabetes. Few epidemiological studies have investigated the effect of physical activity on these outcomes among type 2 diabetics.

Methods and Results--Of the 3058 men who reported a diagnosis of diabetes at age 30 years or older in the Health Professionals' Follow-up Study (HPFS), we excluded 255 who reported a physical impairment. In the remaining 2803 men, physical activity was assessed every 2 years; 266 new cases of CVD and 355 deaths of all causes were identified during 14 years of follow-up. Relative risks of CVD and death were estimated from Cox proportional hazards analysis with adjustment for potential confounders. The multivariate relative risks of CVD incidence corresponding to quintiles of total physical activity were 1.0, 0.87, 0.64, 0.72, and 0.67 (P_trend=0.07). The corresponding multivariate relative risks for total mortality were 1.0, 0.80, 0.57, 0.58, and 0.58 (P_trend=0.005). Walking was associated with reduced risk of total mortality. Relative risks across quintiles of walking were 1.0, 0.97, 0.87, 0.97, and 0.57 (P_trend=0.002). Walking pace was inversely associated with CVD, fatal CVD, and total mortality independently of walking hours.

Conclusions--Physical activity was associated with reduced risk of CVD, cardiovascular death, and total mortality in men with type 2 diabetes. Walking and walking pace were associated with reduced total mortality.

Key words: diabetes mellitus • exercise • heart disease

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