Diabetes Care · 2006

Physical Activity/Exercise and Type 2 Diabetes

Ronald J. Sigal, Glen P. Kenny, David H. Wasserman

DIABETES -Boule ´et al.(6) undertook a systematic review and meta-analysis on the effects of structured exercise interventions in clinical trials of Ն8 weeks duration on HbA 1c (A1C) and body mass in people with type 2 diabetes.Postintervention A1C was significantly lower in exercise than control groups (7.65 vs. 8.31%, weighted mean difference Ϫ0.66%; P Ͻ 0.001).In contrast, postintervention body weight did not differ between the exercise and control groups.Meta-regression confirmed that the beneficial effect of exercise on A1C was independent of any effect on body weight.Therefore, structured exercise programs had a statistically and clinically significant beneficial effect on glycemic control, and this effect was not primarily mediated by weight loss.A subsequent meta-analysis by the same authors (7) showed that exercise intensity predicted postintervention weighted mean difference in A1C (r ϭ Ϫ0.91, P ϭ 0.002) to a larger extent than exercise volume (r ϭ Ϫ0.46, P ϭ 0.26).These results provide support for encouraging type 2 diabetic individuals who are already exercising at moderate intensity to consider increasing the intensity of their exercise in order to obtain additional benefits in both aerobic fitness and glycemic control. PHYSICAL ACTIVITY, AEROBIC FITNESS, AND RISK OF CARDIOVASCULAR AND OVERALL MORTALITY-Large cohort studies have found that higher levels of habitual aerobic fitness and/or physical activity are associated with significantly lower subsequent cardiovascular and overall mortality (8 -10), to a much greater extent than could be explained by glucose lowering alone.For example, Church et al. (8) found that men in the lowest, second, and third quartiles of cardiorespiratory fitness had 4.5-, 2.8-, and 1.6-fold greater risk for overall mortality than men in the highest quartile of cardiorespiratory fitness, even after adjustment for age, examination year, baseline cardiovascular disease (CVD), hypercholesterolemia, hypertriglyceridemia, BMI, hypertension, parental CVD, smoking, and baseline fasting glucose levels.Essentially all of the association between higher BMI and higher mortality was explained by confounding with cardiorespiratory fitness; there was no difference in mortality among normal-weight, overweight, and obese men after adjustment for cardiorespiratory fitness.In the same cohort, it was shown that among moderately fit subjects (21st-60th percentile for age) whose only exercise was walking, the mean time spent per week on exercise was 130 min for men and 148 min for women (11).These times are consistent with recommendations from the U.S. Surgeon General (12) and other respected bodies (13-15) stating that 150 min/week of moderate-intensity exercise should be accumulated.Moderately fit subjects whose only exercise was jogging or running reported a mean of 90 min/week for men and 92 min/week for women.These times are consistent with

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