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

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 11140 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 >15min at least once in the previous week. During a median of 5years 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.