The Effect of Physical Activity Intensity On All-cause and Cardiovascular Mortality in Diabetic Patients

Background To assess the association between physical activity (PA) and mortality risk, few data are available to guide clinical recommendations for individuals with high levels of PA in the presence of clinically diagnosed diabetes. Methods Data on diabetic patients (aged 18 to 85 years) were acquired from the United States (US) National Health and Nutrition Examination Survey (NHANES) 1999–2018. The patients were divided into three groups based on the level and frequency of PA: a) sedentary ( n  = 2,152), b) moderate PA ( n  = 504), and c) vigorous PA ( n  = 1,708). Logistic regression analysis was used to determine the relationship between PA and all-cause mortality (ACM) or cardiovascular mortality (CVM) in diabetic patients. Results Among 4,364 adult respondents (54% men, 46% women, mean age 60.44 ± 15.4 years), 50.69% reported adequate PA. During the study, there were 283 (6.48%) deaths from cardiovascular disease (CVD) and 937 (21.47%) deaths from all causes. The incidence of all-cause or CVM was highest in the sedentary group. Patients who undertook sedentary PA had the highest risk of ACM (odds ratio [ OR ] 2.18; 95% confidence interval [ CI ] 1.69–2.82; P  < 0.01) or CVM ( OR 1.69; 95% CI 1.07–2.66; P  < 0.01) compared to those in the moderate PA group. Vigorous PA did not further improve efficacy. Conclusions There is evidence that moderate PA is associated with reduced all-cause or CVM in diabetes after a decade of follow-up, but vigorous PA is not associated with further reductions in all-cause or cardiovascular mortality.