Leisure-time physical activity is a significant predictor of stroke and total mortality in Japanese patients with type 2 diabetes: analysis from the Japan Diabetes Complications Study (JDCS)

on behalf of the Japan Diabetes Complications Study Group; Sone, H.; Tanaka, S.; Tanaka, S.; Suzuki, S.; Seino, H.; Hanyu, O.; Sato, A.; Toyonaga, T.; Okita, K.; Ishibashi, S.; Kodama, S.; Akanuma, Y.; Yamada, N.

doi:10.1007/s00125-012-2810-z

Cited by 77Physical Activity and HealthDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and Research

Leisure-time physical activity is a significant predictor of stroke and total mortality in Japanese patients with type 2 diabetes: analysis from the Japan Diabetes Complications Study (JDCS)

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on behalf of the Japan Diabetes Complications Study Group, Sone, H., Tanaka, S., Tanaka, S., Suzuki, S., Seino, H., Hanyu, O., Sato, A. +6 more·2013·Diabetologia

DOI 10.1007/s00125-012-2810-z

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Abstract

Aims/hypothesis Our aim was to clarify the association between leisure-time physical activity (LTPA) and cardiovascular events and total mortality in a nationwide cohort of Japanese diabetic patients.Methods Eligible patients (1,702) with type 2 diabetes (mean age, 58.5 years; 47% women) from 59 institutes were followed for a median of 8.05 years. A comprehensive lifestyle survey including LTPA and occupation was performed using standardised questionnaires. Outcome was occurrence of coronary heart disease (CHD), stroke and total mortality. The adjusted HR and 95% CI were calculated by Cox regression analysis.Results A significant reduction in HR in patients in the top (≥ 15.4 metabolic equivalents [MET] h/week) vs the bottom tertile (≤ 3.7 MET h/week) of LTPA, adjusted by age, sex and diabetes duration, was observed in stroke (HR 0.55, 95% CI 0.32, 0.94) and total mortality (HR 0.49, 95% CI 0.26, 0.91) but not in CHD (HR 0.77, 95% CI 0.48, 1.25). The HR for stroke became borderline significant or nonsignificant after adjustment for lifestyle or clinical variables including diet or serum lipids. The significantly reduced total mortality by LTPA was independent of these variables and seemed not to be, at least mainly, attributed to reduced cardiovascular disease.Conclusions/interpretation In Japanese persons with type 2 diabetes, LTPA of 15.4 MET h/week or more was associated with a significantly lower risk of stroke partly through ameliorating combinations of cardiovascular risk factors. It was also associated with significantly reduced total mortality but independently of cardiovascular risk factors or events. These findings, implying differences from Western diabetic populations, should be considered in the clinical management of East Asians with diabetes.

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There is no evidence that lifestyle modifications alone decrease the risk of ASCVD in patients with DM.
“Lifestyle modification such as diet therapy817), increasing physical activity818), and smoking cessation819) are important, but there is no evidence that lifestyle modifications alone decrease the risk of ASCVD in patients with DM820, 821).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [821]

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Additional file 4 of Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies
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Additional file 2 of Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies
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Additional file 5 of Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies
Geidl, W., Schlesinger, S., Mino, E., Miranda, L., & Pfeifer, K. (2020) · Figshare · doi:10.6084/m9.figshare.12864637
Additional file 6 of Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies
Geidl, W., Schlesinger, S., Mino, E., Miranda, L., & Pfeifer, K. (2020) · Figshare · doi:10.6084/m9.figshare.12864640
Additional file 1 of Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies
Geidl, W., Schlesinger, S., Mino, E., Miranda, L., & Pfeifer, K. (2020) · Figshare · doi:10.6084/m9.figshare.12864625
Additional file 3 of Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies
Geidl, W., Schlesinger, S., Mino, E., Miranda, L., & Pfeifer, K. (2020) · Figshare · doi:10.6084/m9.figshare.12864631
Additional file 7 of Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies
Geidl, W., Schlesinger, S., Mino, E., Miranda, L., & Pfeifer, K. (2020) · Figshare · doi:10.6084/m9.figshare.12864643
Additional file 1 of Physical activity modification following a Transient Ischemic Attack in individuals with diabetes
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Authors: on behalf of the Japan Diabetes Complications Study Group, Sone, H., Tanaka, S., Tanaka, S., Suzuki, S., Seino, H., Hanyu, O., Sato, A., Toyonaga, T., Okita, K., Ishibashi, S., Kodama, S., Akanuma, Y., & Yamada, N.
Affiliations: Niigata University (JP)
Kyoto University (JP)
Ohta Nishinouchi Hospital (JP)
Tokyo Women's Medical University (JP)
Kumamoto Medical Center (JP)
Jichi Medical University (JP)
University of Tsukuba (JP)
Corresponding author: Sone, H.
ORCID: Sone, H.
Suzuki, S.
Seino, H.
Sato, A.
Ishibashi, S.
Kodama, S.
Venue: Diabetologia
Publisher: Springer Science and Business Media LLC
Published: 2013-02-27
Volume: 56
Issue: 5
Pages: 1021-1030
ISSN: 0012-186X (ISSN-L)
1432-0428
DOI: 10.1007/s00125-012-2810-z
OpenAlex: W2023713740
Cited by: 77
References: 42
Citations by year: 2026: 1 · 2025: 3 · 2024: 9 · 2023: 3 · 2022: 7 · 2021: 4 · 2020: 11 · 2019: 4 · 2018: 4 · 2017: 7 · 2016: 2 · 2015: 12 · 2014: 8 · 2013: 2
FWCI: 5.56
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Diabetologia (publishedVersion)
PubMed (publishedVersion)
Funders: University of Tsukuba
Japan Society for the Promotion of Science (24300233)
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords: leisure-time physical activity, type 2 diabetes, stroke, all-cause mortality, coronary artery disease, cardiovascular risk factors, metabolic equivalents, Japanese patients, East Asian populations, lifestyle
MeSH terms: Adult, Aged, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Follow-Up Studies, Health Surveys, Humans, Japan, Leisure Activities, Male, Middle Aged, Mortality, Motor Activity, Prospective Studies, Risk Factors, Cohort Studies, Incidence, Survival Analysis, Stroke

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Leisure-time physical activity is a significant predictor of stroke and total mortality in Japanese patients with type 2 diabetes: analysis from the Japan Diabetes Complications Study (JDCS)

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