Association of moderate and vigorous physical activity with incidence of type 2 diabetes and subsequent mortality: 27 year follow-up of the Whitehall II study
Open accessAbstract
Aims/hypothesis: This work examined the role of physical activity in the course of diabetes using data spanning nearly three decades. Our first aim was to examine the long-term association of moderate and vigorous physical activity with incidence of type 2 diabetes. Our second aim was to investigate the association of moderate-to-vigorous physical activity post-diabetes diagnosis with subsequent risk of all-cause and cardiovascular disease mortality. Methods: A total of 9987 participants from the Whitehall II cohort study free of type 2 diabetes at baseline (1985–1988) were followed for incidence of type 2 diabetes, based on clinical assessments between 1985 and 2016 and linkage to electronic health records up to 31 March 2017. We first examined the association of moderate and vigorous physical activity measured by questionnaire in 1985–1988 (mean age 44.9 [SD 6.0] years; women, 32.7%) with incident type 2 diabetes, using the interval-censored, illness–death model, a competing risk analysis that takes into account both competing risk of death and intermittent ascertainment of diabetes due to reliance on data collection cycles (interval-censored). The second analysis was based on individuals with type 2 diabetes over the follow-up period where we used Cox regression with inverse probability weighting to examine the association of moderate-to-vigorous physical activity after diagnosis of type 2 diabetes with risk of all-cause and cardiovascular disease mortality. Results: Of the 9987 participants, 1553 developed type 2 diabetes during a mean follow-up of 27.1 (SD 6.3) years. Compared with participants who were inactive in 1985–1988, those who undertook any duration of moderate-to-vigorous physical activity had a lower risk of type 2 diabetes (HR 0.85 [95% CI 0.75, 0.97], p = 0.02; analysis adjusted for sociodemographic, behavioural and health-related factors). In 1026 participants with a diagnosis of type 2 diabetes over the follow-up period, data on moderate-to-vigorous physical activity after diabetes diagnosis were available; 165 all-cause deaths and 55 cardiovascular disease-related deaths were recorded during a mean follow-up of 8.8 (SD 6.1) years. In these participants with diabetes, any duration of moderate-to-vigorous physical activity was associated with lower all-cause mortality (HR 0.61 [95% CI 0.41, 0.93], p = 0.02) while the association with cardiovascular mortality was evident only for physical activity undertaken at or above recommendations (≥2.5 h per week of moderate-to-vigorous physical activity or ≥1.25 h per week of vigorous physical activity; HR 0.40 [95% CI 0.16, 0.96], p = 0.04) in fully adjusted models. Conclusions/interpretation: Moderate-to-vigorous physical activity plays an important role in diabetes, influencing both its incidence and prognosis. A protective effect on incidence was seen for durations of activity below recommendations and a marginal additional benefit was observed at higher durations. Among individuals with type 2 diabetes, any duration of moderate-to-vigorous physical activity was associated with reduced all-cause mortality while recommended durations of physical activity were required for protection against cardiovascular disease-related mortality. Data availability: Whitehall II data, protocols and other metadata are available to the scientific community. Please refer to the Whitehall II data sharing policy at https://www.ucl.ac.uk/epidemiology-health-care/research/epidemiology-and-public-health/research/whitehall-ii/data-sharing .
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Some prospective cohort studies reported that ≥150 min/week of moderate-to-vigorous-intensity physical activity or ≥75 min/week of vigorous-intensity physical activity was associated with 14%-37% lower risks of all-cause mortality in diabetic adults.
“Moreover, some prospective cohort studies reported that ≥150 min/week of moderate-to-vigorous-intensity PA (MVPA) or ≥75 min/week of vigorous-intensity PA (VPA) was associated with 14%–37% lower risks of all-cause mortality in diabetic adults8–10.”
From Accelerometer-derived physical activity and mortality in individuals with type 2 diabetes (2024) · cites this paper as [8]
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- Authors
- Yerramalla, M. S., Fayosse, A., Dugravot, A., Tabak, A. G., Kivimäki, M., Singh-Manoux, A., & Sabia, S.
- Affiliations
- Inserm (FR)
- Venue
- Diabetologia
- Published
- 2019-12-02
- Volume
- 63
- Issue
- 3
- Pages
- 537-548
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC6997261
- OpenAlex
- W2990320567
- Cited by
- 45
- References
- 44
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 5 · 2023: 4 · 2022: 10 · 2021: 6 · 2020: 4
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Diabetologia (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Medical Research Council (S011676)
- British Department of Health
- British Health and Safety Executive
- British Heart Foundation (RG/13/2/30098)
- National Institute of Health (R01AG056477)
- National Institute on Aging
- 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
- type 2 diabetes, moderate-to-vigorous physical activity, all-cause mortality, cardiovascular mortality, diabetes incidence, competing risk of death, inverse probability weighting, Whitehall II cohort, occupational cohort, long-term follow-up, diabetes prevention, cardiovascular risk reduction
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, United Kingdom, Humans, Male, Middle Aged, Mortality, Risk Factors, Cohort Studies, Exercise, Incidence, Sedentary Behavior
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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