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Cited by 1,634Physical Activity and HealthDiabetes, Cardiovascular Risks, and LipoproteinsObesity, Physical Activity, Diet

Physical activity and reduced occurrence of non–insulin-dependent diabetes mellitus

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Helmrich, Susan P., Ragland, David R., Leung, Rita W., Paffenbarger, Ralph S.·1991·New England Journal of Medicine
DOI 10.1056/nejm199107183250302
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Abstract

BACKGROUND: Physical activity is recommended by physicians to patients with non-insulin-dependent diabetes mellitus (NIDDM), because it increases sensitivity to insulin. Whether physical activity is effective in preventing this disease is not known. METHODS: We used questionnaires to examine patterns of physical activity and other personal characteristics in relation to the subsequent development of NIDDM in 5990 male alumni of the University of Pennsylvania. The disease developed in a total of 202 men during 98,524 man-years of follow-up from 1962 to 1976. RESULTS: Leisure-time physical activity, expressed in kilocalories expended per week in walking, stair climbing, and sports, was inversely related to the development of NIDDM: The incidence rates declined as energy expenditure increased from less than 500 kcal to 3500 kcal. For each 500-kcal increment in energy expenditure, the age-adjusted risk of NIDDM was reduced by 6 percent (relative risk, 0.94; 95 percent confidence interval, 0.90 to 0.98). This association remained the same when the data were adjusted for obesity, hypertension, and a parental history of diabetes. The association was weaker when we considered weight gain between the time of college attendance and 1962 (relative risk, 0.95; 95 percent confidence interval, 0.90 to 1.00). The protective effect of physical activity was strongest in persons at highest risk for NIDDM, defined as those with a high body-mass index, a history of hypertension, or a parental history of diabetes. These factors, in addition to weight gain since college, were also independent predictors of the disease. CONCLUSIONS: Increased physical activity is effective in preventing NIDDM, and the protective benefit is especially pronounced in persons at the highest risk for the disease.

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  • Prospective cohort and cross-sectional observational studies that assessed PA with questionnaires showed that higher PA levels are associated with reduced risk for type 2 diabetes, regardless of method of activity assessment, ranges of activity categories, and statistical methods.

    “Prospective cohort and cross-sectional observational studies that assessed PA with questionnaires showed that higher PA levels are associated with reduced risk for type 2 diabetes, regardless of method of activity assessment, ranges of activity categories, and statistical methods”

    From Exercise and Type 2 Diabetes (2010) · cites this paper as [108]

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  • Physical activity can delay the onset of type 2 diabetes or potentially prevent it through improvements in glycemic control.

    “Physical activity can delay the onset of T2DM or potentially prevent it through improvements in glycemic control (11, 12).”

    From The effectiveness of digital health intervention on glycemic control and physical activity in patients with type 2 diabetes: a systematic review and meta-analysis (2025) · cites this paper as [11]

    The paper reports lower NIDDM incidence with greater physical activity and concludes that increased activity is effective in preventing it (p. 1). The Discussion (p. 4) proposes improved glucose metabolism as a possible mechanism, but the study does not establish that glycemic improvements caused the reduced incidence or specifically demonstrate delayed onset. (LLM, conf=0.85)

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  • In men with BMI of 25 or more, a history of hypertension, a positive parental history of diabetes, or any combination of these factors, type 2 diabetes incidence declined by 41% from the lowest to the highest levels of energy expenditure.

    “in men with a BMI of 25 or more, a history of hypertension, a positive parental history of diabetes, or any combination of these factors, the incidence of T2D declined by 41% from the lowest to the highest levels of energy expenditure (234)”

    From Lack of Exercise Is a Major Cause of Chronic Diseases (2012) · cites this paper as [234]

  • There are prospective cohort studies that have shown that increased physical activity, independent of other risk factors, has a protective effect against the development of T2DM.

    “There are prospective cohort studies that have shown that increased physical activity, independent of other risk factors, has a protective effect against the development of T2DM (Helmrich 1991;Manson 1992).”

    From Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus (2017) · cites this paper as Helmrich 1991

  • Interventional as well as observational studies have shown a reduction in the incidence of T2DM with reduced calorie intake and increased physical activity in people at risk of T2DM.

    “Interventional as well as observational studies have shown a reduction in the incidence of T2DM with reduced calorie intake and increased physical activity in people at risk of T2DM (Da Qing 1997;DPP 2002;Helmrich 1991;Smith 2016).”

    From Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus (2017) · cites this paper as Helmrich 1991

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Research works printed but not linked: 4

  1. [5]5. West KM. Epidemiology of diabetes and its vascular complications. New York: Elsevier, 1978.
  2. [21]21. Ainsworth BE, Jacobs DS Jr, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc (in press).
  3. [29]29. Krotkiewski M. Physical training in the prophylaxis and treatment of obesity, hypertension and diabetes. Scand J Rehabil Med Suppl 1983; 9:55-70.
  4. [34]34. Modan M, Karasik A, Halkin H, et al. Effect of past and concurrent body mass index on prevalence of glucose intolerance and type 2 (non-insulindependent) diabetes and on insulin response. Diabetologia 1986; 29:82-9.

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Authors
Helmrich, S. P., Ragland, D. R., Leung, R. W., & Paffenbarger, R. S.
Affiliations
  • University of California, Berkeley (US)
  • Stanford Medicine (US)
ORCID
Ragland, David R.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1991-07-18
Volume
325
Issue
3
Pages
147-152
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199107183250302
OpenAlex
W2317654055
Cited by
1,634
References
34
Citations by year
2026: 9 · 2025: 11 · 2024: 19 · 2023: 17 · 2022: 26 · 2021: 28 · 2020: 29 · 2019: 26 · 2018: 45 · 2017: 49 · 2016: 62 · 2015: 47 · 2014: 71 · 2013: 55 · 2012: 59
FWCI
19.19
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01hl034174-11)
  • National Heart, Lung, and Blood Institute (T32-HL07365, T32HL007365, R01 HL34174)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
physical activity, type 2 diabetes, diabetes prevention, energy expenditure, leisure-time physical activity, walking, stair climbing, sport, weight gain, body mass index, hypertension, risk factors
MeSH terms
Adult, Aged, Diabetes Mellitus, Type 2, Energy Metabolism, Physical Exertion, Humans, Hypertension, Leisure Activities, Male, Middle Aged, Obesity, Prospective Studies, Surveys and Questionnaires, Risk, Body Mass Index

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