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Cited by 469Physical Activity and HealthDiabetes, Cardiovascular Risks, and LipoproteinsCardiovascular and exercise physiology

Exercise capacity and body composition as predictors of mortality among men with diabetes

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Church, Timothy S., Cheng, Yiling J., Earnest, Conrad P., Barlow, Carolyn E., Gibbons, Larry W., Priest, Elisa L., Blair, Steven N.·2004·Diabetes Care
DOI 10.2337/diacare.27.1.83
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Abstract

OBJECTIVE—To quantify the relation of fitness to mortality among men with diabetes, adjusted for BMI and within levels of BMI. RESEARCH DESIGN AND METHODS—In this observational cohort study, we calculated all-cause death rates in men with diabetes across quartiles of fitness and BMI categories. Study participants were 2,196 men with diabetes (average age 49.3 years, SD 9.5) who underwent a medical examination, including a maximal exercise test, during 1970 to 1995, with mortality follow-up to 31 December 1996. RESULTS—We identified 275 deaths during 32,161 person-years of observation. Risk of all-cause mortality was inversely related to fitness. For example, in the fully adjusted model, the risk of mortality was 4.5 (2.6–7.6), 2.8 (1.6–4.7), and 1.6 (0.93–2.76) for the first, second, and third fitness quartiles, respectively, with the fourth quartile (highest fitness level) as the referent (P for trend <0.0001). There was no significant trend across BMI categories for mortality after adjustment for fitness. Similar results were found when the fitness-mortality relation was examined within levels of body composition. In normal-weight men with diabetes, the relative risks of mortality were 6.6 (2.8–15.0), 3.2 (1.4–7.0), and 2.2 (1.1–4.6) for the first, second, and third quartiles of fitness, respectively, as compared with the fourth quartile (P for trend <0.0001). We found similar results in the overweight and obese weight categories. CONCLUSIONS—There was a steep inverse gradient between fitness and mortality in this cohort of men with documented diabetes, and this association was independent of BMI.

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  • Increases in physical activity and physical fitness are associated with reduced early mortality in both healthy and clinical populations.

    “Increases in PA and physical fitness are also associated with reduced early mortality in both populations as well ( 19 , 42 , 153 , 163 , 164 , 186 , 272 ).”

    From Exercise and Type 2 Diabetes (2010) · cites this paper as [42]

    The Results and Conclusions (pp. 1, 3) associate higher fitness with lower all-cause mortality among men with diabetes; the discussion (p. 4) treats fitness as a marker of physical activity. The study does not examine healthy participants or test whether increases in activity or fitness over time reduce mortality. (LLM, conf=0.87)

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  • A work capacity greater than 10 METs carries the lowest risk, independent of obesity.

    “A work capacity >10 METs (where 1 MET is defined as the equivalent of resting metabolic rate) carries the lowest risk, independent of obesity ( 42 , 153 , 186 ).”

    From Exercise and Type 2 Diabetes (2010) · cites this paper as [42]

    The Statistical analyses section (pp. 2–3) reports that mortality risk was lowest in the highest fitness quartile and that the association persisted after adjustment for BMI. It does not identify >10 METs as the cutoff for that lowest-risk group. The finding is also specific to men with diabetes, rather than people generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • All-cause and cardiovascular mortality risk was 1.7-6.6 times higher in low-fit compared with high-fit men with type 2 diabetes, with the fittest men exhibiting the lowest risk.

    “All-cause and CV mortality risk was 1.7–6.6 times higher in low-fit compared with high-fit men with type 2 diabetes, with the fittest men exhibiting the lowest risk ( 42 , 43 ).”

    From Exercise and Type 2 Diabetes (2010) · cites this paper as [42]

    The Results (p. 1) show an inverse relationship between fitness and all-cause mortality, including a 6.6-fold risk in the lowest versus highest fitness quartile among normal-weight men with diabetes. This study does not report cardiovascular mortality results or a 1.7-fold estimate; its introduction (p. 1) mentions cardiovascular mortality only as a finding of previous work. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The amount of daily physical activity, leisure time physical activity and physical fitness level are negatively correlated with mortality due to cerebrovascular disease and cancer, as well as all-cause mortality.

    “The amount of daily physical activity, leisure time physical activity and physical fitness level have been found to be negatively correlated with morality due to cerebrovascular disease and cancer, as well as all-cause mortality in studies conducted worldwide596–606) and cohort studies in Japan577).”

    From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [602]

  • Both physical inactivity and sedentary behavior are independently associated with increased mortality from any cause and cardiovascular disease in people with type 2 diabetes.

    “and also in people with type 2 diabetes (3,4)”

    From Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals with Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2) (2022) · cites this paper as [3]

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Research works printed but not linked: 1

  1. [12]12. Bouchard C, Pe ´russe L: Heredity, activity level, fitness, and health. In Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement, Toronto, Canada, May 1992 . Bouchard C, Shephard RJ, Stephens T, Eds. Champaign, IL, Human Kinetics, 1994, p. 106-118

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Authors
Church, T. S., Cheng, Y. J., Earnest, C. P., Barlow, C. E., Gibbons, L. W., Priest, E. L., & Blair, S. N.
Affiliations
  • Cooper Institute (US)
  • Cooper Clinic (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2004-01-01
Volume
27
Issue
1
Pages
83-88
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.27.1.83
OpenAlex
W2166212518
Cited by
469
References
22
Citations by year
2026: 2 · 2025: 11 · 2024: 9 · 2023: 11 · 2022: 12 · 2021: 20 · 2020: 12 · 2019: 16 · 2018: 19 · 2017: 23 · 2016: 21 · 2015: 28 · 2014: 30 · 2013: 35 · 2012: 23
FWCI
14.43
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Public Health Service
  • National Institute on Aging (AG06945)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
diabetes mellitus, exercise capacity, physical fitness, all-cause mortality, body composition, body mass index, men, maximal exercise test, cardiovascular risk
MeSH terms
Blood Pressure, Body Composition, Cardiovascular Diseases, Cause of Death, Cholesterol, Diabetes Mellitus, Humans, Hypertension, Male, Middle Aged, Risk Factors, Smoking, Time Factors, Cohort Studies, Exercise

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