The Impact of Physical Activity on the Prevention of Type 2 Diabetes: Evidence and Lessons Learned From the Diabetes Prevention Program, a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures
Open Access
- 10 November 2020
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 44 (1), 43-49
- https://doi.org/10.2337/dc20-1129
Abstract
Across the Diabetes Prevention Program (DPP) follow-up, cumulative diabetes incidence remained lower in the lifestyle compared with the placebo and metformin randomized groups and could not be explained by weight. Collection of self-reported physical activity (PA) (yearly) with cross-sectional objective PA (in follow-up) allowed for examination of PA and its long-term impact on diabetes prevention. Yearly self-reported PA and diabetes assessment and oral glucose tolerance test results (fasting glucose semiannually) were collected for 3,232 participants with one accelerometry assessment 11–13 years after randomization (n = 1,793). Mixed models determined PA differences across treatment groups. The association between PA and diabetes incidence was examined using Cox proportional hazards models. There was a 6% decrease (Cox proportional hazard ratio 0.94 [95% CI 0.92, 0.96]; P < 0.001) in diabetes incidence per 6 MET-h/week increase in time-dependent PA for the entire cohort over an average of 12 years (controlled for age, sex, baseline PA, and weight). The effect of PA was greater (12% decrease) among participants less active at baseline (n = 1,338) (0.88 [0.83, 0.93]; P < 0.0001), with stronger findings for lifestyle participants. Lifestyle had higher cumulative PA compared with metformin or placebo (P < 0.0001) and higher accelerometry total minutes per day measured during follow-up (P = 0.001 and 0.047). All associations remained significant with the addition of weight in the models. PA was inversely related to incident diabetes in the entire cohort across the study, with cross-sectional accelerometry results supporting these findings. This highlights the importance of PA within lifestyle intervention efforts designed to prevent diabetes and urges health care providers to consider both PA and weight when counseling high-risk patients.Funding Information
- National Institute of Diabetes and Digestive and Kidney Diseases
This publication has 24 references indexed in Scilit:
- Validation and comparison of ActiGraph activity monitorsJournal of Science and Medicine in Sport, 2011
- Reliability and convergent validity of the past-week Modifiable Activity QuestionnairePublic Health Nutrition, 2010
- 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes StudyThe Lancet, 2009
- Relationships of self-reported physical activity domains with accelerometry recordings in French adultsEuropean Journal of Epidemiology, 2009
- First versus repeat treatment with a lifestyle intervention program: attendance and weight loss outcomesInternational Journal of Obesity, 2008
- Adiposity Compared With Physical Inactivity and Risk of Type 2 Diabetes in WomenDiabetes Care, 2007
- Effect of Weight Loss With Lifestyle Intervention on Risk of DiabetesDiabetes Care, 2006
- Limits to the measurement of habitual physical activity by questionnaires * CommentaryBritish Journal of Sports Medicine, 2003
- The Philosophy of Multiple ComparisonsStatistical Science, 1991
- Development of Questionnaire to Examine Relationship of Physical Activity and Diabetes in Pima IndiansDiabetes Care, 1990