Key result
Physical activity link to major diabetes complications assessed but lacks quantitative results.
Why the study?
Physical activity is central to diabetes management, but evidence synthesis on its association with long-term diabetes-related complications is scarce.
Does high physical activity reduce the incidence of and mortality from diabetes-related complications in individuals with diabetes?
Meta-Analysis
Does high physical activity reduce the incidence of and mortality from diabetes-related complications in individuals with diabetes?
Physical activity, even below recommended amounts, is associated with a reduced incidence of cardiovascular and microvascular complications in individuals with diabetes.
Supports promoting physical activity in diabetes; extends observational meta-analyses but leaves open RCT confirmation of causality.
Background: Physical activity is a cornerstone in diabetes management; however, evidence synthesis on the association between physical activity and long-term diabetes-related complications is scarce. Purpose: To summarize and evaluate findings on physical activity and diabetes-related complications, a systematic review and meta-analyses were conducted. Data Source: We searched PubMed, Web of Science, and the Cochrane library until July 6, 2021. Study Selection: We included prospective studies investigating the association between physical activity with incidence of and mortality from diabetes-related complications, i.e., cardiovascular disease (CVD), coronary heart disease, cerebrovascular events, heart failure, major adverse cardiovascular events, and microvascular complications such as retinopathy and nephropathy in individuals with diabetes. Data Extraction: Study characteristics and risk ratios (RR) with 95% confidence intervals (CI) were extracted. Random-effects meta-analyses were performed, and the certainty of evidence and risk of bias were evaluated using the GRADE and ROBINS-I approach. Data Synthesis: Overall, 31 studies were included. There was moderate certainty of evidence that high vs. low levels of physical activity were inversely associated with CVD incidence, CVD mortality [summary RR (SRR) (95% CI): 0.84 (0.77, 0.92), n=7 and 0.62 (0.55, 0.69), n=11], and microvascular complications [0.76 (0.67, 0.86), n=8]. Dose-response meta-analyses showed that physical activity was associated with lower risk of diabetes-related complications even at low levels. For other outcomes, similar associations were observed, but certainty of evidence was low or very low. Limitation: Limitations include residual confounding and misclassification of exposure. Conclusions: Physical activity, even below recommended amounts, was associated with reduced incidence of diabetes-related complications.
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Rietz et al. (2022) conducted a meta-analysis in Diabetes mellitus. Physical activity vs. Low physical activity or inactivity was evaluated on Major diabetes-related complications (e.g., cardiovascular disease, retinopathy). Physical activity and its association with the risk of major diabetes-related complications in individuals with diabetes was investigated, though quantitative results are not present in this supplementary material.
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