Key result
More physical activity and less sedentary time link to lower all-cause mortality regardless of diabetes.
Why the study?
Higher physical activity and lower sedentary behaviors are associated with lower premature mortality, especially in diabetes mellitus, but their joint association with mortality stratified by diabetes status needed estimation.
Does higher physical activity and lower sedentary behavior reduce all-cause mortality in individuals with and without diabetes mellitus?
Cohort (n=34,988)
Yes
Does higher physical activity and lower sedentary behavior reduce all-cause mortality in individuals with and without diabetes mellitus?
Moderate-to-high physical activity and low-to-moderate sedentary behavior are associated with a lower risk of all-cause mortality, independent of diabetes status.
Supports joint PA/SB associations with lower mortality independent of diabetes; extends prior individual findings to combined patterns in large cohorts.
Introduction and Objective: Studies have reported both higher physical activity (PA) and lower sedentary behaviors (SB) to be associated with lower risk of premature, all-cause mortality, especially among individuals with diabetes mellitus (DM). We estimated the joint association of PA and SB with all-cause mortality among study participants with and without DM. Methods: Data are from 34,988 participants enrolled in six prospective NIH cohort studies. We performed Cox regression analysis to estimate the joint associations of PA and SB (through a six-level index variable) with all-cause mortality through a priori stratification among participants with and without DM, adjusting for demographic and lifestyle variables. A random effects model was used to pool results. Results: Across cohorts, 8,414 participants (24.1%) had DM. There were 14,614 participants (3,684 with DM) who died within a median follow-up time of 18.0 years. Relative to the index combining low PA (quintile 1) and highest SB (quintile 5), participants with higher PA (quintiles 4 and 5) and low-to-moderate SB (quintiles 1 through 4) combined had the lowest risk for all-cause mortality, regardless of DM status (Figure 1; interaction p > 0.10). Conclusion: Moderate-to-high PA and low-to-moderate SB were associated with a lower risk for all-cause mortality in each DM stratum. These findings support recommendations for increasing PA and reducing SB in improving health. Disclosure F. Avenido: Other - As a current Epidemiology PhD student, I am supported by the NIH-NHLBI T32 Predoctoral Fellowship in Cardiovascular Disease Epidemiology and Prevention.; Current; National Heart, Lung, and Blood Institute. D. Jacobs: None. P.J. Schreiner: None. M. Mathew: None. N.R. Mitchell: None. S. Heckbert: None. K. Gabriel: None. E. Soliman: None. D. Siscovick: None. Z.C. Pope: None. M. Carnethon: None. D.M. Lloyd-Jones: None. M.A. Pereira: None. Funding National Heart, Lung, and Blood Institute (NHLBIT32HL007779)
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Avenido et al. (2026) conducted a cohort in Diabetes Mellitus (n=34,988). Higher physical activity and low-to-moderate sedentary behavior vs. Low physical activity and highest sedentary behavior was evaluated on All-cause mortality. Higher physical activity and low-to-moderate sedentary behavior were associated with a lower risk for all-cause mortality compared to low activity and high sedentary behavior, regardless of diabetes status.
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