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Exercise Capacity and Body Composition Predicts Mortality In Men With Diabetes

Posted: Monday, January 12, 2004

The purpose of the study was to quantify the relation of fitness to mortality among men with diabetes, adjusted for BMI and within levels of BMI.

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.

The study 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.

From the results it was concluded that that fitness had a strong and independent inverse association with mortality in men with diabetes, and this result was seen in all BMI and body fatness groups. The current study expands on these findings by showing a stepwise relation between fitness and mortality and that this relation is evident within all BMI strata. Furthermore, a more direct evaluation of body fatness (% body fat) yielded results similar to those for BMI. To our knowledge, this is the largest group of men with diabetes undergoing assessment of body fatness and fitness by objective laboratory testing.

Previous work in our cohort indicates that men who walked an average of 130 min per week were moderately fit. The Surgeon General’s Report recommendation of 30 min of moderate intensity physical activity most days of the week will keep most individuals out of the lowest fitness quartile. Therefore, we believe that performing 150 min of moderate intensity physical activity per week should be a strong recommendation to individuals with diabetes.

Although many clinicians counsel their patients with diabetes to be physically active, this is often done in the context of weight control. Our results suggest that there is intrinsic value in encouraging patients to be active and fit, whether or not it helps them lose weight. These results should not be interpreted to minimize the importance of weight control and other treatments in the management of diabetes, but our data present a strong rationale for establishing physical activity and fitness as major targets of clinical interventions for patients with diabetes.

We insert a note of caution in regard to focusing more emphasis on increasing physical activity and fitness in patients with diabetes. We believe it is reasonable to assume that there is a level of obesity at which the benefits of more physical activity or higher levels of fitness do not overcome the metabolic abnormalities and risks of excess body fat. Our study sample had >6% of men with a BMI >35 kg/m²; therefore, the results must be extrapolated with caution to men with diabetes and BMI >35 kg/m². However, because regular physical activity is a critical element of successful weight control, including the prevention of additional weight gain, the importance of regular physical activity remains important, even for patients with Class II or Class III obesity.

There is a steep inverse relation between fitness and mortality within this cohort of men with documented diabetes, and this association is independent of BMI or body fat percentage. These results suggest that clinicians should give increased attention to counseling for increasing activity and improving fitness in their patients with diabetes, not only as a means to improve weight control but also for the intrinsic benefits associated with increased cardiorespiratory fitness that are independent of weight. 

Source: Diabetes In Control.com

 

 

 

 

 

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