Abstract
<p> </p> <p><em>Background: </em>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. </p> <p><em>Purpose: </em>To summarize and evaluate findings on physical activity and diabetes-related complications, a systematic review and meta-analyses were conducted. </p> <p><em>Data Source: </em>We searched PubMed, Web of Science, and the Cochrane library until July 6, 2021. </p> <p><em>Study Selection: </em>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. </p> <p><em>Data Extraction: </em>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. </p> <p><em>Data Synthesis: </em>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.</p> <p><em>Limitation: </em>Limitations include residual confounding and misclassification of exposure. </p> <p><em>Conclusions: </em>Physical activity, even below recommended amounts, was associated with reduced incidence of diabetes-related complications. </p>
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