The Physical Activity Guidelines And Diabetes-related Mortality: Nhanes 1999-2006

Abstract

Previous studies have indicated an inverse relationship between aerobic physical activity (PA) and risk of diabetes-related mortality (DRM). Limitations of these previous studies include lack of a measure of PA duration, lack of a representative sample of the U.S. population, only consideration of leisure-time PA measures (LTPA), and no examination of the potential contribution of muscular strengthening activity (MSA) to risk reduction of DRM. The continuous National Health and Nutrition Examination Survey (NHANES) remedies these limitations as the PA questionnaires include data on a PA across different domains, MSA, and duration of all PA measures. PURPOSE: To examine the relationship between meeting the 2018 PA guidelines, for both total aerobic activity and MSA, and DRM. METHODS: The study sample (n=13,739), included adult (20-79 years of age) participants from the 1999-2006 NHANES. Using the 2018 aerobic and MSA guidelines, PA was categorized into 6 categories: category 1 (no aerobic PA and no MSA), category 2 (insufficient aerobic PA and no MSA), category 3 (meet aerobic PA and no MSA), category 4 (no aerobic PA and meet MSA), category 5 (insufficient aerobic PA and meet MSA), and category 6 (meeting both recommendations). The dependent variable in this study was DRM, which includes those who had diabetes as the primary cause of death as well as those with diabetes listed as an underlying cause of death. Cox-proportional hazard models were used for all analyses, adjusting for age, gender, race-ethnicity, education, self-reported smoking, self-reported physician diagnosed diabetes, HbA1c, and body mass index. Category 1 served as the reference group. RESULTS: Significant risk reductions for DRM were found in PA category 2 (HR = 0.62; 95% CI, 0.45-0.85), category 3 (HR = 0.48; 95% CI, 0.31-0.74) and category 6 (HR = 0.32; 95% CI, 0.15-0.69). CONCLUSIONS: Results suggest that aerobic PA has a significant, pronounced effect on reducing risk for DRM. MSA alone showed no effect on reducing DRM risk. However, meeting both recommendations led to greater risk reduction for DRM.