title: Leisure-time physical activity and risk of type 2 diabetes in patients with established vascular disease or poorly controlled vascular risk factors.
abstract: OBJECTIVE
  To investigate the effect of leisure-time physical activity on the incidence of type 2 diabetes (T2DM) in patients with manifest arterial disease, or poorly controlled risk factors.
  
  
  METHODS
  We examined 3940 patients with manifest arterial disease, hypertension or hyperlipidemia, aged 55.2+/-12.2 years. Leisure-time physical activity was measured by a questionnaire and metabolic equivalent (MET) hours per week (h/wk) were calculated. Incident T2DM was evaluated by a specific diabetes questionnaire.
  
  
  RESULTS
  Most patients (65%) were physically inactive (0METh/wk), 12% were insufficiently physically active (0-10.5METh/wk) and 23% were sufficiently physically active (>or=10.5METh/wk). During a mean follow-up of 4.7 years, 194 (5%) incident cases of T2DM occurred. Sufficiently physically active patients had a lower incidence of diabetes (hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.37-0.83). Patients who were physically active and not-obese (BMI<30kg/m(2)) were at the lowest risk for developing T2DM (HR 0.18, 95% CI 0.12-0.28) compared with patients who were physically inactive and obese.
  
  
  CONCLUSIONS
  Leisure-time physical activity is associated with a decreased risk of T2DM in patients with manifest arterial disease, or poorly controlled risk factors. The combination of physical activity and non-obesity is associated with an even lower risk of the development of type 2 diabetes than the sum of their independent, protective effect.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: B G
authors.initials: BG
authors.lastname: Brouwer
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: S S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.forename: A M J
authors.initials: AM
authors.lastname: Wassink
authors.forename: F L J
authors.initials: FL
authors.lastname: Visseren
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007899:Leisure Activities; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D010809:Physical Fitness; D011446:Prospective Studies; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking; D011795:Surveys and Questionnaires; D014652:Vascular Diseases / Q000150:complications*