title: The joint association of physical activity and glycaemic control in predicting cardiovascular death and all-cause mortality in the US population.
abstract: OBJECTIVE
  The aim of this study was to examine the joint association of physical activity and glycaemic control as measured by HbA(1c) on all-cause and cardiovascular disease (CVD) mortality risk.
  
  
  METHODS
  The sample included 10,352 adults from the Third National Health and Nutrition Examination Survey (NHANES III) Linked Mortality Public-use File (follow-up 13.4 ± 3.9 years; 2,463 deaths). Physical activity was assessed by questionnaire and classified into inactive and active categories based on self-reported frequency of leisure-time activity. HbA(1c) was categorised to reflect the American Diabetes Association diagnostic and treatment guidelines.
  
  
  RESULTS
  Being physically active was associated with a decreased risk of all-cause (HR 0.74 [95% CI 0.67, 0.81]) and CVD (HR 0.71 [95% CI 0.62, 0.82]) mortality, whereas higher levels of HbA(1c) were associated with an increased mortality risk. HbA(1c) ≥ 7% (53 mmol/mol) was associated with the highest risk for all-cause (HR 1.54 [95% CI 1.30, 1.82]) and CVD (HR 1.93 [95% CI 1.52, 2.45]) mortality. Across all categories of HbA(1c), active individuals were not at increased risk for all-cause mortality compared with inactive individuals with normal glycaemic control. Similar findings were observed for CVD mortality, except that active individuals with HbA(1c) ≥ 7% (53 mmol/mol) were still at increased risk for CVD mortality. However, their risk for CVD death was substantially lower than the risk for their inactive counterparts (HR 1.38 [95% CI 1.03, 1.84] vs HR 1.98 [95% CI 1.34, 2.92]).
  
  
  CONCLUSIONS
  Physical activity is associated with lower all-cause and CVD mortality risk for individuals across all levels of glycaemic control. Therefore, engaging in a physically active lifestyle and achieving normal levels of glycaemic control may both be important for the prevention of early mortality.
authors.affiliation: School of Kinesiology and Health Science, 2002 Sherman Health Science Centre, York University, 4700 Keele Street, Toronto, ON, Canada M3J 1P3.
authors.forename: J I
authors.initials: JI
authors.lastname: Reddigan
authors.forename: M C
authors.initials: MC
authors.lastname: Riddell
authors.forename: J L
authors.initials: JL
authors.lastname: Kuk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006306:Health Surveys; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009043:Motor Activity; D012306:Risk; D057185:Sedentary Behavior; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
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