title: Lower physical activity is a strong predictor of cardiovascular events in elderly patients with type 2 diabetes mellitus beyond traditional risk factors: the Japanese Elderly Diabetes Intervention Trial.
abstract: OBJECTIVE
  It is well known that a decline in physical activity is associated with lifestyle-related diseases including cardiovascular (CV) events. However, little is known about the association between physical activity and CV events in elderly patients, because recent accumulating reports have mainly dealt with middle-aged populations. In this study, we investigated the correlation between physical activity and CV events in Japanese elderly patients with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  A total of 938 Japanese elderly patients with T2DM (447 men and 491 women, mean age 71.9 years) enrolled (2000-2002) in the Japanese Elderly Diabetes Intervention Trial (J-EDIT) were used in this study. Physical activity consisting of three components, work, sports and leisure-time, of their lifestyle was evaluated using the Baecke questionnaire at baseline. Total activity score (TAS) as a sum of each activity score was divided into four quartiles (Q1 to Q4).
  
  
  RESULTS
  During a follow-up period of 65.2 months, 165 events and 71 deaths in total occurred. Higher TAS grade was associated with reduced risk of all events (hazard ratios: 0.82, 0.77 and 0.54 in Q2, Q3 and Q4, respectively) with statistical significance. Even after multivariate adjustment for covariates, higher TAS grade was a strong predictor of all events, and the prediction by TAS of cerebrovascular events was more effective than that of cardiac events. In contrast, all-cause mortality gradually decreased according to TAS grade; however, no statistical significance was found. Among the four grades of TAS, no significant change in several parameters, such as profiles of lipid and glucose metabolism, blood pressure, physical measurements, cognitive function and depression scale, was found throughout the follow-up period, suggesting that the higher level of physical activity itself was associated with the risk reduction of primary events.
  
  
  CONCLUSIONS
  Lower physical activity is a strong and independent predictor of all CV events in the elderly with T2DM beyond traditional risk factors. In addition to strict management of each atherosclerotic risk factor, engagement with patients to augment and maintain the level of physical activity in their lifestyle is also essential in clinical practice.
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine Institute of Gerontology, the University of Tokyo, Tokyo, Japan. katsu-tky@umin.ac.jp
authors.forename: Katsuya
authors.initials: K
authors.lastname: Iijima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iimuro
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shinozaki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakurai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Umegaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Araki
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Ouchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Ito
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D015444:Exercise; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D011795:Surveys and Questionnaires