title: Leisure-time physical activity is a significant predictor of stroke and total mortality in Japanese patients with type 2 diabetes: analysis from the Japan Diabetes Complications Study (JDCS).
abstract: OBJECTIVE
  Our aim was to clarify the association between leisure-time physical activity (LTPA) and cardiovascular events and total mortality in a nationwide cohort of Japanese diabetic patients.
  
  
  METHODS
  Eligible patients (1,702) with type 2 diabetes (mean age, 58.5 years; 47% women) from 59 institutes were followed for a median of 8.05 years. A comprehensive lifestyle survey including LTPA and occupation was performed using standardised questionnaires. Outcome was occurrence of coronary heart disease (CHD), stroke and total mortality. The adjusted HR and 95% CI were calculated by Cox regression analysis.
  
  
  RESULTS
  A significant reduction in HR in patients in the top (≥ 15.4 metabolic equivalents [MET] h/week) vs the bottom tertile (≤ 3.7 MET h/week) of LTPA, adjusted by age, sex and diabetes duration, was observed in stroke (HR 0.55, 95% CI 0.32, 0.94) and total mortality (HR 0.49, 95% CI 0.26, 0.91) but not in CHD (HR 0.77, 95% CI 0.48, 1.25). The HR for stroke became borderline significant or nonsignificant after adjustment for lifestyle or clinical variables including diet or serum lipids. The significantly reduced total mortality by LTPA was independent of these variables and seemed not to be, at least mainly, attributed to reduced cardiovascular disease.
  
  
  CONCLUSIONS
  In Japanese persons with type 2 diabetes, LTPA of 15.4 MET h/week or more was associated with a significantly lower risk of stroke partly through ameliorating combinations of cardiovascular risk factors. It was also associated with significantly reduced total mortality but independently of cardiovascular risk factors or events. These findings, implying differences from Western diabetic populations, should be considered in the clinical management of East Asians with diabetes.
authors: Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuoh-ku, Niigata 951-8510, Japan. jdcstudy@md.tsukuba.ac.jp
authors: H
authors: H
authors: Sone
authors: S
authors: S
authors: Tanaka
authors: S
authors: S
authors: Tanaka
authors: S
authors: S
authors: Suzuki
authors: H
authors: H
authors: Seino
authors: O
authors: O
authors: Hanyu
authors: A
authors: A
authors: Sato
authors: T
authors: T
authors: Toyonaga
authors: K
authors: K
authors: Okita
authors: S
authors: S
authors: Ishibashi
authors: S
authors: S
authors: Kodama
authors: Y
authors: Y
authors: Akanuma
authors: N
authors: N
authors: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000208:ethnology; D009043:Motor Activity; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D016019:Survival Analysis