title: The influence of physical activity on vascular complications and mortality in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  There is limited evidence regarding the association between physical activity and vascular complications, particularly microvascular disease, in patients with type 2 diabetes.
  
  
  METHODS
  From the 11 140 patients in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial, the effect of physical activity, categorized as none, mild, moderate or vigorous, and the number of sessions within a week, was examined in multivariable regression models adjusted for potential confounders. The study end-points were major cardiovascular events, microvascular complications and all-cause mortality.
  
  
  RESULTS
  Forty-six percent of participants reported undertaking moderate to vigorous physical activity for >15 min at least once in the previous week. During a median of 5 years of follow-up, 1031 patients died, 1147 experienced a major cardiovascular event and 1136 a microvascular event. Compared to patients who undertook no or mild physical activity, those reporting moderate to vigorous activity had a decreased risk of cardiovascular events (HR: 0.78, 95% CI: 0.69-0.88, p < 0.0001), microvascular events (HR: 0.85, 95% CI: 0.76-0.96, p = 0.010) and all-cause mortality (HR: 0.83, 95% CI: 0.73-0.94, p = 0.0044).
  
  
  CONCLUSIONS
  Moderate to vigorous, but not mild, physical activity is associated with a reduced incidence of cardiovascular events, microvascular complications and all-cause mortality in patients with type 2 diabetes.
authors.affiliation: The George Institute for Global Health and University of Sydney, Sydney, Australia; University of Turku, Turku, Finland.
authors.forename: J I
authors.initials: JI
authors.lastname: Blomster
authors.forename: C K
authors.initials: CK
authors.lastname: Chow
authors.forename: S
authors.initials: S
authors.lastname: Zoungas
authors.forename: M
authors.initials: M
authors.lastname: Woodward
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: N R
authors.initials: NR
authors.lastname: Poulter
authors.forename: M
authors.initials: M
authors.lastname: Marre
authors.forename: S
authors.initials: S
authors.lastname: Harrap
authors.forename: J
authors.initials: J
authors.lastname: Chalmers
authors.forename: G S
authors.initials: GS
authors.lastname: Hillis
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D009026:Mortality; D009043:Motor Activity; D016016:Proportional Hazards Models; D012306:Risk; D057185:Sedentary Behavior; D012720:Severity of Illness Index; D014652:Vascular Diseases / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*
chemical_list: D007004:Hypoglycemic Agents
keywords: cardiovascular disease; diabetes complications; exercise