title: The role of physical activity in chronic kidney disease in the presence of diabetes mellitus: a prospective cohort study.
abstract: OBJECTIVE
  Although the effect of exercise on health is well established, nephrologists seldom consider physical activity in the treatment of chronic kidney disease (CKD) or CKD in the presence of diabetes mellitus (DM/CKD). The aim of the present study was to analyze the benefits of leisure-time physical activity (LTPA) in DM/CKD.
  
  
  METHODS
  A total of 445,075 adult participants who underwent a medical screening program between 1996 and 2008 were prospectively recruited. Of these, 7,863 DM/CKD subjects were identified. Each participant was categorized according to LTPA level (a product of duration and intensity) as inactive, low-active or fully active. Hazard ratios (HRs) for mortality risk were calculated.
  
  
  RESULTS
  Fully active LTPA was associated with lower odds of DM/CKD development and lower risk of mortality among patients with DM/CKD in a dose-response relationship. The fully active and low-active DM/CKD groups had a 26% (HR 0.74, 95% CI 0.66-0.85) and 13% (HR 0.87, 95% CI 0.75-1.01) lower risk of all-cause mortality, respectively, in comparison to the inactive group. The association of exercise with mortality rate reduction was more pronounced among DM/CKD subjects (mortality rate reduction of 446.5 per 100,000 person-years) than among subjects with diabetes alone or CKD alone.
  
  
  CONCLUSIONS
  Exercise, at the recommended level or more, is associated not only with lower odds of DM/CKD but also with a 26% lower mortality risk among DM/CKD patients. Nephrologists should encourage all DM/CKD subjects to be physically active
authors.affiliation: Graduate Institute of Clinical Medical Sciences, China Medical University, Taichung, Taiwan, ROC.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: Min-Kuang
authors.initials: MK
authors.lastname: Tsai
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Liang
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
authors.forename: Sung-Feng
authors.initials: SF
authors.lastname: Wen
authors.forename: Chi-Pang
authors.initials: CP
authors.lastname: Wen
mesh_terms: D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus / Q000401:mortality / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D015444:Exercise; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D012306:Risk; D016138:Walking; D055815:Young Adult