Physical activity and incident type 2 diabetes mellitus: a systematic review and dose–response meta-analysis of prospective cohort studiesReport as inadecuate

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, Volume 59, Issue 12, pp 2527–2545

First Online: 17 October 2016Received: 23 May 2016Accepted: 28 July 2016


Aims-hypothesisInverse associations between physical activity PA and type 2 diabetes mellitus are well known. However, the shape of the dose–response relationship is still uncertain. This review synthesises results from longitudinal studies in general populations and uses non-linear models of the association between PA and incident type 2 diabetes.

MethodsA systematic literature search identified 28 prospective studies on leisure-time PA LTPA or total PA and risk of type 2 diabetes. PA exposures were converted into metabolic equivalent of task MET h-week and marginal MET MMET h-week, a measure only considering energy expended above resting metabolic rate. Restricted cubic splines were used to model the exposure–disease relationship.

ResultsOur results suggest an overall non-linear relationship; using the cubic spline model we found a risk reduction of 26% 95% CI 20%, 31% for type 2 diabetes among those who achieved 11.25 MET h-week equivalent to 150 min-week of moderate activity relative to inactive individuals. Achieving twice this amount of PA was associated with a risk reduction of 36% 95% CI 27%, 46%, with further reductions at higher doses 60 MET h-week, risk reduction of 53%. Results for the MMET h-week dose–response curve were similar for moderate intensity PA, but benefits were greater for higher intensity PA and smaller for lower intensity activity.

Conclusions-interpretationHigher levels of LTPA were associated with substantially lower incidence of type 2 diabetes in the general population. The relationship between LTPA and type 2 diabetes was curvilinear; the greatest relative benefits are achieved at low levels of activity, but additional benefits can be realised at exposures considerably higher than those prescribed by public health recommendations.

KeywordsCohort studies Dose–response Meta-analysis Physical activity Systematic review Type 2 diabetes AbbreviationsGLSGeneralised least-squares

LPALow-intensity physical activity

LTPALeisure-time physical activity

METMetabolic equivalent of task

MMETMarginal metabolic equivalent of task

MVPAModerate to vigorous physical activity

NOSNewcastle Ottawa Scale

PAPhysical activity

VPAVigorous physical activity

James Woodcock and Søren Brage contributed equally to this study

Electronic supplementary materialThe online version of this article doi:10.1007-s00125-016-4079-0 contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Author: Andrea D. Smith - Alessio Crippa - James Woodcock - Søren Brage


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