Physical activity and cause‐specific mortality in men with Type 2 diabetes/impaired glucose tolerance: evidence from the Whitehall study

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Abstract
AimsGiven that studies of individuals with Type 2 diabetes or impaired glucose tolerance indicate that physical activity has a normalizing effect on several indices of coronary heart disease (CHD) risk—including body weight, blood pressure, blood lipids, and cardiorespiratory fitness—it is plausible that activity may reduce CHD incidence in this group in the long term. The aim of the present analysis was to explore this hypothesis using data from a prospective observational study.MethodsWe examined the relation of two indices of physical activity—walking pace and leisure activity—to total mortality, CHD, and other cardiovascular diseases in a 25‐year follow‐up of 6408 male British Civil Servants who underwent an oral glucose tolerance test at study entry.ResultsIn 352 men who were identified as having Type 2 diabetes or impaired glucose tolerance (diabetes/IGT) at baseline, 215 had died at follow‐up and, in 6056 normoglycaemics, 2550 deaths had occurred. The two indices of physical activity were inversely related to all‐cause, CHD, and other cardiovascular disease mortality in both normoglycaemics and in men with diabetes/IGT. Although these associations were attenuated somewhat after statistical adjustment for a range of covariates, the majority held, suggesting an independent effect for physical activity. The gradient of the activity–mortality association was steeper in individuals with diabetes/IGT in comparison with the normoglycaemics, with the linear trend across activity levels for CHD risk differing markedly in the analyses of both walking pace (P‐value for interaction test = 0.05) and leisure activity (P‐value = 0.02).ConclusionsThe findings of the present analysis of men with Type 2 diabetes/IGT provide support for those from a small number of other studies of persons with Type 2 diabetes suggesting that this group may benefit from physical activity in terms of CHD risk reduction.