The influence of physical activity on vascular complications and mortality in patients with type 2 diabetes mellitus


Correspondence to: Dr Juuso I. Blomster, MD, Ph.D., The George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Road, Sydney, NSW 2050, Australia.




There is limited evidence regarding the association between physical activity and vascular complications, particularly microvascular disease, in patients with type 2 diabetes.


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.


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).


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.