Original Article
Walking decreased risk of cardiovascular disease mortality in older adults with diabetes

https://doi.org/10.1016/j.jclinepi.2006.06.013Get rights and content

Abstract

Objective

This study examines the association of walking with mortality in persons with type 2 diabetes compared to those with normal glucose tolerance.

Study Design and Setting

This prospective study included community-dwelling adults from the Rancho Bernardo Study aged 50–90 years in 1984–86 who had type 2 diabetes (n = 347) or normal glucose tolerance (n = 1,317). During the 10-year follow up, Cox proportional hazards modeling was used to model time until death from all causes (n = 538), coronary heart disease (CHD, n = 143), other cardiovascular disease (non-CHD CVD, n = 138), and other causes (n = 257) while adjusting for multiple potential confounders.

Results

After adjusting for sex, age, smoking, body mass index, alcohol, exercise, history of CHD, and other covariates, adults with diabetes who walked ≥1 mile per day were half as likely to die from all causes combined (hazard ratio [HR] = 0.54; 95% confidence interval [CI]: 0.33, 0.88), and less than one-fifth as likely to die from non-CHD CVD (HR = 0.19; 95% CI: 0.04, 0.86) compared to adults with diabetes who did not walk. Walking was also protective among adults with normal glucose tolerance (HR = 0.55; 95% CI: 0.32, 0.96).

Conclusion

Results suggest walking ≥1 mile per day may provide strong protection from all-cause and non-CHD CVD mortality in older adults with diabetes.

Introduction

Type 2 diabetes is epidemic, projected to affect 5.4% of the world's adult population by 2025 [1]. This increase is especially alarming because diabetes is a strong risk factor for premature coronary heart disease (CHD) and cardiovascular disease (CVD) mortality [2], [3], [4], [5], [6]. The benefits of regular physical exercise to lower the risk of all-cause CHD and CVD death have been demonstrated [7], [8], [9], [10], [11], with some studies suggesting that even relatively low levels of physical activity, such as regular brisk walking, can lower the risk of CHD and CVD [12], [13]. Exercise has been shown in clinical trials to prevent diabetes [14] and to be of benefit for those who already have diabetes [15], [16], [17], [18], [19], [20], [21], [22], [23]. Some individuals with diabetes may lack the ability to exercise at moderate to strenuous levels but can participate in low stress exercise such as walking. Recently, Gregg et al. [24] reported that walking is associated with lower rates of all-cause mortality and CVD mortality among adults with self-reported diabetes. Such persons could have been prompted to walk after diagnosis of diabetes. The purpose of this study was to examine whether regular walking is associated with all-cause, CHD, and other CVD mortality among older community-dwelling adults with and without known diabetes or previously undiagnosed diabetes identified through an oral glucose tolerance test (OGTT).

Section snippets

Study population

Between 1972 and 1974, 82% of all adult residents of a southern California community, Rancho Bernardo, participated in a study of heart disease risk factors [25]. All were Caucasian, middle class, and community dwelling. They have been followed since initial enrolment with periodic clinic visits and yearly mailed questionnaires. Between 1984 and 1987, 80% of survivors (n = 2,854) who were 40 years of age or older at baseline participated in a follow-up clinic visit [26]. Participants younger than

Results

Of the 1,664 older adults included in this study, 347 (20.9%) had type 2 diabetes, 32% by history, and 68% newly diagnosed by OGTT. The mean age was 73.7 years among those with diabetes and 69.1 years among those with normal glucose tolerance (P-value < 0.0001). As shown in Table 1, slightly more than half were women and 40% were nonwalkers, although 63% of nonwalkers indicated that they exercised >3 times a week. Few participants were current smokers (13%) or reported ≥3 alcoholic drinks per day

Discussion

The prevalence of type 2 diabetes has increased dramatically during the past two decades with further increases predicted and tremendous public health implications [1]. Regular exercise has been recommended to help reduce the cardiovascular complications and mortality among adults with diabetes [15], [16], [17], [18], [19], [20], [21], [22]. Physical activity of moderate intensity and duration has been shown to reduce the risk of developing type 2 diabetes in observational studies and animal

Acknowledgments

This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases Grant DK-31801 and the National Institute on Aging, grant # AG 07181. The authors would also like to thank Ricki Bettencourt, MS, for data management support and Cedric Garland, DrPH, Frank Garland, PhD, and Ed Gorham, PhD, for critical review of the presentation of data.

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