A prospective study of exercise and incidence of diabetes among US male physicians

J. E. Manson, D. M. Nathan, A. S. Krolewski, M. J. Stampfer, W. C. Willett and C. H. Hennekens
Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, Mass.

OBJECTIVE--To examine prospectively the association between regular exercise and the subsequent development of non-insulin-dependent diabetes mellitus (NIDDM). DESIGN--Prospective cohort study including 5 years of follow-up. PARTICIPANTS--21,271 US male physicians participating in the Physicians' Health Study, aged 40 to 84 years and free of diagnosed diabetes mellitus, myocardial infarction, cerebrovascular disease, and cancer at baseline. Morbidity follow-up was 99.7% complete. MAIN OUTCOME MEASURE--Incidence of NIDDM. RESULTS--At baseline, information was obtained about frequency of vigorous exercise and other risk indicators. During 105,141 person-years of follow-up, 285 new cases of NIDDM were reported. The age-adjusted incidence of NIDDM ranged from 369 cases per 100,000 person-years in men who engaged in vigorous exercise less than once weekly to 214 cases per 100,000 person-years in those exercising at least five times per week (P, trend, less than .001). Men who exercised at least once per week had an age-adjusted relative risk (RR) of NIDDM of 0.64 (95% Cl, 0.51 to 0.82; P = .0003) compared with those who exercised less frequently. The age-adjusted RR of NIDDM decreased with increasing frequency of exercise: 0.77 for once weekly, 0.62 for two to four times per week, and 0.58 for five or more times per week (P, trend, .0002). A significant reduction in risk of NIDDM persisted after adjustment for both age and body-mass index: RR, 0.71 (95% Cl, 0.56 to 0.91; P = .006) for at least once per week compared with less than once weekly, and P, trend, .009, for increasing frequency of exercise. Further control for smoking, hypertension, and other coronary risk factors did not materially alter these associations. The inverse relation of exercise to risk of NIDDM was particularly pronounced among overweight men. CONCLUSIONS--Exercise appears to reduce the development of NIDDM even after adjusting for body-mass index. Increased physical activity may be a promising approach to the primary prevention of NIDDM.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Physical Activity for Older Adults at Risk for Alzheimer Disease
Larson
JAMA 2008;300:1077-1079.
FULL TEXT  

Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations
Rosecrans et al.
Health Educ Res 2008;23:272-286.
ABSTRACT | FULL TEXT  

Physical Inactivity Rapidly Induces Insulin Resistance and Microvascular Dysfunction in Healthy Volunteers
Hamburg et al.
Arterioscler. Thromb. Vasc. Bio. 2007;27:2650-2656.
ABSTRACT | FULL TEXT  

Changes in Vigorous Physical Activity and Incident Diabetes in Male Runners
Williams
Diabetes Care 2007;30:2838-2842.
ABSTRACT | FULL TEXT  

The Evidence Is In: Lifestyle Interventions Can Prevent Diabetes
Franz
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:113-121.
ABSTRACT  

Physical Activity of Moderate Intensity and Risk of Type 2 Diabetes: A systematic review
Jeon et al.
Diabetes Care 2007;30:744-752.
ABSTRACT | FULL TEXT  

Diabetes and Risk of Endometrial Cancer: A Population-Based Prospective Cohort Study
Friberg et al.
Cancer Epidemiol. Biomarkers Prev. 2007;16:276-280.
ABSTRACT | FULL TEXT  

Beneficial Associations of Physical Activity With 2-h but Not Fasting Blood Glucose in Australian Adults: The AusDiab Study
Healy et al.
Diabetes Care 2006;29:2598-2604.
ABSTRACT | FULL TEXT  

Physical activity and the incidence of type 2 diabetes in the Shanghai women's health study
Villegas et al.
Int J Epidemiol 2006;35:1553-1562.
ABSTRACT | FULL TEXT  

Physical Activity and Risk of Endometrial Cancer: A Population-Based Prospective Cohort Study
Friberg et al.
Cancer Epidemiol. Biomarkers Prev. 2006;15:2136-2140.
ABSTRACT | FULL TEXT  

Using Activity Monitors to Measure Physical Activity in Free-Living Conditions
Berlin et al.
ptjournal 2006;86:1137-1145.
FULL TEXT  

Promoting Physical Activity in a Low-Income Multiethnic District: Effects of a Community Intervention Study to Reduce Risk Factors for Type 2 Diabetes and Cardiovascular Disease: A community intervention reducing inactivity
Jenum et al.
Diabetes Care 2006;29:1605-1612.
ABSTRACT | FULL TEXT  

Combining Risk Estimates from Observational Studies with Different Exposure Cutpoints: A Meta-analysis on Body Mass Index and Diabetes Type 2
Hartemink et al.
Am J Epidemiol 2006;163:1042-1052.
ABSTRACT | FULL TEXT  

Association of Physical Activity and Body Mass Index With Novel and Traditional Cardiovascular Biomarkers in Women
Mora et al.
JAMA 2006;295:1412-1419.
ABSTRACT | FULL TEXT  

Health benefits of physical activity: the evidence.
Warburton et al.
CMAJ 2006;174:801-809.
ABSTRACT | FULL TEXT  

Physical Activity and Life Expectancy With and Without Diabetes: Life table analysis of the Framingham Heart Study
Jonker et al.
Diabetes Care 2006;29:38-43.
ABSTRACT | FULL TEXT  

Does occupational social class predict coronary heart disease after retirement? A 12-year follow-up study in Sweden
Sundquist et al.
Scand J Public Health 2005;33:447-454.
ABSTRACT  

Effects of Physical Activity on Life Expectancy With Cardiovascular Disease
Franco et al.
Arch Intern Med 2005;165:2355-2360.
ABSTRACT | FULL TEXT  

Rapid Progression From Pre-diabetes to Severely Ill Diabetes While Under "Expert Care": Suggestions for Improved Screening for Disease Progression
Danish and West
Diabetes Spectr. 2005;18:229-239.
ABSTRACT | FULL TEXT  

Prevention of Type 2 Diabetes by Diet and Lifestyle Modification
Bazzano et al.
J. Am. Coll. Nutr. 2005;24:310-319.
ABSTRACT | FULL TEXT  

Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease
Bassuk and Manson
J. Appl. Physiol. 2005;99:1193-1204.
ABSTRACT | FULL TEXT  

Physical activity and diabetes prevention
LaMonte et al.
J. Appl. Physiol. 2005;99:1205-1213.
ABSTRACT | FULL TEXT  

Effect of the Bienestar Health Program on Physical Fitness in Low-Income Mexican American Children
Trevino et al.
Hispanic Journal of Behavioral Sciences 2005;27:120-132.
ABSTRACT  

Effects of exercise and diet on chronic disease
Roberts and Barnard
J. Appl. Physiol. 2005;98:3-30.
ABSTRACT | FULL TEXT  

Effects of Exercise Training on Glucose Homeostasis: The HERITAGE Family Study
Boule et al.
Diabetes Care 2005;28:108-114.
ABSTRACT | FULL TEXT  

Trends in the Prevalence and Ratio of Diagnosed to Undiagnosed Diabetes According to Obesity Levels in the U.S.
Gregg et al.
Diabetes Care 2004;27:2806-2812.
ABSTRACT | FULL TEXT  

Prevention of Type 2 Diabetes: Insulin Resistance and Beta-Cell Function
Chiasson and Rabasa-Lhoret
Diabetes 2004;53:S34-S38.
ABSTRACT | FULL TEXT  

Genetic influence on daily wheel running activity level
Lightfoot et al.
Physiol. Genomics 2004;19:270-276.
ABSTRACT | FULL TEXT  

Physical training may enhance {beta}-cell function in type 2 diabetes
Dela et al.
Am. J. Physiol. Endocrinol. Metab. 2004;287:E1024-E1031.
ABSTRACT | FULL TEXT  

Physical Activity/Exercise and Type 2 Diabetes
Sigal et al.
Diabetes Care 2004;27:2518-2539.
FULL TEXT  

Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women
Schulze et al.
Am. J. Clin. Nutr. 2004;80:348-356.
ABSTRACT | FULL TEXT  

Physical Activity, Body Mass Index, and Risk of Type 2 Diabetes in Patients With Normal or Impaired Glucose Regulation
Hu et al.
Arch Intern Med 2004;164:892-896.
ABSTRACT | FULL TEXT  

Physical Activity, Obesity, and the Incidence of Type 2 Diabetes in a High-Risk Population
Kriska et al.
Am J Epidemiol 2003;158:669-675.
ABSTRACT | FULL TEXT  

Cardiorespiratory Fitness and the Incidence of Type 2 Diabetes: Prospective study of Japanese men
Sawada et al.
Diabetes Care 2003;26:2918-2922.
ABSTRACT | FULL TEXT  

A Quantitative Trait Locus on 7q31 for the Changes in Plasma Insulin in Response to Exercise Training: The HERITAGE Family Study
Lakka et al.
Diabetes 2003;52:1583-1587.
ABSTRACT | FULL TEXT  

Active Lifestyle and Diabetes
Myers et al.
Circulation 2003;107:2392-2394.
FULL TEXT  

Television Watching and Other Sedentary Behaviors in Relation to Risk of Obesity and Type 2 Diabetes Mellitus in Women
Hu et al.
JAMA 2003;289:1785-1791.
ABSTRACT | FULL TEXT  

Physical activity: the evidence of benefit in the prevention of coronary heart disease
Press et al.
QJM 2003;96:245-251.
FULL TEXT  

A stage model for assessing a community-based diabetes prevention program in Sweden
Andersson et al.
HEALTH PROMOT INT 2002;17:317-327.
ABSTRACT | FULL TEXT  

White Paper on the Prevention of Type 2 Diabetes and the Role of the Diabetes Educator
The Diabetes Educator 2002;28:964-971.
 

Exercise Comes of Age: Rationale and Recommendations for a Geriatric Exercise Prescription
Singh
J. Gerontol. A Biol. Sci. Med. Sci. 2002;57:M262-282.
FULL TEXT  

Sex Differences in Risk Factors for Incident Type 2 Diabetes Mellitus: The MONICA Augsburg Cohort Study
Meisinger et al.
Arch Intern Med 2002;162:82-89.
ABSTRACT | FULL TEXT  

Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications
Franz et al.
Diabetes Care 2002;25:148-198.
FULL TEXT  

Potential for the prevention of type 2 diabetes
Eriksson et al.
Br Med Bull 2001;60:183-199.
FULL TEXT  

Insulin, Insulin-Like Growth Factors and Colon Cancer: A Review of the Evidence
Giovannucci
J. Nutr. 2001;131:3109S-3120.
ABSTRACT | FULL TEXT  

Physical Activity and Television Watching in Relation to Risk for Type 2 Diabetes Mellitus in Men
Hu et al.
Arch Intern Med 2001;161:1542-1548.
ABSTRACT | FULL TEXT  

Differential effects of exercise on insulin-signaling gene expression in human skeletal muscle
Wadley et al.
J. Appl. Physiol. 2001;90:436-440.
ABSTRACT | FULL TEXT  

Diabetes Prevention: How About NOW?
Levetan
Clin. Diabetes 2001;19:34-38.
FULL TEXT  

Behavioral Science Research in Diabetes: Lifestyle changes related to obesity, eating behavior, and physical activity
Wing et al.
Diabetes Care 2001;24:117-123.
ABSTRACT | FULL TEXT  

The economic burden of physical inactivity in Canada
Katzmarzyk et al.
CMAJ 2000;163:1435-1440.
ABSTRACT | FULL TEXT  

Methodologic issues in measuring physical activity and physical fitness when evaluating the role of dietary supplements for physically active people
Haskell and Kiernan
Am. J. Clin. Nutr. 2000;72:541S-550.
ABSTRACT | FULL TEXT  

Physical Activity, Metabolic Factors, and the Incidence of Coronary Heart Disease and Type 2 Diabetes
Wannamethee et al.
Arch Intern Med 2000;160:2108-2116.
ABSTRACT | FULL TEXT  

Glucose Intolerance and Physical Inactivity: The Relative Importance of Low Habitual Energy Expenditure and Cardiorespiratory Fitness
Wareham et al.
Am J Epidemiol 2000;152:132-139.
ABSTRACT | FULL TEXT  

Exercise Behavior in a Community Sample With Diabetes: Understanding the Determinants of Exercise Behavioral Change
Plotnikoff et al.
The Diabetes Educator 2000;26:450-459.
 

Waging war on modern chronic diseases: primary prevention through exercise biology
Booth et al.
J. Appl. Physiol. 2000;88:774-787.
ABSTRACT | FULL TEXT  

A prospective study of physical activity and risk of prostate cancer in US physicians
Liu et al.
Int J Epidemiol 2000;29:29-35.
ABSTRACT | FULL TEXT  

Walking Compared With Vigorous Physical Activity and Risk of Type 2 Diabetes in Women: A Prospective Study
Hu et al.
JAMA 1999;282:1433-1439.
ABSTRACT | FULL TEXT  

Genetic and Environmental Influences on Total-Body and Central Abdominal Fat: The Effect of Physical Activity in Female Twins
Samaras et al.
ANN INTERN MED 1999;130:873-882.
ABSTRACT | FULL TEXT  

Body Weight Patterns From 20 to 49 Years of Age and Subsequent Risk for Diabetes Mellitus: The Johns Hopkins Precursors Study
Brancati et al.
Arch Intern Med 1999;159:957-963.
ABSTRACT | FULL TEXT  

The Association between Cardiorespiratory Fitness and Impaired Fasting Glucose and Type 2 Diabetes Mellitus in Men
Wei et al.
ANN INTERN MED 1999;130:89-96.
ABSTRACT | FULL TEXT  

Intensity and Amount of Physical Activity in Relation to Insulin Sensitivity: The Insulin Resistance Atherosclerosis Study
Mayer-Davis et al.
JAMA 1998;279:669-674.
ABSTRACT | FULL TEXT  

Exercise regulation of glucose transport in skeletal muscle
Hayashi et al.
Am. J. Physiol. Endocrinol. Metab. 1997;273:E1039-E1051.
ABSTRACT | FULL TEXT  

Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men
Perry et al.
BMJ 1995;310:560-564.
ABSTRACT | FULL TEXT