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The Insulin Resistance Atherosclerosis Study

Elizabeth J. Mayer-Davis, PhD; Ralph D'Agostino, Jr, PhD; Andrew J. Karter, PhD; Steven M. Haffner, MD, MPH; Marian J. Rewers, MD, PhD; Mohammed Saad, MD; Richard N. Bergman, PhD; for the IRAS Investigators

JAMA. 1998;279:669-674.

Context.— Exercise training is associated with improved insulin sensitivity (S_I), but the potential impact of habitual, nonvigorous activity is uncertain.

Objective.— To determine whether habitual, nonvigorous physical activity, as well as vigorous and overall activity, is associated with better S_I.

Design.— A multicultural epidemiologic study.

Setting.— The Insulin Resistance Atherosclerosis Study, conducted in Oakland, Calif; Los Angeles, Calif; the San Luis Valley, Colo; and San Antonio, Tex.

Participants.— A total of 1467 men and women of African American, Hispanic, and non-Hispanic white ethnicity, aged 40 to 69 years, with glucose tolerance ranging from normal to mild non–insulin-dependent diabetes mellitus.

Main Outcome Measure.— Insulin sensitivity as measured by an intravenous glucose tolerance test.

Results.— The mean S_I for individuals who participated in vigorous activity 5 or more times per week was 1.59 min^-1·µU^-1·mL^-1·10^-4 (95% confidence interval [CI], 1.39-1.79) compared with 0.90 (95% CI, 0.83-0.97) for those who rarely or never participated in vigorous activity, after adjusting for potential confounders (P<.001). When habitual physical activity (estimated energy expenditure [EEE]) was assessed by 1-year recall of activities, the correlation coefficient between S_I and total EEE was 0.14 (P<.001). After adjustment for confounders, vigorous and nonvigorous levels of EEE (metabolic equivalent levels 6.0 and <6.0, respectively) were each positively and independently associated with S_I (P.01 for each). The association was attenuated after adjustment for the potential mediators, body mass index (a measure of weight in kilograms divided by the square of the height in meters), and waist-to-hip ratio. Results were similar for subgroups of sex, ethnicity, and diabetes.

Conclusions.— Increased participation in nonvigorous as well as overall and vigorous physical activity was associated with significantly higher S_I. These findings lend further support to current public health recommendations for increased moderate-intensity physical activity on most days.

From the Department of Epidemiology and Biostatistics, School of Public Health, University of South Carolina, Columbia (Dr Mayer-Davis); Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (Dr D'Agostino); Division of Research, Kaiser Permanente, The Permanente Medical Group Inc, Oakland, Calif (Dr Karter); Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio (Dr Haffner); Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver (Dr Rewers); and the Departments of Medicine (Dr Saad) and Physiology and Biophysics (Dr Bergman), University of Southern California Medical Center, Los Angeles.

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