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A Prospective Study

Frank B. Hu, MD, PhD; Ronald J. Sigal, MD; Janet W. Rich-Edwards, ScD; Graham A. Colditz, MD, DrPH; Caren G. Solomon, MD, MPH; Walter C. Willett, MD, DrPH; Frank E. Speizer, MD; JoAnn E. Manson, MD, DrPH

JAMA. 1999;282:1433-1439.

Context  Although many studies suggest that physical activity may reduce risk of type 2 diabetes, the role of moderate-intensity activity such as walking is not well understood.

Objectives  To examine the relationship of total physical activity and incidence of type 2 diabetes in women and to compare the benefits of walking vs vigorous activity as predictors of subsequent risk of type 2 diabetes.

Design and Setting  The Nurses' Health Study, a prospective cohort study that included detailed data for physical activity from women surveyed in 11 US states in 1986, with updates in 1988 and 1992.

Participants  A total of 70,102 female nurses aged 40 to 65 years who did not have diabetes, cardiovascular disease, or cancer at baseline (1986).

Main Outcome Measure  Risk of type 2 diabetes by quintile of metabolic equivalent task (MET) score, based on time spent per week on each of 8 common physical activities, including walking.

Results  During 8 years of follow-up (534,928 person-years), we documented 1419 incident cases of type 2 diabetes. After adjusting for age, smoking, alcohol use, history of hypertension, history of high cholesterol level, and other covariates, the relative risks (RRs) of developing type 2 diabetes across quintiles of physical activity (least to most) were 1.0, 0.77, 0.75, 0.62, and 0.54 (P for trend <.001); after adjusting for body mass index (BMI), RRs were 1.0, 0.84, 0.87, 0.77, and 0.74 (P for trend = .002). Among women who did not perform vigorous activity, multivariate RRs of type 2 diabetes across quintiles of MET score for walking were 1.0, 0.91, 0.73, 0.69, and 0.58 (P for trend <.001). After adjusting for BMI, the trend remained statistically significant (RRs were 1.0, 0.95, 0.80, 0.81, 0.74; P for trend = .01). Faster usual walking pace was independently associated with decreased risk. Equivalent energy expenditures from walking and vigorous activity resulted in comparable magnitudes of risk reduction.

Conclusions  Our data suggest that greater physical activity level is associated with substantial reduction in risk of type 2 diabetes, including physical activity of moderate intensity and duration.

Author Affiliations: Departments of Nutrition (Drs Hu and Willett) and Epidemiology (Drs Colditz, Willett, and Manson), Harvard School of Public Health, the Channing Laboratory (Drs Sigal, Colditz, Solomon, Willett, Speizer, and Manson), and the Division of Preventive Medicine (Dr Manson), Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, the Department of Ambulatory Care and Prevention (Dr Rich-Edwards), Harvard Medical School, Boston, Mass; and Clinical Epidemiology Unit, Loeb Health Research Institute, University of Ottawa, Ottawa, Ontario (Dr Sigal).

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