Physical activity is a cornerstone in diabetes management; however, evidence synthesis on the association between physical activity and long-term diabetes-related complications is scarce. Researchers from the DZD partner German Diabetes Center have found in a large meta-analysis that exercise is associated with a lower incidence of diabetes-related complications. The results have now been published in Diabetes Care. 

To summarize and evaluate findings on physical activity and diabetes-related complications, the researchers conducted a systematic review and meta-analysis. They included prospective studies investigating the association between physical activity and incidence of and mortality from diabetes-related complications, i.e., cardiovascular disease (CVD), coronary heart disease, cerebrovascular events, heart failure, major adverse cardiovascular events, and microvascular complications such as retinopathy and nephropathy, in individuals with diabetes. Overall, 31 studies published between 1995 and 2021 were included, with examination of populations in the United States, Europe, Asia, and Australia, as well as a cohort from 20 different countries.  

 
Figure: Risk reduction of incidence and mortality of cardiovascular diseases as well as micro-vascular sequelae in persons with diabetes mellitus by physical activity already below WHO recommendation (gray area). Source: Diabetes Care. 2022;45(12):3101-3111. doi:10.2337/dc22-0886 

The results of this review, including its meta-analyses, found moderate certainty of evidence that physical activity was associated with reduced relative risk of cardiovascular disease incidence and mortality, as well as overall microvascular complications, particularly retinopathy. The evaluations showed a dose-response relationship, i.e., as physical activity increased, the risk for diabetes sequelae decreased.  

Dose-response meta-analyses showed that physical activity was associated with lower risk of diabetes-related complications even at lower levels. These results suggest that even a physical activity level below the WHO recommendation reduces the relative risk for diabetes-related complications. 

Original publication: 
Rietz M, Schlesinger S et al. Physical Activity and Risk of Major Diabetes-Related Complications in Individuals With Diabetes: A Systematic Review and MetaAnalysis of Observational Studies  
Diabetes Care 2022;45(12):3101–3111; https://doi.org/10.2337/dc22-0886