Evidence Summary

A prospective observational study published in 2017 investigated the association of physical activity levels with all-cause and cardiovascular mortality in 2,369 patients with type 1 diabetes living in Finland [1]. Using a validated questionnaire, participants self-reported their baseline level of physical activity, including details of exercise intensity, frequency and duration. All patients were included in the follow-up period (mean follow-up time: 11.4 + 3.5 years) through the end of 2014 and 270 deaths were recorded during this time. In 2,099 living patients, baseline leisure time physical activity levels were 17.2 MET-h/week (IQR 6.7-33.8) and in the 270 patients who died baseline leisure physical activity levels were 8.6 MET-h/week (IQR 0.0-26.7). Increased leisure time physical activity (reported at baseline) was associated with a lower risk of premature mortality of all-causes and particularly cardiovascular causes of mortality (p<0.001). All exercise components (intensity, frequency and duration) were associated with reduced mortality rates during follow-up and these findings were unaffected by any adjustment for potential confounders.

310 of 2,639 participants also had chronic kidney disease (CKD – defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2). A total of 127 patients with CKD died during the follow-up period. People with CKD are predicted to be less physically active with lower health and fitness biomarkers compared to people without CKD [2]. However, 30 minutes of moderate-intensity exercise has been recommended as safe for people with CKD [3] and is associated with lower risk of mortality in patients with type 1 diabetes and CKD [1].

Quality of Evidence

B – Moderate.

Strength of Recommendation

1 – Strong recommendation

Conclusion

Exercise is likely to reduce all-cause mortality and cardiovascular mortality in people with type 1 diabetes. Exercise intervention can be recommended to most people, in most circumstances, to help reduce all-cause mortality unless there are compelling reasons to do otherwise.

References

[1] Tikkanen-Dolenc H, Wadén J, Forsblom, C, et al. Physical Activity Reduces Risk of Premature Mortality in Patients With Type 1 Diabetes With and Without Kidney Disease. Diabetes Care 2017;40(12):1727-1732. https://doi.org/10.2337/dc17-0615.

[2] Beddhu S, Baird BC, Zitterkoph J, et al. Physical activity and mortality in chronic kidney disease (NHANES III). Clin J Am Soc Nephrol 2009;4:1901–1906. DOI: 10.2215/CJN.01970309. 

[3] Howden EJ, Coombes JS, Isbel NM. The role of exercise training in the management of chronic kidney disease. Curr Opin Nephrol Hypertens 2015;24:480–487. DOI: 10.1097/MNH.0000000000000165.