Sustained increase in physical fitness independently predicts improvements in cardiometabolic risk profile in type 2 diabetes

Abstract Aims To investigate the relationship between changes in physical fitness and cardiovascular risk factors and scores in patients with type 2 diabetes receiving either a behavioural counselling intervention to increase moderate‐to‐vigorous‐intensity physical activity (MVPA) and decrease sedentary‐time (SED‐time) or standard care. Materials and Methods This is a pre‐specified ancillary analysis of the Italian Diabetes and Exercise Study_2, a 3‐year randomized clinical trial in which 300 physically inactive and sedentary patients were randomized 1:1 to receive either a one‐month theoretical and practical counselling each year or standard care. Mean changes from baseline throughout the 3‐year period in MVPA, SED‐time, cardiorespiratory fitness (VO 2max ), muscle strength, flexibility, cardiovascular risk factors and scores were calculated for study completers ( n = 267) and considered irrespective of study arm. Results Haemoglobin (Hb) A 1c and coronary heart disease (CHD) risk scores decreased with quartiles of VO 2max and lower body muscle strength changes. Multivariable linear regression analysis showed that increases in VO 2max independently predicted decreases in HbA 1c , blood glucose, diastolic blood pressure (BP), CHD and total stroke 10‐year risk and increases in HDL cholesterol, whereas increases in lower body muscle strength independently predicted decreases in body mass index (BMI), waist circumference, triglycerides, systolic BP, CHD and fatal stroke 10‐year risk. These associations remained after including changes in BMI, waist circumference, fat mass and fat‐free mass, or MVPA and SED‐time as covariates. Conclusions Improvement in physical fitness predicts favourable changes in cardiometabolic risk profile, independent of changes not only in (central) adiposity or body composition but also in MVPA and SED‐time. Trial Registration ClinicalTrials.gov; NCT01600937; URL https://clinicaltrials.gov/ct2/show/NCT01600937 .