Association of aerobic and muscle-strengthening physical activity with all-cause and cardiovascular disease mortality among adults with type 2 diabetes: A prospective cohort of US adults

Objective To investigate the relationship of moderate physical activity (MPA), vigorous physical activity (VPA), and muscle strengthening activity (MSA), independently and jointly, with all-cause, cardiovascular disease (CVD), and non-CVD mortality in individuals with type 2 diabetes (T2D). Material and methods This cohort study included 47,538 adults with T2D and 561,963 adults without T2D from the National Health Interview Survey 1997–2018 who provided data on self-reported physical activity (PA). Mortality data were obtained from the National Death Index through 2019. Cox regression was used to estimate hazard ratio (HR) and 95% confidence interval (CI). Results: In analyses mutually adjusted, versus no MPA adults with T2D, performing the recommendations of MPA (150–299 min/week) associated with lower all-cause mortality (HR, 0.72; 95% CI, 0.66–0.78), CVD mortality (HR, 0.68; 95% CI, 0.58–0.79), and non-CVD mortality (HR, 0.72; 95% CI, 0.65–0.79). Similar benefits were observed in those meeting recommendations for VPA and MSA. Higher levels of PA beyond current recommendations may provide a few additional benefits without adverse effects on mortality risk, regardless of diabetes onset age, duration of diabetes, and medication status. The joint analysis indicates that combining MSA with aerobic PA could further lower mortality risk, and lowest all-cause mortality was observed among individuals engaging in either 75–150 min/week of VPA and 1 time/week of MSA (HR, 0.30; 95% CI, 0.13–0.70) or 150–299 min/week of MPA and 1 time/week of MSA (HR, 0.33; 95% CI, 0.20–0.55). Conclusion Our study supports the current PA guidelines and suggests that there may be limited benefits gained from exercising beyond recommended levels in adults with T2D, combining recommended levels of aerobic and resistance exercises could yield the greatest benefits.