How does physical activity affect the occurrence of major diabetes-related complications?

This study evaluated evidence on the association between physical activity and major diabetes-related complications in patients with diabetes. The authors concluded that physical activity was associated with a reduction in the occurrence of major diabetes-related complications, even if performed at levels lower than recommended.

Patients with diabetes are prone to diabetes-related complications. These complications include diseases in which large blood vessels to the heart and brain are affected (macrovascular diseases) or diseases caused by damaged small blood vessels and nerves (microvascular diseases; MVD).

Cardiovascular diseases (CVDs) range from heart disease, heart attacks, strokes (cerebrovascular events), heart failure (HF), irregular heartbeat rhythms to heart valve problems. CVD can result in death. MVD includes coronary heart disease (CHD) caused by damaged walls and inner linings of small coronary artery blood vessels, retinopathy (due to blood vessel damage in the eye’s retina), nephropathy (kidney disease), and neuropathy (nerve damage).

Physical activity has been associated with the prevention of diabetes-related complications. Exercise reduces risk factors that predispose individuals to developing diabetes. At least 150 to 300 minutes of weekly exercise is recommended for patients. However, there is a need to evaluate the relationship between physical activity and the occurrence of diabetes-related complications.

This review included 31 studies with patients with diabetes. Diabetes-related complications under investigation included CVD, CHD, cerebrovascular events, HF, major adverse cardiovascular events (MACE; heart attacks, strokes, and death due to CVC), and MVD.

There was moderate evidence that an increase in high or low levels of physical activity was associated with a decrease in CVD, deaths due to CVD, and microvascular complications. Physical activity levels below the recommendations also reduced the risk of diabetes-related complications.

A high level of physical activity was associated with a 16% lower risk of CVD compared to lower levels of physical activity. A high level of physical activity was associated with a 26% lower risk of cerebrovascular events compared to lower levels of physical activity. A high level of physical activity was associated with a 24% lower risk of HF and an 18% lower risk of MACE compared to lower levels. 

The overall risk of MVD was 24% lower with higher levels of physical activity compared to low. 

The study concluded that physical activity in patients with diabetes was associated with a reduced occurrence of macrovascular and microvascular disease complications even when done below recommended amounts.

The review did not account for socio-economic factors and diabetes duration that would affect the interpretation of the results. Further studies are needed.