The BMI-unadjusted association between moderate-intensity physical activity and diabetes risk was significantly stronger for female (RR 0.58 ) than for male (0.82 ) cohorts ( P = 0.04). We also evaluated potential differences by sex. For the BMI-adjusted RRs, the P values for difference by region was 0.07 before and 0.75 after exclusion of the study by Okada et al. studies was 0.66 (0.54–0.80) and the P value for difference by region 0.96. After excluding the study by Okada et al. We conducted a metaregression analysis for the association between moderate-intensity physical activity and did not find significant differences in results between U.S. ( 17), no inverse association was observed, but this may have been due to the moderate-intensity activity definition that was restricted to weekends, included relatively light-intensity activities, and did not consider duration. The inverse association between moderately intense physical activity and type 2 diabetes was observed in populations from the U.S., Finland, and the U.K. and Europe.ĬONCLUSIONS-These findings indicate that adherence to recommendations to participate in physical activities of moderate intensity such as brisk walking can substantially reduce the risk of type 2 diabetes. Similar associations were observed in men and women and in the U.S. The associations remained significant after adjustment for BMI. Similarly, the RR was 0.70 (0.58–0.84) for regular walking (typically ≥2.5 h/week brisk walking) as compared with almost no walking. The summary RR of type 2 diabetes was 0.69 (95% CI 0.58–0.83) for regular participation in physical activity of moderate intensity as compared with being sedentary. Five of these studies specifically investigated the role of walking. RESULTS-We identified 10 prospective cohort studies of physical activity of moderate intensity and type 2 diabetes, including a total of 301,221 participants and 9,367 incident cases. We calculated summary relative risks (RRs) using a random-effects model for the highest versus the lowest reported duration of activities. Information on study design, participant characteristics, assessment of physical activity, and outcomes and estimates of associations were extracted independently by two investigators. We excluded studies that did not assess physical activity of moderate intensity independent of activities of vigorous intensity (more than six times the resting metabolic rate). RESEARCH DESIGN AND METHODS-We searched EMBASE and Medline through March 2006 and examined reference lists of retrieved articles. OBJECTIVE-To systematically evaluate the evidence for an association between physical activity of moderate intensity and risk of type 2 diabetes.
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