American Diabetes Association
DC22-0886 Supplement_PA_and_diabetes-related_complications.pdf (2 MB)

Physical activity and risk of major diabetes-related complications in individuals with diabetes: A systematic review and meta-analysis of observational studies

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posted on 2022-12-01, 21:06 authored by Marlene Rietz, Alexander Lehr, Eriselda Mino, Alexander Lang, Edyta Szczerba, Tim Schiemann, Christian Herder, Nina Saatmann, Wolfgang Geidl, Janett Barbaresko, Manuela Neuenschwander, Sabrina Schlesinger


Background: Physical activity is a cornerstone in diabetes management; however, evidence synthesis on the association between physical activity and long-term diabetes-related complications is scarce. 

Purpose: To summarize and evaluate findings on physical activity and diabetes-related complications, a systematic review and meta-analyses were conducted. 

Data Source: We searched PubMed, Web of Science, and the Cochrane library until July 6, 2021. 

Study Selection: We included prospective studies investigating the association between physical activity with incidence of and mortality from diabetes-related complications, i.e., cardiovascular disease (CVD), coronary heart disease, cerebrovascular events, heart failure, major adverse cardiovascular events, and microvascular complications such as retinopathy and nephropathy in individuals with diabetes. 

Data Extraction: Study characteristics and risk ratios (RR) with 95% confidence intervals (CI) were extracted. Random-effects meta-analyses were performed, and the certainty of evidence and risk of bias were evaluated using the GRADE and ROBINS-I approach. 

Data Synthesis: Overall, 31 studies were included. There was moderate certainty of evidence that high vs. low levels of physical activity were inversely associated with CVD incidence, CVD mortality [summary RR (SRR) (95% CI): 0.84 (0.77, 0.92), n=7 and 0.62 (0.55, 0.69), n=11], and microvascular complications [0.76 (0.67, 0.86), n=8]. Dose-response meta-analyses showed that physical activity was associated with lower risk of diabetes-related complications even at low levels. For other outcomes, similar associations were observed, but certainty of evidence was low or very low.

Limitation: Limitations include residual confounding and misclassification of exposure. 

Conclusions: Physical activity, even below recommended amounts, was associated with reduced incidence of diabetes-related complications.  


The German Diabetes Center is funded by the German Federal Ministry of Health (Berlin, Germany) and the Ministry of Culture and Science of the state North Rhine-Westphalia (Düsseldorf, Germany) and receives additional funding from the German Federal Ministry of Education and Research (BMBF) through the German Center for Diabetes Research (DZD e.V.). The funders had no role in study design, data collection, data analysis, data interpretation or writing of the report