Introduction
Methods
Results
Study | Country; study name | Cohort size | Sex | Age at baseline (years) | Follow-up (years) | % Cumulative incidence (cases/cohort) | PA unit | PA assessment (PA dose in MET h/weeka) | Reported OR/RR/HR (95% CI) | Adjustments |
---|---|---|---|---|---|---|---|---|---|---|
Helmrich et al, 1991 [14] | USA; University of Pennsylvania Alumni | 5990 | M | 39–68 | 14 | 3.4 (202/5990) | Weekly EE for LTPA | Weekly total EE for LTPA in 500 kcal (2092 kJ) increments: • <500 (3.3) • 500–999 (9.5) • 1000–1499 (16.4) • 1500–1999 (23.0) • 2000–2499 (29.5) • 2500–2999 (36.1) • 3000–3499 (42.7) • ≥3000 (49.2) | RR for T2D relative to most inactive group: 1.00 0.94 (0.9, 0.98) 0.79 0.78 0.68 0.90 0.86 0.52 | Age |
Burchfiel et al, 1995 [58] | USA; Honolulu Heart Programb
| 6815 | M | 45–68 | 6 | 5.7 (391/6815) | H/week in each of five activity levels (multiplied by a weight based on mean oxygen consumption required to perform the activities of the category) | Composite score based on 24 h PA dose calculated by summing the hours spent in each activity intensity level and multiplying by a respective weight factor and categorised into quintiles: • 24.1–29.0 (129.9) • 29.1–30.7 (153.3) • 30.8–33.2 (168.0) • 33.3–36.2 (187.3) • 36.3–65.5 (300.3) | OR for T2D relative to most inactive group: 1.00 0.86 (0.64, 1.16) 0.81 (0.60, 1.09) 0.72 (0.53, 1.03) 0.47 (0.33, 0.67) | Age |
Lynch et al, 1996 [13] | Finland; Kuopio Ischaemic Heart Disease Risk Factor Studyb
| 2682 | M | 42–60 | 18 | 23.9 (640/2682) | Frequency/month; intensity was estimated on a scale of 1 (lowest) –3 (highest) | 1 year retrospective leisure time physical activity assessment of 15 common PA types: • low PA (4.1) • PA below an intensity of 5.5 MET but >2 h/week (36.1) • PA (>5.5 MET intensity) >40 min/week (46.7) | PA (>5.5 MET intensity) >40 min/week had an OR of 0.83 (0.63, 1.10) for T2D compared with participants reporting less duration/intensity of PA The OR for T2D observed for PA below an intensity of 5.5 MET but >2 h/week was 0.83 (0.66,1.03) | Age, fasting baseline glucose, serum triacylglycerol, BP, parental history of diabetes, alcohol consumption, BMI |
Haapanen et al, 1997 [36] | Finland; North-Eastern Finnish Adult cohort (I) | 1340 | M | 35–63c
| 10 | 4.8 (64/1340) | LTPA EE/week Frequency of vigorous PA/week | Weekly LTPA EE (kcal) categories for men: • low: 0–1100 (6.8) • moderate: 1101–1900 (18.5) • high: >1900 (28.3) Participants were asked to report average frequency of vigorous activity (≥6 MET) as: • ≥1/week • <1/week | RR for T2D relative to most inactive group: 1.00 1.54 (0.83, 2.84) 1.63 (0.92, 2.88) | Age |
Haapanen et al, 1997 [36] | Finland; North-Eastern Finnish Adult cohort (II) | 1500 | F | 35–63c
| 10 | 3.6 (54/1500) | LTPA EE/week Frequency of vigorous PA/week | Weekly LTPA EE (kcal) categories for women: • low: 0–900 (6.9) • moderate: 901–1500 (18.3) • high: >1500 (25.7) Participants were asked to report average frequency of vigorous activity (≥6 MET) as: • ≥1/week • <1/week | RR for T2D relative to most inactive group: 1.00 2.64 (1.28, 5.44) 2.23 (0.95, 5.23) | Age |
James et al, 1998 [63] | USA; Pitt County Study | 916 | M/F | 25–55 | 5 | 8.5 (78/916) | Physical activity index based on frequency of physical activity enough to work up a sweat and result in heavy breathing Frequency of strenuous work/exercise >20 min at a time | Four categories of LTPA level defined as: • ‘inactive’ = individuals who did not report any strenuous work/exercise, walking, home maintenance or gardening in a week. (0) • ‘low’ = some home maintenance work (>15 min) or gardening during an average week (1.1) • ‘moderate’ = some strenuous work/exercise but not >3 times/week at 20 min/session (4.5) • ‘strenuous’ = strenuous exercise/work >3/week and >20 min at a time (7.9) | OR for T2D relative to most inactive group: 1.00 0.51 (0.20, 1.28) 0.35 (0.12, 0.98) 0.65 (0.26, 1.63) | Age, sex, education, WHR, BMI |
Folsom et al, 2000 [62] | USA; Iowa Women’s Health Study | 34,257 | F | 55–69 | 12 | 5.8 (1997/34,257) | Frequency/week | Initial assessment of any habitual PA (Y/N) Participants reporting regular PA needed to specify frequency of moderate and vigorous PA (>6 MET) which was categorised into quartiles: • rare or never (0) • 1/week–few times/month (3.4) • 2–4/week (10.1) • >4/week (16.9) | RR for T2D relative to most inactive group: 1.00 0.80 (0.71, 0.90) 0.65 (0.58, 0.74) 0.51 (0.43, 0.59) BMI-adjusted RR for T2D relative to most inactive group: 1.00 0.90 (0.79, 1.01) 0.86 (0.76, 0.98) 0.73 (0.62, 0.85) | Age, education, smoking, alcohol intake, oestrogen replacement, energy intake, wholegrain intake, dietary score, family history of diabetes (+ BMI and WHR in further adjusted model) |
Okada et al, 2000 [66] | Japan; Osaka Health Survey | 6013 | M | 35–60 | 10 | 7.4 (444/6013) | Min/week during the week or weekend | Three categories of weekly LTPA: • ‘sedentary’: no regular exercise (0) • ‘moderate’: 1 h/week (5.1) • ‘vigorous’: ≥1 h/week exercise ‘enough to work up a sweat’ (15.2) | RR for T2D relative to most inactive group: 1.00 0.65 (0.45, 0.95) 0.52 (0.35, 0.79) BMI-adjusted RR for T2D relative to most inactive group: 1.00 0.80 (0.71, 0.99) 0.55 (0.34, 0.87) | Age, daily alcohol consumption, smoking habits, BP levels, parental history of T2D (+BMI in the BMI-adjusted model) |
Wannamethee et al, 2000 [69] | UK; British Regional Heart Study | 7735 | M | 40–59 | 16.8 | 2.5 (196/7735) | Weekly frequency of three intensity categories (combined to an overall PA score): (1) regular walking and cycling (2) recreational activity e.g. gardening or pleasure walking (3) sporting activity e.g. running, golf, swimming or tennis | A PA score was calculated depending on dose/type of regular exercise. Scores were categorised into five groups: • ‘inactive/occasional’ (irregular walking or recreational activity) (2.5) • ‘light’ (more frequent recreational activities or exercise <1/week, or regular walking + recreational activity) (3.4) • ‘moderate’ (frequent weekend recreational activities + regular walking, or sporting activity 1/week) (6.8) • ‘moderately vigorous’ (exercise 1/week or frequent cycling + recreational activities or walking or frequent sporting activities) (11.3) • ‘vigorous’ (very frequent exercise, or frequent exercise + recreational activities) (16.9) | RR for T2D relative to most inactive group: 1.00 0.65 (0.42, 1.00) 0.60 (0.38, 0.95) 0.42 (0.24, 0.72) 0.36 (0.21, 0.62) BMI-adjusted RR for T2D relative to most inactive group: 1.00 0.66 (0.42, 1.02) 0.65 (0.41, 1.03) 0.48 (0.28, 0.83) 0.46 (0.27, 0.79) | Age, smoking, alcohol, social class, pre-existing CHD (+BMI in the BMI-adjusted model) |
Hu et al, 2004 [70] | Finland; Eastern and South-Western Finnish adults | 4369 | M/F | 45–64 | 9.4 | 2.8 (120/4369) | Min/week | A simplified index for LTPA scores was derived and reported in three categories: • ‘low’ = light levels of occupational, commuting (<30 min) and inactive LTPA (0) • ‘moderate’ = 1 type of LTPA activity/week (3.4) • ‘high’ = 2 or 3 types of LTPA/week (8.4) | RR for T2D relative to most inactive group: 1.00 0.71 (0.46, 1.12) 0.32 (0.19, 0.56) BMI-adjusted RR for T2D relative to most inactive group: 1.00 0.85 (0.54, 1.34) 0.43 (0.25, 0.74) | Age, study year, sex, systolic BP, smoking, education (+ BMI in BMI-adjusted model) |
Nakanishi et al, 2004 [57] | Japan; Japanese male office worker cohort | 2924 | M | 35–59 | 7 | 5.8 (168/2924) | Daily EE for total PA | Quartiles of daily EE/kg for 20 activities: • <33.1 (119.1) • 33.1–36.7 (244.3) • 36.8–40.3 (269.9) • ≥40.4 (295.0) | RR for T2D relative to most inactive group: 1.00 0.65 (0.45, 0.95) 0.52 (0.35, 0.79) 0.27 (0.16, 0.45) BMI-adjusted RR for T2D relative to most inactive group: 1.00 0.76 (0.52, 1.11) 0.70 (0.46, 1.06) 0.41 (0.24, 0.70) | Age, family history of diabetes, alcohol consumption, cigarette smoking, weekly EE on PA, systolic BP, HDL-cholesterol and triacylglycerol at baseline (+BMI in the BMI-adjusted model) |
Weinstein et al, 2004 [12] | USA; Women’s Health Study | 37,878 | F | 55 | 6.9 | 3.6 (1361/37,878) | LTPA EE/week and min/week walking | EE/week (kcal) for LTPA in categories of: • 0–199 (1.4) • 200–599 (4.1) • 600–1499 (10.3) • >1500 (22.7) | HR for T2D relative to most inactive group: 1.00 0.78 (0.68, 0.90) 0.69 (0.59, 0.80) 0.74 (0.63, 0.88) BMI-adjusted HR for T2D relative to most inactive group: 1.00 0.91 (0.79, 1.06) 0.86 (0.74, 1.01) 0.82 (0.70, 0.97) | Age, family history of diabetes, smoking, alcohol, hormone therapy, hypertension, high cholesterol, dietary factors, randomised treatment group within the Women’s Health Study (+ BMI in the BMI-adjusted model) |
Hsia et al, 2005 [52] | USA; Women’s Health Initiatived
| 87,907 | F | 63.8 | 5.1 | 2.6 (2271/87,907) | MET h/week | Categories of weekly MET h for total physical activity: • 0–2.2 (1.2) • 2.3–7.4 (4.9) • 7.5–13.9 (10.7) • 14.0–23.4 (18.7) • >23.4 (28.1) | RR for T2D relative to most inactive group: 1.00 0.91 (0.80, 1.03) 0.80 (0.70, 0.91) 0.86 (0.75, 0.99) 0.78 (0.67, 0.91) | Age, BMI alcohol, education, smoking, hypertension, hypercholesterolaemia, dietary fibre intake, per cent energy from carbohydrate |
Meisinger et al, 2005 [37] | Germany; MONICA/KORA Augsburg Cohort Study (I) | 4069 | M | 24–75c
| 7.4 | 3.6 (145/4069) | H/week Frequency/season (summer/winter) | Four categories of LTPA defined as: • ‘no activity’ = no sports in summer or winter (0) • ‘low activity’ = irregular, <1 h/week in at least one season (2.3) • ‘moderate’ = regular 1 h/week in at least one season (4.5) • ‘high’ = regular > 2 h/week in both seasons (11.3) | HR for T2D relative to most inactive group: 1.00 0.86 (0.57, 1.29) 0.73 (0.45, 1.20) 0.73 (0.45, 1.20) | Age, survey, actual hypertension, dyslipidaemia, parental history of diabetes, regular smoking, alcohol intake, education, BMI |
Meisinger et al, 2005 [37] | Germany; MONICA/KORA Augsburg Cohort Study (II) | 4034 | F | 24–75c
| 7.4 | 2 (82/4034) | H/week Frequency/season (summer/winter) | Four categories of LTPA defined as: • ‘no activity’ = no sports in summer or winter (0) • ‘low activity’ = irregular, <1 h/week in at least one season (2.3) • ‘moderate’ = regular 1 h/week in at least one season (4.5) • ‘high’ = regular, >2 h/week in both seasons (11.3) | HR for T2D relative to most inactive group: 1.00 0.85 (0.51, 1.41) 0.59 (0.31, 1.11) 0.21 (0.05, 0.86) | Age, survey, actual hypertension, dyslipidaemia, parental history of diabetes, regular smoking, alcohol intake, education, BMI |
Villegas et al, 2006 [47] | China; Shanghai Women’s Health Study | 70,658 | F | 40–70 | 4.6 | 2.8 (1973/70,658) | MET h/day/year | EE for retrospective regular LTPA during previous 5 years in MET h/day/year, DPA (including walking), CPA (bus or vehicle, walking or cycling <30 min/day or 30+ min/day) and EE in OPA (high/medium/low) LTPA h/day: • 0 (0) • <0.8 (3.6) • 0.8–1.99 (11.3) • >1.99 (27.0) | RR for T2D relative to most inactive group: 1.00 0.89 (0.76, 1.03) 0.99 (0.85, 1.15) 0.83 (0.70, 0.97) | Age, daily calories, education level, income level, occupation, smoking, alcohol, hypertension, chronic diseases |
Carlsson et al, 2007 [41] | Sweden; Nord-Trøndelag Health Survey | 38,800 | M/F | ≥20 | 11 | 1.9 (738/38,800) | Exercise frequency ranging from ‘never’ to ‘every day’ | Frequency of weekly LTPA: • never (0) • <1×/week (1.7) • 1×/week (3.4) • 2–3×/week (8.4) • every day (23.6) | RR for T2D relative to most inactive group: 1.00 0.79 (0.64, 0.99) 0.61 (0.48, 0.77) 0.60 (0.48, 0.73) 0.49 (0.37, 0.66) | Sex, smoking, BMI |
Magliano et al, 2008 [40] | Australia; The Australian Diabetes, Obesity and Lifestyle Study | 5842 | M/F | 50.9 | 5 | 3.8 (224/5842) | Total LTPA time derived from sum of the time spent performing MVPA + double the time spent performing VPA in the previous week | Categories of weekly LTPA min/week: • inactive (0 min/week) • insufficient (1–49 min/week) (5.6) • sufficient (≥150 min/week) (14.6) | OR for T2D relative to most inactive group: 1.00 0.97 (0.58, 1.63) 0.64 (0.46, 0.89) Fully-adjusted OR for T2D relative to most inactive group: 1.00 0.86 (0.58, 1.27) 0.50 (0.35, 0.72) | Age, sex, waist circumference, smoking, education, hypertension, family history of diabetes, log FPG, hypertriacylglycerolaemia, low HDL-cholesterol and cholesterol |
Chien et al, 2009 [68] | Taiwan; Chin-Shan community cardiovascular cohort study (CCCC) | 1639 | M/F | >35 | 9.02 | 19 (312/1639) | Sports, occupational and leisure PA frequency was rated on a 5-point Likert scale | Frequency of sports exercise was reported in quartiles corresponding to: • never (0) • rarely (2.3) • sometimes (6.8) • often (16.9) | RR for T2D relative to most inactive group: 1.00 0.83 (0.62, 1.12) 0.70 (0.52, 0.94) 0.74 (0.54, 1.03) BMI-adjusted RR for T2D relative to most inactive group: 1.00 0.82 (0.60, 1.12) 0.65 (0.47, 0.89) 0.68 (0.49, 0.95) | Age, sex, the metabolic syndrome, smoking, current alcohol drinking, marital status, education level, occupation, hypertension status, HDL-cholesterol, triacylglycerols, glucose levels, family history of diabetes, BMI |
Fretts et al, 2009 [46] | USA; The Strong Heart Study | 1651 | M/F | 45–74 | 10 | 27.5 (454/1651) | LTPA MET h/week Total PA MET h/week | LTPA MET h/week: • no activity • <8 MET h/week (3.5) • 8–24 MET h/week (15.3) • >24 MET h/week (64.2) Total PA MET h/week: • no activity • <30 MET h/week • 30–106 MET h/week • >106 MET h/week | OR for T2D relative to most inactive group: 1.00 1.04 (0.74, 1.47) 0.76 (0.55, 1.07) 0.68 (0.49, 0.95) BMI-adjusted RR for T2D relative to most inactive group: 1.00 1.09 (0.76, 1.56) 0.80 (0.56, 1.15) 0.75 (0.53, 1.00) | Age, study site, sex, education, cigarette smoking, alcohol use, family history of diabetes, systolic BP, diastolic BP, HDL-cholesterol, LDL-cholesterol, plasma fibrinogen, BMI |
Krishnan et al, 2009 [64] | USA; Black Women’s Health Study | 45,668 | F | 21–69 | 10 | 6.4 (2928/45,668) | H/week spent on VPA (e.g. running, swimming), walking for exercise and walking to and from work | MVPA was reported in categories of: • 0 h/week (0) • <1 h/week (2.3) • 1–2 h/week (6.8) • 3–4 h/week (15.8) • 5–6 h/week (20.3) • ≥7 h/week (33.8) | RR for T2D relative to most inactive group: 1.00 0.90 (0.82, 0.99) 0.77 (0.69, 0.85) 0.53 (0.45, 0.63) 0.49 (0.38, 0.64) 0.43 (0.31, 0.59) | Age, time period, family history of diabetes, years of education, family income, marital status, cigarette use, alcohol use, energy intake, coffee consumption, television watching, walking |
Siegel et al, 2009 [60] | USA; Physicians Health Study | 20,757 | M | 40–84 | 23.1 | 8.8 (1836/20,757) | Weekly frequency of vigorous exercise ‘enough to work up a sweat’ | Weekly vigorous exercise in number of times/week: • rarely/never (0) • 1–3/month (1.7) • once/week (3.4) • 2–4/week (10.1) • ≥5 times/week (20.3) | RR for T2D relative to most inactive group: 1.00 0.84 (0.72, 0.98) 0.78 (0.68, 0.91) 0.63 (0.55, 0.73) 0.49 (0.41, 0.59) BMI-adjusted RR for T2D relative to most inactive group: 1.00 0.84 (0.72, 0.98) 0.81 (0.70, 0.93) 0.69 (0.61, 0.79) 0.58 (0.48, 0.69) | Age, alcohol use, smoking, history of high cholesterol, history of hypertension (+ BMI in the BMI-adjusted model) |
Demakakos et al, 2010 [71] | UK; English Longitudinal Study of Ageing (ELSA) | 7466 | M/F | 62.9–68.3 | 3.8 | 3.5 (258/7466) | Frequency/week | Frequency of each vigorous, moderate and low intensity PA: • >1/week • 1/week • 1–3/month • Hardly ever/never Combined to a derived summary three-category index: • physical inactivity (0) • low-intensity but not vigorous/moderate-intensity physical activity at least once a week (3.4) • MVPA or VPA at least once a week (7.0) | HR for T2D relative to most inactive group: 1.00 0.76 (0.51, 1.13) 0.49 (0.33, 0.71) BMI-adjusted HR for T2D relative to most inactive group: 1.00 0.83 (0.56, 1.23) 0.57 (0.39, 0.84) | Age, age-squared, sex, marital status, educational attainment, total household wealth (+ BMI in the BMI-adjusted model) |
Ekelund et al, 2012 [39] | Denmark, France, Germany, Italy, Spain, Sweden, UK and the Netherlands; EPIC-InterAct (I) | EPIC total cohort 340,234; InterAct subcohort 15,934; men 6009 | M/F; M/F; M | 51.4–55.4 (mean) | 12.3 | 3.6 (12,403/340,234); 4.9 (778/15,934); 6.5 (391/6009) | Physical activity index (including OPA) | Four category index which incorporates OPA and LTPA: • ‘inactive’ = sedentary job and no LTPA (0) • ‘moderately inactive’ = sedentary job with 0.5 h LTPA/day or standing job with no LTPA (10.0) • ‘moderately active’ = sedentary job with 0.5–1 h LTPA/day or standing job with 0.5 h LTPA/day or physical job with no LTPA (20.0) • ‘active’ = sedentary job with >1 h LTPA or standing job with 0.5 h LTPA or physical job with some LTPA or heavy manual job (33.4) | HR for T2D relative to most inactive group: 1.00 0.89 (0.78, 1.01) 0.73 (0.64, 0.85) 0.69 (0.60, 0.80) | Education, smoking status, alcohol consumption, energy intake, BMI |
Ekelund et al, 2012 [39] | Denmark, France, Germany, Italy, Spain, Sweden, UK and the Netherlands; EPIC-InterAct (II) | EPIC total cohort 340,234; InterAct subcohort 15,934; women 9925 | M/F; M/F; F | 51.4–55.4 (mean) | 12.3 | 3.6 (12,403/340,234); 4.9(778/15,934); 4(397/9925) | Physical activity index (including OPA) | Four category index which incorporates OPA and LTPA: • ‘inactive’ = sedentary job and no LTPA (0) • ‘moderately inactive’ = sedentary job with 0.5 h LTPA/day or standing job with no LTPA (10.0) • ‘moderately active’ = sedentary job with 0.5–1 h LTPA/day or standing job with 0.5 h LTPA/day or physical job with no LTPA (20.0) • ‘active’ = sedentary job with >1 h LTPA or standing job with 0.5 h LTPA or physical job with some LTPA or heavy manual job (33.4) | HR for T2D relative to most inactive group: 1.00 0.93 (0.89, 0.98) 0.89 (0.78, 1.01) 0.79 (0.68, 0.91) | Education, smoking status, alcohol consumption, energy intake, BMI |
Grøntved et al, 2012 [61] | USA; Health Professionals Follow-up Study | 32,002 | M | 44–79 | 18 | 7.1 (2278/32,002) | Aerobic exercise min/week | Total time spent on aerobic exercise of at least moderate intensity (≥3 METs); participants grouped into four categories: • none (0) • 1–59 min (2.0) • 60–149 min (7.3) • ≥150 min (27.0) | RR for T2D relative to most inactive group: 1.00 0.93 (0.81, 1.06) 0.61 (0.60, 0.80) 0.55 (0.42, 0.55) BMI-adjusted RR for T2D relative to most inactive group: 1.00 1.00 (0.88, 1.15) 0.80 (0.69, 0.92) 0.61 (0.53, 0.70) | Age, smoking, alcohol consumption, coffee intake, race, family history of diabetes, total energy, trans fat, polyunsaturated fat to saturated fat ratio, cereal fibre, wholegrain, and glycaemic load, weight, physical activity of at least moderate intensity, TV viewing (+ BMI in the BMI-adjusted model) |
Lee et al, 2012 [67] | South Korea; National Health Insurance Corporation Study | 675,496 | M | 39.4 | 7.5 | 7.9 (52,995/675,496) | Frequency and duration of LTPA that ‘causes sweating’ | Physical activity volume was calculated and participants were classified into four categories: • ‘inactive’ (0 min/week) (0) • ‘low’ (1–149 min/week) (5.6) • ‘medium’ (150–299 min/week) (16.9) • ‘high’ (≥300 min/week) (28.1) | HR for T2D relative to most inactive group: 1.00 0.98 (0.96, 0.99) 0.94 (0.91, 0.96) 0.94 (0.91, 0.97) BMI-adjusted HR for T2D relative to most inactive group: 1.00 0.95 (0.93, 0.97) 0.90 (0.87, 0.93) 0.91 (0.89, 0.94) | Age, smoking status, alcohol intake, hypertension, parental diabetes, baseline glucose (+ BMI in the BMI-adjusted model) |
Steinbrecher et al, 2012 [38] | USA; The Multiethnic Cohort (I) | 35,976 (men) | M | 45–75 | 14 | 12.6 (4527/35,927) | H/week of strenuous sport, vigorous work or moderate activity | Physical activity frequency for strenuous sport was collapsed into four categories: • never (0) • 0.5–1 h/week (3.4) • 2–3 h/week (11.3) • >4 h/week (20.3) | HR for T2D relative to most inactive group: 1.00 0.94 (0.87, 1.02) 0.85 (0.77, 0.94) 0.80 (0.72, 0.88) | Age, ethnicity, education, BMI |
Steinbrecher et al, 2012 [38] | USA; The Multiethnic Cohort (II) | 38,937 (women) | F | 45–75 | 14 | 10.4 (4034/38,937) | H/week of strenuous sport, vigorous work or moderate activity | Physical activity frequency for strenuous sport was collapsed into four categories: • never (0) • 0.5–1 h/week (3.4) • 2–3 h/week (11.3) • >4 h/week (20.3) | HR for T2D relative to most inactive group: 1.00 1.00 (0.91, 1.09) 0.85 (0.75, 0.96) 0.67 (0.57, 0.79) | Age, ethnicity, education, BMI |
Shi et al, 2013 [51] | China; Shanghai Men’s Health Studyd
| 51,464 | M | 54.1 | 5.4 | 2.5 (1304/51,464) | Appraisal of LTPA, DPA and CPA Participants had to indicate whether they had undertaken any LTPA ≥1/week over the preceding 5 years | LTPA volume was reported as four categories of MET h/week/year • none (0) • low (<1.2) (4.2) • medium (1.2–3) (14.7) • high (≥3) (27.3) | HR for T2D relative to most inactive group: 1.00 0.79 (0.65, 0.96) 0.87 (0.72, 1.04) 0.87 (0.75, 1.07) BMI-adjusted HR for T2D relative to most inactive group: 1.00 0.80 (0.65, 0.97) 0.89 (0.74, 1.07) 0.91 (0.76, 1.08) | Age, energy intake, smoking, alcohol consumption, education level, occupation, income level, hypertension, family history of diabetes (+ BMI and WHR in further adjusted model) |
Fan et al, 2014 [59] | China; China Multicenter Collaborative Study of Cardiovascular Epidemiology (China MUCA) and China Cardiovascular Health Study | 6348 | M/F | 49.2 | 7.9 | 7.5 (478/6348) | Physical activity level (PAL) = method to estimate total daily energy expenditure (80) | Average h/day spent in vigorous activity (e.g. jogging), moderate activity (e.g. yard work), light activity (e.g. office work), sedentary activity (e.g. TV) and periods of reclining during the previous 12 months Four PAL categories: • sedentary (PAL 1.00–1.39) (136.2) • low active (PAL 1.40–1.59) (173.0) • active (PAL 1.60–1.89) (202.9) • very active (PAL >1.89) (238.6) | HR for T2D relative to most inactive group: 1.00 0.92 (0.69, 1.22) 0.70 (0.52, 0.93) 0.55 (0.42, 0.73) BMI-adjusted HR for T2D relative to most inactive group: 1.00 0.82 (0.62, 1.09) 0.63 (0.47, 0.83) 0.47 (0.36, 0.61) | Age, sex, geographic region, educational level, cigarette smoking, alcohol consumption, family history of diabetes (+ BMI in the BMI adjusted model) |
Grøntved et al, 2014 [35] | USA; Nurses’ Health Study (2000–2008) (I) | 51,642 | F | 53–81 | 8 | 4.2 (2158/51,642) | MVPA min/week | MVPA defined as brisk walking, jogging, running, bicycling, tennis, swimming, other aerobic exercise, other vigorous exercise and stair climbing (>3 METs) and categorised into quintiles according to average min/week: • none (0) • 1–29 (1.1) • 30–59 (3.4) • 60–150 (7.9) • >150 (14.6) | RR for T2D relative to most inactive group: 1.00 0.84 (0.73, 0.97) 0.76 (0.66, 0.88) 0.68 (0.60, 0.77) 0.48 (0.42, 0.54) BMI-adjusted RR for T2D relative to most inactive group: 1.00 0.94 (0.81, 1.09) 0.88 (0.76, 1.02) 0.85 (0.74, 0.96) 0.66 (0.58, 0.75) | Race, alcohol, weight training, coffee intake, smoking, postmenopausal hormone use, oral contraceptive use, menopausal status, family history of diabetes, total calorie intake, saturated to polyunsaturated fat ratio, trans fat, cereal fibre, wholegrains, glycaemic load (+ BMI in the BMI-adjusted model) |
Grøntved et al, 2014 [35] | USA; Nurses’ Health Study II (2001–2009) (II) | 47,674 | F | 36–55 | 8 | 2.8 (1333/47,674) | MVPA min/week | MVPA defined as brisk walking, jogging, running, bicycling, tennis, swimming, other aerobic exercise, other vigorous exercise, and stair climbing (>3 METs) and categorised into quintiles according to average min/week: • none (0) • 1–29 (1.1) • 30–59 (3.4) • 60–50 (7.9) • >150 (14.6) | RR for T2D relative to most inactive group: 1.00 0.80 (0.67, 0.95) 0.68 (0.57, 0.82) 0.63 (0.54, 0.74) 0.42 (0.36, 0.50) BMI-adjusted RR for T2D relative to most inactive group: 1.00 0.94 (0.79, 1.13) 0.83 (0.69, 1.00) 0.86 (0.73, 1.01) 0.70 (0.59, 0.83) | Race, alcohol, weight training, coffee, smoking, post-menopausal hormone use, oral contraceptive use, menopausal status, family history of diabetes, total calorie intake, saturated to polyunsaturated fat ratio, trans fat, cereal fibre, wholegrains, glycaemic load (+ BMI in the BMI-adjusted model) |
Ding et al, 2015 [42] | Australia; 45 and Up study | 54,997 | M/F | ≥45 | 3.4 | 1.6 (888/54,997) | PA calculated as the sum of time spent in walking, MVPA and VPA (weighted by a factor of two), in the previous week | Total min MVPA/week: • <150 min (5.6) • 150–<300 min (16.9) • ≥300 min (28.1) | OR for T2D relative to most inactive group: 1.00 0.72 (0.56, 0.94) 0.71 (0.85, 0.97) | Age, sex, BMI, SES, health status, BP, blood cholesterol, weight, family history of T2D/heart disease, smoking, alcohol, sitting time, sleep, fruit and vegetable intake, psychological distress |
Characteristic | RR per 10 MET h/week | 95% CI |
I
2 (%) |
p
Het
| Independent observations (n) | Incident cases of type 2 diabetes |
---|---|---|---|---|---|---|
Degree of adjustment | ||||||
Overall pooled estimates | 0.87 | 0.84, 0.89 | 93.5 | <0.001 | 32 | 84,144 |
BMI unadjusted | 0.81 | 0.77, 0.84 | 96.8 | <0.001 | 21 | 70,251 |
BMI adjusted | 0.87 | 0.84, 0.90 | 92.6 | <0.001 | 27 | 80,505 |
Sex | ||||||
M | 0.89 | 0.86, 0.93 | 95.3 | <0.001 | 13 | 11,282 |
F | 0.83 | 0.77, 0.90 | 89.5 | <0.001 | 10 | 16,317 |
M/F | 0.84 | 0.78, 0.91 | 86.9 | <0.001 | 9 | 56,545 |
Follow up | ||||||
< 10 years | 0.92 | 0.90, 0.95 | 86.1 | <0.001 | 16 | 69,849 |
> 10 years | 0.84 | 0.80, 0.89 | 90.6 | <0.001 | 16 | 14,295 |
Location | ||||||
Europe | 0.83 | 0.77, 0.89 | 80.6 | <0.001 | 11 | 55,440 |
N America | 0.85 | 0.79, 0.91 | 96.6 | <0.001 | 13 | 17,074 |
Asia | 0.97 | 0.95, 0.98 | 65.2 | 0.01 | 6 | 10,518 |
Australia | 0.81 | 0.65, 1.01 | 77.1 | 0.04 | 2 | 1112 |
Study quality | ||||||
High (≥7 stars) | 0.93 | 0.90, 0.95 | 82.0 | <0.001 | 17 | 17,131 |
Medium to low | 0.81 | 0.75, 0.88 | 96.2 | <0.001 | 15 | 67,013 |
BMI | ||||||
< 30 kg/m2
| 0.75 | 0.65, 0.95 | 63.1 | 0.01 | 4 | 907 |
> 30 kg/m2
| 0.88 | 0.80, 0.96 | 0.00 | <0.001 | 3 | 1155 |
PA intensity | ||||||
VPA only | 0.44 | 0.23, 0.84 | 0.00 | 0.01 | 2 | 118 |
PA domain | ||||||
Total PA | 0.95 | 0.93, 0.98 | 85.6 | <0.001 | 5 | 1825a
|
LTPA | 0.83 | 0.79, 0.87 | 92.7 | <0.001 | 27 | 82,319 |