Occupational, commuting, and leisure-time physical activity in relation to total and cardiovascular mortality among Finnish subjects with type 2 diabetes.

BACKGROUND Some previous studies have assessed the association between leisure-time physical activity and mortality among patients with diabetes, but the potential effect of occupational and commuting physical activity remains uncertain. METHODS AND RESULTS We prospectively followed up 3316 Finnish participants 25 to 74 years of age with type 2 diabetes. The association of different types of physical activity with mortality was examined with Cox proportional-hazard models. During a mean follow-up of 18.4 years, 1410 deaths were recorded, 903 of which were due to cardiovascular disease (CVD). The multivariate-adjusted (age, sex, study year, body mass index, systolic blood pressure, cholesterol, smoking, and the 2 other types of physical activity) hazard ratios associated with light, moderate, and active work were 1.00, 0.86, and 0.60 (P(trend)<0.001) for total mortality and 1.00, 0.91, and 0.60 (P(trend)<0.001) for CVD mortality, respectively. The multivariate-adjusted hazard ratios associated with low, moderate, and high leisure-time physical activity were 1.00, 0.82, and 0.71 (P(trend)<0.001) for total mortality and 1.00, 0.83, and 0.67 (P(trend)=0.005) for CVD mortality, respectively. Active commuting had significant inverse associations with total and CVD mortality, but these relations were no longer significant after additional adjustment for occupational and leisure-time physical activity. CONCLUSIONS Moderate or high levels of physical activity reduce total and CVD mortality among patients with type 2 diabetes. Not only leisure-time physical activity but also occupational and commuting physical activities are important components of a healthy lifestyle among patients with diabetes.