Exercise capacity and body mass as predictors of mortality among male veterans with type 2 diabetes
ABSTRACT To demonstrate the relation of exercise capacity and BMI to mortality in a population of male veterans with type 2 diabetes.
After excluding two underweight patients (BMI <18.5 kg/m2), the study population comprised 831 consecutive patients with type 2 diabetes (mean age 61 +/- 9 years) referred for exercise testing for clinical reasons between 1995 and 2006. Exercise capacity was determined from a maximal exercise test and measured in metabolic equivalents (METs). Patients were classified both according to BMI category (18.5-24.9, 25.0-29.9, and > or =30 kg/m2) and by exercise capacity (<5.0 or > or =5.0 maximal METs). The association among exercise capacity, BMI, other clinical variables, and all-cause mortality was assessed by Cox proportional hazards. Study participants were followed for mortality up to 30 June 2006.
During a mean follow-up of 4.8 +/- 3.0 years, 112 patients died, for an average annual mortality rate of 2.2%. Each 1-MET increase in exercise capacity conferred a 10% survival benefit (hazard ratio 0.90 [95% CI 0.82-0.98]; P = 0.01), but BMI was not significantly associated with mortality. After adjustment for age, ethnicity, examination year, BMI, presence of cardiovascular disease (CVD), and CVD risk factors, diabetic patients achieving <5 maximal METs were 70% more likely to die (1.70 [1.13-2.54]) than those achieving > or =5 maximal METs.
There was a strong inverse association between exercise capacity and mortality in this cohort of men with documented diabetes, and this relationship was independent of BMI.
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ABSTRACT: Background The role of structured exercise in improving cardio-metabolic profile and quality of life in patients with type 2 diabetes mellitus (2DM) has been widely demonstrated. Little is known about the effects of an aquatic-based exercise program in patients with 2DM. Objective to evaluate the effects of a supervised aquatic-based exercise program on cardio-metabolic profile, quality of life and physical activity levels in 2DM patients. Design and Setting: Observational study, community pre-post aquatic-based exercise program, primary care intervention Patients Eighteen men diagnosed with 2DM (52.2±9.3 years) Methods and Main Outcome Measurements: Cardio-metabolic profile, quality of life and physical activity levels were assessed before and after 12-weeks of an aquatic-based exercise program Results The results show a significant improvement of cardio-metabolic assessments (VO₂Max:24.1 vs 21.1 ml/kg/min, p<.05; blood pressure:125.4/77 vs 130.7/82.5 mmHg, p<.05; fasting blood glucose:119.6 vs 132.5 mg/dl, p<.05; body mass index:29.9 vs 31.1 Kg/m², p<.005; LDL-Chol:95.2 vs 104.9 mg/dl, p<.05 and diastolic function:E/E’ 9.1 vs 10.1, <.005) and an increase in quality of life and physical activity levels (Sf-36 - Mental component summary:72.3 vs 67, p<.05; PAID:20.1 vs 33.2, p<.005 and energy expenditure in general physical activity (PA:3888.7 vs 1239.5 Kcal/week, p<.05). Conclusions These findings demonstrate that an aquatic-based exercise program produces benefits on the cardiovascular system, metabolic profile and appears to be safe and effective improving quality of life and increasing physical activity levels in 2DM patients.PM&R 09/2014; 7(2). DOI:10.1016/j.pmrj.2014.09.004 · 1.66 Impact Factor
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ABSTRACT: Previous studies have demonstrated that diabetic patients undergoing exercise stress single-photon emission-computed tomography (SPECT) myocardial perfusion imaging (MPI) have significantly lower cardiac events when compared to the diabetic patients undergoing pharmacologic stress SPECT MPI across all perfusion categories. However, there are limited data on the level of exercise achieved during exercise SPECT MPI among diabetic patients and its impact on cardiovascular outcomes.Journal of Nuclear Cardiology 09/2014; 21(6). DOI:10.1007/s12350-014-9986-1 · 2.65 Impact Factor
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ABSTRACT: Background-Mortality risk decreases beyond a certain fitness level. However, precise definition of this threshold is elusive and varies with age. Thus, fitness-related mortality risk assessment is difficult. Methods and Results-We studied 18 102 male veterans (8305 blacks and 8746 whites). All completed an exercise test between 1986 and 2011 with no evidence of ischemia. We defined the peak metabolic equivalents (METs) level associated with no increase in all-cause mortality risk (hazard ratio, 1.0) for the age categories of <50, 50 to 59, 60 to 69, and = 70 years. We used this as the threshold group to form additional age-specific fitness categories based on METs achieved below and above it: least-fit (>2 METs below threshold; n=1692), low-fit (2 METs below threshold; n=4884), moderate-fit (2 METs above threshold; n=4646), fit (2.1-4 METs above threshold; n=1874), and high-fit (>4 METs above threshold; n=1301) categories. Multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality across fitness categories. During follow-up (median=10.8 years), 5102 individuals died. Mortality risk for the cohort and each age category increased for the least-fit and low-fit categories (HR, 1.51; 95% CI, 1.37-1.66; and HR, 1.21; 95% CI, 1.12-1.30, respectively) and decreased for the moderate-fit; fit and high-fit categories (HR, 0.71; 95% CI, 0.65-0.78; HR, 0.63; 95% CI, 0.56-0.78; and HR, 0.49; 95% CI, 0.41-0.58, respectively). The trends were similar for 5- and 10-year mortality risk. Conclusion-We defined age-specific exercise capacity thresholds to guide assessment of mortality risk in individuals undergoing a clinical exercise test.Circulation 06/2014; 130(8). DOI:10.1161/CIRCULATIONAHA.114.009666 · 14.95 Impact Factor