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Physical activity and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis

Abstract

We investigated the association between specific types of physical activity and the risk of type 2 diabetes in a systematic review and meta-analysis of published studies. PubMed, Embase and Ovid databases were searched for prospective studies and randomized trials up to 2nd of March 2015. Summary relative risks (RRs) were calculated using a random effects model. Eighty-one studies were included. The summary RRs for high versus low activity were 0.65 (95 % CI 0.59–0.71, I2 = 18 %, n = 14) for total physical activity, 0.74 (95 % CI 0.70–0.79, I2 = 84 %, n = 55) for leisure-time activity, 0.61 (95 % CI 0.51–0.74, I2 = 73 %, n = 8) for vigorous activity, 0.68 (95 % CI 0.52–0.90, I2 = 93 %, n = 5) for moderate activity, 0.66 (95 % CI 0.47–0.94, I2 = 47 %, n = 4) for low intensity activity, and 0.85 (95 % CI 0.79–0.91, I2 = 0 %, n = 7) for walking. Inverse associations were also observed for increasing activity over time, resistance exercise, occupational activity and for cardiorespiratory fitness. Nonlinear relations were observed for leisure-time activity, vigorous activity, walking and resistance exercise (p nonlinearity < 0.0001 for all), with steeper reductions in type 2 diabetes risk at low activity levels than high activity levels. This meta-analysis provides strong evidence for an inverse association between physical activity and risk of type 2 diabetes, which may partly be mediated by reduced adiposity. All subtypes of physical activity appear to be beneficial. Reductions in risk are observed up to 5–7 h of leisure-time, vigorous or low intensity physical activity per week, but further reductions cannot be excluded beyond this range.

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References

  1. 1.

    Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311–21.

    PubMed  Google Scholar 

  2. 2.

    Burchfiel CM, Sharp DS, Curb JD, Rodriguez BL, Hwang LJ, Marcus EB, Yano K. Physical activity and incidence of diabetes: the Honolulu Heart Program. Am J Epidemiol. 1995;141(4):360–8.

    CAS  PubMed  Google Scholar 

  3. 3.

    Monterrosa AE, Haffner SM, Stern MP, Hazuda HP. Sex difference in lifestyle factors predictive of diabetes in Mexican-Americans. Diabetes Care. 1995;18(4):448–56.

    CAS  PubMed  Google Scholar 

  4. 4.

    Njolstad I, Arnesen E, Lund-Larsen PG. Sex differences in risk factors for clinical diabetes mellitus in a general population: a 12-year follow-up of the Finnmark Study. Am J Epidemiol. 1998;147(1):49–58.

    CAS  PubMed  Google Scholar 

  5. 5.

    Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC, Speizer FE, Manson JE. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA. 1999;282(15):1433–9.

    CAS  PubMed  Google Scholar 

  6. 6.

    Folsom AR, Kushi LH, Hong CP. Physical activity and incident diabetes mellitus in postmenopausal women. Am J Public Health. 2000;90(1):134–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  7. 7.

    Wannamethee SG, Shaper AG, Alberti KG. Physical activity, metabolic factors, and the incidence of coronary heart disease and type 2 diabetes. Arch Intern Med. 2000;160(14):2108–16.

    CAS  PubMed  Google Scholar 

  8. 8.

    Kriska AM, Saremi A, Hanson RL, Bennett PH, Kobes S, Williams DE, Knowler WC. Physical activity, obesity, and the incidence of type 2 diabetes in a high-risk population. Am J Epidemiol. 2003;158(7):669–75.

    PubMed  Google Scholar 

  9. 9.

    Nakanishi N, Takatorige T, Suzuki K. Daily life activity and risk of developing impaired fasting glucose or type 2 diabetes in middle-aged Japanese men. Diabetologia. 2004;47(10):1768–75.

    CAS  PubMed  Google Scholar 

  10. 10.

    Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Meigs JB, Bonadonna RC, Muggeo M. Population-based incidence rates and risk factors for type 2 diabetes in white individuals: the Bruneck study. Diabetes. 2004;53(7):1782–9.

    CAS  PubMed  Google Scholar 

  11. 11.

    Hsia J, Wu L, Allen C, Oberman A, Lawson WE, Torrens J, Safford M, Limacher MC, Howard BV. Physical activity and diabetes risk in postmenopausal women. Am J Prev Med. 2005;28(1):19–25.

    PubMed  Google Scholar 

  12. 12.

    Patja K, Jousilahti P, Hu G, Valle T, Qiao Q, Tuomilehto J. Effects of smoking, obesity and physical activity on the risk of type 2 diabetes in middle-aged Finnish men and women. J Intern Med. 2005;258(4):356–62.

    CAS  PubMed  Google Scholar 

  13. 13.

    Jonker JT, De Laet C, Franco OH, Peeters A, Mackenbach J, Nusselder WJ. Physical activity and life expectancy with and without diabetes: life table analysis of the Framingham Heart Study. Diabetes Care. 2006;29(1):38–43.

    PubMed  Google Scholar 

  14. 14.

    Lecomte P, Vol S, Caces E, Born C, Chabrolle C, Lasfargues G, Halimi JM, Tichet J. Five-year predictive factors of type 2 diabetes in men with impaired fasting glucose. Diabetes Metab. 2007;33(2):140–7.

    CAS  PubMed  Google Scholar 

  15. 15.

    Burke V, Zhao Y, Lee AH, Hunter E, Spargo RM, Gracey M, Smith RM, Beilin LJ, Puddey IB. Predictors of type 2 diabetes and diabetes-related hospitalisation in an Australian Aboriginal cohort. Diabetes Res Clin Pract. 2007;78(3):360–8.

    PubMed  Google Scholar 

  16. 16.

    Villegas R, Shu XO, Li H, Yang G, Matthews CE, Leitzmann M, Li Q, Cai H, Gao YT, Zheng W. Physical activity and the incidence of type 2 diabetes in the Shanghai women’s health study. Int J Epidemiol. 2006;35(6):1553–62.

    PubMed  Google Scholar 

  17. 17.

    Siegel LC, Sesso HD, Bowman TS, Lee IM, Manson JE, Gaziano JM. Physical activity, body mass index, and diabetes risk in men: a prospective study. Am J Med. 2009;122(12):1115–21.

    PubMed Central  PubMed  Google Scholar 

  18. 18.

    Fretts AM, Howard BV, Kriska AM, Smith NL, Lumley T, Lee ET, Russell M, Siscovick D. Physical activity and incident diabetes in American Indians: the Strong Heart Study. Am J Epidemiol. 2009;170(5):632–9.

    PubMed Central  PubMed  Google Scholar 

  19. 19.

    Longo-Mbenza B, On'kin JB, Okwe AN, Kabangu NK, Fuele SM. Metabolic syndrome, aging, physical inactivity, and incidence of type 2 diabetes in general African population. Diabetes Vasc Dis Res. 2010;7(1):28–39.

    CAS  Google Scholar 

  20. 20.

    The InterAct Consortium. Physical activity reduces the risk of incident type 2 diabetes in general and in abdominally lean and obese men and women: the EPIC-InterAct Study. Diabetologia. 2012;55(7):1944–52.

    PubMed Central  Google Scholar 

  21. 21.

    Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS Jr. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med. 1991;325(3):147–52.

    CAS  PubMed  Google Scholar 

  22. 22.

    Simonsick EM, Lafferty ME, Phillips CL, Mendes de Leon CF, Kasl SV, Seeman TE, Fillenbaum G, Hebert P, Lemke JH. Risk due to inactivity in physically capable older adults. Am J Public Health. 1993;83(10):1443–50.

    CAS  PubMed Central  PubMed  Google Scholar 

  23. 23.

    Lynch J, Helmrich SP, Lakka TA, Kaplan GA, Cohen RD, Salonen R, Salonen JT. Moderately intense physical activities and high levels of cardiorespiratory fitness reduce the risk of non-insulin-dependent diabetes mellitus in middle-aged men. Arch Intern Med. 1996;156(12):1307–14.

    CAS  PubMed  Google Scholar 

  24. 24.

    Haapanen N, Miilunpalo S, Vuori I, Oja P, Pasanen M. Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women. Int J Epidemiol. 1997;26(4):739–47.

    CAS  PubMed  Google Scholar 

  25. 25.

    Kawakami N, Takatsuka N, Shimizu H, Ishibashi H. Effects of smoking on the incidence of non-insulin-dependent diabetes mellitus. Replication and extension in a Japanese cohort of male employees. Am J Epidemiol. 1997;145(2):103–9.

    CAS  PubMed  Google Scholar 

  26. 26.

    Okada K, Hayashi T, Tsumura K, Suematsu C, Endo G, Fujii S. Leisure-time physical activity at weekends and the risk of Type 2 diabetes mellitus in Japanese men: the Osaka Health Survey. Diabet Med. 2000;17(1):53–8.

    CAS  PubMed  Google Scholar 

  27. 27.

    Hu FB, Leitzmann MF, Stampfer MJ, Colditz GA, Willett WC, Rimm EB. Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men. Arch Intern Med. 2001;161(12):1542–8.

    CAS  PubMed  Google Scholar 

  28. 28.

    Hu G, Qiao Q, Silventoinen K, Eriksson JG, Jousilahti P, Lindstrom J, Valle TT, Nissinen A, Tuomilehto J. Occupational, commuting, and leisure-time physical activity in relation to risk for type 2 diabetes in middle-aged Finnish men and women. Diabetologia. 2003;46(3):322–9.

    CAS  PubMed  Google Scholar 

  29. 29.

    Weinstein AR, Sesso HD, Lee IM, Cook NR, Manson JE, Buring JE, Gaziano JM. Relationship of physical activity vs body mass index with type 2 diabetes in women. JAMA. 2004;292(10):1188–94.

    CAS  PubMed  Google Scholar 

  30. 30.

    Dotevall A, Johansson S, Wilhelmsen L, Rosengren A. Increased levels of triglycerides, BMI and blood pressure and low physical activity increase the risk of diabetes in Swedish women. A prospective 18-year follow-up of the BEDA study. Diabet Med. 2004;21(6):615–22.

    CAS  PubMed  Google Scholar 

  31. 31.

    Kumari M, Head J, Marmot M. Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II study. Arch Intern Med. 2004;164(17):1873–80.

    PubMed  Google Scholar 

  32. 32.

    Nilsson PM, Roost M, Engstrom G, Hedblad B, Berglund G. Incidence of diabetes in middle-aged men is related to sleep disturbances. Diabetes Care. 2004;27(10):2464–9.

    PubMed  Google Scholar 

  33. 33.

    Waki K, Noda M, Sasaki S, Matsumura Y, Takahashi Y, Isogawa A, Ohashi Y, Kadowaki T, Tsugane S. Alcohol consumption and other risk factors for self-reported diabetes among middle-aged Japanese: a population-based prospective study in the JPHC study cohort I. Diabet Med. 2005;22(3):323–31.

    CAS  PubMed  Google Scholar 

  34. 34.

    Meisinger C, Lowel H, Thorand B, Doring A. Leisure time physical activity and the risk of type 2 diabetes in men and women from the general population. The MONICA/KORA Augsburg Cohort Study. Diabetologia. 2005;48(1):27–34.

    CAS  PubMed  Google Scholar 

  35. 35.

    Onat A, Hergenc G, Kucukdurmaz Z, Bulur S, Kaya Z, Can G. Prospective evidence for physical activity protecting Turkish adults from metabolic disorders. Arch Turk Soc Cardiol. 2007;35(8):467–74.

    Google Scholar 

  36. 36.

    Rana JS, Li TY, Manson JE, Hu FB. Adiposity compared with physical inactivity and risk of type 2 diabetes in women. Diabetes Care. 2007;30(1):53–8.

    PubMed  Google Scholar 

  37. 37.

    Sato KK, Hayashi T, Kambe H, Nakamura Y, Harita N, Endo G, Yoneda T. Walking to work is an independent predictor of incidence of type 2 diabetes in Japanese men: the Kansai Healthcare Study. Diabetes Care. 2007;30(9):2296–8.

    PubMed  Google Scholar 

  38. 38.

    Lucke J, Waters B, Hockey R, Spallek M, Gibson R, Byles J, Dobson A. Trends in women’s risk factors and chronic conditions: findings from the Australian Longitudinal Study on Women’s Health. Womens Health (Lond Engl). 2007;3(4):423–32.

    Google Scholar 

  39. 39.

    Holme I, Tonstad S, Sogaard AJ, Larsen PG, Haheim LL. Leisure time physical activity in middle age predicts the metabolic syndrome in old age: results of a 28-year follow-up of men in the Oslo study. BMC Public Health. 2007;7:154.

    PubMed Central  PubMed  Google Scholar 

  40. 40.

    Carlsson S, Midthjell K, Tesfamarian MY, Grill V. Age, overweight and physical inactivity increase the risk of latent autoimmune diabetes in adults: results from the Nord-Trondelag health study. Diabetologia. 2007;50(1):55–8.

    CAS  PubMed  Google Scholar 

  41. 41.

    Schulze MB, Hoffmann K, Boeing H, Linseisen J, Rohrmann S, Mohlig M, Pfeiffer AF, Spranger J, Thamer C, Haring HU, Fritsche A, Joost HG. An accurate risk score based on anthropometric, dietary, and lifestyle factors to predict the development of type 2 diabetes. Diabetes Care. 2007;30(3):510–5.

    PubMed  Google Scholar 

  42. 42.

    Katzmarzyk PT, Craig CL, Gauvin L. Adiposity, physical fitness and incident diabetes: the physical activity longitudinal study. Diabetologia. 2007;50(3):538–44.

    CAS  PubMed  Google Scholar 

  43. 43.

    Magliano DJ, Barr EL, Zimmet PZ, Cameron AJ, Dunstan DW, Colagiuri S, Jolley D, Owen N, Phillips P, Tapp RJ, Welborn TA, Shaw JE. Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian diabetes, obesity and lifestyle study. Diabetes Care. 2008;31(2):267–72.

    PubMed  Google Scholar 

  44. 44.

    Montgomery MP, Kamel F, Saldana TM, Alavanja MC, Sandler DP. Incident diabetes and pesticide exposure among licensed pesticide applicators: Agricultural Health Study, 1993–2003. Am J Epidemiol. 2008;167(10):1235–46.

    CAS  PubMed Central  PubMed  Google Scholar 

  45. 45.

    Mozaffarian D, Kamineni A, Carnethon M, Djousse L, Mukamal KJ, Siscovick D. Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med. 2009;169(8):798–807.

    PubMed Central  PubMed  Google Scholar 

  46. 46.

    Chien KL, Chen MF, Hsu HC, Su TC, Lee YT. Sports activity and risk of type 2 diabetes in Chinese. Diabetes Res Clin Pract. 2009;84(3):311–8.

    PubMed  Google Scholar 

  47. 47.

    Engberg S, Glumer C, Witte DR, Jorgensen T, Borch-Johnsen K. Differential relationship between physical activity and progression to diabetes by glucose tolerance status: the Inter99 Study. Diabetologia. 2010;53(1):70–8.

    CAS  PubMed  Google Scholar 

  48. 48.

    Sun F, Tao Q, Zhan S. An accurate risk score for estimation 5-year risk of type 2 diabetes based on a health screening population in Taiwan. Diabetes Res Clin Pract. 2009;85(2):228–34.

    PubMed  Google Scholar 

  49. 49.

    Rathmann W, Strassburger K, Heier M, Holle R, Thorand B, Giani G, Meisinger C. Incidence of Type 2 diabetes in the elderly German population and the effect of clinical and lifestyle risk factors: KORA S4/F4 cohort study. Diabet Med. 2009;26(12):1212–9.

    CAS  PubMed  Google Scholar 

  50. 50.

    Sieverdes JC, Sui X, Lee DC, Church TS, McClain A, Hand GA, Blair SN. Physical activity, cardiorespiratory fitness and the incidence of type 2 diabetes in a prospective study of men. Br J Sports Med. 2010;44(4):238–44.

    PubMed  Google Scholar 

  51. 51.

    Joseph J, Svartberg J, Njolstad I, Schirmer H. Incidence of and risk factors for type-2 diabetes in a general population: the Tromso Study. Scand J Public Health. 2010;38(7):768–75.

    PubMed  Google Scholar 

  52. 52.

    Laaksonen MA, Knekt P, Rissanen H, Harkanen T, Virtala E, Marniemi J, Aromaa A, Heliovaara M, Reunanen A. The relative importance of modifiable potential risk factors of type 2 diabetes: a meta-analysis of two cohorts. Eur J Epidemiol. 2010;25(2):115–24.

    PubMed  Google Scholar 

  53. 53.

    Waller K, Kaprio J, Lehtovirta M, Silventoinen K, Koskenvuo M, Kujala UM. Leisure-time physical activity and type 2 diabetes during a 28 year follow-up in twins. Diabetologia. 2010;53(12):2531–7.

    CAS  PubMed  Google Scholar 

  54. 54.

    Pronk NP, Lowry M, Kottke TE, Austin E, Gallagher J, Katz A. The association between optimal lifestyle adherence and short-term incidence of chronic conditions among employees. Popul Health Manag. 2010;13(6):289–95.

    PubMed  Google Scholar 

  55. 55.

    Shirom A, Toker S, Jacobson O, Balicer RD. Feeling vigorous and the risks of all-cause mortality, ischemic heart disease, and diabetes: a 20-year follow-up of healthy employees. Psychosom Med. 2010;72(8):727–33.

    PubMed  Google Scholar 

  56. 56.

    Reis JP, Loria CM, Sorlie PD, Park Y, Hollenbeck A, Schatzkin A. Lifestyle factors and risk for new-onset diabetes: a population-based cohort study. Ann Intern Med. 2011;155(5):292–9.

    PubMed Central  PubMed  Google Scholar 

  57. 57.

    Xu F, Wang Y, Ware RS, Tse LA, Dunstan DW, Liang Y, Wang Z, Hong X, Owen N. Physical activity, family history of diabetes and risk of developing hyperglycaemia and diabetes among adults in Mainland China. Diabet Med. 2012;29(5):593–9.

    CAS  PubMed  Google Scholar 

  58. 58.

    Doi Y, Ninomiya T, Hata J, Hirakawa Y, Mukai N, Iwase M, Kiyohara Y. Two risk score models for predicting incident type 2 diabetes in Japan. Diabet Med. 2012;29(1):107–14.

    CAS  PubMed  Google Scholar 

  59. 59.

    Jee SH, Foong AW, Hur NW, Samet JM. Smoking and risk for diabetes incidence and mortality in Korean men and women. Diabetes Care. 2010;33(12):2567–72.

    PubMed Central  PubMed  Google Scholar 

  60. 60.

    Demakakos P, Hamer M, Stamatakis E, Steptoe A. Low-intensity physical activity is associated with reduced risk of incident type 2 diabetes in older adults: evidence from the English Longitudinal Study of Ageing. Diabetologia. 2010;53(9):1877–85.

    CAS  PubMed  Google Scholar 

  61. 61.

    Grontved A, Rimm EB, Willett WC, Andersen LB, Hu FB. A prospective study of weight training and risk of type 2 diabetes mellitus in men. Arch Intern Med. 2012;172(17):1306–12.

    PubMed  Google Scholar 

  62. 62.

    Stringhini S, Tabak AG, Akbaraly TN, Sabia S, Shipley MJ, Marmot MG, Brunner EJ, Batty GD, Bovet P, Kivimaki M. Contribution of modifiable risk factors to social inequalities in type 2 diabetes: prospective Whitehall II cohort study. BMJ. 2012;345:e5452.

    PubMed Central  PubMed  Google Scholar 

  63. 63.

    Jefferis BJ, Whincup PH, Lennon L, Wannamethee SG. Longitudinal associations between changes in physical activity and onset of type 2 diabetes in older British men: the influence of adiposity. Diabetes Care. 2012;35(9):1876–83.

    PubMed Central  PubMed  Google Scholar 

  64. 64.

    Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis. 2013;23(4):292–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  65. 65.

    Lee DC, Park I, Jun TW, Nam BH, Cho SI, Blair SN, Kim YS. Physical activity and body mass index and their associations with the development of type 2 diabetes in korean men. Am J Epidemiol. 2012;176(1):43–51.

    PubMed  Google Scholar 

  66. 66.

    Elwood P, Galante J, Pickering J, Palmer S, Bayer A, Ben-Shlomo Y, Longley M, Gallacher J. Healthy lifestyles reduce the incidence of chronic diseases and dementia: evidence from the caerphilly cohort study. PLoS ONE. 2013;8(12):e81877.

    PubMed Central  PubMed  Google Scholar 

  67. 67.

    Shi L, Shu XO, Li H, Cai H, Liu Q, Zheng W, Xiang YB, Villegas R. Physical activity, smoking, and alcohol consumption in association with incidence of type 2 diabetes among middle-aged and elderly Chinese men. PLoS ONE. 2013;8(11):e77919.

    CAS  PubMed Central  PubMed  Google Scholar 

  68. 68.

    Grontved A, Pan A, Mekary RA, Stampfer M, Willett WC, Manson JE, Hu FB. Muscle-strengthening and conditioning activities and risk of type 2 diabetes: a prospective study in two cohorts of US women. PLoS Med. 2014;11(1):e1001587.

    PubMed Central  PubMed  Google Scholar 

  69. 69.

    Fossum E, Gleim GW, Kjeldsen SE, Kizer JR, Julius S, Devereux RB, Brady WE, Hille DA, Lyle PA, Dahlof B. The effect of baseline physical activity on cardiovascular outcomes and new-onset diabetes in patients treated for hypertension and left ventricular hypertrophy: the LIFE study. J Intern Med. 2007;262(4):439–48.

    CAS  PubMed  Google Scholar 

  70. 70.

    Brouwer BG, van der Graff Y, Soedamah-Muthu SS, Wassink AM, Visseren FL. Leisure-time physical activity and risk of type 2 diabetes in patients with established vascular disease or poorly controlled vascular risk factors. Diabetes Res Clin Pract. 2010;87(3):372–8.

    CAS  PubMed  Google Scholar 

  71. 71.

    Williams PT, Thompson PD. Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction. Arterioscler Thromb Vasc Biol. 2013;33(5):1085–91.

    CAS  PubMed Central  PubMed  Google Scholar 

  72. 72.

    Jacobsen BK, Bonaa KH, Njolstad I. Cardiovascular risk factors, change in risk factors over 7 years, and the risk of clinical diabetes mellitus type 2. The Tromso study. J Clin Epidemiol. 2002;55(7):647–53.

    PubMed  Google Scholar 

  73. 73.

    Rolando L, Byrne DW, McGown PW, Goetzel RZ, Elasy TA, Yarbrough MI. Health risk factor modification predicts incidence of diabetes in an employee population: results of an 8-year longitudinal cohort study. J Occup Environ Med. 2013;55(4):410–5.

    PubMed Central  PubMed  Google Scholar 

  74. 74.

    Manson JE, Rimm EB, Stampfer MJ, Colditz GA, Willett WC, Krolewski AS, Rosner B, Hennekens CH, Speizer FE. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet. 1991;338(8770):774–8.

    CAS  PubMed  Google Scholar 

  75. 75.

    Krishnan S, Rosenberg L, Palmer JR. Physical activity and television watching in relation to risk of type 2 diabetes: the Black Women’s Health Study. Am J Epidemiol. 2009;169(4):428–34.

    PubMed Central  PubMed  Google Scholar 

  76. 76.

    Steinbrecher A, Erber E, Grandinetti A, Nigg C, Kolonel LN, Maskarinec G. Physical activity and risk of type 2 diabetes among Native Hawaiians, Japanese Americans, and Caucasians: the Multiethnic Cohort. J Phys Act Health. 2012;9(5):634–41.

    PubMed Central  PubMed  Google Scholar 

  77. 77.

    Sawada SS, Lee IM, Naito H, Noguchi J, Tsukamoto K, Muto T, Higaki Y, Tanaka H, Blair SN. Long-term trends in cardiorespiratory fitness and the incidence of type 2 diabetes. Diabetes Care. 2010;33(6):1353–7.

    PubMed Central  PubMed  Google Scholar 

  78. 78.

    Sui X, Hooker SP, Lee IM, Church TS, Colabianchi N, Lee CD, Blair SN. A prospective study of cardiorespiratory fitness and risk of type 2 diabetes in women. Diabetes Care. 2008;31(3):550–5.

    PubMed Central  PubMed  Google Scholar 

  79. 79.

    Fan S, Chen J, Huang J, Li Y, Zhao L, Liu X, Li J, Cao J, Yu L, Deng Y, Chen N, Guo D, et al. Physical activity level and incident type 2 diabetes among Chinese adults. Med Sci Sports Exerc. 2015;47(4):751–6.

  80. 80.

    Mehlig K, Skoog I, Waern M, Miao JJ, Lapidus L, Bjorkelund C, Ostling S, Lissner L. Physical activity, weight status, diabetes and dementia: a 34-year follow-up of the population study of women in Gothenburg. Neuroepidemiology. 2014;42(4):252–9.

    PubMed  Google Scholar 

  81. 81.

    Koloverou E, Panagiotakos DB, Pitsavos C, Chrysohoou C, Georgousopoulou EN, Pitaraki E, Metaxa V, Stefanadis C. 10-year incidence of diabetes and associated risk factors in Greece: the ATTICA study (2002–2012). Rev Diabet Stud. 2014;11(2):181–9.

    PubMed  Google Scholar 

  82. 82.

    Tsai AC, Lee SH. Determinants of new-onset diabetes in older adults—results of a national cohort study. Clin Nutr. 2014. doi:10.1016/j.clnu.2014.09.021.

  83. 83.

    Someya Y, Kawai S, Kohmura Y, Aoki K, Daida H. Cardiorespiratory fitness and the incidence of type 2 diabetes: a cohort study of Japanese male athletes. BMC Public Health. 2014;14:493.

    PubMed Central  PubMed  Google Scholar 

  84. 84.

    Kuwahara K, Uehara A, Kurotani K, Pham NM, Nanri A, Yamamoto M, Mizoue T. Association of cardiorespiratory fitness and overweight with risk of type 2 diabetes in Japanese men. PLoS ONE. 2014;9(6):e98508.

    PubMed Central  PubMed  Google Scholar 

  85. 85.

    Radford NB, DeFina LF, Barlow CE, Kerr A, Chakravorty R, Khera A, Levine BD. Effect of fitness on incident diabetes from statin use in primary prevention. Atherosclerosis. 2015;239(1):43–9.

    CAS  PubMed  Google Scholar 

  86. 86.

    Laaksonen DE, Lindstrom J, Lakka TA, Eriksson JG, Niskanen L, Wikstrom K, Aunola S, Keinanen-Kiukaanniemi S, Laakso M, Valle TT, Ilanne-Parikka P, Louheranta A, et al. Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Diabetes. 2005;54(1):158–65.

    CAS  PubMed  Google Scholar 

  87. 87.

    Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, Li H, Li H, Jiang Y, An Y, Shuai Y, Zhang B, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008;371(9626):1783–9.

    PubMed  Google Scholar 

  88. 88.

    Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, Hamalainen H, Harkonen P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368(9548):1673–9.

    PubMed  Google Scholar 

  89. 89.

    Jeon CY, Lokken RP, Hu FB, van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care. 2007;30(3):744–52.

    PubMed  Google Scholar 

  90. 90.

    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.

    CAS  PubMed  Google Scholar 

  91. 91.

    Wells G, Shea B, O’Connell D., Peterson J, Welch V, Losos M, Tugwell P. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 13 Aug 2014.

  92. 92.

    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    CAS  PubMed  Google Scholar 

  93. 93.

    Hamling J, Lee P, Weitkunat R, Ambuhl M. Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med. 2008;27(7):954–70.

    PubMed  Google Scholar 

  94. 94.

    Greenland S, Longnecker MP. Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol. 1992;135(11):1301–9.

    CAS  PubMed  Google Scholar 

  95. 95.

    Aune D, Saugstad OD, Henriksen T, Tonstad S. Physical activity and the risk of preeclampsia: a systematic review and meta-analysis. Epidemiology. 2014;25(3):331–43.

    PubMed  Google Scholar 

  96. 96.

    Nilsen TI, Romundstad PR, Vatten LJ. Recreational physical activity and risk of prostate cancer: a prospective population-based study in Norway (the HUNT study). Int J Cancer. 2006;119(12):2943–7.

    CAS  PubMed  Google Scholar 

  97. 97.

    Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS. 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–81.

    PubMed  Google Scholar 

  98. 98.

    Jackson D, White IR, Thompson SG. Extending DerSimonian and Laird’s methodology to perform multivariate random effects meta-analyses. Stat Med. 2010;29(12):1282–97.

    PubMed  Google Scholar 

  99. 99.

    Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D. Meta-analysis for linear and nonlinear dose–response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175(1):66–73.

    PubMed Central  PubMed  Google Scholar 

  100. 100.

    Royston P. A strategy for modelling the effect of a continuous covariate in medicine and epidemiology. Stat Med. 2000;19(14):1831–47.

    CAS  PubMed  Google Scholar 

  101. 101.

    Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.

    PubMed  Google Scholar 

  102. 102.

    Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    CAS  PubMed Central  PubMed  Google Scholar 

  103. 103.

    Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364(25):2392–404.

    CAS  PubMed Central  PubMed  Google Scholar 

  104. 104.

    Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–7.

    CAS  PubMed  Google Scholar 

  105. 105.

    Rockl KS, Witczak CA, Goodyear LJ. Signaling mechanisms in skeletal muscle: acute responses and chronic adaptations to exercise. IUBMB Life. 2008;60(3):145–53.

    CAS  PubMed Central  PubMed  Google Scholar 

  106. 106.

    Perseghin G, Price TB, Petersen KF, Roden M, Cline GW, Gerow K, Rothman DL, Shulman GI. Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects. N Engl J Med. 1996;335(18):1357–62.

    CAS  PubMed  Google Scholar 

  107. 107.

    Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–67.

    PubMed Central  PubMed  Google Scholar 

  108. 108.

    Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001;286(10):1218–27.

    CAS  PubMed  Google Scholar 

  109. 109.

    Mayer-Davis EJ, D’Agostino R Jr, Karter AJ, Haffner SM, Rewers MJ, Saad M, Bergman RN. Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study. JAMA. 1998;279(9):669–74.

    CAS  PubMed  Google Scholar 

  110. 110.

    Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, Liu PA, Jiang XG, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537–44.

    CAS  PubMed  Google Scholar 

  111. 111.

    WHO. Global recommendations on physical activity for health. Geneva: World Health Organization. 2010.

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Acknowledgments

This project was funded by the Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU). The funding source had no role in the planning of the project, conduct of the analyses, interpretation of the results, or decision to submit the manuscript for publication.

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The authors declare that there is no duality of interest associated with this manuscript.

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Correspondence to Dagfinn Aune.

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Aune, D., Norat, T., Leitzmann, M. et al. Physical activity and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis. Eur J Epidemiol 30, 529–542 (2015). https://doi.org/10.1007/s10654-015-0056-z

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Keywords

  • Physical activity
  • Sports
  • Exercise
  • Walking
  • Type 2 diabetes
  • Systematic review
  • Meta-analysis