Impact of Physical Activity on Premature Mortality and Cardiovascular Diseases in People with Type 2 Diabetes: A Systematic Review

Abstract

Diabetes mellitus (DM), especially type 2 (T2DM), has reached epidemic proportions globally, representing a significant burden on health systems due to its high prevalence and associated complications. Regular physical activity (PA) has been identified as a key intervention not only for the prevention but also for the management of T2DM, by improving insulin sensitivity, controlling body weight, and reducing cardiovascular risk. This systematic review aimed to analyse in the existing literature, the relationship between different intensities of PA (light, moderate and vigorous) and the risk of premature mortality, as well as the incidence of cardiovascular diseases (CVDs) in people with type 2 diabetes. We sought to determine the minimum, optimal and maximum doses of PA necessary to reduce morbidity and mortality in this population. To this end, an exhaustive search was carried out in three databases: PubMed, Web of Science (WOS) and Cochrane Controlled Register of Trials (CENTRAL). Prospective cohort studies investigating the relationship between physical activity and all-cause mortality, as well as CVD incidence and mortality, were included. Study characteristics and hazard ratios with 95% confidence intervals were extracted and tabulated, and the methodological quality of the studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Of the 11 articles selected, the methodological evaluation indicated that 1 was of "excellent" quality, 6 of "good" quality, and 4 of "fair quality." It was found that a greater amount of physical activity, regardless of its intensity, was inversely associated with mortality and incidence of CVDs. Even moderate to vigorous physical activity, even if it was below international recommendations, was associated with a lower risk. In addition, higher intensity physical activity showed benefits in less time. The optimal dose generally exceeded current physical activity recommendations. No maximum harmful dose was identified. In conclusion, promoting physical activity in people with T2DM is an effective strategy to reduce mortality and the incidence of CVDs. Even PA below the recommendations offers benefits. Physical activity of any intensity reduces these risks, but higher intensity provides greater benefits in less time.