Impact of Physical Activity on Cardiometabolic Risk in Type 2 Diabetes

woman going for a run
Exercise helps cardiovascular and other physical and clinical outcomes in type 2 diabetes, but the amount and intensity of the exercise needed to make a difference is debated.

An increase in moderate- to vigorous-intensity physical activity (MVPA) and a decrease in sedentary-time (SED-time) are associated with improvement in physical fitness and cardiovascular disease (CVD) risk profiles in sedentary patients with type 2 diabetes (T2D), according to a study in Diabetes Care.

Researchers assessed the relationship regarding changes in MVPA and SED-time with clinically meaningful changes in physical fitness and CVD risk factors in patients with type 2 diabetes from the Italian Diabetes and Exercise Study_2 (IDES_2).

Study participants had T2D of at least 1-year duration, were aged 40 to 80 years, and had a body mass index (BMI) of 27 to 40 kg/m2. Additionally, participants had to have led a sedentary lifestyle for at least 6 months prior to the study but still have the ability to walk 1.6 km without assistance. Participants were then randomized 1:1 to either an intervention  group, which received theoretical and practical exercise counseling, or a control  group, which received only general physician recommendations.

A total of 300 participants were enrolled; 150 in the intervention group and 150 in the control group. A total of 267 participants completed the study. Changes in physical fitness and cardiovascular risk factors/scores were assessed according to quartiles of accelerometer-measured changes in physical activity, SED-time, and other factors.

Patients in quartile I of MVPA and SED-time change had a substantial decrease in MVPA and an increase in SED-time (on average, –10.8 min · day–1 and +0.72 h · day–1, respectively), those in quartile II had virtually no change, and those in quartiles III and IV showed modest improvement (on average, +4.0 min · day–1 and –0.60 h · day–1, respectively) and marked (on average, +14.3 min · day–1 and –1.53 h · day–1 , respectively), as noted by the study authors.

In quartile IV of MVPA increase and SED time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL · min–1 · kg–1, and glycated hemoglobin (HbA1C)decreased by 0.73% and 0.85%, respectively.

Univariate analysis showed that changes in MVPA and SED-time correlated significantly with those in physical fitness parameters and in HbA1c, fasting plasma glucose, high-sensitivity C-reactive protein, total and fatal coronary heart disease 10-year risk, BMI and waist circumference (in MVPA changes only), and total stroke 10-year risk score (in SED-time changes only).

The researchers noted that generalizability of their findings would require further investigation and validation. In addition, the trial did not evaluate the impact of changes in MVPA and SED-time on physical fitness and CVD risk factors/scores, and the results might have been affected by unmeasured confounders, such as diet.

“In physically inactive and sedentary patients with type 2 diabetes, even modest increments in MVPA may have a clinically meaningful impact on physical fitness and cardiovascular risk profile, and reallocating SED-time to light-intensity physical activity may also contribute to improve these outcomes, possibly by increasing total energy expenditure,” the investigators wrote.

Disclosure: This work was supported by the Metabolic Fitness Association. Some of the study authors declared affiliations with pharmaceutical companies and with a company that sells equipment and digital technologies for fitness. Please see the original reference for a full list of disclosures.


Balducci S, Haxhi J, Sacchetti M, et al. Relationships of changes in physical activity and sedentary behavior with changes in physical fitness and cardiometabolic risk profile in individuals with type 2 diabetes: the Italian Diabetes and Exercise Study 2 (IDES_2). Diabetes Care. Published online November 2, 2021. doi:10.2337/dc21-1505