Association between physical exercise and all-cause and CVD mortality in patients with diabetes: an updated systematic review and meta-analysis.

Objectives: Physical activity is recommended in guidelines for treatment for diabetes, but the association between physical activity and mortality among diabetic patients has not been extensively studied. Methods: Databases were searched from inception to July 10, 2020. Prospective studies were selected to evaluate the association between physical activity and risk for total and cardiovascular diseases (CVD) mortality among diabetic patients. Data were pooled using random-effect model to calculate the relative risks (RRs) with 95% confidence intervals (CIs). Results: We included 16 eligible studies involving with 155,203 diabetic participants and 13,821 cases of death. Our study suggested that physical activity in diabetic patients may decrease risk for all-cause (RR 0.57, 95% CI 0.49-0.67) and CVD mortality (RR 0.55, 95% CI 0.34-0.68). The summary RR for CVD events was 0.65 (95% CI 0.41-1.03). Furthermore, the reductions in all-cause mortality were more significant in diabetic patients with old age (> 60 years) (RR 0.46, 95% CI 0.29 -0.75), higher body mass index (BMI ≥ 28) (RR 0.53, 95% CI 0.42-0.69) and shorter duration of diabetes (RR 0.45, 95% CI 0.24-0.84). Conclusion: Physical activity reduced the risk of total and CVD mortality among patients with diabetes, in particular in diabetic patients with old age (> 60 years), obesity and shorter duration of diabetes.