Combating Sloth as Well as Gluttony: The Role of Physical Fitness in Mortality among Men with Type 2 Diabetes

• Physical fitness
• Diabetes mellitus, non-insulin-dependent
• Exercise
• Cardiovascular diseases
• Weight gain

In this issue, Wei and associates (1) report the results of their survey of 1263 men with type 2 diabetes who self-reported their physical activity and were evaluated for physical fitness and cardiovascular risk factors. They found a strong relation between these measures of cardiorespiratory fitness and mortality, which held after statistical correction of baseline differences in traditional cardiovascular risk factors, such as hypertension, hyperlipidemia, smoking, and a personal or familial history of cardiovascular disease. The results are consistent with a previous report on men and women without diabetes (2) and adds to our understanding of the risks of physical inactivity in persons with type 2 diabetes.

As Wei and colleagues point out, their study was a baseline analysis of self-selected, mostly white, men. Persons taking insulin, whose disease is presumably at a more advanced stage, were not included. The least physically fit patients (those in the lowest 20% of the fitness categories) also had the most preexisting risk factors and history of cardiovascular disease. Finally, the study did not examine the benefits, if any, of initiating a program of physical activity.

Notwithstanding these limitations, the study is welcomed because it specifically addresses people with diabetes. In many epidemiologic studies and clinical trials of cardiovascular disease, persons with diabetes have been systematically excluded to simplify analysis of the results, leaving us with the problem of how to apply their results to persons …