Walking Compared With Vigorous Physical Activity and Risk of Type 2 Diabetes in Women
Authors: Frank B. Hu, Ronald J. Sigal, Janet W. Rich-Edwards, Graham A. Colditz, Caren G. Solomon, Walter C. Willett, Frank E. Speizer, JoAnn E. Manson
Journal: JAMA (1999)

dence suggests that physical activity is associated with reduced risk of type 2 diabetes.In cross-sectional and ecological studies, higher levels of physical activity are associated with lower prevalence of type 2 diabetes. 1,2Populations who migrate to westernized countries with more sedentary lifestyles have greater risks of type 2 diabetes than their counterparts who remain in their native countries. 2Populations undergoing westernization in the absence of migration, such as North American Indians 3 and Western Samoans, 4,5 also have experienced increases in obesity and type 2 diabetes.Such studies must be interpreted with caution, however.In crosssectional studies, it is difficult to establish cause and effect, and in the studies of migrant or westernizing populations, many other factors in addition to physical activity undergo change, including modifications in diet and other lifestyle factors.][8][9][10][11][12][13] Most of these studies, how-ever, did not examine separately the role of moderate-intensity physical activity such as walking vs vigorous activ-Context Although many studies suggest that physical activity may reduce risk of type 2 diabetes, the role of moderate-intensity activity such as walking is not well understood.Objectives To examine the relationship of total physical activity and incidence of type 2 diabetes in women and to compare the benefits of walking vs vigorous activity as predictors of subsequent risk of type 2 diabetes. Design and SettingThe Nurses' Health Study, a prospective cohort study that included detailed data for physical activity from women surveyed in 11 US states in 1986, with updates in 1988 and 1992.Participants A total of 70 102 female nurses aged 40 to 65 years who did not have diabetes, cardiovascular disease, or cancer at baseline (1986).Main Outcome Measure Risk of type 2 diabetes by quintile of metabolic equivalent task (MET) score, based on time spent per week on each of 8 common physical activities, including walking. ResultsDuring 8 years of follow-up (534 928 person-years), we documented 1419 incident cases of type 2 diabetes.After adjusting for age, smoking, alcohol use, history of hypertension, history of high cholesterol level, and other covariates, the relative risks (RRs) of developing type 2 diabetes across quintiles of physical activity (least to most) were 1.0, 0.77, 0.75, 0.62, and 0.54 (P for trend Ͻ.001); after adjusting for body mass index (BMI), RRs were 1.0, 0.84, 0.87, 0.77, and 0.74 (P for trend = .002).Among women who did not perform vigorous activity, multivariate RRs of type 2 diabetes across quintiles of MET score for walking were 1.0, 0.91, 0.73, 0.69, and 0.58 (P for trend Ͻ.001).After adjusting for BMI, the trend remained statistically significant (RRs were 1.0, 0.95, 0.80, 0.81, 0.74; P for trend = .01).Faster usual walking pace was independently associated with decreased risk.Equivalent energy expenditures from walking and vigorous activity resulted in comparable magnitudes of risk reduction.Conclusions Our data suggest that greater physical activity level is associated with substantial reduction in risk of type 2 diabetes, including physical activity of moderate intensity and duration.