In people with a recent diagnosis of type 2 diabetes (T2D) and no prior cardiovascular disease (CVD), self-reported physical activity was independently associated with major adverse cardiac events (MACE) and mortality, new research showed.
“A single question about physical activity could serve as an accessible tool for clinicians to identify patients at higher CVD risk, complementing, but not replacing, existing biomarker-based strategies. The protective association observed even at light physical activity levels further emphasizes that avoiding a sedentary lifestyle has substantial health benefits in this high-risk population,” study author Line Bruun Eriksen, a master’s student in medicine at the Steno Diabetes Centre at Odense University Hospital, Odense, Denmark, told Medscape Medical News.
Eriksen will present the findings with slightly revised numbers on September 16, 2025, at European Association for the Study of Diabetes (EASD) Annual Meeting in Vienna, Austria.
In the prospective cohort study, Eriksen and colleagues analyzed data for 11,355 participants in the Danish Centre for Strategic Research in T2D cohort who responded to the Saltin-Grimby Physical Activity Level Scale during 2010-2023.
Overall, 18% reported being sedentary, 62.5% reported engaging in light physical activity, and 19.5% in moderate-to-vigorous physical activity (MVPA). They were followed until first occurrence of either a MACE, death, emigration, or study end on May 3, 2024. A total of 1671 were excluded due to previous CVD.
Primary outcomes were all cause mortality and MACE including myocardial infarction, ischemic stroke, coronary revascularization, heart failure, and CVD death.
During a median follow-up of 8.4 years, there were 1149 CVD events and 1048 deaths. Higher physical activity levels were inversely associated with both MACE and all-cause mortality. After adjustment for age, sex, year of study enrolment, T2D duration, smoking, alcohol consumption, and waist circumference, participants who engaged in light and MVPA had a 23% and 28% lower risk for MACE, respectively, and a 27% and 33% lower risk for all-cause mortality, respectively, compared with those who were sedentary.
The primary driver of the association was CVD death. After adjustment for CVD risk factors (low-density lipoprotein cholesterol, A1c, systolic blood pressure, estimated glomerular filtration rate, urine albumin-creatinine ratio) that could potentially influence the associations, the hazard ratios for both light physical activity and MVPA remained significant for MACE (0.80 for light; 0.70 for MVPA) and all-cause mortality (0.78 and 0.69, respectively) compared with sedentary individuals.
A somewhat unexpected finding was that the association between physical activity and reduced risk was strongest in adults older than 61.7 years and in women, “which has not been consistently demonstrated before in the T2D population,” Eriksen said.
Furthermore, “our study highlights the clinical relevance of physical activity regardless of body size; both light and MVPA were associated with lower risk of MACE and all-cause mortality, independent of waist circumference,” Eriksen added.
Asked to comment, session moderator Naveed Sattar, MBChB, PhD, professor of cardiometabolic medicine and honorary consultant at the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, told Medscape Medical News that the findings might be affected by unmeasured confounders, such as waist circumference by gender, or triglycerides, and high-density lipoprotein cholesterol.
Nonetheless, Sattar said, “good activity means better muscles, lower fat mass, lower heart rates, and better longer-term health. So even with some caveats, the overall message seems to be to try to help patients consider being more active and to do so, we have to give them realistic messages.”
One such suggestion might be to advise patients to find ways of increasing their walking by 500-1000 steps per day from their average, which means an extra 5-10 minutes of walking per day. “This is realistic and for most achievable, whereas messages like ‘go to the gym or do 150 minutes of activity per week’ are rightly ignored as unachievable for most with diabetes,” Sattar said.
Another tip from Sattar: “Perhaps ask what are the barriers to increasing activity levels….and can we help people overcome those barriers.”
Eriksen had no disclosures. Sattar has consulted for and/or reported receiving speaker honoraria from Abbott Laboratories, AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Carmot Therapeutics, Eli Lilly, GlaxoSmithKline, Hanmi Pharmaceuticals, Menarini-Ricerche, Metsera, Novartis, Novo Nordisk, Pfizer, and Roche; and reported receiving grant support paid to his University from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche.
Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.