Association of Muscle-Strengthening and Aerobic Physical Activity With All-Cause, Cardiovascular Disease, and Cancer Mortality in U.S. Adults With Diabetes

Abstract Aims To evaluate associations of muscle-strengthening activity (MSA) with all-cause, cardiovascular disease (CVD), and cancer mortality in adults with diabetes, independent of and jointly with moderate-to-vigorous aerobic physical activity (MVPA). Methods This prospective cohort study included 29,609 adults with diabetes free of CVD and cancer from the U.S. National Health Interview Survey 1997-2018 (baseline). MSA and MVPA were derived from standardized questionnaires. Mortality by 2019 was ascertained through linkage to the National Death Index. Cox models were utilized to estimate adjusted hazard ratios (aHRs). Results Over 270,178 person-years, 6,716 all-cause, 1,995 CVD, and 1,202 cancer deaths were documented in the study population (mean age, 55.7 years, 51.6% female). There were U-shaped associations of MSA with all-cause mortality risk, with ≤3 times/week associated with mortality benefits. Compared with no MSA, aHRs of all-cause mortality were 0.72 (95% CI, 0.47-1.10) for MSA <1 time/week, 0.58 (0.44-0.77) for 1 time/week, 0.76 (0.61-0.96) for 2 times/week, 0.80 (0.67-0.96) for 3 times/week, 0.97 (0.65-1.47) for 4-6 times/week, and 0.99 (0.83-1.19) for ≥7 times/week. Nonlinear associations with CVD and cancer mortality were also observed. These associations did not vary by age or sex. Jointly, compared with no MSA and MVPA<150 minutes/week, adults performing MSA≤2 times/week and MVPA≥150 minutes/week had the lowest all-cause and CVD mortality risk. Conclusions For adults with diabetes, performing MSA ≤3 times/week may be associated with lower all-cause, CVD, and cancer mortality risk, independent of MVPA. Jointly performing MSA≤2 times/week and MVPA≥150 minutes/week may confer the lowest all-cause and CVD mortality risk.