Daily physical activity and type 2 diabetes: A review

Table 1 Excerpt of various daily physical activities and their associated metabolic equivalents

Daily physical activity	METs
Walking
Very slow, < 3.2 km/h	2
Slow, 3.2-4.0 km/h	2.8-3.0
For pleasure, moderate pace, 4.5-5.1 km/h	3.5
Brisk, 5.6 km/h	4.3
Very brisk, 6.4-7.2 km/h	5.0-7.0
Stair climbing, slow pace	4
Stair climbing, fast pace	8.8
Gardening	3.8
Yard work	3.0-6.0
Mowing lawn	5.5
Shoveling	5.3-7.5
Housework
Washing dishes	1.8-2.5
Cleaning	2.3-3.8
Cooking	2.0-3.0
Child care	2.0-3.0
Elder care	2.3-4.0

Each activity is quoted from Ainsworth et al[15] (2011 Compendium Physical Activities). METs: Metabolic equivalents.

Table 2 Epidemiological studies investigating the associations of walking with the risk of type 2 diabetes, cardiovascular events, and mortality

Ref.	Study design	Subjects	Physical activity measurement	Outcome, results
Hu et al[25]	Prospective cohort study	70102 female participants without diabetes, CVD, or cancer	MET score and walking pace based on a questionnaire	Risk of type 2 diabetes, normal walking pace (3.2-4.8 km/h): RR = 0.72; 95%CI: 0.62-0.85
				Brisk or very brisk walking pace (> 4.8 km/h): RR = 0.41; 95%CI: 0.33-0.52
Tanasescu et al[26]	Prospective cohort study	3058 men with type 2 diabetes	MET-hour score measured by a questionnaire	Mortality, walking ≥ 16.1 MET-hours/week: RR = 0.60; 95%CI: 0.41-0.88
				Very brisk walking pace (≥ 4 mph): RR = 0.42; 95%CI: 0.19-0.97
Gregg et al[27]	Prospective cohort study	2896 subjects with diabetes	Time spent walking measured by a questionnaire	Mortality, walking ≥ 2 h/wk, all-cause mortality: HRR = 0.61; 95%CI: 0.48-0.78; CVD mortality: HRR = 0.66; 95%CI: 0.45-0.96
Yates et al[32]	Prospective data analysis from the NAVIGATOR trial (a multicenter, randomized, placebo controlled, 2 × 2 factorial trial)	9306 individuals with impaired glucose tolerance	Number of steps assessed by a pedometer	Cardiovascular events, baseline ambulatory activity (2000 step/d increment): HR = 0.90; 95%CI: 0.84-0.96 Change in ambulatory activity from baseline to 12 mo (2000 step/d difference in change): HR = 0.92; 95%CI: 0.86-0.99

MET: Metabolic equivalents; RR: Relative risk; HRR: Hazard rate ratio; CVD: Cardiovascular disease; HR: Hazard ratio; NAVIGATOR: Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research.

Table 3 Clinical trials investigating the effects of walking on the risk of type 2 diabetes

Ref.	Study design	Subjects, follow-up time	Intervention	Results
Knowler et al[34]	Randomized clinical trial	3234 individuals with impaired glucose tolerance, 2.8 yr	A minimum of 150 min of physical activity similar intensity to brisk walking and 7% weight loss	58% reduction in the incidence rate of type 2 diabetes
Pan et al[35]	Randomized clinical trial	577 individuals with impaired glucose tolerance, 6 yr	At least 30 min/d of walking	46% reduction in the risk of developing diabetes
Kosaka et al[36]	Randomized clinical trial	458 men with impaired glucose tolerance, 4 yr	Recommendations for physical activity: walking 30-40 min/d, using staircase instead of an elevator or an escalator, 30-min cycling on weekends and getting off one bus stop before the destination	67.4% reduction in the risk of developing diabetes