Association of Cycling With All-Cause and Cardiovascular Disease Mortality Among Persons With Diabetes

Abstract

IMPORTANCEPremature death from all causes and cardiovascular disease (CVD) causes is higher among persons with diabetes.OBJECTIVE To investigate the association between time spent cycling and all-cause and CVD mortality among persons with diabetes, as well as to evaluate the association between change in time spent cycling and risk of all-cause and CVD mortality. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study included 7459 adults with diabetes from the European Prospective Investigation into Cancer and Nutrition study. Questionnaires regarding medical history, sociodemographic, and lifestyle information were administered in 10 Western European countries from 1992 through 2000 (baseline examination) and at a second examination 5 years after baseline. A total of 5423 participants with diabetes completed both examinations. The final updated primary analysis was conducted on November 13, 2020.EXPOSURES The primary exposure was self-reported time spent cycling per week at the baseline examination. The secondary exposure was change in cycling status from baseline to the second examination. MAIN OUTCOMES AND MEASURESThe primary and secondary outcomes were all-cause and CVD mortality, respectively, adjusted for other physical activity modalities, diabetes duration, and sociodemographic and lifestyle factors. RESULTSOf the 7459 adults with diabetes included in the analysis, the mean (SD) age was 55.9 (7.7) years, and 3924 (52.6%) were female. During 110 944 person-years of follow-up, 1673 deaths from all causes were registered. Compared with the reference group of people who reported no cycling at baseline (0 min/wk), the multivariable-adjusted hazard ratios for all-cause mortality were 0.78 (95% CI, 0.61-0.99), 0.76 (95% CI, 0.65-0.88), 0.68 (95% CI, 0.57-0.82), and 0.76 (95% CI, 0.63-0.91) for cycling 1 to 59, 60 to 149, 150 to 299, and 300 or more min/wk, respectively. In an analysis of change in time spent cycling with 57 802 person-years of follow-up, a total of 975 deaths from all causes were recorded. Compared with people who reported no cycling at both examinations, the multivariable-adjusted hazard ratios for all-cause mortality were 0.90 (95% CI, 0.71-1.14) in those who cycled and then stopped, 0.65 (95% CI, 0.46-0.92) in initial noncyclists who started cycling, and 0.65 (95% CI, 0.53-0.80) for people who reported cycling at both examinations. Similar results were observed for CVD mortality. CONCLUSION AND RELEVANCEIn this cohort study, cycling was associated with lower all-cause and CVD mortality risk among people with diabetes independent of practicing other types of physical activity. Participants who took up cycling between the baseline and second examination had a considerably lower risk of both all-cause and CVD mortality compared with consistent noncyclists.

Association of Cycling With All-Cause and Cardiovascular Disease Mortality Among Persons With Diabetes—Reply

“…We agree with Burtscher and colleagues that participants with diabetes who engage in cycling may be healthier than those with diabetes who do not. This may confound the relationship between cycling and mortality.…”

“…Along with strong experimental evidence showing that cycling elicits health benefits similar to structured exercise in people with overweight or obesity, we have confidence that cycling could contribute directly to a decreased risk of premature mortality. However, as we acknowledge in our article, known and unknown confounding cannot be ruled out in this cohort study …”

“…In Reply We thank Dr Burtscher and colleagues for raising the concern regarding the potential influence of “the healthy worker effect” on the findings of our Original Investigation . The limitation of a possible selection bias of participants able to cycle was also alluded to in the Editor’s Note published alongside our article.…”

Association of Cycling With All-Cause and Cardiovascular Disease Mortality Among Persons With Diabetes

“…To the Editor We read with great interest the Original Investigation recently published in this journal by Dr Ried-Larsen and colleagues . The authors reported decreased mortality from all causes and from cardiovascular diseases associated with cycling in adults with diabetes.…”

Anatomical distribution of mandibular fractures from severe bicycling accidents: A 12‐year experience from a Norwegian level 1 trauma center

“…Bicycling is associated with several health benefits, including reduced all-cause mortality, cancer, and cardiovascular risk. [1][2][3][4] In addition, a shift from motorized travel to active transport such as bicycling, may reduce greenhouse gas emissions. 5 Despite the benefits, bicycle riders are at risk of injuries due to accidents.…”