OBJECTIVE -To establish the impact of different amounts of increased energy expenditure on type 2 diabetes care.
RESEARCH DESIGN AND METHODS-Post hoc analysis of long-term effects of different amounts of increased energy expenditure (metabolic equivalents [METS] per hour per week) through voluntary aerobic physical activity was performed in 179 type 2 diabetic subjects (age 62 Ϯ 1 years [mean Ϯ SE]) randomized to a physical activity counseling intervention. Subjects were followed for 2 years and divided into six groups based on their increments in METs per hour per week: group 0 (no activity, n ϭ 28), group 1-10 (6.8 Ϯ 0.3, n ϭ 27), group 11-20 (17.1 Ϯ 0.4, n ϭ 31), group 21-30 (27.0 Ϯ 0.5, n ϭ 27), group 31-40 (37.5 Ϯ 0.5, n ϭ 32), and group Ͼ40 (58.3 Ϯ 1.8, n ϭ 34).RESULTS -At baseline, the six groups did not differ for energy expenditure, age, sex, diabetes duration, and all parameters measured. After 2 years, in group 0 and in group 1-10, no parameter changed; in groups [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and Ͼ40, HbA 1c , blood pressure, total serum cholesterol, triglycerides, and estimated percent of 10-year coronary heart disease risk improved (P Ͻ 0.05). In group 21-30, 31-40, and Ͼ40, body weight, waist circumference, heart rate, fasting plasma glucose, serum LDL and HDL cholesterol also improved (P Ͻ 0.05). METs per hour per week correlated positively with changes of HDL cholesterol and negatively with those of other parameters (P Ͻ 0.001). After 2 years, per capita yearly costs of medications increased (P ϭ 0.008) by $393 in group 0, did not significantly change in group 1-10 ($206, P ϭ 0.09), and decreased in group 11-20 (Ϫ$196, P ϭ 0.01), group 21-30 (Ϫ$593, P ϭ 0.009), group 31-40 (Ϫ$660, P ϭ 0.003), and group Ͼ40 (Ϫ$579, P ϭ 0.001).
CONCLUSIONS -Energy expenditure Ͼ10METs ⅐ h Ϫ1 ⅐ week Ϫ1 obtained through aerobic leisure time physical activity is sufficient to achieve health and financial advantages, but full benefits are achieved with energy expenditure Ͼ20 METs ⅐ h Ϫ1 ⅐ week Ϫ1 .
Diabetes Care 28:1295-1302, 2005W estern and developing countries face two serious health problems: the rising prevalence of obesity and diabetes and the fact that people no longer need to be physically active in their daily lives (1-4). Many studies have shown that regular physical activity improves quality of life, reduces the risk of mortality from all causes (1-4), and is particularly advantageous in subjects with impaired glucose tolerance (5,6) or type 2 diabetes (7-12). Physical activity counseling can motivate most diabetic subjects to increase their levels of voluntary energy expenditure (9 -11), but, at present, the relationship between amounts of physical activity and longterm beneficial effects in type 2 diabetes care is unknown. The American Diabetes Association emphasizes the benefits of regular physical activity in the prevention and treatment of type 2 diabetes, referring to proposals given to the general population by...