Objectives: Physical activity is an important part of diabetes management. However, studies concerning the relation between physical activity and metabolic control have shown conflicting results. In this study we wanted to evaluate the effect of physical activity (PA) on metabolic control, measured by glycosylated hemoglobin (HbA1c) in a large cohort of children and adolescents with type 1 diabetes.
Methods: Cross-sectional analysis of data from 4,655 patients in 2010-2011, comparing HbA1c values with levels of physical activity. Data were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7–18 years of age, had type 1 diabetes and were out of remission. The patients were grouped by frequency of physical activity lasting at least 30 minutes each week as follows: PA0, none, PA1, less than once a week, PA2, 1-2 times per week, PA3, 3-5 times per week, and PA4, every day.
Results: The frequency of physical activity was lower for older children and adolescents (p < 0.001), mean age varying from 13.5 years in PA4 to 15.9 years in PA0.
Mean HbA1c level was higher in the least active group (PA0: 70 ± 15 mmol/mol (8.5% ± 1.4)) than in the most active group (PA4: 61 ± 13 mmol/mol (7.8% ± 1.2)) (p<0.001). Linear regression showed an inverse dose-response association between physical activity and HbA1c (β: -2.7, 95% CI: -3.0 to -2.3, p<0.001). This effect was found in both sexes and all age groups, apart from girls aged 7-10 years (p=0.252). Multiple regression analysis revealed that the association remained significant (β: -2.0, 95% CI: -2.4 to -1.7, p<0.001) when adjusted for disease duration, insulin dose, insulin methods, and hypoglycemia.
Conclusions: This study indicates that a higher level of physical activity results in better metabolic control. More studies with objective methods in large populations are required to confirm the inverse dose-response relationship between physical activity and HbA1c.
2013.