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Supervised moderate and vigorous aerobic activity helped stave off type 2 diabetes in at-risk individuals with central obesity and nonalcoholic fatty liver disease, according to 10-year follow-up of a randomized trial from China.

Compared with adults who did not exercise, the risk of diabetes was reduced by 49% in the vigorous exercise group (relative risk [RR] 0.51, 95% CI 0.27-0.94, P=0.01) and by 53% in the moderate exercise group (RR 0.47, 95% CI 0.25-0.89, P=0.01), reported Xiaoying Li, MD, PhD, of Fudan University in Shanghai, and colleagues.

Over 10 years, the cumulative incidence of type 2 diabetes was 2.1 per 100 person-years in the vigorous group, 1.9 per 100 person-years in the moderate group, and 4.1 per 100 person-years in the non-exercise group, they noted in a research letter published in .

Li and team said that lifestyle interventions have been widely studied as a key prevention method against diabetes, but most prior research has only focused on the combined effects of exercise and diet. Here, they looked solely at the benefits of aerobic exercise alone.

"The exercise programs during 1-year intervention were strictly coached and supervised, and all participants were instructed not to change their diet," they wrote.

Although there weren't any significant changes in body weight seen between any of the groups at either 2-year or 10-year follow-up, body weight did trend slightly lower in the exercise groups compared with the non-exercisers. This was also true for fasting plasma glucose levels.

Both exercise groups did see a significantly lower waist circumference -- 96.8 cm for the moderate group and 96.6 cm for the vigorous group -- versus 101.4 cm for non-exercisers at 10 years. Likewise, exercisers saw significantly lower HbA1c levels at 10 years (5.95 for moderate and 5.96 for vigorous versus 6.25 for no exercise).

"Our results are supportive of physical exercise as an effective scheme for obesity management to delay the progression of type 2 diabetes, and vigorous and moderate aerobic exercise programs could be implemented for prevention of type 2 diabetes in people with obesity," Li and colleagues concluded.

The vast majority of the 220 participants completed the 1-year exercise program (94.5%), and 81.4% remained for the 10-year follow-up. After the exercise intervention, all participants were encouraged to stick to a healthy lifestyle and engage in moderate-intensity aerobic exercise.

Among the participants, mean age was 54, and 32.3% were men. Average baseline body weight was 159 lb (72 kg).

All groups had similar levels of leisure time physical activity at baseline, but both exercise groups just about doubled their median time by the end of the program (33.1 metabolic equivalent-hours/week for moderate, 31 for vigorous, 15.4 for non-exercisers). While the exercise groups never fully dropped back down to baseline levels of leisure time physical activity, levels did taper off a bit in the following years, to the point where they were no longer significantly different than the non-exercisers's levels.

A (METS) quantifies exercise intensity compared with resting. Though it depends on someone's body weight, a brisk walk can typically range from between 3 and 6 METS, according to the CDC. Essentially, this finding suggests those who participated in the formal aerobic exercise program also reported moving around more during periods outside the program.

Of the three groups, 30 new cases of type 2 diabetes were diagnosed in the non-exercise group, 14 in the moderate exercise group, and 15 in the vigorous exercise group. Incident diabetes was defined as a fasting plasma glucose level of 126 mg/dL or greater, an HbA1c of 6.5% or more, and/or use of antidiabetic medication.

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