Diabetes Mellitus, Physical Activity, and Longevity Between the Ages of 70 and 90

OBJECTIVES: To determine the effect of physical activity (PA) on survival in older adults (70-90) with diabetes mellitus (DM). DESIGN: The Jerusalem Longitudinal Cohort Study (1990-2010) prospectively follows up a representative cohort born in 1920-1921. SETTING: Home-based assessment. PARTICIPANTS: Individuals aged 70 in 1990 (n = 463), 78 in 1998 (n = 972), and 85 in 2005 (n = 1,181). MEASUREMENTS: Comprehensive geriatric assessment; self-reported PA dichotomized to active (>= 4 hours of activity/wk) or inactive (<4 hours of activity/wk); mortality data (1990-2010). RESULTS: Prevalence of DM was 15.7% at age 70, 18.4% at age 78, and 21.3% at age 85. DM was associated with greater morbidity. Survival was higher in active than inactive with DM (aged 70-77: 78.8% vs 48.7%, P = .008; aged 78-84: 60.0% vs 40%, P = .01; aged 85-90: 70.2% vs 49.6%, P < .001) and without DM (aged 70-77: 85.9% vs 74.1%, P = .002; aged 78-84: 75.0% vs 64.0%, P = .004; aged 85-90: 82.3% vs 60.3%, P < .001). Cox proportional hazards ratios (HRs) according to PA status compared active subjects without DM (reference) with inactive subjects without DM, active subjects with DM, and inactive subjects with DM after adjusting for sex, self-rated health, ischemic heart disease, hypertension, smoking, and body mass index. Adjusted HRs were 1.39 for inactive subjects without DM, 1.34 for active subjects with DM, and 3.54 for inactive subjects with DM for age 70 to 77 (P < .001); 1.43 for inactive subjects without DM, 1.55 for active subjects with DM, and 3.74 for inactive subjects with DM for age 78 to 84 (P < .001); and 1.98 for inactive subjects without DM, 1.56 for active subjects with DM, and 2.18 for inactive with DM for age 85 to 90 (P < .001). CONCLUSION: In adults with DM, greater survival continues to be associated with PA up to and including very old adults (70-90). These findings support the encouragement of regular PA in people with DM regardless of advancing age.