OBJECTIVE The aims of the study were to assess how baseline leisure-time physical activity (LTPA) and its exercise components intensity, duration, and frequency are associated with all-cause and cardiovascular mortality in patients with type 1 diabetes 1) overall, 2) stratified by presence or absence of chronic kidney disease (CKD), and 3) stratified by sex.

RESEARCH DESIGN AND METHODS The study design was prospective and observational and included 2,639 patients with type 1 diabetes from the ongoing nationwide multicenter Finnish Diabetic Nephropathy (FinnDiane) Study. Mean follow-up time was 11.4 ± 3.5 years. LTPA was assessed by using a validated self-report questionnaire. Three hundred ten patients (11.7%) had CKD defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m².

RESULTS During follow-up, 270 deaths occurred. LTPA and all its components were associated with all-cause mortality, even after adjustment for the potential confounders sex, diabetic nephropathy, duration of diabetes, age at onset of diabetes, systolic blood pressure, triglycerides, BMI, and HbA_1c. Only exercise intensity was associated with cardiovascular mortality after adjustment for the confounders. Of the patients with CKD, 127 died during follow-up. The total amount of LTPA and exercise frequency were independently associated with lower risk of all-cause mortality when adjusted for covariates.

CONCLUSIONS Exercise is associated with a lower risk of premature all-cause and cardiovascular mortality in patients with type 1 diabetes. This study also demonstrates that physical activity is associated with a lower risk of mortality in patients with type 1 diabetes and CKD.

目的本研究的目的是评估基线休闲时间体育锻炼（LTPA）及其运动成分的强度，持续时间和频率如何与1型糖尿病患者的全因和心血管疾病死亡率相关1）总体而言，2）按是否存在慢性肾脏病（CKD ）分层；3）按性别分层。

研究设计和方法研究设计是前瞻性和观察性研究，纳入了2639名来自正在进行的全国性多中心芬兰糖尿病肾病（FinnDiane）研究的1型糖尿病患者。平均随访时间为11.4±3.5年。LTPA是通过使用经过验证的自我报告调查表进行评估的。三百零一例（11.7％）的CKD定义为肾小球滤过率估计≤60mL / min / 1.73 m ²。

结果在随访期间，有270人死亡。即使调整了潜在的混杂因素性别，糖尿病肾病，糖尿病持续时间，糖尿病发作年龄，收缩压，甘油三酸酯，BMI和HbA _1c，LTPA及其所有成分也与全因死亡率相关。调整混杂因素后，仅运动强度与心血管疾病死亡率相关。在CKD患者中，有127例在随访期间死亡。调整协变量后，LTPA的总量和运动频率与全因死亡率较低的风险独立相关。

结论运动与1型糖尿病患者过早全因和心血管疾病死亡的风险较低有关。这项研究还表明，体育锻炼与1型糖尿病和CKD患者的较低的死亡风险相关。