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American Journal of Epidemiology Advance Access originally published online on July 21, 2009
American Journal of Epidemiology 2009 170(5):632-639; doi:10.1093/aje/kwp181
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Physical Activity and Incident Diabetes in American Indians

The Strong Heart Study

Amanda M. Fretts, Barbara V. Howard, Andrea M. Kriska, Nicolas L. Smith, Thomas Lumley, Elisa T. Lee, Marie Russell and David Siscovick

Correspondence to Amanda M. Fretts, Cardiovascular Health Research Unit, University of Washington, 1730 Minor Avenue, Suite 1360, Seattle, WA 98101 (e-mail: amfretts{at}u.washington.edu).

Received for publication February 26, 2009. Accepted for publication May 29, 2009.

The authors examined the association between total physical activity (leisure-time plus occupational) and incident diabetes among 1,651 American Indians who participated in the Strong Heart Study, a longitudinal study of cardiovascular disease and its risk factors among 13 American Indian communities in 4 states (North Dakota, South Dakota, Oklahoma, and Arizona). Discrete Cox models were used to examine the association between physical activity level (in tertiles), compared with no physical activity, and incident diabetes, after adjustment for potential confounders. During 10 years of follow-up (f1989–1999), 454 incident cases of diabetes were identified. Compared with participants who reported no physical activity, those who reported any physical activity had a lower risk of diabetes: Odds ratios were 0.67 (95% confidence interval (CI): 0.46, 0.99), 0.67 (95% CI: 0.45, 0.99), and 0.67 (95% CI: 0.45, 0.99) for increasing tertile of physical activity, after adjustment for age, sex, study site, education, smoking, alcohol use, and family history of diabetes. Further adjustment for body mass index and other potential mediators attenuated the risk estimates. These data suggest that physical activity is associated with a lower risk of incident diabetes in American Indians. This study identifies physical activity as an important determinant of diabetes among American Indians and suggests the need for physical activity outreach programs that target inactive American Indians.

diabetes mellitus, type 2; health behavior; Indians, North American; life style; motor activity

Abbreviations: CI, confidence interval; MET, metabolic equivalent; SHS, Strong Heart Study


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