The Da Qing study in China (211) included an exercise-only treatment arm and reported that even modest changes in exercise (20 min of mild or moderate, 10 min of strenuous, or 5 min of very strenuous exercise one to two times a day) reduced diabetes risk by 46% (compared with 42% for diet plus exercise and 31% for diet alone). The Finnish Diabetes Prevention Study (74,260) and the U.S. Diabetes Prevention Program (DPP) (149) included intensive, lifestyle modifications with both diet and increased PA. In the former, 522 middle-aged, overweight adults with IGT completed either lifestyle modifications of at least 30 min of daily, moderate PA, or no change in behavior (74,260). The DPP randomized 3,234 men and women with IGT or IFG into control, medication (metformin), or lifestyle modification groups, composed of dietary and weight loss goals and 150 min of weekly aerobic activity (149). Lifestyle modification in both studies reduced incident diabetes by 58% and, in the DPP, had a greater effect than metformin (31%). Weight loss was the dominant predictor of a lower incidence, but increased PA reduced risk of type 2 diabetes even when weight loss goals were not achieved (104,158,173). PA seems to play a role in preventing type 2 diabetes across ethnic groups and in both sexes (154,224).
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