For People with Diabetes and Overweight, These Two Factors May Lead to 61% Lower Cardiovascular Event Risk, New Study Shows

We know how important lifestyle factors, including physical activity and maintaining a healthy weight, are for diabetes management. The same applies to helping prevent heart disease.

But what about physical activity and weight loss for preventing cardiovascular events in people with diabetes? Do physical activity and weight loss have the same effect when factors are combined? A new study, published on February 22, 2024, in JAMA Network Open, sheds some light on this.

How Was the Study Conducted?

This study was a secondary examination of the data from the Look AHEAD study, a randomized clinical trial that took place at 16 clinical sites. According to a 2016 article in The Lancet, the Look AHEAD study recruited 5,145 patients, ages 45 to 76, with type 2 diabetes plus overweight or obesity. Recruitment took place between August 2001 and April 2004, and researchers followed up with participants for about 10 years.

The original Look AHEAD study investigated the cardiovascular benefits of an intensive lifestyle intervention—aiming for at least 7% weight loss from each participant’s baseline body weight—compared to those who received just diabetes support and education.

For this newest round, what is referred to as the sub-study, 1,229 participants met the criteria the researchers were looking for. Participants included men (43.4%) and women of various races and ethnicities. 

Researchers first looked at accelerometer data from the first four years of the study. An accelerometer is a wearable device that tracks all movements to determine physical activity levels—as opposed to a pedometer, which just tracks steps taken.

Researchers also looked at average weight loss during the first four years of the study. They chose the first four years because participants received more frequent physical activity measurements, individual supervision and group sessions during this period of the Look AHEAD study. 

They then examined participants’ records, looking for nonfatal cardiovascular events, as well as causes of death in participants, which included death from cardiovascular events, like heart attack and stroke, and death from all other causes. 

After data was adjusted for several confounders and variables, including age, sex, race and other medical conditions, several statistical analyses were run. 

What Did the Study Show?

Compared to participants with low physical activity and no weight loss, those with high physical activity levels plus weight loss had a significantly lower risk of cardiovascular events. 

Researchers also found:

• Cardiovascular benefits from high physical activity volume were more significant among participants with weight loss of 7% or greater.
• Higher physical activity volume was linearly associated with a decreased risk of cardiovascular events among participants with weight loss—so the more physical activity participants got, the lower their risk of cardiovascular events, as long as there was also some weight loss involved.
• For those who did not lose weight, the cardiovascular benefits appeared to reach a plateau at approximately 1,000 MET-min/week—which is equivalent to the 2018 Physical Activity Guidelines for Americans recommendation of 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week.

Keeping in mind that these individuals fell into overweight or obese categories at the time, perhaps the most interesting finding was that weight loss alone was not associated with a statistically significant reduction in cardiovascular events risk—nor was physical activity alone. It was the combination of physical activity with weight loss that significantly reduced the risk of cardiovascular events. 

Specifically, higher physical activity combined with weight loss of at least 7% of baseline body weight resulted in a 61% reduction in what researchers called the “composite cardiovascular outcome,” which included death from cardiovascular causes, nonfatal myocardial infarction (heart attack), nonfatal stroke or hospitalization for angina. 

“This study highlights the association between combined weight loss and increased physical activity with a reduced risk of cardiovascular events in individuals with type 2 diabetes and overweight or obesity,” concluded the study authors. “First, maintaining a high physical activity volume and losing weight are important, but the combination may be more beneficial in this population.”

How Does This Apply to Real Life?

According to the Centers for Disease Control and Prevention, people who have diabetes are twice as likely to have heart disease or a stroke compared to people who don’t have diabetes. And the longer you have diabetes, the more likely you are to have heart disease. 

We also know that exercise, including strength training, can reduce the risk of heart disease and diabetes. And research supports the importance maintaining a healthy weight to reduce the risk of diabetes and heart disease, too. 

As the study authors said, being physically active and losing weight (if you need to) each on their own will have some benefits. 

It’s important to note that “losing weight” isn’t something that just happens. It’s the lifestyle behaviors you engage in that influence your weight (along with other things, like genetics and hormones). 

So instead of focusing on weight loss, focus on what you can control, like nourishing your body with a healthy variety of foods, being physically active, getting quality sleep and managing your stressors—all of which, by the way, can affect your risk of heart disease and diabetes. 

And while the combination of physical activity and weight loss had more benefits than each one on their own in this study, there is evidence from other studies that focusing on weight loss alone may not work for lasting change, is stressful and ultimately can result in weight regain. Rather, shifting the focus from weight loss to increasing physical activity and improving cardiorespiratory fitness lowers the risk of death. 

The Bottom Line

This study focused on physical activity and weight loss in people with diabetes who also fell into the overweight or obese categories. The participants who had higher levels of physical activity and lost at least 7% of their body weight had a 61% lower risk of cardiovascular events compared to those with low physical activity and no weight loss. If you’re not already physically active and aren’t sure where to begin, this 12-week walking plan may be a good place to start.