Supplementary Material for: The Role of Physical Activity in Chronic Kidney Disease in the Presence of Diabetes Mellitus: A Prospective Cohort Study

<b><i>Background/Aims:</i></b> Although the effect of exercise on health is well established, nephrologists seldom consider physical activity in the treatment of chronic kidney disease (CKD) or CKD in the presence of diabetes mellitus (DM/CKD). The aim of the present study was to analyze the benefits of leisure-time physical activity (LTPA) in DM/CKD. <b><i>Methods:</i></b> A total of 445,075 adult participants who underwent a medical screening program between 1996 and 2008 were prospectively recruited. Of these, 7,863 DM/CKD subjects were identified. Each participant was categorized according to LTPA level (a product of duration and intensity) as inactive, low-active or fully active. Hazard ratios (HRs) for mortality risk were calculated. <b><i>Results:</i></b> Fully active LTPA was associated with lower odds of DM/CKD development and lower risk of mortality among patients with DM/CKD in a dose-response relationship. The fully active and low-active DM/CKD groups had a 26% (HR 0.74, 95% CI 0.66-0.85) and 13% (HR 0.87, 95% CI 0.75-1.01) lower risk of all-cause mortality, respectively, in comparison to the inactive group. The association of exercise with mortality rate reduction was more pronounced among DM/CKD subjects (mortality rate reduction of 446.5 per 100,000 person-years) than among subjects with diabetes alone or CKD alone. <b><i>Conclusion:</i></b> Exercise, at the recommended level or more, is associated not only with lower odds of DM/CKD but also with a 26% lower mortality risk among DM/CKD patients. Nephrologists should encourage all DM/CKD subjects to be physically active.

<b><i>背景与目的：</i></b> 尽管运动对健康的益处已得到广泛证实，但肾内科医师在治疗慢性肾脏病（CKD）或合并糖尿病的慢性肾脏病（DM/CKD）时，极少考虑将体力活动纳入诊疗方案。本研究旨在分析闲暇时间体力活动（LTPA）对DM/CKD患者的获益效果。<b><i>方法：</i></b> 本研究于1996年至2008年间前瞻性招募了445075名接受医学筛查的成年受试者，其中共确诊7863名DM/CKD患者。所有受试者均根据闲暇时间体力活动（LTPA）水平（由运动时长与运动强度的乘积计算得出）分为不活动、低活动量与充分活动量三组，并计算了死亡风险的风险比（HRs）。<b><i>结果：</i></b> 充分活动量的LTPA与DM/CKD患者的发病风险降低及死亡风险下降呈剂量反应关系。与不活动组相比，充分活动量组与低活动量组的全因死亡风险分别降低26%（风险比HR=0.74，95%置信区间CI=0.66-0.85）与13%（HR=0.87，95%CI=0.75-1.01）。相较于仅患糖尿病或仅患CKD的受试者，DM/CKD患者中运动与死亡率降低的关联更为显著（每10万人年死亡率降低446.5）。<b><i>结论：</i></b> 达到或超过推荐水平的运动，不仅可降低DM/CKD的发病风险，还可使DM/CKD患者的死亡风险降低26%。肾内科医师应鼓励所有DM/CKD患者积极参与体力活动。