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Antje Herbst, MD; Rainer Bachran, MD; Thomas Kapellen, MD; Reinhard W. Holl, PhD; for the DPV Science Initiative

Arch Pediatr Adolesc Med. 2006;160:573-577.

Objective  To evaluate the effect of regular physical activity (RPA) on the control of glycemia (glycosylated hemoglobin A_1c level) and the frequency of severe hypoglycemia in a large cohort of patients with type 1 diabetes mellitus.

Design  Cross-sectional analysis of data for 19 143 patients, comparing control of glycemia and rate of hypoglycemia by frequency of RPA.

Setting  One hundred seventy-nine pediatric diabetes clinics in Germany and Austria.

Participants  Patients aged 3 to 20 years with type 1 diabetes mellitus.

Main Exposure  Patients were grouped by the frequency of RPA per week as follows: RPA0, none; RPA1, 1 or 2 times per week; and RPA2, 3 or more times per week.

Main Outcome Measures  Glycosylated hemoglobin A_1c level, body mass index (calculated as weight in kilograms divided by the square of height in meters) z score, and frequency of severe hypoglycemia.

Results  Glycosylated hemoglobin A_1c level was higher in the groups with less frequent RPA (8.4% in group RPA0 vs 8.1% in group RPA2; P<.001). This effect was found in both sexes and in all age groups (P<.001). In female patients but not in male patients, the body mass index z score decreased from 0.60 in group RPA0 to 0.51 in group RPA2 (P<.001). Multiple regression analysis revealed that RPA was one of the most important factors influencing the glycosylated hemoglobin level. No association was noted between frequency of RPA and frequency of severe hypoglycemia or hypoglycemia with loss of consciousness or seizure.

Conclusions  In pediatric patients with type 1 diabetes mellitus, frequency of RPA is a major factor influencing the control of glycemia without increasing the risk for severe hypoglycemia. Regular physical activity should be recommended in pediatric patients with type 1 diabetes mellitus.

Author Affiliations: Department of Paediatrics, University of Bonn, Bonn (Dr Herbst); Hospital for Children and Adolescents, University of Leipzig, Leipzig (Dr Kapellen); and Institute for Biomedical Engineering, University of Ulm, Ulm (Dr Holl), Germany. Dr Bachran is in private practice in Oberhausen, Germany.
Group Information: For a current listing of the members of the DPV Science Initiative see http://dpv.mathematik.uni-ulm.de.

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