articlePhysical activity and optimal self-rated health of adults with and without diabetes

Background: Regular physical activity can improve people's overall health and contribute to both primary and secondary prevention of many chronic diseases and conditions including diabetes. The aim of this study was to examine the association between levels of physical activity and optimal self-rated health (SRH) of U.S. adults with and without diabetes in all 50 states and territories of the Unites States. Methods: We estimated the prevalence of optimal SRH by diabetes status of 430,912 adults aged 18 years and older who participated in the 2007 state-based survey of the Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using levels of physical activity as a predictor and status of optimal SRH as an outcome variable while controlling for sociodemographic and behavioral health risk factors. Results: The prevalence of reporting optimal SRH was 53.3%, 52.2%, and 86.2% for adults with type 1 diabetes, type 2 diabetes, and without diabetes, respectively. Also in the aforementioned order, adults who reported being active had an increased likelihood of 81%, 32%, and 18% for reporting optimal SRH, when compared with adults who reported being inactive. Conclusions: Regular physical activity of adults, particularly adults with diabetes, is associated with optimal SRH. The findings of this study underscore the importance of advising and motivating adults with diabetes so that physical activity can be integrated into their lifestyle for diabetes care. Additionally, a population-based effort to promote physical activity in communities may benefit adults in general by improving their overall health and well-being. Background Regular physical activity can improve people's overall health and reduce various risks for morbidity and mortality due to a sedentary lifestyle [1,2]. Accumulating evidence from observational and experimental studies shows that routine physical activity exerts enormous benefits for both primary and secondary prevention of diabetes mellitus, cardiovascular disease, obesity, cancer, musculoskeletal diseases, and depression [3-8]. For most health outcomes, the report of 2008 Physical Activity Guidelines for Americans (2008 Guidelines) recommends a combination of active time equivalent to at least 150 minutes of moderate activity a week. These health benefits can occur in healthy people and in individuals who currently have or are at risk of developing chronic diseases and conditions [1,3,9]. In particular, regular physical activity may improve glucose homeostasis and insulin sensitivity thereby preventing, delaying or reversing the development of type 2 diabetes [3,4,7,10]. Self-rated health (SRH) is a powerful indicator of a population's overall well-being because its lower ratings (i.e., fair or poor) are strongly predictive of future morbidity, mortality, functional decline, and health care utilization [11-16]. For instance, individuals with ''poor'' SRH had a two-fold higher mortality risk than those with ''excellent'' SRH [14]. In addition, the lower ratings of diabetic patients have been linked to diabetes-related complications such as lower extremity amputation, blindness, kidney failure, and cardiovascular diseases (e.g., heart disease and stroke) [17]. Not surprisingly, maintaining and improving health-related quality of life of people with diabetes is a public health goal, whereas assisting patients to achieve optimal SRH is a quality indicator in primary care [17-19]. * Correspondence: jxt9@cdc.gov 1 Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention (CDC), Atlanta, GA 30341, USA Full list of author information is available at the end of the article © 2010 Tsai et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tsai et al. BMC Public Health 2010, 10:365 http://www.biomedcentral.com/1471-2458/10/365 Page 2 of 9 Despite substantial practical interest to consumers, researchers, and practitioners, much remains unknown regarding levels of physical activity in relation to optimal SRH pertaining to diabetes in adults in the general population. The aim of this study was to examine the association between levels of physical activity and optimal SRH of adults with and without diabetes in the United States by using the data from the 2007 state-based survey of the Behavioral Risk Factor Surveillance System (BRFSS). Methods Participants The Behavioral Risk Factor Surveillance System (BRFSS) is the world's largest, ongoing, state-based, random-digitdialed telephone survey that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury, and is considered to be exempt from review by the Centers for Disease Control and Prevention's Institutional Review Board [20]. Details about its purpose, sampling methods, data collection, and reporting are available elsewhere [20]. Survey information from noninstitutionalized adults aged 18 years and older has been used to track health conditions and risk behaviors for improving the health of the American people. With a survey median cooperation rate of 72.1% in 2007, a total of 430,912 individuals from all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands participated in the survey [20]. Based on the history of diabetes collected (Table 1), participants were considered to have type 1 diabetes if their age at diagnosis was less than 30 years and they were currently using insulin. Participants were considered to have type 2 diabetes if their age at diagnosis was at least 30 years or if their age at diagnosis was less than 30 years and they were currently not using insulin [21-23].