***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Although many studies suggest that physical activity may reduce risk of type 2 diabetes , the role of moderate-intensity activity such as walking is not well understood . OBJECTIVES To examine the relationship of total physical activity and incidence of type 2 diabetes in women and to compare the benefits of walking vs vigorous activity as predictors of subsequent risk of type 2 diabetes . DESIGN AND SETTING The Nurses ' Health Study , a prospect i ve cohort study that included detailed data for physical activity from women surveyed in 11 US states in 1986 , with up date s in 1988 and 1992 . PARTICIPANTS A total of 70,102 female nurses aged 40 to 65 years who did not have diabetes , cardiovascular disease , or cancer at baseline ( 1986 ) . MAIN OUTCOME MEASURE Risk of type 2 diabetes by quintile of metabolic equivalent task ( MET ) score , based on time spent per week on each of 8 common physical activities , including  walking .  RESULTS During 8 years of follow-up ( 534 , 928 person-years ) , we documented 1419 incident cases of type 2 diabetes . After adjusting for age , smoking , alcohol use , history of hypertension , history of high cholesterol level , and other covariates , the relative risks ( RRs ) of developing type 2 diabetes across quintiles of physical activity ( least to most ) were 1.0 , 0.77 , 0.75 , 0.62 , and 0.54 ( P for trend < .001 ) ; after adjusting for body mass index ( BMI ) , RRs were 1.0 , 0.84 , 0.87 , 0.77 , and 0.74 ( P for trend = .002 ) . Among women who did not perform vigorous activity , multivariate RRs of type 2 diabetes across quintiles of MET score for walking were 1.0 , 0.91,0.73 , 0.69 , and 0.58 ( P for trend < .001 ) . After adjusting for BMI , the trend remained statistically significant ( RRs were 1.0 , 0.95 , 0.80 , 0.81 , 0.74 ; P for trend = .01 ) . Faster usual walking pace was independently associated with decreased risk . Equivalent energy expenditures from walking and vigorous activity result ed in comparable magnitudes of risk reduction . CONCLUSIONS Our data suggest that greater physical activity level is associated with substantial reduction in risk of type 2 diabetes , including physical activity of moderate intensity and duration AIMS To investigate association between leisure-time physical activity at weekends and the risk of developing Type 2 diabetes mellitus ( DM ) . METHODS Prospect i ve examination of 6,013 Japanese men aged 35 - 60 years who were free of DM , impaired fasting glycaemia , or hypertension at study entry . Type 2 DM was defined by a fasting plasma glucose level > or = 7.0 mmol/l or a 2-h post-load plasma glucose level > or = 11.1 mmol/l . Data on physical activity obtained from question naires consisted of overall leisure-time physical activity weekly and leisure-time physical activity at weekends . RESULTS During the 59,966 person-years follow-up , 444 cases developed Type 2 DM .  Regular physical exercise at least once a week was associated with a reduced risk of Type 2 DM . After adjustments for age , body mass index , daily alcohol consumption , smoking habits , blood pressure levels and a parental history of Type 2 DM , men who engaged in regular physical exercise at least once a week had a relative risk of Type 2 DM of 0.75 ( 95 % CI , 0.61 - 0.93 ) compared with men engaging in exercise less often . Even vigorous activity only once a week at weekends was associated with a reduced risk of Type 2 DM . Men who engaged in vigorous activity at least once a week at weekends had a multiple-adjusted relative risk of Type 2 DM of 0.55 ( 95 % CI , 0.35 - 0.88 ) compared with sedentary men . CONCLUSIONS Regular physical exercise at least once a week and vigorous activity even only once a week at weekends are associated with a decreased risk of Type 2 DM PURPOSE To determine whether physical activity is associated with glucose tolerance in the elderly . METHODS We examined current and 5-yr change in physical activity in relation to glucose tolerance in 424 r and omly selected male inhabitants of the Dutch town Zutphen , aged 69 - 89 yr , without known diabetes mellitus .  Physical activity was assessed by a vali date d question naire design ed for retired men . Glucose intolerance was assessed by an oral glucose tolerance test and defined as impaired glucose tolerance or diabetes mellitus . RESULTS Men with 30 min x d(-1 ) or more of physical activity of at least moderate intensity had a lower prevalence of glucose intolerance as compared to men without these activities ( age-adjusted odds ratio 0.32 ; 95 % CI , 0.18 - 0.57 ) . Adjustment for family history of diabetes , smoking , alcohol intake , dietary factors , body mass index , and subscapular skin-fold thickness or exclusion of men with cardiovascular diseases or disabilities did not substantially change the results . With specific activities modeled simultaneously , bicycling ( P for trend = 0.01 ) and gardening ( P for trend = 0.02 ) were inversely associated with glucose intolerance . Men whose amount of physical activity  had decreased during the past 5 yr had significantly higher age-adjusted 2-h glucose concentrations as compared with men who remained at least as active ( difference 0.7 mmol x L(-1 ) ; 95 % CI , 0.1 - 1.3 ) . CONCLUSION These findings suggest that common types of physical activity such as bicycling and gardening may contribute to the prevention of glucose intolerance in elderly BACKGROUND To evaluate the hypothesis that physical activity independently predicts type 2 diabetes  risk in postmenopausal African-American , Hispanic , Asian , and Caucasian women . METHODS We prospect ively evaluated the relationship between incident type 2 diabetes , walking , and total physical activity  at baseline in the Women 's Health Initiative Observational Study . Baseline data were collected between September 1994 and December 1998 ; incident diabetes was identified through August 2002 . Hazard ratios for self-reported diabetes adjusted for body mass index ( BMI ) and other variables were evaluated across categories of physical activity in Caucasian , African-American , Hispanic , and Asian/Pacific Isl and er women . RESULTS Incident diabetes was reported by 2.2 % of Caucasian , 6.2 % of African-American , 4.5 % of Hispanic , 3 % of Asian , and 5.7 % of American Indian women ( p < 0.0001 across ethnic groups ) during 458,018 woman-years of follow-up . Among Caucasian women ,  walking  ( multivariate-adjusted hazard ratios 1.00 , 0.85 , 0.87 , 0.75 , 0.74 ; p < 0.001 for trend across exercise quintiles ) and  total physical activity score ( hazard ratios 1.00 , 0.88 , 0.74 , 0.80 , 0.67 ; p = 0.002 ) demonstrated a strong inverse relationship with diabetes risk . In BMI -adjusted models , African-American women in higher physical activity categories were less likely to develop diabetes than women in the lowest physical activity category . After adjusting for age and multiple risk factors , however , no significant association between  physical activity and diabetes risk was apparent for African-American , Hispanic , or Asian women . CONCLUSIONS These findings suggest a stronger and more independent association of physical inactivity with development of  diabetes in Caucasian women than in minority women , but could also be explained by less precise risk estimates in minority women or the role of chance Clinical trials have demonstrated that lifestyle changes can prevent type 2 diabetes , but the importance of leisure-time physical activity ( LTPA ) is still unclear . We carried out post hoc analyses on the role of LTPA in preventing type 2 diabetes in 487 men and women with impaired glucose tolerance who had completed 12-month LTPA question naires . The subjects were participants in the Finnish Diabetes Prevention Study , a r and omized controlled trial of lifestyle changes including diet , weight loss , and LTPA .  There were 107 new cases of diabetes during the 4.1-year follow-up period . Individuals who increased moderate-to-vigorous LTPA or strenuous , structured LTPA the most were 63 - 65 % less likely to develop diabetes . Adjustment for changes in diet and body weight during the study attenuated the association somewhat ( upper versus lower third : moderate-to-vigorous LTPA , relative risk 0.51 , 95 % CI 0.26 - 0.97 ; strenuous , structured LTPA , 0.63 , 0.35 - 1.13 ) . Low-intensity and lifestyle LTPA  and walking also conferred benefits , consistent with the finding that the change in total LTPA ( upper versus lower third : 0.34 , 0.19 - 0.62 ) was the most strongly associated with incident diabetes . Thus increasing physical activity may substantially reduce the incidence of type 2 diabetes in high-risk individuals BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects Aims /hypothesisLifestyle modification helps in the primary prevention of diabetes in multiethnic American , Finnish and Chinese population s. In a prospect i ve community-based study , we tested whether the progression to diabetes could be influenced by interventions in native Asian Indians with IGT who were younger , leaner and more insulin resistant than the above population s. Methods We r and omised 531 ( 421 men 110 women ) subjects with IGT ( mean age 45.9±5.7 years , BMI 25.8±3.5 kg/m2 ) into four groups . Group 1 was the control , Group 2 was given advice on lifestyle modification ( LSM ) , Group 3 was treated with metformin ( MET ) and Group 4 was given LSM plus MET . The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria . Results The median follow-up period was 30 months , and the 3-year cumulative incidences of diabetes were 55.0 % , 39.3 % , 40.5 % and 39.5 % in Groups 1–4 , respectively . The relative risk reduction was 28.5 % with LSM ( 95 % CI 20.5–37.3 , p=0.018 ) , 26.4 % with MET ( 95 % CI 19.1–35.1 , p=0.029 ) and 28.2 % with LSM + MET ( 95 % CI 20.3–37.0 , p=0.022 ) , as compared with the control group . The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM , 6.9 for MET and 6.5 for LSM + MET . Conclusions /interpretationProgression of IGT to diabetes is high in native Asian Indians .  Both LSM and MET significantly reduced the incidence of diabetes  in Asian 
    Output:
    
—These findings indicate that adherence to recommendations to participate in physical activities of moderate intensity such as brisk walking can substantially reduce the risk of type 2 diabetes