Do peer-reviewed studies report hazard ratios for all-cause mortality when comparing high vs low non-aerobic physical performance (gait speed, grip strength, chair rise, balance tests, Short Physical Performance Battery (SPPB), or frailty scores) in people with Type 2 Diabetes, and how do these compare to unfit individuals without Type 2 Diabetes?

Evidence on Non-Aerobic Physical Performance and Mortality in Type 2 Diabetes

Direct Answer to Your Question

The available peer-reviewed literature does not report hazard ratios specifically comparing high versus low non-aerobic physical performance measures (gait speed, grip strength, chair rise, balance tests, SPPB, or frailty scores) with all-cause mortality in people with Type 2 Diabetes, nor do studies establish performance thresholds where fit individuals with diabetes achieve mortality rates equal to or lower than unfit individuals without diabetes.

What the Evidence Actually Shows

Aerobic Fitness Data in Type 2 Diabetes

The existing research focuses almost exclusively on aerobic physical activity rather than non-aerobic performance measures:

• Moderate-to-vigorous physical activity in people with Type 2 Diabetes reduces all-cause mortality with hazard ratios ranging from 0.60-0.71 depending on activity level, with the greatest benefit seen in those transitioning from inactive to any level of activity 1, 2

• Very active individuals with Type 2 Diabetes (>500 min/week of moderate-to-vigorous activity) achieve a hazard ratio of 0.44 for diabetes-specific mortality compared to inactive diabetics 2

• The dose-response relationship shows that even insufficiently active diabetics have 29% lower diabetes mortality (HR 0.71) compared to inactive diabetics, while very active diabetics have 56% lower risk (HR 0.44) 2

Comparative Risk: Diabetes vs. No Diabetes

• Inactive individuals with Type 2 Diabetes have 7.38 times the risk of diabetes mortality compared to people without diabetes 2

• Very active individuals with Type 2 Diabetes reduce this excess risk substantially to 3.34 times that of people without diabetes, but still do not achieve mortality equivalence 2

• The gradient of mortality reduction from physical activity is steeper in people with diabetes/impaired glucose tolerance compared to normoglycemic individuals, particularly for coronary heart disease mortality (p-value for interaction = 0.02-0.05) 3

Why Non-Aerobic Performance Data Is Missing

Guideline Focus on Aerobic Activity

The American Diabetes Association and American College of Sports Medicine guidelines emphasize:

• 150+ minutes per week of moderate-to-vigorous aerobic activity spread over at least 3 days with no more than 2 consecutive days without activity 4

• Resistance exercise 2-3 sessions per week on non-consecutive days 4

• Flexibility and balance training 2-3 times per week for older adults, including yoga and tai chi 4

However, these guidelines do not provide mortality data stratified by non-aerobic performance measures like SPPB scores, gait speed thresholds, or grip strength cutoffs 4

Available Cardiorespiratory Fitness Thresholds (Not Diabetes-Specific)

From cardiovascular disease populations (which may include some diabetics but are not diabetes-specific):

• Peak VO₂ >22 mL/kg/min achieves hazard ratios of 0.39 for cardiac deaths and 0.45 for all-cause deaths compared to <15 mL/kg/min 5, 6

• Peak VO₂ 15-22 mL/kg/min represents an intermediate threshold with HR 0.62 for cardiac deaths and 0.66 for all-cause deaths 5

• In older adults ≥60 years, the highest cardiorespiratory fitness level is associated with HR 0.59 for all-cause mortality and 0.57 for cardiovascular mortality compared to the lowest fitness level 5

Critical Gap in the Literature

The specific question you're asking—whether high grip strength, fast gait speed, good balance, or high SPPB scores in diabetics can achieve mortality rates comparable to unfit non-diabetics—has not been studied. The research focuses on:

1. Aerobic activity volume (minutes per week of moderate-to-vigorous activity) 7, 1, 2
2. Cardiorespiratory fitness (peak VO₂, METs) in mixed or cardiovascular populations 5, 6
3. Step counts in general populations (not diabetes-specific for mortality outcomes) 4

Practical Clinical Implications

What We Can Recommend Based on Available Evidence

• Target ≥150-300 minutes per week of moderate-intensity aerobic activity or 75-150 minutes of vigorous-intensity activity to achieve approximately 40% mortality reduction in diabetics 4, 1, 2

• Even modest activity (1.5 hours per week) produces 20% mortality reduction, representing the largest marginal benefit 5, 6

• Higher activity volumes (>500 min/week) plateau in benefit, achieving maximum mortality reduction of approximately 56% compared to inactive diabetics 2

• Resistance training should be added 2-3 times per week, though mortality data specific to resistance training in diabetes is lacking 4

What Remains Unknown

• Whether achieving specific gait speed thresholds (e.g., >1.0 m/s) in diabetics confers mortality benefits
• Whether grip strength cutoffs (e.g., >26 kg for women, >40 kg for men) predict mortality in diabetes populations
• Whether SPPB scores (e.g., ≥10 out of 12) stratify mortality risk in diabetics
• The exact performance threshold where fit diabetics achieve mortality parity with unfit non-diabetics

Why This Matters Clinically

The evidence suggests that physical activity attenuates but does not eliminate the excess mortality risk from Type 2 Diabetes—even very active diabetics maintain 3.34 times the diabetes mortality risk of non-diabetics 2. This indicates that while fitness is crucial, it cannot fully compensate for the metabolic derangements of diabetes, emphasizing the need for comprehensive glycemic control alongside physical activity 4.