Long-term impact of cardiorespiratory fitness on type 2 diabetes incidence: A cohort study of Japanese men

Ryoko Kawakami, Susumu S. Sawada*, I. Min Lee, Yuko Gando, Haruki Momma, Shin Terada, Chihiro Kinugawa, Takashi Okamoto, Koji Tsukamoto, Mitsuru Higuchi, Motohiko Miyachi, Steven N. Blair

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Background: We sought to examine the association between cardiorespiratory fitness (CRF) and incidence of type 2 diabetes considering the follow-up period in a cohort of Japanese men with a maximum follow-up period of 23 years. Methods: This study enrolled 7,804 male workers free of diabetes in 1986. CRF was measured using a cycle ergometer, and maximal oxygen uptake was estimated. During 1986–2009, participants were followed for development of type 2 diabetes, which was diagnosed using fasting blood tests, self-administered questionnaires, or oral glucose tolerance tests after urinary tests from annual health checkups. Hazard ratios for the incidence of type 2 diabetes were estimated using Cox proportional hazards models. Results: During the follow-up period, 1,047 men developed type 2 diabetes. In analyses by follow-up periods (1986–1993, 1994–2001, and 2002–2009), there was an inverse dose-response relationship between CRF and the development of type 2 diabetes for all three follow-up periods (P for trend 0.019, <0.001, and 0.001, respectively), and the association between CRF at baseline and the incidence of type 2 diabetes did not weaken with longer follow-up period. Compared with the lowest CRF group, hazard ratios of developing type 2 diabetes were 0.69 (95% confidence interval [CI], 0.49–0.97) for the highest CRF group in 1986–1993, 0.57 (95% CI, 0.42–0.79) for the highest CRF in 1994–2001, and 0.47 (95% CI, 0.30–0.74) for the highest CRF in 2002–2009. Conclusion: High CRF is associated with a lower risk of the incidence of type 2 diabetes over an extended period of >20 years among men.

Original languageEnglish
Pages (from-to)266-273
Number of pages8
JournalJournal of epidemiology
Issue number5
Publication statusPublished - 2018 May 5
Externally publishedYes


  • Cohort study
  • Epidemiology
  • Exercise test
  • Hyperglycemia
  • Physical fitness

ASJC Scopus subject areas

  • Epidemiology


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