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The Association between Cardiorespiratory Fitness and Impaired Fasting Glucose and Type 2 Diabetes Mellitus in Men

Ming Wei, MD; Larry W. Gibbons, MD; Tedd L. Mitchell, MD; James B. Kampert, PhD; Chong D. Lee, EdD; and Steven N. Blair, PED
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From the Cooper Institute for Aerobics Research and the Cooper Clinic, Dallas, Texas.

Ann Intern Med. 1999;130(2):89-96. doi:10.7326/0003-4819-130-2-199901190-00002
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Background: Several studies show an inverse association between self-reported physical activity and type 2 diabetes. It is not known whether physical activity or cardiorespiratory fitness is associated with the onset of objectively determined impaired fasting glucose and type 2 diabetes.

Objective: To determine whether cardiorespiratory fitness, an objective marker of physical activity, is associated with risk for impaired fasting glucose and type 2 diabetes.

Design: Population-based prospective study.

Setting: Preventive medicine clinic.

Patients: 8633 nondiabetic men (of whom 7511 did not have impaired fasting glucose) who were examined at least twice.

Measurements: Cardiorespiratory fitness (determined by a maximal exercise test on a treadmill), fasting plasma glucose level, and other clinical and personal characteristics and incidence of impaired fasting glucose and type 2 diabetes.

Results: During an average follow-up of 6 years, 149 patients developed type 2 diabetes and 593 patients developed impaired fasting glucose. After age, cigarette smoking, alcohol consumption, and parental diabetes were considered, men in the low-fitness group (the least fit 20% of the cohort) at baseline had a 1.9-fold risk (95% CI, 1.5- to 2.4-fold) for impaired fasting glucose and a 3.7-fold risk (CI, 2.4- to 5.8-fold) for diabetes compared with those in the high-fitness group (the most fit 40% of the cohort). The risk for impaired fasting glucose was elevated in older men and those with a higher body mass index. Age, body mass index, blood pressure, triglyceride level, and a history of parental diabetes were also directly related to risk for type 2 diabetes.

Conclusions: Low cardiorespiratory fitness was associated with increased risk for impaired fasting glucose and type 2 diabetes. A sedentary lifestyle may contribute to the progression from normal fasting glucose to impaired fasting glucose and diabetes. Risk for type 2 diabetes was elevated in older persons and those with higher body mass index, blood pressure, and triglyceride levels and a parental history of diabetes.


Grahic Jump Location
Incidence of type 2 diabetes per 1000 persons-years by cardiorespiratory fitness levels according to age group (top left), body mass index (BMI) (top right), history of parental diabetes (bottom left), and impaired fasting glucose (bottom right).

White bars represent the low-fitness group, striped bars represent the moderate-fitness group, and black bars represent the high-fitness group.

Grahic Jump Location




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