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J Epidemiol. 2018 May 5;28(5):230-236. doi: 10.2188/jea.JE20160199. Epub 2017 Nov 25.

Importance of Achieving a "Fit" Cardiorespiratory Fitness Level for Several Years on the Incidence of Type 2 Diabetes Mellitus: A Japanese Cohort Study.

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Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering.
Department of Health Promotion and Exercise, National Institutes of Biomedical Innovation, Health and Nutrition.
Department of Psychosomatic Internal Medicine, Graduate Medical and Dental School, Kagoshima University.
Faculty of Sport Sciences, Waseda University.
Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo.
Tokyo Gas Health Promotion Center.
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina.
Department of Exercise Science, Arnold School of Public Health, University of South Carolina.



The "Physical Activity Reference for Health Promotion 2013" provides "fit" reference values for cardiorespiratory fitness (CRF) for good health. The importance of achieving a fit CRF level for several years on the subsequent prevention of type 2 diabetes mellitus (T2DM) remains to be clarified.


This cohort study was conducted in 2,235 nondiabetic males aged 21 to 59 years, enrolled in April 1986 through March 1987. We calculated the ratio of the area under the curve (AUCratio) for actual measured values and the AUC for the reference values of CRF in each individual during an 8-year measurement period before the baseline. According to whether they met a fit CRF level or not, participants were categorized into groups based on the AUCratio (FitAUC or UnfitAUC) and initial CRF (Fitinitial or Unfitinitial), respectively. T2DM was evaluated on health checkups until March 2010.


During the follow-up period, 400 men developed T2DM. After adjustment for confounders, as compared with those in the FitAUC group, the hazard ratio (HR) for those in the UnfitAUC group was 1.33 (95% confidence interval [CI], 1.06-1.65). A combined analysis with the categories of initial value and AUCratio showed that, compared with the Fitinitial and FitAUC group, the HRs of Fitinitial and UnfitAUC, Unfitinitial and FitAUC, and Unfitinitial and UnfitAUC groups were 1.41 (95% CI, 0.99-2.00), 1.18 (95% CI, 0.81-1.70), and 1.40 (95% CI, 1.08-1.83), respectively.


Achievement of a fit CRF level established in the Japan physical activity guideline for several years was associated with lower subsequent risk of T2DM.


Physical Activity Reference for Health Promotion 2013; area under the curve; maximal oxygen uptake; metabolic memory

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