In this prospective study, 6,249 women from the Aerobics Center Longitudinal Study (ACLS) were followed for an average of 17 years, during which time 143 women developed type 2 diabetes. The objective of the study was to assess the respective (and possibly independent) contributions of cardiorespiratory fitness (CRF), as assessed by a maximal treadmill exercise test, and body mass index (BMI) to the development of type 2 diabetes. After adjusting for potential confounders and BMI, women in the top fitness tertile had a relative risk of developing type 2 diabetes of 0.61 (95% CI, 0.38-0.96). Moreover, women with a BMI >30 kg/m2 had a relative risk of 3.70 (95% CI, 2.12-6.44), compared to normal weight women (BMI<25 kg/m2) and even after adjusting for CRF. In normal weight women, being unfit did not increase type 2 diabetes risk, whereas low CRF increased the risk associated with overweight/obesity. Based on these results, the authors emphasized the importance of being physically active in order to maintain a high level of CRF and consequently to prevent the development of type 2 diabetes.
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