Association Between Cardiorespiratory Fitness and Risk of Type 2 Diabetes: A Meta‐Analysis

Objective This meta‐analysis aimed to (1) quantify the association of cardiorespiratory fitness (CRF) with type 2 diabetes risk in the general population and statin users and (2) investigate the joint effects of CRF and fatness with type 2 diabetes risk. Methods Databases were searched for cohort studies reporting the association between CRF and type 2 diabetes risk. Summary hazard ratios (HRs) were obtained using random‐effects models. Results Fifteen studies were included. The HRs of type 2 diabetes for every 1–metabolic equivalent increase in CRF were 0.90 (95% CI: 0.86‐0.94) for the general population and 0.92 (95% CI: 0.87‐0.97) for statin users, and the HRs were linearly shaped (both P nonlinearity  > 0.40). Compared with the nonstatin cohort, there was an increased risk of type 2 diabetes in statin users with the lowest and moderate CRF categories, but this was not present in the highest CRF category. The HR of type 2 diabetes for overweight/obesity‐fit category versus normal weight–fit category was larger than that of the normal weight–unfit category versus the normal weight–fit category ( P interaction   = 0.004). Conclusions There was an inverse and dose‐dependent association between CRF and type 2 diabetes risk. High CRF may eliminate the diabetogenic effect from statins, yet decreased body weight index seems superior in preventing type 2 diabetes.