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Increased leisure-time physical activity associated with lower onset of diabetes in 44 828 adults with impaired fasting glucose: a population-based prospective cohort study
  1. Xiang Qian Lao1,2,
  2. Han-Bing Deng1,
  3. Xudong Liu1,
  4. Ta-Chien Chan3,
  5. Zilong Zhang1,
  6. Ly-yun Chang4,5,
  7. Eng-Kiong Yeoh1,
  8. Tony Tam6,
  9. Martin Chi Sang Wong1,
  10. G Neil Thomas7
  1. 1 Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
  2. 2 Shenzhen Research Institute, the Chinese University of Hong Kong, Shenzhen, China
  3. 3 Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
  4. 4 Institute of Sociology, Academia Sinica, Taipei, Taiwan
  5. 5 MJ Group, MJ Health Research Foundation, Taipei, Taiwan
  6. 6 Department of Sociology, The Chinese University of Hong Kong, Hong Kong
  7. 7 Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Xiang Qian Lao, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong; xqlao{at}


Aims To evaluate the effects of habitual leisure-time physical activity (LTPA) on incident type 2 diabetes in a prospective cohort of Chinese adults with impaired fasting glucose (IFG).

Methods 44 828 Chinese adults aged 20–80 years with newly detected IFG but free from cardiovascular and cerebrovascular disease were recruited and followed up from 1996 to 2014. Incident type 2 diabetes was identified by fasting plasma glucose ≥7 mmol/L. The participants were classified into four categories based on their self-reported weekly LTPA: inactive, low, moderate, or high. Hazard ratios (HRs) and population attributable fractions (PAFs) were estimated with adjustment for established diabetic risk factor.

Results After 214 148 person-years of follow-up, we observed an inverse dose–response relationship between LTPA and diabetes risk. Compared with inactive participants, diabetes risk in individuals reporting low, moderate and high volume LTPA were reduced by 12% (HR 0.88, 95% CI 0.80 to 0.99; P=0.015), 20% (HR 0.80, 95% CI 0.71 to 0.90; P<0.001), and 25% (HR 0.75, 95% CI 0.67 to 0.83; P<0.001), respectively. At least 19.2% (PAF 19.2%, 95% CI 5.9% to 30.6%) of incident diabetes cases could be avoided if the inactive participants had engaged in WHO recommendation levels of LTPA. This would correspond to a potential reduction of at least 7 million diabetic patients in the Greater China area.

Conclusions Our results show higher levels of LTPA are associated with a lower risk of diabetes in IFG subjects. These data emphasise the urgent need for promoting physical activity as a preventive strategy against diabetes to offset the impact of population ageing and the growing obesity epidemic.

  • Diabetes
  • Physical Activity
  • Cohort Study

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  • Contributors XQL designed the study, reviewed and revised the manuscript. HBD analysed and interpreted the data and drafted the manuscript. GNT interpreted the data, reviewed the manuscript and contributed to critical revision of the manuscript for important intellectual content. XL, TCC, ZZ, LC, EKY, TT and MCSW interpreted the data, reviewed and revised the manuscript. All authors can take responsibility for the integrity of the data and the accuracy of the data analysis and have read and approved the final manuscript.

  • Funding This study is partially supported by Environmental Health Research Fund (7104946). HBD is partially supported by the Faculty Postdoctoral Fellowship Scheme of Faculty of Medicine of the Chinese University of Hong Kong.

  • Competing interests None declared.

  • Ethics approval The ethics approval of the present study was obtained from the Joint Chinese University of Hong Kong and New Territories East Cluster Clinical Research Ethics Committee in Hong Kong (No. 2015.672).

  • Provenance and peer review Not commissioned; externally peer reviewed.