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Association between Estimated Cardiorespiratory Fitness and Insulin Resistance in Korean Adults: Results from the Korea National Health and Nutrition Survey 2019–2021
Korean J Sports Med 2023;41:233-240
Published online December 1, 2023;  https://doi.org/10.5763/kjsm.2023.41.4.233
© 2023 The Korean Society of Sports Medicine.

Yunmin Han, Yeonsoo Kim

Department of Physical Education, College of Education, Seoul National University, Seoul, Korea
Correspondence to: Yeonsoo Kim
Department of Physical Education, College of Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea
Tel: +82-2-880-7794, Fax: +82-2-872-2867, E-mail: kys0101@snu.ac.kr
Received August 16, 2023; Revised October 24, 2023; Accepted October 26, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: The purpose of this study was to investigate the association between estimated cardiorespiratory fitness (eCRF) and insulin resistance in Korean adults, and to compare this association through sex and age-specific analyses.
Methods: A total of 13,405 adults aged 19 years and older (male, 5,869; female, 7,536) were analyzed using data from the Korea National Health and Nutrition Survey (KNHANES) for the years 2019 to 2021. eCRF was analyzed by dividing it into quartiles using the estimation equation based on age, sex, body mass index, waist circumference, smoking status, resting heart rate, and self-reported physical activity level. Insulin resistance was measured to calculate the HOMA-IR. Logistic regression was used to predict the odds ratio (OR) and 95% confidence interval (CI) of the relationship between the two variables, with adjustment for potential confounders.
Results: The results showed a stronger association between fitness level and insulin resistance. Based on the first quartile (reference group), the lower the cardiorespiratory fitness level, the higher the OR. In male subjects, the lowest quartile had an OR of insulin resistance 17.65 (95% CI, 13.76–22.64). For female subjects, the lowest quartile had an OR of insulin resistance 7.96 (95% CI, 6.37–9.94). These results indicate a strong inverse relationship between cardiorespiratory fitness and insulin resistance and younger groups exhibited significantly higher ORs in age-specific ORs.
Conclusion: The analysis results demonstrated that increasing cardiorespiratory fitness levels can significantly impact insulin sensitivity and reduce insulin resistance risk.
Keywords : Cardiorespiratory fitness, Insulin resistance, Metabolism
꽌 濡

씤뒓由 빆 삁떦 議곗젅怨 愿젴맂 以묒슂븳 궗 씠긽쑝濡, 떦눊蹂 諛 떖삁愿 吏덊솚怨쇱쓽 愿젴꽦씠 옒 븣젮졇 엳떎1. 씤뒓由 빆 議곗쭅뿉꽌 씤뒓由곗쓽 슚怨쇨 媛먯냼븯嫄곕굹 遺덉셿쟾븯寃 쟾떖릺뒗 긽깭瑜 留뚮뱾뼱, 삁떦 議곗젅씠 뼱젮썙吏怨 怨좏삁떦 긽깭媛 吏냽맆 닔 엳떎2. 듅엳, 븳援씤뱾 理쒓렐 鍮꾨쭔, 떊泥댄솢룞 븯, 떇뒿愿 臾몄젣濡 씤뒓由 빆꽦씠 痍⑥빟븳 씤援ш 利앷븯怨 엳떎3,4.

궙 떖룓泥대젰 떖삁愿 吏덊솚, 젣2삎 떦눊, 怨좏삁븬 벑 떎뼇븳 留뚯꽦吏덊솚怨 愿젴씠 엳떎5,6. 떖룓泥대젰 떊泥닿 궛냼瑜 怨듦툒諛쏄퀬 궗슜븯뒗 뒫젰쑝濡, 湲곕뒫씠 궙쑝硫 洹쇱쑁씠 젣濡 옉룞븯吏 紐삵븯뒗뜲 씠뒗 씤뒓由 빆꽦쓣 넂씠嫄곕굹 誘쇨컧꽦 넀긽쓽 썝씤씠 맂떎6,7. 떊泥댄솢룞 利앷瑜 넻븳 떖룓泥대젰 뼢긽 씤뒓由 빆꽦 媛먯냼瑜 媛졇삩떎怨 븣젮졇 엳怨, 꽕怨꾩뿉 뵲씪 궓 諛 뿰졊뿉 뵲瑜 李⑥씠媛 떎뼇븯寃 굹궃떎8. 떎젣 떖룓泥대젰 吏몴뒗 엫긽 쁽옣뿉꽌 떎뼇븳 留뚯꽦吏덊솚쓽 쐞뿕쓣 룊媛븯湲 쐞빐 꼸由 궗슜릺뒗 吏몴씠떎. 洹몃윭굹 湲곗〈쓽 떖룓泥대젰 痢≪젙 諛⑸쾿 쟾臾 옣鍮꾩 썕젴맂 씤젰씠 븘슂븯뿬 鍮꾩슜씠 留롮씠 뱾怨 젒洹쇱꽦씠 궙 떒젏씠 엳떎. 씠윭븳 젣븳젏쓣 洹밸났븯湲 쐞빐 鍮꾩슫룞쑝濡 떖룓泥대젰쓣 異붿젙븯뒗 異붿젙 떖룓泥대젰(estimated cardiorespiratory fitness, eCRF) 븣怨좊━利섏씠 媛쒕컻릺뿀뒗뜲, 뿰졊, 꽦蹂, 뿀由щ몮젅, 븞젙 떖諛뺤닔, 떊泥댄솢룞 벑쓽 湲곗큹 엫긽 젙蹂대 궗슜븯뿬 돺寃 궛異쒗븷 닔 엳떎9. 꽑뻾뿰援щ뒗 엫긽쟻 떖룓泥대젰 痢≪젙怨 留덉갔媛吏濡 eCRF濡쒕룄 떖삁愿 吏덊솚 쐞뿕怨 궗留앸쪧쓣 삁痢≫븷 닔 엳쓬쓣 蹂댁뿬二쇱뿀떎10-12.

씠윭븳 諛곌꼍쓣 怨좊젮븷 븣, 떖룓泥대젰 媛쒖씤쓽 嫄닿컯 諛 궗꽦 吏덊솚 諛쒖깮 쐞뿕怨 愿젴씠 엳뒗 以묒슂븳 슂냼씠떎. 洹몃윭굹 븳援 꽦씤 씤援щ 긽쑝濡 븳 떖룓泥대젰怨 씤뒓由 빆꽦 媛꾩쓽 愿怨꾩뿉 愿븳 뿰援щ뒗 젣븳쟻쑝濡 닔뻾릺뿀떎.

蹂 뿰援ъ쓽 紐⑹쟻 援誘쇨굔媛뺤쁺뼇議곗궗 2019–2021뀈 뜲씠꽣瑜 솢슜븯뿬 븳援 꽦씤쓽 eCRF 씤뒓由 빆꽦 媛꾩쓽 뿰愿꽦쓣 議곗궗븯怨 꽦蹂 諛 뿰졊뿉 뵲瑜 李⑥씠瑜 遺꾩꽍븯뒗 寃껋쑝濡, 씠瑜 넻빐 궗꽦 吏덊솚 삁諛 諛 愿由щ 쐞븳 以묒슂븳 젙蹂대 룄異쒗븷 닔 엳쓣 寃껋쑝濡 湲곕븳떎.

뿰援 諛⑸쾿

1. 뿰援 긽

蹂 뿰援ъ뿉 궗슜븳 뜲씠꽣뒗 蹂닿굔蹂듭遺 吏덈퀝愿由ъ껌뿉꽌 떎떆븳 援誘쇨굔媛뺤쁺뼇議곗궗 옄猷뚮줈, 援誘쇱쓽 嫄닿컯 닔以, 嫄닿컯 愿젴 쓽떇 諛 뻾깭, 留뚯꽦吏덊솚 쑀臾 諛 쁺뼇 꽠痍 떎깭 벑뿉 愿븳 寃껋씠떎. 븳誘쇨뎅 씤援щ 몴븯怨 痢, 吏묐씫 諛 議곗궗 遺臾 諛 빆紐⑹쓣 怨좊젮븳 蹂듯빀 몴蹂 꽕怨꾨 궗슜븯뒗 議곗궗濡, 媛以묒튂瑜 씠슜븯뿬 렪뼢쓣 蹂댁젙븯쑝硫 몴꽦쓣 솗蹂댄븯떎. 젣8湲 1, 2, 3李 뿰룄씤 2019–2021뀈룄 옄猷뚮 솢슜븯쑝硫, 留 19꽭 씠긽씤 꽦씤쓣 긽쑝濡(n=18,691) 룆由쎈닔 醫낆냽蹂닔, 洹몃━怨 二쇱슂 怨듬씤뿉 寃곗륫移섍 엳뒗 긽옄瑜 젣쇅븳 13,405紐낆쓣 遺꾩꽍븯떎. 蹂 뿰援щ뒗 븳誘쇨뎅 吏덈퀝愿由ъ껌 뿰援ъ쑄由ш린愿쑝濡쒕꽣 듅씤쓣 諛쏆 젣8湲 援誘쇨굔媛뺤쁺뼇議곗궗瑜 씠슜븯쑝硫, 꽌슱븰援 깮紐낆쑄由ъ떖쓽 쐞썝쉶濡쒕꽣 떖쓽瑜 硫댁젣諛쏆븯떎(No. E2308/022-005).

2. 뿰援 궡슜 諛 諛⑸쾿

1) 씤援ы븰쟻 듅꽦 諛 湲곕낯 痢≪젙

씤援ы븰쟻 듅꽦쑝濡 꽦蹂꾧낵 뿰졊쓣 議곗궗븯怨, 湲곕낯 떊泥 怨꾩륫(떊옣, 泥댁쨷, 뿀由щ몮젅) 諛 삁븸 蹂씤쓽 痢≪젙怨 떎뼇븳 옄湲곕낫怨 꽕臾몄씠 吏꾪뻾릺뿀떎.

2) 떖룓泥대젰 痢≪젙

떖룓泥대젰 Jackson 벑9씠 媛쒕컻븯怨 Lee 벑13씠 떦룄瑜 寃궗븳 怨듭떇쓣 씠슜븯뿬 怨꾩궛븯떎. 꽦蹂꾩뿉 뵲瑜 媛곴컖쓽 怨듭떇 궗떦 웾(metabolic equivalents, METs)쑝濡 궗슜븯떎. 湲곗〈 꽑뻾뿰援ъ뿉 뵲씪 19꽭 씠긽 40꽭 誘몃쭔, 40꽭 씠긽 50꽭 誘몃쭔, 50꽭 씠긽 60꽭 誘몃쭔, 洹몃━怨 60꽭 씠긽쑝濡 痢듯솕븯뿬 遺꾩쐞닔瑜 굹늿 뮘 寃고빀븯뿬 遺꾩꽍븯떎14.

궓꽦: 21.2870竊(age×0.1654)–(age2×0.0023)–(BMI×0.2318)– (waist circumference×0.0337)–(resting heart rate×0.0390)竊(phy-sical activity [active vs. inactive]×0.6351)–(smoking [yes vs. no]× 0.4263)

뿬꽦: 14.7973竊(age×0.1159)–(age2×0.0017)–(BMI×0.1534)– (waist circumference×0.0088)–(resting heart rate×0.364)竊(phy-sical activity [active vs. inactive]×0.5987)–(smoking [yes vs. no]× 0.2994)

泥댁쭏웾吏닔(body mass index, BMI)뒗 泥댁쨷쓣 궎쓽 젣怨깆쑝濡 굹늿 媛(kg/m2)쓣 궗슜븳떎. 씉뿰 긽깭뒗 꽕臾몄쓣 넻빐 쁽옱 씉뿰 뿬遺濡 遺꾨쪟븯떎. 븞젙 떆 떖諛뺤닔뒗 삁븬 痢≪젙 떆뿉 痢≪젙븳 留λ컯쓣 湲곗쑝濡 쉶/遺꾩쑝濡 굹깉떎. 뿀由щ몮젅뒗 븳鍮꾨쭔븰쉶뿉꽌 젙쓽븳 湲곗쑝濡 궓꽦 90 cm 씠긽, 뿬꽦 85 cm 씠긽쓣 蹂듬鍮꾨쭔쑝濡 遺꾨쪟븯떎15. 떊泥댄솢룞 援젣 떊泥댄솢룞 꽕臾몄 (General Physical Activity Questionnaire, GPAQ)瑜 넻빐 媛뺣룄, 吏냽떆媛, 鍮덈룄뿉 뵲씪 痢≪젙릺硫, 꽭 媛吏 솢룞 쁺뿭(삁: 씪 愿젴, 옣냼 씠룞, 뿬媛떆媛 솢룞)쓣 룊媛븯떎16. GPAQ 쁺뿭蹂꾨줈 10遺 씠긽 吏냽릺뒗 떊泥댄솢룞씠 二쇰떦 硫곗튌, 紐 떆媛, 洹몃━怨 紐 遺 諛쒖깮븯뒗吏瑜 臾삳뒗떎. 쟻떦븳 떖샇씉 삉뒗 떖諛뺤닔 긽듅쓣 쑀諛쒗븯硫댁꽌 理쒖냼븳 10遺꾧컙 吏냽릺뒗 뿰냽쟻씤 솢룞쓣 湲곗쑝濡, 以묎컯룄 솢룞 4.0 METs濡 젙쓽릺怨, 怨좉컯룄 솢룞 8.0 METs濡 젙쓽릺뿀떎. 떊泥댄솢룞 吏移 以닔뒗 씪, 옣냼 씠룞, 뿬媛떆媛 쁺뿭蹂꾨줈 以묎컯룄, 怨좉컯룄, 洹몃━怨 以묎컯룄 怨좉컯룄瑜 紐⑤몢 寃고빀븳 떊泥댄솢룞쓣 媛곴컖 二쇰떦 理쒖냼븳 150遺, 75遺, 洹몃━怨 150遺 씠긽 李몄뿬븯뒗 寃껋쓣 쓽誘명븳떎. 씠뿉 뵲씪, 떊泥댄솢룞 媛씠뱶씪씤 異⑹” 뿬遺濡 遺꾨쪟븯떎.

3) 씤뒓由 빆꽦 痢≪젙

HOMA-IR (homeostatic model assessment of insulin resistance)쓣 怨꾩궛븯뿬(씤뒓由[μU/L]×怨듬났삁떦[mg/dL]/405), 2.5 씠긽씤 寃쎌슦 씤뒓由 빆꽦씠 엳떎怨 젙쓽븯떎17,18.

4) 怨듬씤

쓬二 삎깭뒗 궓옄뒗 1쉶 룊洹 7옍 씠긽, 뿬옄뒗 5옍 씠긽, 二 2쉶 씠긽 쓬二 떆 怨좎쐞뿕 쓬二쇱옄濡 踰붿<솕븯떎. 삁븬 痢≪젙 닔異뺢린 諛 씠셿湲 삁븬 3쉶 痢≪젙媛믪쓽 룊洹좎쓣 궗슜븯쑝硫 珥앹퐳젅뒪뀒濡ㅺ낵 以묒꽦吏諛⑹ 삁븸寃궗瑜 넻빐 痢≪젙븯怨 紐⑤몢 뿰냽삎 蹂닔濡 궗슜븯떎. 怨좏삁븬 쑀臾대뒗 닔異뺢린 삁븬씠 140 mmHg 씠긽씠嫄곕굹 씠셿湲 삁븬씠 90 mmHg 씠긽, 삉뒗 怨좏삁븬 빟臾쇱쓣 蹂듭슜븳 궗엺쑝濡 젙쓽븯怨, 삁븬씠 젙긽씤 옄 怨좏삁븬 쟾 떒怨 씠긽씤 옄濡 씠遺꾪븯뿬 踰붿<솕븯떎19. 떦눊 媛議깅젰 遺紐 以 떦눊蹂 쓽궗 吏꾨떒 뿬遺媛 엳뒗 궗엺怨 뾾뒗 궗엺쑝濡 씠遺꾪븯뿬 踰붿<솕븯떎. 怨듬씤뿉 븳 湲곗 援誘쇨굔媛뺤쁺뼇議곗궗 吏移⑥꽌瑜 湲곗쑝濡 븯떎20.

3. 옄猷 遺꾩꽍

紐⑤뱺 蹂씤 룊洹(mean)怨 몴以렪李(standard deviation)濡 굹깉쑝硫, 踰붿<삎 蹂씤 鍮덈룄(frequency) 鍮꾩쑉(%)濡 몴湲고븯떎. 湲곕낯쟻 듅꽦 eCRF 遺꾩쐞닔뿉 뵲씪 굹늻뼱 踰붿<삎 蹂닔뒗 移댁씠젣怨 寃젙, 뿰냽삎 蹂닔뒗 遺꾩궛遺꾩꽍 寃젙쓣 씠슜븯뿬 吏묐떒 媛꾩쓽 李⑥씠瑜 솗씤븯떎. 蹂듯빀 몴蹂 꽕怨꾩 긽 씤援 媛 臾댁쓳떟瑜, 궗썑 怨꾩링솕瑜 怨좊젮븳 몴蹂 媛以묒튂瑜 씠슜븯쑝硫, 떎以 濡쒖뒪떛 쉶洹遺꾩꽍쑝濡 룆由쎈닔 媛꾩쓽 愿怨꾨 뙆븙븯뿬 援먯감鍮(odds ratio, OR) 95% 떊猶곌뎄媛(confidence interval, CI)쑝濡 몴쁽븯떎. eCRF뒗 궓 媛곴컖 4遺꾩쐞닔濡 굹늻뼱 怨꾩궛븯쑝硫, 泥대젰 닔以씠 媛옣 넂 吏묐떒쓣 李몄“ 吏묐떒(reference group)쑝濡 꽕젙븯떎. Model 1 뿰졊쓣, model 2뒗 뿰졊, 씉뿰, 쓬二, 닔異뺢린 삁븬, 씠셿湲 삁븬, 珥앹퐳젅뒪뀒濡, 以묒꽦吏諛, 怨좏삁븬 뿬遺, 떦눊 媛議깅젰쓣 蹂댁젙븯떎. 넻怨꾨텇꽍 怨꾩링솕맂 떎떒怨 솗瑜 깦뵆留 꽕怨꾨 쟻슜븯湲 쐞빐 R software (version 4.2.2; The R Foundation)쓽 svydesign 紐⑤뱢쓣 궗슜븯쑝硫 쑀쓽 닔以 p<0.05濡 꽕젙븯떎.

寃 怨

蹂 뿰援ъ쓽 긽옄뒗 꽦씤 13,405紐(궓꽦, 5,869紐; 뿬꽦, 7,536紐)씠硫 꽦蹂꾩뿉 뵲瑜 湲곕낯쟻 듅꽦 Table 12뿉 옄꽭엳 젣떆븯떎. 쟾泥댁쟻쑝濡 泥대젰 닔以씠 궙 吏묐떒씠 넂 吏묐떒뿉 鍮꾪빐 씤뒓由 빆꽦쓽 OR씠 뜑 넂寃 굹궗쑝硫, 굹씠瑜 굹늻뼱 솗씤븳 寃곌낵뿉꽌룄 룞씪븳 寃쏀뼢쓣 솗씤븯떎. 궓꽦쓽 寃쎌슦 뿰졊留 蹂댁젙븳 model 1뿉꽌 泥대젰 닔以씠 媛옣 넂 吏묐떒쓣 湲곗쑝濡 2遺꾩쐞 吏묐떒(OR, 3.07; 95% CI, 2.44–3.87), 3遺꾩쐞 吏묐떒(OR, 6.57; 95% CI, 5.27–8.19), 媛옣 궙 吏묐떒(OR, 20.12; 95% CI, 16.01–25.57)닚쑝濡 씤뒓由 빆꽦쓽 OR씠 쑀쓽誘명븯寃 利앷븯뒗 寃껋쓣 솗씤븷 닔 엳뿀떎(p<0.001) (Table 3). 넻젣 蹂씤뱾쓣 紐⑤몢 蹂댁젙븳 model 2뿉꽌룄 泥대젰 닔以씠 媛옣 넂 吏묐떒쓣 湲곗쑝濡 2遺꾩쐞 吏묐떒(OR, 2.87; 95% CI, 2.25–3.67), 3遺꾩쐞 吏묐떒(OR, 6.00; 95% CI, 4.73–7.62), 媛옣 븯쐞 吏묐떒(OR, 17.65; 95% CI, 13.76–22.64)닚쑝濡 씤뒓由 빆꽦뿉 븳 OR씠 媛먯냼븯怨 넻怨꾩쟻쑝濡 쑀쓽븯떎(p<0.001). 뿬꽦쓽 寃쎌슦 궓꽦뿉 鍮꾪빐 씤뒓由 빆꽦뿉 븳 OR媛믪씠 떎냼 媛먯냼븳 寃껋쑝濡 솗씤릺뿀吏留, model 1뿉꽌 1遺꾩쐞 吏묐떒쓣 湲곗쑝濡 媛곴컖 2遺꾩쐞 吏묐떒(OR, 2.06; 95% CI, 1.64–2.59), 3遺꾩쐞 吏묐떒(OR, 3.36; 95% CI, 2.67–4.23), 媛옣 븯쐞 吏묐떒(OR, 11.66; 95% CI, 9.41–14.46)쓽 씤뒓由 빆꽦뿉 븯뿬 OR씠 利앷븯뒗 寃껋쓣 솗씤븯쑝硫, model 2뒗 1遺꾩쐞 吏묐떒쓣 湲곗쑝濡 媛곴컖 2遺꾩쐞 吏묐떒(OR, 1.82; 95% CI, 1.44–2.29), 3遺꾩쐞 吏묐떒(OR, 2.73; 95% CI, 2.15–3.45), 媛옣 븯쐞 吏묐떒(OR, 7.96; 95% CI, 6.37–9.94)닚쑝濡 씤뒓由 빆꽦뿉 븳 OR씠 紐⑤몢 넻怨꾩쟻쑝濡 쑀쓽븯寃 利앷븯떎(p<0.001).

Table 1 . Baseline characteristics of participants (male)

Characteristic eCRF groupp-value
Highest2nd3rdLowest
No. of participants1,4611,4671,4691,472
Age (yr)47.0±15.148.5±15.749.8±16.851.0±18.9<0.001
Height (cm)171.5±6.4171.8±6.6171.5±6.7171.6±7.20.248
Weight (kg)63.7±7.670.5±8.274.9±9.284.0±14.3<0.001
BMI (kg/m2)21.6±2.123.8±2.025.4±2.128.4±3.5<0.001
WC (cm)79.4±6.585.7±5.890.3±5.898.4±8.0<0.001
RHR (bpm)67.4±6.970.3±8.271.2±8.274.7±9.9<0.001
Fasting glucose (mg/dL)98.8±19.6102.0±21.9105.1±23.0111.6±32.0<0.001
Current smoker358 (24.5)434 (29.6)503 (34.2)592 (40.2)<0.001
Heavy drinker231 (15.8)293 (20.0)290 (19.7)304 (20.7)<0.001
Physically active956 (65.4)769 (52.4)578 (39.3)428 (29.1)<0.001
SBP (mmHg)116.6±4.0120.2±13.4122.4±13.9124.7±13.4<0.001
DBP (mmHg)75.7±9.077.6±9.178.4±9.779.6±10.9<0.001
TC (mg/dL)189.0±36.6190.7±38.3189.6±39.3190.3±40.60.132
Triglyceride (mg/dL)124.8±120.5147.4±125.4164.7±130.9189.1±154.7<0.001
HOMA-IR1.6±1.62.1±1.62.7±2.34.3±4.3<0.001
eCRF (METs)13.4±1.012.4±1.011.6±1.110.1±1.4<0.001

Values are presented as number only, mean±standard deviation, or number (%).

eCRF: estimated cardiorespiratory fitness, BMI: body mass index, WC: waist circumference, RHR: resting heart rate, SBP: systolic blood pressure, DBP: diastolic blood pressure, TC: total cholesterol, HOMA-IR: homeostatic model assessment of insulin resistance, MET: metabolic equivalent.


Table 2 . Baseline characteristics of participants (female)

CharacteristiceCRF groupp for trend
Highest2nd3rdLowest
No. of participants1,8781,8821,8861,890
Age (yr)48.4±13.949.5±15.050.9±16.852.9±18.9<0.001
Height (cm)159.3±5.8158.7±6.1157.9±6.4157.3±6.9<0.001
Weight (kg)52.6±5.756.6±6.859.3±7.867.3±12.1<0.001
BMI (kg/m2)20.8±2.222.5±2.523.8±2.827.1±4.0<0.001
WC (cm)73.0±6.977.9±8.081.5±8.289.6±9.6<0.001
RHR (bpm)67.0±6.170.2±7.272.3±8.375.9±9.4<0.001
Fasting glucose (mg/dL)94.7±14.797.0±15.799.2±21.8105.0±25.7<0.001
Current smoker41 (2.2)87 (4.6)115 (6.1)165 (8.7)<0.001
Heavy drinker78 (4.2)94 (5.0)106 (5.6)117 (6.2)<0.001
Physically active1338 (71.2)842 (44.7)533 (28.3)360 (19.0)<0.001
SBP (mmHg)112.0±15.9115.6±17.1117.2±16.5121.5±16.4<0.001
DBP (mmHg)72.0±9.173.4±9.373.8±9.275.4±9.3<0.001
TC (mg/dL)193.2±34.6195.4±37.8192.2±38.7192.9±39.60.549
Triglyceride (mg/dL)91.2±50.103.2±68.8114.3±84.8133.8±80.2<0.001
HOMA-IR1.5±0.91.9±2.12.2±1.93.6±4.4<0.001
eCRF (METs)10.3±0.99.6±1.09.0±1.18.0±1.3<0.001

Values are presented as number only, mean±standard deviation, or number (%).

eCRF: estimated cardiorespiratory fitness, BMI: body mass index, WC: waist circumference, RHR: resting heart rate, SBP: systolic blood pressure, DBP: diastolic blood pressure, TC: total cholesterol, HOMA-IR: homeostatic model assessment of insulin resistance, MET: metabolic equivalent.


Table 3 . Association between estimated cardiorespiratory fitness and insulin resistance

VariableModel 1Model 2
Male
Highest1 (Reference)1 (Reference)
2nd3.07 (2.44−3.87)2.87 (2.25−3.67)
3rd6.57 (5.27−8.19)6.00 (4.73−7.62)
Lowest20.12 (16.01−25.27)17.65 (13.76−22.64)
p for trend<0.001<0.001
Female
Highest1 (Reference)1 (Reference)
2nd2.06 (1.64−2.59)1.82 (1.44−2.29)
3rd3.36 (2.67−4.23)2.73 (2.15−3.45)
Lowest11.66 (9.41−14.46)7.96 (6.37−9.94)
p for trend<0.001<0.001

Model 1: adjusted for age model, 2: adjusted for age, smoking status, alcohol consumption, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, hypertension, and family history of diabetes.



Fig. 1뿉꽌 50꽭 씠긽怨 誘몃쭔쑝濡 뿰졊쓣 굹늻뼱 泥대젰 닔以怨 씤뒓由 빆꽦 媛꾩쓽 愿怨꾨 솗씤븯떎. 넻젣 蹂씤뱾쓣 紐⑤몢 蹂댁젙븳 寃곌낵, 50꽭 誘몃쭔쓽 궓꽦쓽 寃쎌슦 1遺꾩쐞 吏묐떒쓣 李몄“ 吏묐떒쑝濡 븯뿬 2遺꾩쐞 吏묐떒(OR, 3.41; 95% CI, 2.38–4.89), 3遺꾩쐞 吏묐떒(OR, 7.59; 95% CI, 5.34–10.78), 媛옣 븯쐞 吏묐떒(OR, 26.28; 95% CI, 18.11–38.12)쓽 씤뒓由 빆꽦뿉 븳 OR씠 넻怨꾩쟻쑝濡 쑀쓽븯寃 利앷븯떎(p<0.001). 50꽭 씠긽 궓꽦쓽 寃쎌슦, 1遺꾩쐞 吏묐떒쓣 李몄“ 吏묐떒쑝濡 븯뿬 2遺꾩쐞 吏묐떒(OR, 2.39; 95% CI, 1.71–3.34), 3遺꾩쐞 吏묐떒(OR, 4.69; 95% CI, 3.37–6.53), 媛옣 븯쐞 吏묐떒(OR, 11.43; 95% CI, 8.01–16.31)쓽 씤뒓由 빆꽦뿉 븳 OR씠 利앷븯뒗 寃껋쓣 솗씤븯쑝硫, 以묐뀈 씠긽쓽 궓꽦(50꽭 씠긽)뿉 鍮꾪빐 긽쟻쑝濡 젇 궓꽦(50꽭 誘몃쭔)쓽 吏묐떒뿉꽌 泥대젰 닔以뿉 뵲瑜 씤뒓由 빆꽦쓽 OR씠 뜑 넂 寃껋쓣 솗씤븷 닔 엳뿀떎(p<0.001).

Fig. 1. Odds ratio (OR) and 95% confidence interval (CI) for estimated cardiorespiratory fitness (eCRF) and insulin resistance by age-specific (≥50 and <50 years) for male (A) and female (B). Adjusted for age, smoking status, alcohol consumption, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, hypertension, and family history of diabetes.

50꽭 誘몃쭔쓽 뿬꽦쓽 寃쎌슦, 1遺꾩쐞 吏묐떒쓣 李몄“ 吏묐떒쑝濡 븯뿬 2遺꾩쐞 吏묐떒(OR, 1.85; 95% CI, 1.25–2.73), 3遺꾩쐞 吏묐떒(OR, 2.94; 95% CI, 1.99–4.33), 媛옣 븯쐞 吏묐떒(OR, 11.29; 95% CI, 7.79–16.36)쓽 씤뒓由 빆꽦쓽 OR씠 利앷븯뒗 寃껋쓣 솗씤븯떎(p<0.001). 50꽭 씠긽쓽 뿬꽦쓽 寃쎌슦, 1遺꾩쐞 吏묐떒쓣 李몄“ 吏묐떒쑝濡 븯뿬 2遺꾩쐞 吏묐떒(OR, 1.85; 95% CI, 1.39–2.45), 3遺꾩쐞 吏묐떒(OR, 2.66; 95% CI, 1.98–3.56), 媛옣 븯쐞 吏묐떒(OR, 5.59; 95% CI, 4.18–7.49)쓽 씤뒓由 빆꽦뿉 븳 OR쓣 솗씤븯쑝硫 넻怨꾩쟻쑝濡 쑀쓽븯寃 利앷븯떎(p<0.001). 뿬꽦 吏묐떒 삉븳 긽쟻쑝濡 젇 뿬꽦 吏묐떒(50꽭 誘몃쭔)씠 뜑 媛뺥븳 뿰愿꽦쓣 蹂댁쑝굹, 쟾泥댁쟻쑝濡 궓꽦 吏묐떒뿉 鍮꾪빐꽌뒗 씤뒓由 빆꽦쓽 OR씠 궙 寃껋쓣 솗씤븷 닔 엳뿀떎.

怨 李

蹂 뿰援щ뒗 援誘쇨굔媛뺤쁺뼇議곗궗쓽 옄猷뚮 諛뷀깢쑝濡 떖룓泥대젰쓣 異붿젙븯뿬 씤뒓由 빆꽦 媛꾩쓽 愿怨꾨 솗씤븯떎. 洹 寃곌낵 泥대젰 닔以씠 궙쓣닔濡 씤뒓由 빆꽦쓽 OR씠 쑀쓽븯寃 利앷븯쑝硫, 젇 궗엺쓽 吏묐떒뿉꽌 슚怨 겕湲곌 뜑 겕寃 굹궗떎. 궙 泥대젰 닔以 怨좏삁븬, 떦눊, 궡遺꾨퉬 湲곕뒫 븯, 떖삁愿 吏덊솚 諛쒕퀝 諛 븫쓽 쐞뿕 씤옄씪怨 븣젮졇 엳쑝誘濡21, 씠윴 吏덈퀝쓽 쐞뿕 슂냼씤 씤뒓由 빆꽦쓣 愿由ы븯뒗 寃껋 뜑슧 떖媛곹븳 吏덈퀝쓣 삁諛⑺븷 닔 엳쓬쓣 떆궗븳떎.

Leite 벑6쓽 뿰援ъ뿉꽌 理쒕궛냼냼鍮꾨웾(maximal oxygen consumption, VO2 max)濡 솗씤븳 궙 떖룓泥대젰 씤뒓由 媛먯닔꽦 븯 뿰愿씠 엳쑝硫, 吏덈퀝씠 뾾뒗 씤援ъ뿉꽌 媛옣 쓷븳 씠긽 吏덊솚 쁽긽씠씪怨 蹂닿퀬븯떎. 쁺援 嫄곗< 湲곕컲 긽옄뱾濡 吏꾪뻾븳 뿰援ъ뿉꽌 쑀읇씤뱾蹂대떎 궓븘떆븘씤뱾쓽 HOMA-IR씠 67% 뜑 넂븯쑝硫(p<0.001), 궓븘떆븘씤뱾 궙 VO2 max, 궙 떊泥댄솢룞웾, 洹몃━怨 넂 珥 泥댁諛⑸웾쑝濡 씤빐 씤醫 媛 83%쓽 HOMA-IR 李⑥씠媛 궃떎怨 蹂닿퀬븯떎(p<0.001)22. Lee 벑23쓽 뿰援щ뒗 븳援 꽦씤뱾쓣 긽쑝濡 eCRF 궗利앺썑 媛꾩쓽 愿怨꾨 궡렣蹂댁븯뒗뜲, eCRF 닔以씠 넂쓣닔濡 궗利앺썑援곗쓽 쑀蹂묐쪧씠 쑀쓽븯寃 궙븯쑝硫 씠寃껋 룆由쎌쟻쑝濡 뿰愿릺뼱 엳쓬쓣 솗씤븯떎.

諛섎㈃, 씠쟾 꽑뻾뿰援ъ뿉꽌 泥대궡 吏諛 긽깭媛 泥대젰 닔以蹂대떎 씤뒓由 빆꽦쓽 뜑 媛뺣젰븳 삁痢 씤옄엫쓣 솗씤븯떎24. 蹂 뿰援ъ뿉 궗슜븳 떖룓泥대젰 異붿젙떇 BMI굹 뿀由щ몮젅媛 以묒슂븳 슂씤쑝濡 옉슜븯誘濡, 떎젣 媛앷쟻씤 泥대젰怨 씤뒓由 빆꽦쓽 愿怨꾩뿉꽌 怨쇰 異붿젙맆 닔 엳뒗 遺遺꾩쓣 怨좊젮븯뿬 빐꽍븷 븘슂媛 엳떎. 鍮꾨쭔 닔以怨 떖룓泥대젰쓣 뿮뼱꽌 씤뒓由 빆꽦 媛꾩쓽 뿰愿꽦쓣 솗씤븳 뿰援 寃곌낵, 鍮꾨쭔씠硫 泥대젰 닔以씠 궙 吏묐떒뿉꽌 젙긽 泥댁쨷씠硫 泥대젰 닔以씠 醫뗭 吏묐떒뿉 鍮꾪빐 씤뒓由 빆꽦쓽 OR씠 넂 寃껋쓣 솗씤븷 닔 엳뿀떎(궓꽦 吏묐떒: OR, 20.3 [95% CI, 15.6–26.5]; 뿬꽦 吏묐떒: OR, 12.9 [95% CI, 11.4–14.6])25. 븯吏留 BMI 愿怨꾩뾾씠 궙 泥대젰 닔以 궓 紐⑤몢뿉寃뚯꽌 씤뒓由 빆꽦 쐞뿕 利앷 愿젴씠 엳뿀떎.

씠 뿰援ъ쓽 二쇱슂븳 諛쒓껄 以 븯굹뒗 꽦蹂 諛 뿰졊뿉 뵲씪 吏묐떒 媛꾩쓽 OR媛 李⑥씠媛 굹궃떎뒗 寃껋씠떎. 룓寃 쟾 뿬꽦 궗쟻 吏덊솚뿉 엳뼱꽌 궓꽦蹂대떎 뜑 쟻 諛쒕퀝쓣 蹂댁씠硫, 듅엳 뿬꽦 꽦샇瑜대が씤 뿉뒪듃씪뵒삱(estradiol) proopiomelanocortin 돱윴쓣 씤뒓由 빆꽦쑝濡쒕꽣 蹂댄샇븯怨, 뿬윭 議곗쭅뿉꽌 씤뒓由 빆꽦뿉 쓳븳떎26. 삉븳 뿉뒪듃濡쒓쾺(estrogen) 泥댁諛⑸웾 遺꾪룷, 룷룄떦 궗, 씤뒓由 媛먯닔꽦 議곗젅뿉 쁺뼢쓣 誘몄튂湲 븣臾몄뿉27, 뿬꽦쓽 씤뒓由 媛먯닔꽦怨 씤뒓由 諛섏쓳 뒫젰씠 궓꽦蹂대떎 넂븘 뜑 궙 OR媛믪쓣 蹂댁씤떎怨 깮媛곷맂떎. 삉븳, 泥뀈湲곗뿉 뜑 넂 泥대젰쓣 媛吏뒗 寃껋씠 씤뒓由 빆꽦怨 留ㅼ슦 諛젒븳 愿젴씠 엳뒗 떦눊蹂 諛쒕퀝 쐞뿕쓣 理쒖냼솕븯뒗 뜲 뿰愿릺뼱 엳쓬쓣 솗씤븳 뿰援 寃곌낵媛 엳떎28. 씠뒗 泥뀈湲곗뿉 넂 泥대젰쓣 媛吏뒗 寃껋씠 뜑 겙 씠젏쓣 媛졇삱 닔 엳떎뒗 寃껋쓣 떆궗븳떎. 삉븳 궓꽦쓽 寃쎌슦 뿬꽦蹂대떎 吏묐떒 媛꾩쓽 泥대젰 닔以 李⑥씠媛 뜑 留롮씠 굹뒗 寃껋쓣 솗씤븷 닔 엳뿀떎. 뵲씪꽌 媛옣 泥대젰 닔以씠 醫뗭 吏묐떒쓣 李몄“ 吏묐떒쑝濡 遊ㅼ쓣 븣 OR씠 뜑 넂寃 굹삤뒗 씠쑀濡 빐꽍븷 닔 엳떎. 씠 뜑遺덉뼱 떖룓泥대젰怨 씤뒓由 빆꽦 媛꾩쓽 愿怨꾨 遺꾩꽍븳 뿰援 以 븘룞∙泥냼뀈쓣 긽쑝濡 븳 뿰援щ뱾씠 議댁옱븯뒗뜲29,30, 씠뱾 뿰援 寃곌낵뒗 떖룓泥대젰怨 씤뒓由 빆꽦 媛꾩쓽 뿭 긽愿愿怨꾨 蹂댁씠湲 븣臾몄뿉 굹씠媛 뼱由댁닔濡 泥대젰怨 씤뒓由 빆꽦쓽 愿由ш 븘슂븿쓣 떆궗븳떎.

蹂 뿰援ъ쓽 寃곌낵뒗 eCRF 닔以뿉 뵲瑜 씤뒓由 빆꽦쓽 뿰愿꽦怨 굹씠 諛 꽦蹂꾩뿉 뵲瑜 寃곌낵瑜 쑀쓽誘명븯寃 젣떆븯吏留 紐 媛吏 젣븳젏씠 엳떎. 泥レ㎏, 李몄뿬옄뱾 떊泥댄솢룞, 씉뿰 뿬遺, 쓬二쇰웾 벑쓽 二쇱슂 蹂닔뱾쓣 옄湲곕낫怨좎떇 꽕臾몄쑝濡 議곗궗븯떎. 뵲씪꽌, 쉶긽 鍮꾨슕由 샊 궗쉶쟻 諛붾엺吏곸꽦 벑쓽 렪뼢씠 議댁옱븷 닔 엳떎. 몮吏, 泥대젰 닔以怨 씤뒓由 빆꽦 媛꾩쓽 愿怨꾨 슒떒뿰援щ줈 솗씤븯湲 븣臾몄뿉 蹂닔 궗씠쓽 씤怨쇨怨꾨 諛앺엳湲곗뿉 젣븳쟻씠떎. 뀑吏, eCRF 怨듭떇씠 씤醫 젣븳쟻씠떎. 빐떦 怨듭떇 諛깆씤쓣 긽쑝濡 븳 뿰援ъ뿉꽌 룄異쒕맂 異붿젙떇쑝濡, 븳援씤뱾쓣 긽쑝濡 異붿젙떇뿉 븳 떦룄瑜 솗씤뻽吏留13 꽦蹂꾩씠굹 뿰졊 벑쓣 怨좊젮븳 醫뜑 젙援먰븳 뿰援щ 嫄곗퀜 븘떆븘씤쓣 긽쑝濡 븳 怨듭떇씠 븘슂븯떎怨 뙋떒맂떎. 留덉留됱쑝濡, HOMA-IR 닔移섎뒗 뿰냽삎 蹂닔씠吏留 湲곗移섎 젙븯뿬 빆꽦 쑀臾대 뙋떒븯湲곗뿉 씤뒓由 옉슜쓽 뿰냽쟻씤 踰붿쐞뿉 븳 뿰愿꽦쓣 꽭遺쟻쑝濡 遺꾩꽍븯吏 紐삵븯떎. 諛섎㈃ 援媛 몴蹂 뜲씠꽣瑜 궗슜븯뿬 遺꾩꽍븯쑝硫 넻젣 蹂씤뱾쓣 蹂댁젙븯뿬 뿰援щ 吏꾪뻾뻽떎뒗 젏 蹂 뿰援ъ쓽 媛뺤젏씠씪 븷 닔 엳떎. 삉븳 븳援씤쓣 긽쑝濡 eCRF瑜 씠슜븯뿬 씤뒓由 빆꽦 媛꾩쓽 愿怨꾨 꽦蹂 諛 뿰졊瑜 굹늻뼱 遺꾩꽍븳 泥 뿰援щ씪뒗 쓽쓽媛 엳떎. 뼢썑 洹쒕え 몴蹂몄쓣 긽쑝濡 媛앷쟻씤 泥대젰 痢≪젙쓣 넻븳 씤뒓由 빆꽦怨쇱쓽 愿怨꾨 솗씤븷 븘슂媛 엳쑝硫, 뿰졊쓣 꽭遺쟻쑝濡 怨꾩링솕븯怨 蹂씤뱾쓽 닔以쓣 떎뼇븯寃 굹늻뿀쓣 븣 쁺뼢뿉 뼱뼡 李⑥씠媛 굹뒗吏 솗씤븯뒗 뿰援ш 븘슂븯떎. 삉븳 醫낅떒뿰援щ 넻빐 몢 蹂씤 媛꾩쓽 씤怨쇱꽦쓣 솗씤븷 븘슂媛 엳떎.

蹂 뿰援щ뒗 븳援씤 궓꽦怨 뿬꽦뿉꽌 eCRF媛 씤뒓由 빆꽦 諛쒖깮쓣 삁諛⑺븯뒗 뿭븷쓣 븷 닔 엳쓬쓣 蹂댁뿬以떎. 떊泥댄솢룞 諛 깮솢뒿愿 愿由щ 넻븳 떖룓泥대젰 利앹쭊 泥대젰 닔以씠 궙 궗엺뿉寃 엫긽쟻쑝濡 以묒슂븯硫, 젇 굹씠씪닔濡 泥대젰 뼢긽씠 뜑 留롮 씠젏쓣 젣怨듯븷 닔 엳쓬쓣 떆궗븳떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Conceptualization, Data curation, Formal analysis, Investigation, Resources, Software, Validation, Visualization: YH. Methodology, Project administration: YH, YK. Supervision: YK. Writing–original draft: YH. Writing–review & editing: YH, YK.

References
  1. Wilcox G. Insulin and insulin resistance. Clin Biochem Rev 2005;26:19-39.
  2. Petersen MC, Shulman GI. Mechanisms of insulin action and insulin resistance. Physiol Rev 2018;98:2133-223.
    Pubmed KoreaMed CrossRef
  3. Kim Mh, Lee Sh, Shin KS, et al. The change of metabolic syndrome prevalence and its risk factors in Korean adults for decade: Korea National Health and Nutrition Examination Survey for 2008-2017. Korean J Fam Pract 2020;10:44-52.
    CrossRef
  4. Lim J, Kim J, Koo SH, Kwon GC. Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: an analysis of the 2007-2010 Korean National Health and Nutrition Examination Survey. PLoS One 2019;14:e0212963.
    Pubmed KoreaMed CrossRef
  5. Al-Mallah MH, Sakr S, Al-Qunaibet A. Cardiorespiratory fitness and cardiovascular disease prevention: an update. Curr Atheroscler Rep 2018;20:1.
    Pubmed CrossRef
  6. Leite SA, Monk AM, Upham PA, Bergenstal RM. Low cardiorespiratory fitness in people at risk for type 2 diabetes: early marker for insulin resistance. Diabetol Metab Syndr 2009;1:8.
    Pubmed KoreaMed CrossRef
  7. Lin X, Zhang X, Guo J, et al. Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc 2015;4:e002014.
    Pubmed KoreaMed CrossRef
  8. Gill JM. Physical activity, cardiorespiratory fitness and insulin resistance: a short update. Curr Opin Lipidol 2007;18:47-52.
    Pubmed CrossRef
  9. Jackson AS, Sui X, O'Connor DP, et al. Longitudinal cardiorespiratory fitness algorithms for clinical settings. Am J Prev Med 2012;43:512-9.
    Pubmed KoreaMed CrossRef
  10. Garnvik LE, Malmo V, Janszky I, et al. Physical activity, cardiorespiratory fitness, and cardiovascular outcomes in individuals with atrial fibrillation: the HUNT study. Eur Heart J 2020;41:1467-75.
    Pubmed KoreaMed CrossRef
  11. Nauman J, Nes BM, Lavie CJ, et al. Prediction of cardiovascular mortality by estimated cardiorespiratory fitness independent of traditional risk factors: the HUNT Study. Mayo Clin Proc 2017;92:218-27.
    Pubmed CrossRef
  12. Stamatakis E, Hamer M, O'Donovan G, Batty GD, Kivimaki M. A non-exercise testing method for estimating cardiorespiratory fitness: associations with all-cause and cardiovascular mortality in a pooled analysis of eight population-based cohorts. Eur Heart J 2013;34:750-8.
    Pubmed KoreaMed CrossRef
  13. Lee I, Han K, Song M, Kang H. Development and cross-validation of non-exercise-based prediction equations for estimating cardiorespiratory fitness in Korean college students. Korean J Sports Med 2022;40:39-48.
    CrossRef
  14. Artero EG, Jackson AS, Sui X, et al. Longitudinal algorithms to estimate cardiorespiratory fitness: associations with nonfatal cardiovascular disease and disease-specific mortality. J Am Coll Cardiol 2014;63:2289-96.
    Pubmed KoreaMed CrossRef
  15. Clinical Guideline Committee, Korean Society for the Study of Obesity. Clinical practice guidelines for obesity 2022 (8th ed). Korean Society for the Study of Obesity; 2022.
  16. World Health Organization (WHO). Global physical activity questionnaire analysis guide. WHO; 2012.
  17. Yamada C, Mitsuhashi T, Hiratsuka N, Inabe F, Araida N, Takahashi E. Optimal reference interval for homeostasis model assessment of insulin resistance in a Japanese population. J Diabetes Investig 2011;2:373-6.
    Pubmed KoreaMed CrossRef
  18. Yun KJ, Han K, Kim MK, et al. Insulin resistance distribution and cut-off value in Koreans from the 2008-2010 Korean National Health and Nutrition Examination Survey. PLoS One 2016;11:e0154593.
    Pubmed KoreaMed CrossRef
  19. Lee HY, Shin J, Kim GH, et al. 2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension. Clin Hypertens 2019;25:20.
    Pubmed KoreaMed CrossRef
  20. Kweon S, Kim Y, Jang MJ, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014;43:69-77.
    Pubmed KoreaMed CrossRef
  21. Grundy SM, Barlow CE, Farrell SW, Vega GL, Haskell WL. Cardiorespiratory fitness and metabolic risk. Am J Cardiol 2012;109:988-93.
    Pubmed CrossRef
  22. Ghouri N, Purves D, McConnachie A, Wilson J, Gill JM, Sattar N. Lower cardiorespiratory fitness contributes to increased insulin resistance and fasting glycaemia in middle-aged South Asian compared with European men living in the UK. Diabetologia 2013;56:2238-49.
    Pubmed KoreaMed CrossRef
  23. Lee I, Kim S, Kang H. Non-exercise based estimation of cardiorespiratory fitness is inversely associated with metabolic syndrome in a representative sample of Korean adults. BMC Geriatr 2020;20:146.
    Pubmed KoreaMed CrossRef
  24. Christou DD, Gentile CL, DeSouza CA, Seals DR, Gates PE. Fatness is a better predictor of cardiovascular disease risk factor profile than aerobic fitness in healthy men. Circulation 2005;111:1904-14.
    Pubmed CrossRef
  25. Clarke SL, Reaven GM, Leonard D, et al. Cardiorespiratory fitness, body mass index, and markers of insulin resistance in apparently healthy women and men. Am J Med 2020;133:825-30.
    Pubmed KoreaMed CrossRef
  26. Greenhill C. Obesity: sex differences in insulin resistance. Nat Rev Endocrinol 2018;14:65.
    Pubmed CrossRef
  27. Gerdts E, Regitz-Zagrosek V. Sex differences in cardiometabolic disorders. Nat Med 2019;25:1657-66.
    Pubmed CrossRef
  28. Juraschek SP, Blaha MJ, Blumenthal RS, et al. Cardiorespiratory fitness and incident diabetes: the FIT (Henry Ford ExercIse Testing) project. Diabetes Care 2015;38:1075-81.
    Pubmed CrossRef
  29. Benson AC, Torode ME, Singh MA. Muscular strength and cardiorespiratory fitness is associated with higher insulin sensitivity in children and adolescents. Int J Pediatr Obes 2006;1:222-31.
    Pubmed CrossRef
  30. Nyström CD, Henriksson P, Martínez-Vizcaíno V, et al. Does cardiorespiratory fitness attenuate the adverse effects of severe/morbid obesity on cardiometabolic risk and insulin resistance in children?: a pooled analysis. Diabetes Care 2017;40:1580-7.
    CrossRef