Background: 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.

Methods: 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 (AUC_ratio) 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 AUC_ratio (Fit_AUC or Unfit_AUC) and initial CRF (Fit_initial or Unfit_initial), respectively. T2DM was evaluated on health checkups until March 2010.

Results: During the follow-up period, 400 men developed T2DM. After adjustment for confounders, as compared with those in the Fit_AUC group, the hazard ratio (HR) for those in the Unfit_AUC group was 1.33 (95% confidence interval [CI], 1.06–1.65). A combined analysis with the categories of initial value and AUC_ratio showed that, compared with the Fit_initial and Fit_AUC group, the HRs of Fit_initial and Unfit_AUC, Unfit_initial and Fit_AUC, and Unfit_initial and Unfit_AUC 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.

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