Habitual exercise is associated with reduced risk of diabetes regardless of air pollution: a longitudinal cohort study



Physical activity may increase a person’s inhalation of air pollutants and exacerbate the adverse health effects. This study aimed to investigate the combined associations of chronic exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) and habitual physical activity with the incidence of type 2 diabetes in Taiwan.


We selected 156,314 non-diabetic adults (≥18 years old) who joined an ongoing longitudinal cohort between 2001 and 2016. Incident type 2 diabetes was identified at the follow-up medical examinations. Two-year mean PM2.5 exposure was estimated at each participant’s address using a satellite-based spatiotemporal model. Information on physical activity and a wide range of covariates was collected using a standard self-administered questionnaire. We analysed the data using a Cox regression model with time-varying covariates. An interaction term between PM2.5 and physical activity was included to examine the overall interaction effects.


Compared with high physical activity, moderate and inactive/low physical activity were associated with a higher risk of diabetes (HR [95% CI] 1.31 [1.22, 1.41] and 1.56 [1.46, 1.68], respectively). Participants with moderate/high PM2.5 had a higher risk of type 2 diabetes than the participants exposed to low PM2.5 (HR 1.31 [1.22, 1.40] and 1.94 [1.76, 2.14], respectively). The participants with high physical activity and low PM2.5 had a 64% lower risk of type 2 diabetes than those with inactive/low physical activity and high PM2.5.


Higher physical activity and lower PM2.5 exposure are associated with lower risk of type 2 diabetes. Habitual physical activity can reduce the risk of diabetes regardless of the levels of PM2.5 exposure. Our results indicate that habitual physical activity is a safe diabetes prevention strategy for people residing in relatively polluted regions.

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Fig. 1
Fig. 2

Data availability

The datasets generated during and/or analysed during the current study are not publicly available for data protection reasons but are available from MJ Health Research Foundation.



Aerosol optical depth


Fasting plasma glucose


Metabolic equivalents

PM2.5 :

Particulate matter with an aerodynamic diameter less than 2.5 μm


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We would like to thank MJ Health Research Foundation for authorising the use of MJ health data (authorisation code: MJHR2019006A). Any interpretation or conclusion related to this manuscript does not represent the views of MJ Health Research Foundation. We also appreciate the contributions of the editors and reviewers for their valuable and constructive comments, which helped us improve our manuscript substantially.

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Any interpretation or conclusion related to this manuscript is solely that of the authors and does not represent the views of the MJ Health Research Foundation. The authors declare that there are no relationships or activities that might bias, or be perceived to bias their work.


This work was supported by RGC General Research Fund (14603019) and Environmental Health Research Fund of the Chinese University of Hong Kong (7104946). CG is in part supported by the Faculty Postdoctoral Fellowship Scheme of the Faculty of Medicine of the Chinese University of Hong Kong. YB and YZ are supported by the PhD Studentship of the Chinese University of Hong Kong.

Author information




XQL conceived and designed the study. LC, AKHL, CL, TT and XQL acquired the data. CG, HTY, YB and YZ searched the literature. CG, HTY, GH and XQL analysed and interpreted the data. CG, HTY, GH and XQL drafted the manuscript. All authors contributed to study conception and design, revised the manuscript critically for important intellectual content, and approved the final version to be published. XQL obtained the funding. LC, AKHL, GH, TT and XQL supervised this study. XQL is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Xiang Qian Lao.

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Cui Guo and Hsiao Ting Yang are joint first authors

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Guo, C., Yang, H.T., Chang, Ly. et al. Habitual exercise is associated with reduced risk of diabetes regardless of air pollution: a longitudinal cohort study. Diabetologia (2021). https://doi.org/10.1007/s00125-021-05408-4

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  • Chinese adults
  • Long-term exposure
  • Physical activity
  • PM2.5 air pollution
  • Type 2 diabetes