The Associations Between Health-related Physical Fitness and Fasting Blood Glucose in War Veterans: a Population-based Study

The Associations Between Health-related Physical Fitness and Fasting Blood Glucose in War Veterans: a Population-based Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Associations Between Health-related Physical Fitness and Fasting Blood Glucose in War Veterans: a Population-based Study Mario Kasović, Lovro Štefan, Zvonimir Kalčik This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-900596/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract The main purpose of the study was to analyze the associations between health-related physical fitness and fasting blood glucose in war veterans. In this cross-sectional study, we recruited 764 men and women aged 45–75 years, who were part of the Homeland War between 1990 and 1995 (33.5% women). Health-related physical fitness included: 1) fat mass and fat-free mass (body composition), 2) push-ups in 30 sec (muscular dynamic endurance of upper extremities), 3) sit-ups in 30 sec (repetitive upper body strength), 4) chair-stands in 30 sec (lower body strength), 5) sit-and-reach test (flexibility) and 6) the 2-minute step test (cardiorespiratory function). Laboratory measurement of fasting blood glucose was performed according to standardized procedures in resting seated position after a 12-h overnight fast. Generalized estimating equations with multiple regression models were used to calculate the associations between health-related physical fitness and fasting blood glucose. In model adjusted for sex and age, fasting blood glucose was associated with fat mass ( β = 0.12, p = 0.012), fat-free mass ( β =-0.19, p < 0.001), push-ups in 30 sec ( β =-0.19, p < 0.001), chair-stands in 30 sec ( β =-0.15, p < 0.001), sit-ups in 30 sec ( β =-0.21, p < 0.001), sit-and-reach test ( β =-0.15, p < 0.001) and the 2-minute step test ( β =-0.25, p < 0.001). The multiple regression model was strongly correlated with fasting blood glucose ( R = 0.78, R 2 = 0.61, standard error of the estimate = 0.88 mmol/L, p < 0.001). This study shows that fasting blood glucose may be predicted by health-related physical fitness test in war veterans. Sports Medicine and Kinesiology performance blood sugar veterans associations Introduction Blood glucose is one of the essential sources of energy in the body, being critical for optimal health functioning [ 1 ]. Studies have shown, that even small increases in blood glucose may lead to negative health-related outcomes, including cardiovascular [ 2 ], metabolic [ 3 ] and eye vision diseases [ 4 ]. According to The World Health Organization, 2.2 million deaths were attributable to high blood glucose in 2012 worldwide [ 5 ]. Because the levels of blood glucose depend on various factors [ 6 – 9 ], the measurement is standardized to fasting or resting state [ 10 ]. Although elevated fasting blood glucose has been associated with a wide range of diseases [ 11 , 12 ], one previous study has shown a nonlinear, J-shaped curve, where both decreased and increased levels of fasting blood glucose may augment the risk of coronary heart disease [ 7 ]. It has been reported, that three-quarter of cardiovascular deaths can be prevented by embracing healthy lifestyle changes [ 13 ], including adequate physical activity. Evidence suggests that regular physical activity may have beneficial effects on blood glucose control [ 1 , 13 – 17 ] and glycemic variability [ 18 ]. On the other hand, studies using cross section sedentary adults have shown no change [ 19 , 20 ] or even an increase [ 17 , 21 ] in fasting blood glucose under the physical activity regime. Along with physical activity, physical fitness is defined as ‘a measure of the capacity to perform physical activity and/or physical exercise that integrates the majority of the bodily functions (skeletomuscular, cardio-respiratory, hematocirculatory, endocrine-metabolic, and psycho-neurological) involved in bodily movement’ [ 22 ]. The distinction between physical activity (‘any bodily movement produced by skeletal muscle which requires consumption of energy’) [ 22 ] and physical fitness is crucial, because previous research has shown only a moderate correlation between them [ 23 ]. Thus, the associations between physical activity and physical fitness with other health-related outcomes may exhibit different results. The associations between physical fitness and blood glucose have been previously studied [ 24 – 28 ]. The majority of studies have used cardiorespiratory [ 24 – 26 ] and muscular [ 27 , 28 ] fitness to explore the associations with blood glucose. In general, lower levels of cardiorespiratory and muscular fitness lead to more impaired blood glucose. Compared to general population, war veterans are at increased risk for having unstable glucose control and vascular complications [ 29 ]. On the other hand, it has been reported that veterans describe challenges in maintaining their physical performance [ 30 , 31 ]. By exploring the associations between various physical fitness components and blood glucose, health-related professionals and trainers may be more aware of which aspect of physical fitness is more protective against high blood glucose and which training mode needs to be incorporated within the rehabilitation center. Therefore, the purpose of the study was to analyze the associations between health-related physical fitness and fasting blood glucose in war veterans. We hypothesized, that all physical fitness components would be associated with fasting blood glucose, irrespective of sex and age. Methods Study participants In this cross-sectional study, we recruited men and women aged 45–75 years, who participated in a homeland war between Croatia and Serbia from 1990 to 1995. More detailed information about the rehabilitation institution and specific programs done with war veterans are described elsewhere [ 32 ]. In brief, the Home for Croatian Veterans is a rehabilitation center established by the Ministry of Croatian Veterans specialized in improving quality of life and overall well-being. The users of the Home are accommodated 24 h a day for 21 days. For the purpose of this study, we collected the data from 2017 to 2020 for all of the participants within the facility care. During the period of 4 years, approximately 2500 users used the accommodation service. The inclusion criteria to be part of the study were: 1) being without chronic diseases, 2) having no history of psychiatric symptoms or treatments, 3) being able to perform CRF and MF tests and 4) participating in the Homeland War for at least 100 days. Of 2500, 764 war veterans met the inclusion criteria. By using such sample size, two-tailed test, α < 0.05, and the statistical power of 0.95, we would be able to detect a minimum effect size of 0.13. Before the study began, all of the participants gave written informed consent for participation. All of the procedures were anonymous and in accordance with the Declaration of Helsinki and were also approved by The Home for Croatian Veterans (Ethics code number: 2017/04). Fasting blood glucose Blood samples were collected in the morning hours in resting seated position after a 12-h overnight fast. Each blood sample was drawn from the forearm using a vacutainer blood collection tube with a needle. Laboratory measurement of fasting blood glucose was performed according to standardized procedures. Health-related physical fitness To assess the level of cardiorespiratory fitness, we administrated the 2-minute step test [ 33 ]. The procedure for performing the test has been described previously [ 33 ]. In brief, the participant stands up straight next to the wall while a mark is placed on the wall at the level corresponding to midway between the patella (kneecap) and iliac crest (top of the hip bone). When the measurer gives the signal, the participant starts to march in place for two minutes, lifting the knees to the height of the mark on the wall. If the participant needs to rest, it is allowed by holding onto the wall or a stable chair. The test is completed after two minutes of stepping and the result is expressed as the total number of times the right and the left knee reach the tape level in two minutes. Previous evidence confirms an excellent test-retest reliability property (ICC = 0.90, p < 0.001) and satisfactory validity, when compared with treadmill performance ( r = 0.74, p < 0.001) [ 33 ]. Also, the 2-minute step test may successfully detect expected declines across different age groups and significant differences in active vs. inactive individuals [ 33 ]. To assess muscular dynamic endurance and ability to stabilize the upper body, the push-up test in 30 sec was applied [ 34 ]. Alternately, if the participants could not complete the push-up test, the test was carried out on the knees. The final score was recorded as the number of push-ups in 30 sec. The chair stands in 30 sec is the test developed to assess lower body strength [ 33 ]. It consists of standing up and sitting down from a chair as many times as possible within 30 sec. The participant sat on the standard chair (with an approximate height of 40 cm) with their back in an upright position. Each participant was instructed to look straight forward and to rise with their legs fully extended after the “1, 2, 3, go” command at their own preferred speed with their arms folded across their chest. All trials were performed using the same chair and with similar ambient conditions [ 35 ]. The final score involved counting the number of stand-ups in 30 sec. The sit-up test was performed to assess repetitive upper body strength [ 36 ]. The participants were instructed to perform as many correct bent-knee sit-ups as possible in 30 sec, while lying on a mat in a supine position with the knees bent at an angle of approximately 90° and keeping the feet together [ 36 ]. The arms were put at the chest with the hands-on opposite shoulders. From the initial position, each participant performed a full sit-up to the upright position with their elbows touching their thighs and then returned to the supine position where their shoulders (scapula) touched the mat surface [ 36 ]. The performance was scored as having as many correct sit-ups in 30 sec. The sit-and reach test was conducted on the floor or a mat, legs straight under the angle of 90º, the person being tested reached forward with the arms (hands overlapping). The distance of reach was measured in centimeters using a measuring non-elastic tape attached on the floor [ 37 ]. Body composition assessment To assess body composition, we used bioelectrical impedance analysis (Omron BF500 Body Composition Monitor, Omron Medizintechnik). The device uses eight electrodes and requires the participant to stand on metal footpads in bare feet and grasp a pair of electrodes fixed on a handle with arms extended in front of the chest [ 38 ]. The manufacturer’s pre-programmed equations were used to predict fat mass. All participants were instructed not to consume food or water before the testing. The same equipment was used for each participant. Standing height and weight were measured following the instruction from previous studies [ 39 ] by using Seca portable 202 scales (Seca, Hamburg, Germany) and a digital scale (Seca, model 769). Data analysis Basic descriptive statistics are presented as mean ± SD. Sex differences were examined using the analysis of covariance (ANCOVA), adjusted for age for normally and Man-Whitney test for not normally distributed variables. Cohen d effect sizes (ES) were calculated to determine the magnitude of the sex differences. ES was classified as trivial ( 2.0) and extremely large (> 4.0) [ 40 ]. Pearson coefficients of correlation ( r ) and generalized estimating equations with multiple regression models were used to calculate the associations between physical fitness and fasting blood glucose. We tested the data for multicollinearity using the variance inflation factors, normality of residuals using the normal probability plot and histogram of residuals and heteroscedasticity using the standardized residuals versus predicted plot. The variance inflation factors in our model ranged from 1.53 to 2.49 indicating no multicollinearity and the other assumptions were also met. In an unadjusted model (Model 1), we calculated separate associations between various physical fitness components and fasting blood glucose. In Model 2, all physical fitness components were put simultaneously, adjusted for sex and age. The results are presented as β coefficients. All analyses were performed in Statistical Packages for Social Sciences version 23. (SPSS Inc., Chicago, IL, USA) with statistical significance of p ≤ 0.05. Results Basic descriptive statistics of the study participants are presented in Table 1 . Men were significantly taller, heavier, and had lower percentage of fat mass and higher percentage of fat-free mass, compared to women. Men also performed better in muscular fitness tests, while women exhibited higher results in flexibility. No significant differences in cardiorespiratory function nor fasting blood glucose were observed. Table 1 Basic descriptive statistics of the study participants ( N = 764). Total ( N = 764) Men ( N = 508) Women ( N = 256) Cohen’s D p –value† mean ± SD mean ± SD mean ± SD Age (years) 59.9 ± 7.6 60.0 ± 7.8 59.9 ± 7.1 0.01 0.878 Stature (cm) 172.5 ± 9.1 177.1 ± 6.7 163.5 ± 5.9 2.03 < 0.001 Body mass (kg) 90.3 ± 18.5 96.2 ± 22.2 78.3 ± 14.7 0.81 < 0.001 Body-mass index (kg/m 2 ) 29.7 ± 5.5 29.8 ± 5.9 29.4 ± 5.0 0.07 0.303 Fat mass (%) 27.7 ± 12.9 23.9 ± 11.0 35.0 ± 13.3 1.01 < 0.001 Fat-free mass (%) 27.0 ± 11.3 28.1 ± 11.2 25.0 ± 11.3 0.28 < 0.001 Fasting glucose (mmol/L) 5.8 ± 1.3 5.8 ± 1.3 5.9 ± 1.3 0.08 0.610 Push-ups in 30 sec (reps) 9.7 ± 4.3 10.2 ± 4.9 8.7 ± 3.9 0.31 0.008 Chair-stands in 30 sec (reps) 11.4 ± 4.8 12.0 ± 5.1 10.1 ± 3.9 0.37 < 0.001 Sit-ups in 30 sec (reps) 9.4 ± 3.2 9.9 ± 3.3 8.4 ± 3.0 0.45 0.006 2-minute step test (reps) 111.6 ± 19.7 111.4 ± 20.1 112.0 ± 19.0 0.03 0.722 Sit-and-reach test (cm) 42.6 ± 16.4 39.5 ± 16.2 48.7 ± 15.1 0.57 < 0.001 †denotes using the analysis of covariance (ANCOVA) for normally distributed or Man–Whitney Z –test for not normally distributed variables; p < 0.05 Pearson coefficient of correlation showed that higher levels of fasting blood glucose were significantly correlated with lower values in fat-free mass ( r =-0.23, p < 0.001), push-ups in 30 sec ( r =-0.57, p < 0.001), chair-stands in 30 sec ( r =-0.51, p < 0.001), sit-ups in 30 sec ( r =-0.51, p < 0.001), the sit-and reach test ( r =-0.44, p < 0.001) and the 2-minute step test ( r =-0.27, p < 0.001). No significant correlation between fasting blood glucose and fat mass was observed ( r =-0.01, p = 0.729). Table 2 shows the associations between fasting blood glucose and physical fitness. In the unadjusted model (Model 1), all physical fitness components were negatively associated with fasting blood glucose, except for fat mass, where a positive association was found. When all physical fitness tests were entered simultaneously into the model and adjusted for sex and age (Model 2), all physical fitness components remained significantly associated with fasting blood glucose with similar direction of the association. Of note, a multiple regression model showed, that all seven physical fitness tests were highly associated with fasting blood glucose ( R = 0.77, R 2 = 0.60, standard error of the estimate = 0.88 mmol/L, p < 0.001). Table 2 The associations between health-related physical fitness and fasting blood glucose in the study participants ( N = 764). Study variables Model 1 Model 2 β t -value p -value β t -value p -value Fat mass (%) 0.10 2.419 0.016 0.12 2.520 0.012 Fat-free mass (%) -0.22 -6.232 < 0.001 -0.19 -4.398 < 0.001 Push-ups in 30 sec (reps) -0.53 -14.441 < 0.001 -0.19 -4.249 < 0.001 Chair-stands in 30 sec (reps) -0.49 -13.741 < 0.001 -0.15 -3.476 < 0.001 Sit-ups in 30 sec (reps) -0.48 -12.695 < 0.001 -0.21 -5.082 < 0.001 2-minute step test (reps) -0.23 -6.089 < 0.001 -0.25 -8.025 < 0.001 Sit-and-reach test (cm) -0.46 -12.497 < 0.001 -0.15 -3.248 < 0.001 Model 1: examines the associations between health-related physical fitness tests entered separately into the model and fasting blood glucose. Model 2: examines the associations between health-related physical fitness tests entered simultaneously into the model and fasting blood glucose; i.e. the whole model was adjusted for sex and age. Discussion The main purpose of the study was to analyze the associations between health-related physical fitness and fasting blood glucose in war veterans. We found significant inversed associations between fasting blood glucose and all physical fitness components, except for positive association with fat mass. If all physical fitness components were used simultaneously, fasting blood glucose accounted for 60% of the variance. We the regression model, we found that fat mass was positively associated with fasting blood glucose, yet negative association between fat-free mass and fasting blood glucose was observed. Such results have been confirmed previously [ 41 – 44 ]. Specifically, a study by Kim & Park [ 41 ] showed that compared to high muscle and low-fat group, those participants categorized as having low muscle and high fat and high muscle and high fat were 1.90 and 2.30 more likely to develop metabolic syndrome. However, a follow-up study by Kim et al. [ 44 ] highlighted that only changes in total body fat mass were associated with development of Type 2 diabetes, while no significant associations between the changes in fat-free mass and Type 2 diabetes were observed. Finally, a large cohort study examining the associations between fat-free mass and insulin resistance concluded that fat-free mass was an independent predictor of insulin resistance [ 43 ]. Our findings of the associations between fasting blood glucose and cardiorespiratory fitness are in line with previous studies [ 24 – 28 ]. For example, a study by Loprinzi and Pariser [ 24 ] showed that cardiorespiratory fitness assessed through a submaximal treadmill-based test was significantly associated with impaired blood glucose control in in obese and inactive adults. Another cross-sectional study presented similar results, where a low maximal oxygen uptake was moderately associated with high fasting blood glucose ( r =-0.34) [ 26 ]. Similar associations have been obtained in previous longitudinal studies [ 25 ]. During an average follow-up of 6 years, men in the low-fitness group (the least fit 20% of the cohort) at baseline were almost two times more likely to have impaired blood glucose, compared to with those in the high-fitness group (the most fit 40% of the cohort) [ 25 ]. On the other hand, studies have also shown that muscular fitness may have beneficial effects on glycemic control [ 28 ]. In a recent meta-analysis, groups who performed a muscular training lowered glycosylated hemoglobin (mean ES=-0.37, 95% CI -0.55 to -0.20, p < 0.01), compared to those who did not receive a treatment. Moreover, the same study showed that high-intensity muscular training groups had a slight tendency to improve glycemic control, irrespective of duration, frequency, and weekly volume [ 28 ]. The mechanism underlying the aforementioned associations in our context may be explained by acute and regular exercise training [ 10 ]. For example, exercise may acutely increase muscle glucose transport [ 45 ], which can lead to reverse impaired insulin sensitivity and a reduced endogenous glucose production [ 46 ]. Moreover, higher physical performance is associated with induced adaptations of in pancreatic β-cells, leading to a reduction in glucose-induced insulin secretion [ 47 ]. This study has a few strengths. First, the findings of the study were based on a large representative sample of war veterans aged 45–75 years. Second, we covered all aspects of physical fitness, including cardiorespiratory, muscular and flexibility fitness and body composition. However, this study is not without limitations. By using a cross-sectional design, we cannot establish the causality of the association, where higher fasting blood glucose led to lower physical fitness values. Next, cardiorespiratory fitness was assessed by the 2-minute step test, which was only moderately correlated with the treadmill protocol and might underestimate the level of ‘real’ cardiorespiratory fitness. Finally, we did not adjust for genetical and environmental factors, which might be associated to both physical fitness and fasting blood glucose. Therefore, future research among war veterans should focus in exploring longitudinal associations between physical fitness and fasting blood glucose with additional adjustments, to establish bidirectional associations between physical fitness and fasting blood glucose. In conclusion, this study confirms the findings of previous studies, where fat-free mass, cardiorespiratory and muscular fitness are negatively associated, and fat mass is positively associated with fasting blood glucose. Of all physical fitness components in the regression model, cardiorespiratory fitness exhibits the most protective effects against having high fasting blood glucose, followed by muscular dynamic endurance of upper extremities and fat-free mass. Therefore, randomized controlled trials consisted of both aerobic and resistance training protocols should be implemented within the rehabilitation centers. Declarations Acknowledgments: We would like to thank all the study participants for their enthusiastic participation in the study. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflicts of interest/Competing interests: The authors declare that they have no competing interests. Authors' contributions: Z.K. conducted the study. L.Š. analyzed the data. M.K., L.Š. and Z.K. wrote and drafted the manuscript. The author(s) read and approved the final version of the manuscript. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-900596","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":53100836,"identity":"e34657ac-af41-42a9-8c0f-83e94216a2db","order_by":0,"name":"Mario Kasović","email":"","orcid":"","institution":"University of Zagreb","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mario","middleName":"","lastName":"Kasović","suffix":""},{"id":53100837,"identity":"330deb58-593b-4f82-a2c8-66e72526034d","order_by":1,"name":"Lovro Štefan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIie3RMUvEMBTA8XcU0iWaTV4R7r5CpFBvEPwqCQfOTtIpVIROimsPP4KLECiOgcBNLa4nDt4tbkIn6eDg5RRB7BXdBPNf2sD7kYQA+Hx/sO3Pv8AAyFekzC3E8WZCPr4IRAAss/EwyhzhPySDZZbG3Lh1HwnPk6YBpRgJnhbyFqW+u5bNgsOI7ZhuQqt4WoDFKCf7XFYoy/mzxtXB9qZXopvg0SSgYJA/ZgkK4kh944jgD71E4eEsfFkTXdS67ScTuyIBckITlDnGnF2U/btQawcFt1ExoycoKhzifKscC44b78LC0zNoUsVYHpZRmyrKLmt936YHI7bbTd778gq4nsSe8e8bm99M+3w+3z/oDegbVmwEt32iAAAAAElFTkSuQmCC","orcid":"","institution":"University of Zagreb","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Lovro","middleName":"","lastName":"Štefan","suffix":""},{"id":53100838,"identity":"2e4fdf07-b4ab-4699-8a57-ec52bf6d70f5","order_by":2,"name":"Zvonimir Kalčik","email":"","orcid":"","institution":"Home of Croatian Veterans","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zvonimir","middleName":"","lastName":"Kalčik","suffix":""}],"badges":[],"createdAt":"2021-09-13 12:44:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-900596/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-900596/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13890708,"identity":"bd094c0f-62b0-4092-9290-5a939343d8c8","added_by":"auto","created_at":"2021-09-22 22:24:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":448481,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-900596/v1/afa3c0d8-fd83-4aae-b832-5fe6b5ebe020.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Associations Between Health-related Physical Fitness and Fasting Blood Glucose in War Veterans: a Population-based Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBlood glucose is one of the essential sources of energy in the body, being critical for optimal health functioning [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Studies have shown, that even small increases in blood glucose may lead to negative health-related outcomes, including cardiovascular [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], metabolic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and eye vision diseases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. According to The World Health Organization, 2.2\u0026nbsp;million deaths were attributable to high blood glucose in 2012 worldwide [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Because the levels of blood glucose depend on various factors [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the measurement is standardized to fasting or resting state [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough elevated fasting blood glucose has been associated with a wide range of diseases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], one previous study has shown a nonlinear, J-shaped curve, where both decreased and increased levels of fasting blood glucose may augment the risk of coronary heart disease [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt has been reported, that three-quarter of cardiovascular deaths can be prevented by embracing healthy lifestyle changes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], including adequate physical activity. Evidence suggests that regular physical activity may have beneficial effects on blood glucose control [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and glycemic variability [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. On the other hand, studies using cross section sedentary adults have shown no change [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] or even an increase [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] in fasting blood glucose under the physical activity regime.\u003c/p\u003e \u003cp\u003eAlong with physical activity, physical fitness is defined as \u0026lsquo;a measure of the capacity to perform physical activity and/or physical exercise that integrates the majority of the bodily functions (skeletomuscular, cardio-respiratory, hematocirculatory, endocrine-metabolic, and psycho-neurological) involved in bodily movement\u0026rsquo; [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The distinction between physical activity (\u0026lsquo;any bodily movement produced by skeletal muscle which requires consumption of energy\u0026rsquo;) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and physical fitness is crucial, because previous research has shown only a moderate correlation between them [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Thus, the associations between physical activity and physical fitness with other health-related outcomes may exhibit different results. The associations between physical fitness and blood glucose have been previously studied [\u003cspan additionalcitationids=\"CR25 CR26 CR27\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The majority of studies have used cardiorespiratory [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and muscular [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] fitness to explore the associations with blood glucose. In general, lower levels of cardiorespiratory and muscular fitness lead to more impaired blood glucose.\u003c/p\u003e \u003cp\u003eCompared to general population, war veterans are at increased risk for having unstable glucose control and vascular complications [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. On the other hand, it has been reported that veterans describe challenges in maintaining their physical performance [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. By exploring the associations between various physical fitness components and blood glucose, health-related professionals and trainers may be more aware of which aspect of physical fitness is more protective against high blood glucose and which training mode needs to be incorporated within the rehabilitation center.\u003c/p\u003e \u003cp\u003eTherefore, the purpose of the study was to analyze the associations between health-related physical fitness and fasting blood glucose in war veterans. We hypothesized, that all physical fitness components would be associated with fasting blood glucose, irrespective of sex and age.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, we recruited men and women aged 45\u0026ndash;75 years, who participated in a homeland war between Croatia and Serbia from 1990 to 1995. More detailed information about the rehabilitation institution and specific programs done with war veterans are described elsewhere [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In brief, the Home for Croatian Veterans is a rehabilitation center established by the Ministry of Croatian Veterans specialized in improving quality of life and overall well-being. The users of the Home are accommodated 24 h a day for 21 days. For the purpose of this study, we collected the data from 2017 to 2020 for all of the participants within the facility care. During the period of 4 years, approximately 2500 users used the accommodation service. The inclusion criteria to be part of the study were: 1) being without chronic diseases, 2) having no history of psychiatric symptoms or treatments, 3) being able to perform CRF and MF tests and 4) participating in the Homeland War for at least 100 days. Of 2500, 764 war veterans met the inclusion criteria. By using such sample size, two-tailed test, α\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and the statistical power of 0.95, we would be able to detect a minimum effect size of 0.13. Before the study began, all of the participants gave written informed consent for participation. All of the procedures were anonymous and in accordance with the Declaration of Helsinki and were also approved by The Home for Croatian Veterans (Ethics code number: 2017/04).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eFasting blood glucose\u003c/h2\u003e \u003cp\u003eBlood samples were collected in the morning hours in resting seated position after a 12-h overnight fast. Each blood sample was drawn from the forearm using a vacutainer blood collection tube with a needle. Laboratory measurement of fasting blood glucose was performed according to standardized procedures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eHealth-related physical fitness\u003c/h2\u003e \u003cp\u003eTo assess the level of cardiorespiratory fitness, we administrated \u003cb\u003ethe 2-minute step test\u003c/b\u003e [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The procedure for performing the test has been described previously [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In brief, the participant stands up straight next to the wall while a mark is placed on the wall at the level corresponding to midway between the patella (kneecap) and iliac crest (top of the hip bone). When the measurer gives the signal, the participant starts to march in place for two minutes, lifting the knees to the height of the mark on the wall. If the participant needs to rest, it is allowed by holding onto the wall or a stable chair. The test is completed after two minutes of stepping and the result is expressed as the total number of times the right and the left knee reach the tape level in two minutes. Previous evidence confirms an excellent test-retest reliability property (ICC\u0026thinsp;=\u0026thinsp;0.90, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and satisfactory validity, when compared with treadmill performance (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.74, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Also, the 2-minute step test may successfully detect expected declines across different age groups and significant differences in active \u003cem\u003evs.\u003c/em\u003e inactive individuals [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo assess muscular dynamic endurance and ability to stabilize the upper body, \u003cb\u003ethe push-up test in 30 sec\u003c/b\u003e was applied [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Alternately, if the participants could not complete the push-up test, the test was carried out on the knees. The final score was recorded as the number of push-ups in 30 sec.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe chair stands in 30 sec\u003c/b\u003e is the test developed to assess lower body strength [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. It consists of standing up and sitting down from a chair as many times as possible within 30 sec. The participant sat on the standard chair (with an approximate height of 40 cm) with their back in an upright position. Each participant was instructed to look straight forward and to rise with their legs fully extended after the \u0026ldquo;1, 2, 3, go\u0026rdquo; command at their own preferred speed with their arms folded across their chest. All trials were performed using the same chair and with similar ambient conditions [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The final score involved counting the number of stand-ups in 30 sec.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe sit-up test\u003c/b\u003e was performed to assess repetitive upper body strength [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The participants were instructed to perform as many correct bent-knee sit-ups as possible in 30 sec, while lying on a mat in a supine position with the knees bent at an angle of approximately 90\u0026deg; and keeping the feet together [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The arms were put at the chest with the hands-on opposite shoulders. From the initial position, each participant performed a full sit-up to the upright position with their elbows touching their thighs and then returned to the supine position where their shoulders (scapula) touched the mat surface [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The performance was scored as having as many correct sit-ups in 30 sec.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe sit-and reach test\u003c/b\u003e was conducted on the floor or a mat, legs straight under the angle of 90\u0026ordm;, the person being tested reached forward with the arms (hands overlapping). The distance of reach was measured in centimeters using a measuring non-elastic tape attached on the floor [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eBody composition assessment\u003c/h2\u003e \u003cp\u003eTo assess body composition, we used bioelectrical impedance analysis (Omron BF500 Body Composition Monitor, Omron Medizintechnik). The device uses eight electrodes and requires the participant to stand on metal footpads in bare feet and grasp a pair of electrodes fixed on a handle with arms extended in front of the chest [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The manufacturer\u0026rsquo;s pre-programmed equations were used to predict fat mass. All participants were instructed not to consume food or water before the testing. The same equipment was used for each participant. Standing height and weight were measured following the instruction from previous studies [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] by using Seca portable 202 scales (Seca, Hamburg, Germany) and a digital scale (Seca, model 769).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eBasic descriptive statistics are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Sex differences were examined using the analysis of covariance (ANCOVA), adjusted for age for normally and Man-Whitney test for not normally distributed variables. Cohen d effect sizes (ES) were calculated to determine the magnitude of the sex differences. ES was classified as trivial (\u0026lt;\u0026thinsp;0.2), small (0.2\u0026ndash;0.6), moderate (0.6\u0026ndash;1.2), large (1.2\u0026ndash;2.0), very large (\u0026gt;\u0026thinsp;2.0) and extremely large (\u0026gt;\u0026thinsp;4.0) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Pearson coefficients of correlation (\u003cem\u003er\u003c/em\u003e) and generalized estimating equations with multiple regression models were used to calculate the associations between physical fitness and fasting blood glucose. We tested the data for multicollinearity using the variance inflation factors, normality of residuals using the normal probability plot and histogram of residuals and heteroscedasticity using the standardized residuals versus predicted plot. The variance inflation factors in our model ranged from 1.53 to 2.49 indicating no multicollinearity and the other assumptions were also met. In an unadjusted model (Model 1), we calculated separate associations between various physical fitness components and fasting blood glucose. In Model 2, all physical fitness components were put simultaneously, adjusted for sex and age. The results are presented as \u003cem\u003eβ\u003c/em\u003e coefficients. All analyses were performed in Statistical Packages for Social Sciences version 23. (SPSS Inc., Chicago, IL, USA) with statistical significance of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBasic descriptive statistics of the study participants are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Men were significantly taller, heavier, and had lower percentage of fat mass and higher percentage of fat-free mass, compared to women. Men also performed better in muscular fitness tests, while women exhibited higher results in flexibility. No significant differences in cardiorespiratory function nor fasting blood glucose were observed.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eBasic descriptive statistics of the study participants (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;764).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;764)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMen\u003c/p\u003e\n\u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;508)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eWomen\u003c/p\u003e\n\u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;256)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCohen\u0026rsquo;s \u003cem\u003eD\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026ndash;value\u0026dagger;\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.878\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eStature (cm)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e172.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e177.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e163.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e2.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBody mass (kg)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e96.2\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e78.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBody-mass index (kg/m\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.303\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFat mass (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e1.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFat-free mass (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFasting glucose (mmol/L)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.610\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePush-ups in 30 sec (reps)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.008\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eChair-stands in 30 sec (reps)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSit-ups in 30 sec (reps)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2-minute step test (reps)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e111.6\u0026thinsp;\u0026plusmn;\u0026thinsp;19.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e111.4\u0026thinsp;\u0026plusmn;\u0026thinsp;20.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e112.0\u0026thinsp;\u0026plusmn;\u0026thinsp;19.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.722\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSit-and-reach test (cm)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003e\u0026dagger;denotes using the analysis of covariance (ANCOVA) for normally distributed or Man\u0026ndash;Whitney \u003cem\u003eZ\u003c/em\u003e\u0026ndash;test for not normally distributed variables; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePearson coefficient of correlation showed that higher levels of fasting blood glucose were significantly correlated with lower values in fat-free mass (\u003cem\u003er\u003c/em\u003e=-0.23, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), push-ups in 30 sec (\u003cem\u003er\u003c/em\u003e=-0.57, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), chair-stands in 30 sec (\u003cem\u003er\u003c/em\u003e=-0.51, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), sit-ups in 30 sec (\u003cem\u003er\u003c/em\u003e=-0.51, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the sit-and reach test (\u003cem\u003er\u003c/em\u003e=-0.44, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the 2-minute step test (\u003cem\u003er\u003c/em\u003e=-0.27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant correlation between fasting blood glucose and fat mass was observed (\u003cem\u003er\u003c/em\u003e=-0.01, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.729).\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the associations between fasting blood glucose and physical fitness. In the unadjusted model (Model 1), all physical fitness components were negatively associated with fasting blood glucose, except for fat mass, where a positive association was found. When all physical fitness tests were entered simultaneously into the model and adjusted for sex and age (Model 2), all physical fitness components remained significantly associated with fasting blood glucose with similar direction of the association. Of note, a multiple regression model showed, that all seven physical fitness tests were highly associated with fasting blood glucose (\u003cem\u003eR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.77, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.60, \u003cem\u003estandard error of the estimate\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.88 mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe associations between health-related physical fitness and fasting blood glucose in the study participants (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;764).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStudy variables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eModel 1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eModel 2\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003e\u0026beta;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003et\u003c/span\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003ep\u003c/span\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003e\u0026beta;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003et\u003c/span\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003ep\u003c/span\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFat mass (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.419\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.520\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.012\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFat-free mass (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-6.232\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-4.398\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePush-ups in 30 sec (reps)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-14.441\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-4.249\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eChair-stands in 30 sec (reps)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-13.741\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-3.476\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSit-ups in 30 sec (reps)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-12.695\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-5.082\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2-minute step test (reps)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-6.089\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-8.025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSit-and-reach test (cm)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-12.497\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e-0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-3.248\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eModel 1: \u003c/strong\u003eexamines the associations between health-related physical fitness tests entered separately into the model and fasting blood glucose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModel 2:\u003c/strong\u003e examines the associations between health-related physical fitness tests entered simultaneously into the model and fasting blood glucose; i.e. the whole model was adjusted for sex and age.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main purpose of the study was to analyze the associations between health-related physical fitness and fasting blood glucose in war veterans. We found significant inversed associations between fasting blood glucose and all physical fitness components, except for positive association with fat mass. If all physical fitness components were used simultaneously, fasting blood glucose accounted for 60% of the variance.\u003c/p\u003e \u003cp\u003eWe the regression model, we found that fat mass was positively associated with fasting blood glucose, yet negative association between fat-free mass and fasting blood glucose was observed. Such results have been confirmed previously [\u003cspan additionalcitationids=\"CR42 CR43\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Specifically, a study by Kim \u0026amp; Park [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] showed that compared to high muscle and low-fat group, those participants categorized as having low muscle and high fat and high muscle and high fat were 1.90 and 2.30 more likely to develop metabolic syndrome. However, a follow-up study by Kim \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] highlighted that only changes in total body fat mass were associated with development of Type 2 diabetes, while no significant associations between the changes in fat-free mass and Type 2 diabetes were observed. Finally, a large cohort study examining the associations between fat-free mass and insulin resistance concluded that fat-free mass was an independent predictor of insulin resistance [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur findings of the associations between fasting blood glucose and cardiorespiratory fitness are in line with previous studies [\u003cspan additionalcitationids=\"CR25 CR26 CR27\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. For example, a study by Loprinzi and Pariser [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] showed that cardiorespiratory fitness assessed through a submaximal treadmill-based test was significantly associated with impaired blood glucose control in in obese and inactive adults. Another cross-sectional study presented similar results, where a low maximal oxygen uptake was moderately associated with high fasting blood glucose (\u003cem\u003er\u003c/em\u003e=-0.34) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Similar associations have been obtained in previous longitudinal studies [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. During an average follow-up of 6 years, men in the low-fitness group (the least fit 20% of the cohort) at baseline were almost two times more likely to have impaired blood glucose, compared to with those in the high-fitness group (the most fit 40% of the cohort) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. On the other hand, studies have also shown that muscular fitness may have beneficial effects on glycemic control [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In a recent meta-analysis, groups who performed a muscular training lowered glycosylated hemoglobin (mean ES=-0.37, 95% CI -0.55 to -0.20, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), compared to those who did not receive a treatment. Moreover, the same study showed that high-intensity muscular training groups had a slight tendency to improve glycemic control, irrespective of duration, frequency, and weekly volume [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mechanism underlying the aforementioned associations in our context may be explained by acute and regular exercise training [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. For example, exercise may acutely increase muscle glucose transport [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], which can lead to reverse impaired insulin sensitivity and a reduced endogenous glucose production [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Moreover, higher physical performance is associated with induced adaptations of in pancreatic β-cells, leading to a reduction in glucose-induced insulin secretion [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has a few strengths. First, the findings of the study were based on a large representative sample of war veterans aged 45\u0026ndash;75 years. Second, we covered all aspects of physical fitness, including cardiorespiratory, muscular and flexibility fitness and body composition.\u003c/p\u003e \u003cp\u003eHowever, this study is not without limitations. By using a cross-sectional design, we cannot establish the causality of the association, where higher fasting blood glucose led to lower physical fitness values. Next, cardiorespiratory fitness was assessed by the 2-minute step test, which was only moderately correlated with the treadmill protocol and might underestimate the level of \u0026lsquo;real\u0026rsquo; cardiorespiratory fitness. Finally, we did not adjust for genetical and environmental factors, which might be associated to both physical fitness and fasting blood glucose. Therefore, future research among war veterans should focus in exploring longitudinal associations between physical fitness and fasting blood glucose with additional adjustments, to establish bidirectional associations between physical fitness and fasting blood glucose.\u003c/p\u003e \u003cp\u003eIn conclusion, this study confirms the findings of previous studies, where fat-free mass, cardiorespiratory and muscular fitness are negatively associated, and fat mass is positively associated with fasting blood glucose. Of all physical fitness components in the regression model, cardiorespiratory fitness exhibits the most protective effects against having high fasting blood glucose, followed by muscular dynamic endurance of upper extremities and fat-free mass. Therefore, randomized controlled trials consisted of both aerobic and resistance training protocols should be implemented within the rehabilitation centers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the study participants for their enthusiastic participation in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZ.K. conducted the study. L.\u0026Scaron;. analyzed the data. M.K., L.\u0026Scaron;. and Z.K. wrote and drafted the manuscript. The author(s) read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical Committee of The Home for Croatian Veterans (Ethics code number: 2017/04).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe informed consent voluntarily was signed by the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eNorton, L., Norton, K., \u0026amp; Lewis, N. 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Effects of exercise training intensity on pancreatic \u0026beta;-cell function. \u003cem\u003eDiabetes Care\u003c/em\u003e. \u003cstrong\u003e32,\u003c/strong\u003e 1807\u0026ndash;1811 (2009).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"performance, blood sugar, veterans, associations","lastPublishedDoi":"10.21203/rs.3.rs-900596/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-900596/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe main purpose of the study was to analyze the associations between health-related physical fitness and fasting blood glucose in war veterans. In this cross-sectional study, we recruited 764 men and women aged 45\u0026ndash;75 years, who were part of the Homeland War between 1990 and 1995 (33.5% women). Health-related physical fitness included: 1) fat mass and fat-free mass (body composition), 2) push-ups in 30 sec (muscular dynamic endurance of upper extremities), 3) sit-ups in 30 sec (repetitive upper body strength), 4) chair-stands in 30 sec (lower body strength), 5) sit-and-reach test (flexibility) and 6) the 2-minute step test (cardiorespiratory function). Laboratory measurement of fasting blood glucose was performed according to standardized procedures in resting seated position after a 12-h overnight fast. Generalized estimating equations with multiple regression models were used to calculate the associations between health-related physical fitness and fasting blood glucose. In model adjusted for sex and age, fasting blood glucose was associated with fat mass (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.12, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012), fat-free mass (\u003cem\u003eβ\u003c/em\u003e=-0.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), push-ups in 30 sec (\u003cem\u003eβ\u003c/em\u003e=-0.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), chair-stands in 30 sec (\u003cem\u003eβ\u003c/em\u003e=-0.15, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), sit-ups in 30 sec (\u003cem\u003eβ\u003c/em\u003e=-0.21, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), sit-and-reach test (\u003cem\u003eβ\u003c/em\u003e=-0.15, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the 2-minute step test (\u003cem\u003eβ\u003c/em\u003e=-0.25, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The multiple regression model was strongly correlated with fasting blood glucose (\u003cem\u003eR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.78, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.61, standard error of the estimate\u0026thinsp;=\u0026thinsp;0.88 mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This study shows that fasting blood glucose may be predicted by health-related physical fitness test in war veterans.\u003c/p\u003e","manuscriptTitle":"The Associations Between Health-related Physical Fitness and Fasting Blood Glucose in War Veterans: a Population-based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-09-22 22:24:16","doi":"10.21203/rs.3.rs-900596/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-03-29T06:32:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-03-28T10:00:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d4e88c75-1602-476f-b4eb-ac48cd124db4","date":"2022-01-24T20:31:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-01-18T19:55:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27de8e20-2ae5-4520-88dc-ae363a8522d3","date":"2022-01-18T18:27:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-12-20T12:25:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-12-20T07:57:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-09-20T05:29:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-09-20T05:14:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2021-09-13T12:33:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5990a1a-ea4d-42c4-8bee-bbd10abd2535","owner":[],"postedDate":"September 22nd, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":7374509,"name":"Sports Medicine and Kinesiology"}],"tags":[],"updatedAt":"2022-04-19T06:44:18+00:00","versionOfRecord":[],"versionCreatedAt":"2021-09-22 22:24:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-900596","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-900596","identity":"rs-900596","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}