Stair climbing, genetic predisposition, and the risk of incident type 2 diabetes: A large population-based prospective cohort study

BACKGROUND: Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation. However, few studies have examined the long-term association between stair climbing and the incidence of type 2 diabetes (T2D). We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D. METHODS: We included 451,699 adults (mean age = 56.3 ± 8.1 years, mean ± SD; 55.2% females) without T2D at baseline in the UK Biobank and followed up to March 31, 2021. Stair climbing information was collected through the touchscreen questionnaire. Genetic risk score for T2D consisted of 424 single nucleotide polymorphisms. RESULTS: During a median follow up of 12.1 years, 14,896 T2D cases were documented. Compared with participants who reported no stair climbing, those who climbed stairs regularly had a lower risk of incident T2D (10–50 steps/day: hazard ratio (HR) = 0.95, 95% confidence interval (95%CI): 0.89–1.00; 60–100 steps/day: HR = 0.92, 95%CI: 0.87–0.98; 110–150 steps/day: HR = 0.86, 95%CI: 0.80–0.91; >150 steps/day: HR = 0.93, 95%CI: 0.87–0.99, p for trend = 0.0007). We observed a significant interaction between stair climbing and genetic risk score on the subsequent T2D risk (p for interaction = 0.0004), where the risk of T2D showed a downward trend in subjects with low genetic risk and those who reported stair climbing activity of 110–150 steps/day appeared to have the lowest overall T2D risk among those with intermediate to high genetic risk. CONCLUSION: A higher number of stairs climbed at home was associated with lower T2D incidence risk, especially among individuals with a low genetic predisposition to T2D. These findings highlight that stair climbing, as incidental physical activity, offers a simple and low-cost complement to public health interventions for T2D prevention.