Cardiorespiratory Fitness as a Quantitative Predictor of All-Cause Mortality and Cardiovascular Events in Healthy Men and Women: A Meta-analysis

Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, 3-2-7 Miya-machi, Mito, Ibaraki 310-0015, Japan.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2009; 301(19):2024-35. DOI: 10.1001/jama.2009.681
Source: PubMed


Epidemiological studies have indicated an inverse association between cardiorespiratory fitness (CRF) and coronary heart disease (CHD) or all-cause mortality in healthy participants.
To define quantitative relationships between CRF and CHD events, cardiovascular disease (CVD) events, or all-cause mortality in healthy men and women.
A systematic literature search was conducted for observational cohort studies using MEDLINE (1966 to December 31, 2008) and EMBASE (1980 to December 31, 2008). The Medical Subject Headings search terms used included exercise tolerance, exercise test, exercise/physiology, physical fitness, oxygen consumption, cardiovascular diseases, myocardial ischemia, mortality, mortalities, death, fatality, fatal, incidence, or morbidity. Studies reporting associations of baseline CRF with CHD events, CVD events, or all-cause mortality in healthy participants were included.
Two authors independently extracted relevant data. CRF was estimated as maximal aerobic capacity (MAC) expressed in metabolic equivalent (MET) units. Participants were categorized as low CRF (< 7.9 METs), intermediate CRF (7.9-10.8 METs), or high CRF (> or = 10.9 METs). CHD and CVD were combined into 1 outcome (CHD/CVD). Risk ratios (RRs) for a 1-MET higher level of MAC and for participants with lower vs higher CRF were calculated with a random-effects model.
Data were obtained from 33 eligible studies (all-cause mortality, 102 980 participants and 6910 cases; CHD/CVD, 84 323 participants and 4485 cases). Pooled RRs of all-cause mortality and CHD/CVD events per 1-MET higher level of MAC (corresponding to 1-km/h higher running/jogging speed) were 0.87 (95% confidence interval [CI], 0.84-0.90) and 0.85 (95% CI, 0.82-0.88), respectively. Compared with participants with high CRF, those with low CRF had an RR for all-cause mortality of 1.70 (95% CI, 1.51-1.92; P < .001) and for CHD/CVD events of 1.56 (95% CI, 1.39-1.75; P < .001), adjusting for heterogeneity of study design. Compared with participants with intermediate CRF, those with low CRF had an RR for all-cause mortality of 1.40 (95% CI, 1.32-1.48; P < .001) and for CHD/CVD events of 1.47 (95% CI, 1.35-1.61; P < .001), adjusting for heterogeneity of study design.
Better CRF was associated with lower risk of all-cause mortality and CHD/CVD. Participants with a MAC of 7.9 METs or more had substantially lower rates of all-cause mortality and CHD/CVD events compared with those with a MAC of less 7.9 METs.

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Available from: Hitoshi Shimano, Oct 05, 2015
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    • "Nowadays, cardiorespiratory fitness is considered one of the most powerful markers of health, even above other traditional markers such as weight status, blood pressure or cholesterol level (Blair, 2009). Current evidence has shown how cardiorespiratory fitness status is an important quantitative predictor of cardiovascular events and allcause mortality in healthy adults (Kodama et al., 2009). "
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    ABSTRACT: The main purpose of the present meta-analysis was to examine the criterion-related validity of the 20-m shuttle run test for estimating cardiorespiratory fitness. Relevant studies were searched from twelve electronic databases up to December 2014, as well as from several alternative modes of searching. The Hunter-Schmidt's psychometric meta-analysis approach was conducted to estimate the population criterion-related validity of the 20-m shuttle run test. From 57 studies that were included in the present meta-analysis, a total of 78 correlation values were analyzed. The overall results showed that the performance score of the 20-m shuttle run test had a moderate-to-high criterion-related validity for estimating maximum oxygen uptake (r p = 0.66-0.84), being higher when other variables (e.g. sex, age or body mass) were used (r p = 0.78-0.95). The present meta-analysis also showed that the criterion-related validity of Léger's protocol was statistically higher for adults (r p = 0.94, 0.87-1.00) than for children (r p = 0.78, 0.72-0.85). However, sex and maximum oxygen uptake level do not seem to affect the criterion-related validity values. When an individual's maximum oxygen uptake attained during a laboratory-based test is not feasible, the 20-m shuttle run test seems to be a useful alternative for estimating cardiorespiratory fitness. In adults the performance score only seems to be a strong estimator of cardiorespiratory fitness, in contrast among children the performance score should be combined with other variables. Nevertheless, as in the application of any physical fitness field test, evaluators must be aware that the performance score of the 20-m shuttle run test is simply an estimation and not a direct measure of cardiorespiratory fitness. Key pointsOverall the 20-m shuttle run test has a moderate-to-high mean criterion-related validity for estimating cardiorespiratory fitness.The criterion-related validity of the 20-m shuttle run test is significantly higher for adults than for children. However, when the performance score is combined with other variables, the criterion-related validity value increases considerably among children.Sex and maximum oxygen uptake level of individuals seem not to affect the criterion-related validity of the 20-m shuttle run test.When individuals' maximum oxygen uptake attained during a laboratory-based test is not feasible, the 20-m shuttle run test seems to be a useful alternative for estimating cardiorespiratory fitness.
    Journal of sports science & medicine 09/2015; 14(3):536-47. · 1.03 Impact Factor
    • "VO 2max is found to be the single best predictor of cardiovascular morbidity and premature cardiovascular mortality, and low VO 2max is clearly associated with a clustering of cardiovascular risk factors (Aspenes et al. 2011). A large metaanalysis in healthy individuals reported that a ~3.5 ml/kg/ min higher fitness level was associated with 13 and 15 % decreased risk of all-cause mortality and cardiovascular events, respectively (Kodama et al. 2009). "
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    ABSTRACT: Rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are inflammatory diseases which involve increased risk of cardiovascular disease (CVD). High intensity interval training (HIIT) is known to be effective in improving cardiovascular health. The aim of this study was to investigate whether 10 weeks of HIIT at 85-95 % of HRmax would improve important risk factors of CVD in rheumatic patients, and if these patients would tolerate exercise intensities above today's recommendations. Seven women with RA and eleven with adult-JIA, 20-50 years, were recruited to this cross-over study. Participants performed HIIT, consisting of 4 × 4 min intervals at 85-95 % of HRmax twice a week for 10 weeks on spinning bikes. Maximal oxygen uptake (VO2max), heart rate recovery, blood pressure, body composition, and blood variables were measured before and after the exercise and control period. Disease activity was determined and questionnaire data were collected. HIIT resulted in 12.2 % increase in VO2max and 2.9 % improvement in heart rate recovery (p < 0.05). BMI, body fat, and waist circumference decreased 1.2, 1.0, and 1.6 %, respectively, whereas muscle mass increased 0.6 % (p < 0.05). A trend toward decreased CRP was detected after HIIT (p = 0.08). No changes were detected in disease activity or pain. Despite rigorous high intensity exercise, no increase was detected in disease activity or pain, indicating that HIIT was well tolerated by these patients. Furthermore, HIIT had positive effects on several CVD risk factors. In light of this pilot study, HIIT seems like a promising non-pharmacological treatment strategy for patients with RA and adult-JIA.
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    • "Prior studies found that the dose–response relationship between cardiorespiratory (aerobic) fitness and health is stronger than that between physical activity and health [5] [6]. Furthermore, in the last decade, a low level of cardiorespiratory fitness has been confirmed as a powerful predictor of mortality in healthy and diseased individuals [7] [8] [9] [10]. "
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    ABSTRACT: Muscular strength, an important component of physical fitness, has an independent role in the prevention of chronic diseases whereas muscular weakness is strongly related to functional limitations and physical disability. Our purpose was to investigate the role of muscular strength as a predictor of mortality in health and disease. We conducted a systematic search in EMBASE and MEDLINE (1980-2014) looking for the association between muscular strength and mortality risk (all-cause and cause-specific mortality). Selected publications included 23 papers (15 epidemiological and 8 clinical studies). Muscular strength was inversely and independently associated with all-cause mortality even after adjusting for several confounders including the levels of physical activity or even cardiorespiratory fitness. The same pattern was observed for cardiovascular mortality; however more research is needed due to the few available data. The existed studies failed to show that low muscular strength is predictive of cancer mortality. Furthermore, a strong and inverse association of muscular strength with all-cause mortality has also been confirmed in several clinical populations such as cardiovascular disease, peripheral artery disease, cancer, renal failure, chronic obstructive pulmonary disease, rheumatoid arthritis and patients with critical illness. However, future studies are needed to further establish the current evidence and to explore the exact independent mechanisms of muscular strength in relation to mortality. Muscular strength as a modifiable risk factor would be of great interest from a public health perspective. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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