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.

Download full-text


Available from: Hitoshi Shimano,
  • Source
    • "Several hypotheses, including hypothalamic-pituitary-adrenal and sympathetic-adrenal-medullary dysfunction and inflammation, in addition to lifestyle factors, have been suggested as potential mechanisms explaining premature mortality (Boscarino, 2004; Dedert et al., 2010; Eraly et al., 2014). For example , people with PTSD are at an increased risk of engaging in binge eating (Hoerster et al., 2015), are significantly more likely to smoke (Fu et al., 2007), have poor sleep behaviors (Lamarche and De Koninck, 2007; Talbot et al., 2013), and are known to be less physically active (de Assis et al., 2008), despite physical activity being the cornerstone of cardiovascular disease prevention and treatment in the general population (Kodama et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to determine whether posttraumatic stress disorder (PTSD) symptom severity and psychological and functional variables were associated with physical activity (PA) upon admission to an inpatient facility. PTSD symptoms, depression, anxiety and stress, sleep quality, and PA participation were assessed among 76 participants (age, 47.6 ± 11.9 years; 83% male). Backward stepwise regression analyses identified variables independently associated with time spent walking and engaging in moderate-vigorous PA (MVPA). No significant correlations were found between any of the variables and MVPA. Total PTSD symptoms (r = -0.39, p < 0.001), combined symptoms of depression, anxiety, and stress (r = -0.31, p < 0.01), and sleep behavior (r = -0.24, p < 0.05) were significantly and negatively associated with total walking time. Total PTSD symptoms were the only significant predictor of walking time (B = -0.03, SE = 0.008, β = -0.4; t = -3.4; p < 0.001). Results indicate that increased PTSD symptoms are associated with lower levels of walking. Results highlight the importance of considering symptoms when designing PA programs for people with PTSD.
    The Journal of nervous and mental disease 11/2015; DOI:10.1097/NMD.0000000000000415 · 1.69 Impact Factor
  • Source
    • "Also only a limited number of screening, monitoring and treatment guidelines refer to the role of physical activity and exercise in people with severe mental illness, yet none of these guidelines have an adequate focus on the importance of cardiorespiratory fitness testing within this population (De Hert et al., 2011). Cardiorespiratory fitness is an important health outcome measure, predictive for cardiorespiratory diseases and premature mortality (Kodoma et al., 2009) and sensitive to physical activity (Naci and Ioannidis, 2013), also in people with severe mental illness (Vancampfort et al., 2015b). Cardiorespiratory fitness testing therefore has important clinical implications and can be used to help guide the intensity of exercise prescriptions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiorespiratory fitness is a major modifiable risk factor for cardiovascular diseases. People with bipolar disorder have a reduced cardiorespiratory fitness and its assessment within a multidisciplinary treatment therefore is necessary. We investigated the validity of the 6min walk test in people with bipolar disorder. A secondary aim was to assess clinical and demographic characteristics that might interfere with cardiorespiratory fitness performance. 19 (5♂) outpatients (47.1±8.3 years) underwent a 6min walk test and a maximal cardiopulmonary exercise test on a cycle ergometer and completed the Positive-and-Negative-Affect-Schedule (PANAS) and Beck Depression Inventory (BDI). The distance achieved on the 6min walk test correlated moderately with peak oxygen uptake obtained during the maximal cardiopulmonary exercise test. The variance in age, weight and the PANAS negative score explained 70% of the variance in the distance achieved on the 6min walk test. The 6min walk test can be used as a measure-of-proxy to gauge cardiorespiratory fitness in people with bipolar disorder when maximal cardiopulmonary exercise test equipment is not available. Negative mood should be considered when evaluating the cardiorespiratory fitness of this vulnerable population.
    11/2015; DOI:10.1016/j.psychres.2015.09.039
  • Source
    • "In the general population, low cardiorespiratory fitness (CRF), defined as the ability of the circulatory and respiratory systems to supply oxygen to working muscles during sustained physical activity, is a strong and independent predictor of cardiovascular diseases (relative risk (RR) 1.56 (95% CI=1.39- 1.75; P<0.001) and all-cause mortality (RR 1.70 (95% CI=1.51-1.92; P<0.001)) (Kodama et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Cardiorespiratory fitness (CRF) is an independent predictor of cardiovascular disease and all-cause mortality. CRF improves in response to exercise interventions, yet the effectiveness of such interventions to improve CRF among people with depression is unclear. We conducted a systematic review and meta-analysis to evaluate whether CRF improves in people with depression in exercise randomized control trials (RCTs). Method Three authors identified RCTs from a recent Cochrane review and conducted updated searches of major electronic databases. We included RCTs of exercise interventions in people with depression (including major depressive disorder (MDD) and above-threshold depressive symptoms) that reported CRF (defined as predicted maximal oxygen uptake (VO2max predicted) or peak oxygen uptake (VO2peak)) versus a control condition. A random effects meta-analysis was conducted. Results Seven unique RCTs including 8 aerobic exercise interventions for depression were eligible, including 293 people allocated to exercise (mean age=40.3years, range=27.2–64.7years and 35-100% female) and 205 allocated to control conditions. Across all studies exercise results in a significant increase in CRF (g=0.64, 95%CI=0.32-0.96, p<0.001) equating to a mean increase of 3.05 ml/kg/min. Results remained significant when restricted to MDD only (N=5, g= 0.41, 95%CI=0.18–0.64, p<0.001) and in high quality studies (N=5, g=0.60, 95%CI=0.19-1.00, p=0.004). Conclusions People with depression can achieve clinically relevant improvements in CRF in response to exercise interventions. Targeting ‘fitness’ rather than ‘fatness’ may be another feasible intervention strategy in this population.
    Journal of Affective Disorders 11/2015; 190. DOI:10.1016/j.jad.2015.10.010 · 3.38 Impact Factor
Show more