Cardiorespiratory Fitness in Young Adulthood and the Development of Cardiovascular Disease Risk Factors

Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 12/2003; 290(23):3092-100. DOI: 10.1001/jama.290.23.3092
Source: PubMed


Low cardiorespiratory fitness is an established risk factor for cardiovascular and total mortality; however, mechanisms responsible for these associations are uncertain.
To test whether low fitness, estimated by short duration on a maximal treadmill test, predicted the development of cardiovascular disease risk factors and whether improving fitness (increase in treadmill test duration between examinations) was associated with risk reduction.
Population-based longitudinal cohort study of men and women 18 to 30 years of age in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants who completed the treadmill examination according to the Balke protocol at baseline were followed up from 1985-1986 to 2000-2001. A subset of participants (n = 2478) repeated the exercise test in 1992-1993.
Incident type 2 diabetes, hypertension, the metabolic syndrome (defined according to National Cholesterol Education Program Adult Treatment Panel III), and hypercholesterolemia (low-density lipoprotein cholesterol > or =160 mg/dL [4.14 mmol/L]).
During the 15-year study period, the rates of incident diabetes, hypertension, the metabolic syndrome, and hypercholesterolemia were 2.8, 13.0, 10.2, and 11.7 per 1000 person-years, respectively. After adjustment for age, race, sex, smoking, and family history of diabetes, hypertension, or premature myocardial infarction, participants with low fitness (<20th percentile) were 3- to 6-fold more likely to develop diabetes, hypertension, and the metabolic syndrome than participants with high fitness (> or =60th percentile), all P<.001. Adjusting for baseline body mass index diminished the strength of these associations to 2-fold (all P<.001). In contrast, the association between low fitness and hypercholesterolemia was modest (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.1-1.7; P =.02) and attenuated to marginal significance after body mass index adjustment (P =.13). Improved fitness over 7 years was associated with a reduced risk of developing diabetes (HR, 0.4; 95% CI, 0.2-1.0; P =.04) and the metabolic syndrome (HR, 0.5; 95% CI, 0.3-0.7; P<.001), but the strength and significance of these associations was reduced after accounting for changes in weight.
Poor fitness in young adults is associated with the development of cardiovascular disease risk factors. These associations involve obesity and may be modified by improving fitness.

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    • "The Harvard Alumni Study, a long-term cohort study, reported that a low vital capacity at entrance age predisposed subjects to type 2 diabetes later in life [12]. Carnethon et al. also found a significant inverse relationship between cardiorespiratory fitness levels and the incidence of type 2 diabetes in 18- to 30-year-olds [13]. These studies, conducted among Caucasian non-athletes, reported an inverse relationship between cardiorespiratory fitness at a young age and the incidence of type 2 diabetes. "
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    ABSTRACT: Background In Japan, although the incidence of overweight (BMI ≥ 25) is still low compared with that in Europe and the United States, the prevalence of type 2 diabetes has increased over the last 15 years,. In both Japanese and Caucasian populations it has been reported that a high level of cardiorespiratory fitness protects against the development of type 2 diabetes. However, there are no reports focused specifically on athletes that investigate whether high cardiorespiratory fitness at a young age can prevent disease later in life. We examined the relationship between cardiorespiratory fitness at a young age and the development of type 2 diabetes in Japanese athletes using a cohort study. Methods The cardiorespiratory fitness of male alumni of the physical education department of Juntendo University, as measured by stored data of a 1,500-m endurance run in college (1971–1991) was compared with their incidence of type 2 diabetes as determined by follow-up questionnaires (2007–2009). This study used Cox’s proportional hazards models and adjusted for age, year of graduation, BMI, smoking, and sports club participation at college age. Results We collected data on cardiorespiratory fitness at college age and medical history survey data during 2007–2009 from 570 male alumni. The median follow-up period was 26 years (IQR: 23–29 years), and 22 men had developed type 2 diabetes. An inverse relationship was observed between incidence of type 2 diabetes and level of cardiorespiratory fitness at time of college after adjustment for age, year of graduation, BMI, smoking, and sports participation. The adjusted hazards ratio and 95% CI by category (low, medium, and high) were 1.00 (reference), 0.40 (0.14–1.13) and 0.26 (0.07–1.00) (p = 0.03 for trend). Conclusions A high level of cardiorespiratory fitness at a young age can help prevent type 2 diabetes later in life.
    BMC Public Health 05/2014; 14(1):493. DOI:10.1186/1471-2458-14-493 · 2.26 Impact Factor
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    • "Additional support for [Au: need credentials for all] encouraging PA in this population is provided by the finding that cardiorespiratory fitness shows significant negative association with cancer mortality (Sui et al., #1 #2 #3 #4 #5 2007), and that supervised regular PA interventions are effective in improving cardiorespiratory fitness in adults with cancer (Jones et al., 2011). In addition to the independent protective role of cardiorespiratory fitness against cardiovascular risk, obesity tends to attenuate the protective value of fitness (Carnethon et al., 2003). Therefore, to design effective PA interventions, PA levels and their relationship with cardiorespiratory fitness and adiposity indicators need to be accurately assessed in different population subsets (WHO, 2010). "
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    ABSTRACT: Purpose/Objectives: To objectively assess physical activity (PA) levels in a cohort of Spanish cancer survivors. Design: Descriptive, cross-sectional. Setting: The Hospital Universitario de Fuenlabrada and two healthcare centers in Madrid, Spain. Sample: 204 cancer survivors and 115 adults with no history of cancer. Methods: Participants wore a triaxial accelerometer for seven or more consecutive days to assess PA levels. Body mass index (BMI), indirect indicators of adiposity (waist circumference, waist-to-hip ratio), and cardiorespiratory fitness also were determined. Main Research Variables: Light, moderate, vigorous, and total PA (sum of the former). Findings: Most (94%) of the cancer survivors met international recommendations for moderate PA, but very few (3%) fulfilled those (75 minutes or more per week) for vigorous PA. Except for lower total (minute per day, p = 0.048) and vigorous PA levels (p < 0.001 for both minute per day and minute per week) recorded in the cancer survivors group, no between-group differences were detected (p > 0.05). A high percentage of the survivors (33%) were obese (BMI greater than 30 kg/m2), and many also showed poor cardiorespiratory fitness (45% were below the 8 metabolic equivalent threshold). Conclusions: Although cancer survivors overall met international PA recommendations for a healthy lifestyle, their BMI and cardiorespiratory profiles were not within the healthy range. Implications for Nursing: Cancer survivors need to be informed about healthy lifestyle habits and should be regularly monitored.
    Oncology Nursing Forum 01/2014; 41(1):E12-20. DOI:10.1188/14.ONF.E12-E20 · 2.79 Impact Factor
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    • "This is the first study that we are aware of to assess these relationships in any population. Given that cell phones are ever-present on college campuses and their most common uses such as texting, updating social networking sites, and browsing the internet are standard practices [16,17], the negative association between cell phone use and fitness illustrated herein deserves further attention as cardiorespiratory fitness (i.e., VO2 peak) is an excellent indicator of an individual’s risk for a number of health concerns [43,44]. "
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    ABSTRACT: Today's cell phones increase opportunities for activities traditionally defined as sedentary behaviors (e.g., surfing the internet, playing video games). People who participate in large amounts of sedentary behaviors, relative to those who do not, tend to be less physically active, less physically fit, and at greater risk for health problems. However, cell phone use does not have to be a sedentary behavior as these devices are portable. It can occur while standing or during mild-to-moderate intensity physical activity. Thus, the relationship between cell phone use, physical and sedentary activity, and physical fitness is unclear. The purpose of this study was to investigate these relationships among a sample of healthy college students. Participants were first interviewed about their physical activity behavior and cell phone use. Then body composition was assessed and the validated self-efficacy survey for exercise behaviors completed. This was followed by a progressive exercise test on a treadmill to exhaustion. Peak oxygen consumption (VO2 peak) during exercise was used to measure cardiorespiratory fitness. Hierarchical regression was used to assess the relationship between cell phone use and cardiorespiratory fitness after controlling for sex, self-efficacy, and percent body fat. Interview data was transcribed, coded, and Chi-square analysis was used to compare the responses of low and high frequency cell phone users. Cell phone use was significantly (p=0.047) and negatively (ß= -0.25) related to cardio respiratory fitness independent of sex, self-efficacy, and percent fat which were also significant predictors (p<0.05). Interview data offered several possible explanations for this relationship. First, high frequency users were more likely than low frequency users to report forgoing opportunities for physical activity in order to use their cell phones for sedentary behaviors. Second, low frequency users were more likely to report being connected to active peer groups through their cell phones and to cite this as a motivation for physical activity. Third, high levels of cell phone use indicated a broader pattern of sedentary behaviors apart from cell phone use, such as watching television. Cell phone use, like traditional sedentary behaviors, may disrupt physical activity and reduce cardiorespiratory fitness.
    International Journal of Behavioral Nutrition and Physical Activity 06/2013; 10(1):79. DOI:10.1186/1479-5868-10-79 · 4.11 Impact Factor
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