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Physical Activity and Cardiorespiratory Fitness as Major Markers of Cardiovascular Risk: Their Independent and Interwoven Importance to Health Status
Abstract
The evolution from hunting and gathering to agriculture, followed by industrialization, has had a profound effect on human physical activity (PA) patterns. Current PA patterns are undoubtedly the lowest they have been in human history, with particularly marked declines in recent generations, and future projections indicate further declines around the globe. Non-communicable health problems that afflict current societies are fundamentally attributable to the fact that PA patterns are markedly different than those for which humans were genetically adapted. The advent of modern statistics and epidemiological methods has made it possible to quantify the independent effects of cardiorespiratory fitness (CRF) and PA on health outcomes. Based on more than five decades of epidemiological studies, it is now widely accepted that higher PA patterns and levels of CRF are associated with better health outcomes. This review will discuss the evidence supporting the premise that PA and CRF are independent risk factors for cardiovascular disease (CVD) as well as the interplay between both PA and CRF and other CVD risk factors. A particular focus will be given to the interplay between CRF, metabolic risk and obesity.
... 7 Among 1458 civilian and military police in Rio de Janeiro, the prevalence of inactivity was 63.9% among the civilian one and 48,6% among the military PO. 4 In Recife-PE, the prevalence of insufficient physical activity among 288 military police officers was 72.6%. 13 Another critical health indicator to be considered in the context of police job-related activities is cardiorespiratory fitness (CRF), which is a predictor of mortality, potentially as significant as other traditionally established cardiometabolic risk factors such as smoking, hypertension, and hypercholesterolemia. 14 The benefits related to PA and adequate CRF have been strongly evidenced in the literature. Higher levels of PA and CRF decrease the profile risk of cardiometabolic diseases, even in already-established diseases. ...
... Higher levels of PA and CRF decrease the profile risk of cardiometabolic diseases, even in already-established diseases. 9,14 More than two decades ago, evidence showed that good CRF was associated with lower overall cardiovascular morbidity and mortality. 15 Despite the recognized importance of these factors in the general population's health, studies on PA in police officers are still incipient in Latin America and Brazil. ...
... It is noteworthy that conditions such as PAL and CRF are modifiable, and there is robust scientific evidence of the benefits of creating institutional strategies or programs to increase both, as they are associated with reduced overall mortality, cardiometabolic mortality, and the occurrence of chronic non-communicable diseases. 9,14 It is essential to highlight that our data strongly support actions to increase PAL, considering, that physically active police officers were 12.7 times more likely to reach adequate CRF compared to physically inactive officers. ...
Background
A high level of physical activity (PAL) is necessary for the safety performance of police officers.
Objective
To evaluate the PAL, quality of life (QoL), and cardiorespiratory fitness (CRF) of Civil Police Officers (PO) of Brazil, in association with gender and career time.
Methods
We evaluated 55 PO (50.9% male), with a median age of 40 and a BMI of 25.7 kg/m ² . Descriptive analysis and associations with gender and career time (G1: longer/G2: shorter) were carried out. PAL was evaluated by the IPAQ-short version. QoL and CRF were estimated using the WHOQOL and Jackson questionnaires. The chi-square test was used for associations; the odds ratio was calculated with a 95% confidence interval (95%CI) to express the strength of the association.
Results
There was a proportion of 72.7% (95% CI:69.0–91.0%) of active PO, with a trend for a higher proportion among women and G2 ( p = 0.07/0.08), respectively. Only 36.4% of PO (95% CI:24.0–49.0) achieved the minimum CRF required for career entry, with G1 showing a lower proportion than G2 ( p < 0.01) and a lower chance of achieving the recommended CRF (OR: 0.03 / 95% CI:0.01–0.17). The median QoL was >70 points in three of the four evaluated domains, with G2 showing higher scores than G1 in the physical domain ( p = 0.02).
Conclusion
More than two-thirds of the PO assessed achieved the PA recommendations for health, but the majority had a CRF below the recommended. The median QoL was good in 3 of the four WHOQOL domains. Women and those with less carrier time had higher QoL, PAL, and CRF.
... 6,[18][19][20][21][22] Cardiorespiratory fitness (CRF) is in part a consequence of regular physical activity. [23][24][25] In recent years, CRF has been found to be a powerful predictor of risk for mortality and other adverse health outcomes. [23][24][25][26][27][28][29] In fact, numerous observational studies have found that CRF is a more powerful predictor of risk for mortality and other adverse health outcomes than traditional risk factors such as hypertension, smoking, and lipid abnormalities. ...
... [23][24][25] In recent years, CRF has been found to be a powerful predictor of risk for mortality and other adverse health outcomes. [23][24][25][26][27][28][29] In fact, numerous observational studies have found that CRF is a more powerful predictor of risk for mortality and other adverse health outcomes than traditional risk factors such as hypertension, smoking, and lipid abnormalities. 17,19,[23][24][25][26][27][28][29] A growing body of research has determined that higher levels of CRF reduce the risk of many highly prevalent noncommunicable diseases, including CVD, diabetes, and several sitespecific cancers. ...
... [23][24][25][26][27][28][29] In fact, numerous observational studies have found that CRF is a more powerful predictor of risk for mortality and other adverse health outcomes than traditional risk factors such as hypertension, smoking, and lipid abnormalities. 17,19,[23][24][25][26][27][28][29] A growing body of research has determined that higher levels of CRF reduce the risk of many highly prevalent noncommunicable diseases, including CVD, diabetes, and several sitespecific cancers. 6,17,19,[23][24][25][26][27][28][29] The fact that CRF reflects the integrity of numerous systems at least partially explains the growing recognition that CRF predicts morbidity and mortality risk beyond commonly obtained risk factors. ...
... However, confusion can arise when no distinction is made between various forms of physical activity [1]. Apart from the energy expended through bodily movement, attention can be directed toward physical fitness, which is the (potentially inherited) ability of the body to perform activities efficiently and effectively [6][7][8][9][10][11][12][13][14][15][16]. Only a limited number of studies have thoroughly examined the distinct roles of muscular, cardio-circulatory, and respiratory functions as indicators of physical activity in relation to cardiovascular disease and life expectancy [13][14][15][16]. ...
... Apart from the energy expended through bodily movement, attention can be directed toward physical fitness, which is the (potentially inherited) ability of the body to perform activities efficiently and effectively [6][7][8][9][10][11][12][13][14][15][16]. Only a limited number of studies have thoroughly examined the distinct roles of muscular, cardio-circulatory, and respiratory functions as indicators of physical activity in relation to cardiovascular disease and life expectancy [13][14][15][16]. Objectively measured physical fitness derived from linearly combined arm circumference, heart rate and vital capacity (by Fitscore) may represent an improvement over classes of physical activity estimated from the type of work performed. ...
... This was so when these two parameters were challenged alone yet together (Table 3 and Figures 1-4) or when they were considered concomitantly and by adding classic risk factors for each respective subtype (Tables 4-6) or as CVD (Table 7), and there were also covariates defining countries. This suggests that OPA and Fitscore are relatively independent from each other and that Fitscore [probably due to being the result of actual measurements of muscular (arm circumference) [21,26], cardiocirculatory (heart rate) [11,[27][28][29] and respiratory (vital capacity) [11,20,[30][31][32] capacities] seems more intimately related to physical fitness [7,[13][14][15][16]. Although some connections between OPA and Fitscore may exist, there were no mathematical connections between them, and they performed in different ways when used to predict events. ...
Aim and Background: To determine whether occupational physical activity (OPA) and physical fitness (Fitscore) predict cardiovascular disease (CVD) mortality and its components. Methods: Among middle-aged men (N = 5482) of seven cohorts of the Seven Countries Study (SCS), several baseline risk factors were measured, and there was a follow-up for 60 years until virtual extinction. OPA was estimated from the type of work while Fitscore was derived from linear combinations of levels of arm circumference, heart rate and vital capacity computed as a factor score by principal component analysis. The predictive adjusted power of these characteristics was obtained by Cox models for coronary heart disease (CHD), heart diseases of uncertain etiology (HDUE), stroke and CVD outcomes. Results: Single levels of the three indicators of fitness were highly related to the three levels of OPA and Fitscore. High levels of both OPA and Fitscore forced into the same models were associated with lower CVD, CHD, HDUE and stroke mortality. When assessed concomitantly in the same models, hazard ratios (high versus low) for 60-year CVD mortality were 0.88 (OPA: 95% CI: 0.78–0.99) and 0.68 (Fitscore 95% CI: 0.61–0.75), and the predictive power of Fitscore outperformed that of OPA for CHD, HDUE and stroke outcomes. Similar results were obtained in individual outcome models in the presence of risk factors. Segregating the first 30 from the second 30 years of follow-up indicated that people dying earlier had lower arm circumference and vital capacity, whereas heart rate was higher for CVD and most of its major components (all p < 0.0001). Conclusions: OPA was well related to the indicators of fitness involving muscular mass, cardio-circulatory and respiratory functions, thus adding predictive power for CVD events. The Fitscore derived from the above indicators represents another powerful long-term predictor of CHD, HDUE and stroke mortality.
... Compared to CRF testing, muscular fitness and motor fitness testing such as handgrip strength tests and standing long-jump tests are practical to administer in most settings without expensive devices [9]. Therefore, physical fitness testing has been considered a valuable tool for evaluating health status and CVD risk in children and adolescents [10,11]. Physical fitness is a set of health-and skill-related attributes, including cardiorespiratory fitness (CRF), muscular fitness and motor fitness [12,13]. ...
... CRF is considered one of the most accurate indicators of physical health status [10]. Therefore, measuring CRF is a valuable assessment of CVD risk in youth [16]. ...
Background
Cardiovascular diseases (CVDs) are the leading cause of morbidity and premature mortality globally. While the relationship between indicators of physical fitness and arterial structure and stiffness are reasonably well-studied in adults, these associations in children and adolescents remain less understood. The aim of this study was to investigate longitudinal associations of cardiorespiratory fitness, muscular fitness and motor fitness with arterial structure and stiffness from childhood to adolescence.
Results
Higher mean value of VO2peak/LM from childhood to adolescence was associated with higher carotid intima-media thickness (cIMT) at 8-year follow-up (β = 0.184, 95% confidence interval [CI] = 0.019 to 0.350). Better performance in sit-up test at baseline was associated with lower cardio-ankle vascular index (CAVI) (β = − 0.219, 95% CI = − 0.387 to − 0.051) at 8-year follow-up, and higher mean sit-up performance from baseline to 8-year follow-up was associated with lower carotid-femoral pulse-wave velocity (cfPWV) (β = − 0.178, 95% CI = − 0.353 to − 0.003) and CAVI (β = − 0.190, 95% CI = − 0.365 to − 0.016) at 8-year follow-up. Also cross-sectionally, better sit-up performance at 8-year follow-up was associated with lower cfPWV (β = − 0.232, 95% CI = − 0.411 to − 0.054) and CAVI (β = − 0.185, 95% CI = − 0.365 to − 0.005) and higher carotid artery distensibility (β = 0.165, 95% CI = 0.004 to 0.327) at 8-year follow-up. Most of the associations were explained by body fat percentage (BF%).
Conclusions
Physical fitness had a weak if any association with indicators of arterial structure and arterial stiffness in adolescence. BF% largely explained the associations of higher VO2peak/LM with higher cIMT and better sit-up performance with lower arterial stiffness in adolescents. Therefore, preventing adiposity rather than improving CRF should be addressed in public health strategies to prevent CVDs in general paediatric populations.
Key Points
Better sit-up performance was associated with lower arterial stiffness, but the association was largely explained by body fat percentage.
Lower body muscular strength, handgrip strength, or motor fitness was not associated with arterial stiffness or carotid artery intima-media thickness.
Measures other than cardiorespiratory fitness, muscular fitness, or motor fitness, such as adiposity, should be used to screen children and adolescents at increased risk of cardiovascular diseases.
... Other investigators measured the time spent doing physical activity to reach a valuable classification [14]. There were several other methods used to classify physical activity, including self-reported information [15], the use of activity pattern questionnaires [16], and the estimate of metabolic equivalents [17]. ...
... In most studies, physical fitness was defined by the outcome of maximal exercise testing, either comparing physical activity with physical fitness or considering only physical fitness [15][16][17][18][19][20][21][22]. In general, comparative studies showed a better performance in physical fitness than physical activity, as partly was the case in our previous experience [5,6]. ...
Objective: Working physical activity, physical fitness and energy intake were studied for their effect on all-cause mortality and age at death in residential cohorts followed-up for 61 years. Material and Methods: There were two residential cohorts of middle-aged men examined in 1960 with a total of 1712 subjects, and three indexes were measured, i.e., physical activity by a questionnaire (three classes—sedentary, moderate, vigorous: Phyac), physical fitness, estimated by combining arm circumference, heart rate, and vital capacity by Principal Component Analysis, whose score was divided into three tertile classes (low, intermediate, and high: Fitscore), and energy intake in Kcalories, estimated by dietary history divided into three tertile classes (low, intermediate, high: Calories), plus five traditional cardiovascular risk factors (age, cigarette smoking, body mass index, systolic blood pressure, and serum cholesterol). Cox models were used to predict all-cause mortality as a function of those adjusted indexes. Multiple linear regression models were used to predict age at death as a function of the same co-variates and a larger number of them. At the 61-year follow-up, 1708 men had died. Results: There were large correlations across the three indexes. Prediction of all-cause mortality showed the independent and complementary roles of the three indexes to all be statistically significant and all protective for their highest levels. However, the Fitness score outperformed the role of Phyac, while the role of Calories was unexpectedly strong. The same outcome was found when predicting age at death, even in the presence of 25 covariates representing risk factors, personal characteristics, and prevalent major diseases. Conclusions: Working physical activity, a score of physical fitness and energy intake, seems directly related to lower all-cause mortality and to higher age at death, thus suggesting a large part of independence.
... Promoting physical activities holds profound implications for creating healthier communities. Active living contributes to reduced healthcare costs, as individuals are less prone to chronic diseases and associated medical expenses (Myers et al., 2015). Moreover, societies benefit from increased workforce productivity, enhanced mental well-being, and improved overall quality of life. ...
... The findings of this study underscore the urgency of prioritizing physical activities to enhance the physical fitness and overall health of the community. By adopting active lifestyles, individuals can significantly reduce the risk of chronic diseases and improve their quality of life (Myers et al., 2015). A population with improved physical fitness not only experiences lower healthcare costs but also exhibits higher levels of productivity and well-being. ...
This paper delves into the significance of engaging in sports and physical activities to improve the physical fitness of the community. The study explores the impact of physical activities on overall health and presents various strategies to promote and encourage participation in sports and exercise. The research methodology includes a comprehensive review of literature and case studies to highlight the benefits and challenges of implementing physical activities in enhancing the well-being of society. The findings emphasize the importance of early education, accessible facilities, and technological advancements in fostering a healthier and more active lifestyle. In conclusion, promoting physical activities emerges as a pivotal solution to counter the prevailing sedentary lifestyle and boost the physical fitness of the community.
... Adequate levels of cardiorespiratory [1][2][3][4] and muscular fitness [1,5,6] are crucial determinants for the maintenance of general health and for preventing numerous chronic diseases. It has been documented, for example, that the degree of maximal oxygen consumption (VO 2max ) as an indicator of cardiorespiratory fitness is a key predictor of cardiovascular disease and overall mortality, even stronger than traditional risk factors, such as obesity, hypertension, type 2 diabetes mellitus, or nicotine abuse [7,8]. Additionally, research indicates that muscle strength is an independent and significant factor related to morbidity and mortality [6,9]. ...
... Thus, in conjunction with previous findings, our data provide further evidence for the effectiveness of LOW-HIIT in improving cardiovascular health with relatively little time invested. Given the paramount importance of VO 2max for health and longevity [7,8], this finding has clinical significance and supports the role of LOW-HIIT in cardiometabolic disease prevention. ...
Combined endurance and resistance training, also known as “concurrent training”, is a common practice in exercise routines. While concurrent training offers the benefit of targeting both cardiovascular and muscular fitness, it imposes greater physiological demands on the body compared to performing each modality in isolation. Increased protein consumption has been suggested to support adaptations to concurrent training. However, the impact of protein supplementation on responses to low-volume concurrent training is still unclear. Forty-four untrained, healthy individuals (27 ± 6 years) performed two sessions/week of low-volume high-intensity interval training on cycle ergometers followed by five machine-based resistance training exercises for 8 weeks. Volunteers randomly received (double-blinded) 40 g of whey-based protein (PRO group) or an isocaloric placebo (maltodextrin, PLA group) after each session. Maximal oxygen consumption (VO2max) and overall fitness scores (computed from volunteers’ VO2max and one-repetition maximum scores, 1-RM) significantly increased in both groups. The PRO group showed significantly improved 1-RM in all major muscle groups, while the PLA group only improved 1-RM in chest and upper back muscles. Improvements in 1-RM in leg muscles were significantly greater in the PRO group versus the PLA group. In conclusion, our results indicate that adaptations to low-volume concurrent training, particularly leg muscle strength, can be improved with targeted post-exercise protein supplementation in untrained healthy individuals.
... Page 75 Maximal oxygen uptake and exercise test duration represent the strongest predictors of mortality [17][18][19]. We estimate indirectly the maximum oxygen uptake (VO 2 max) from Heart Rate (HR) and measuring maximal Activity Energy Expenditure (aEEmax) during graded exercise. ...
Background: There is a need to facilitate efforts to reduce metabolic, cardiovascular, and stressrelated risks with a healthy lifestyle and improve cardio metabolic and cardio-vegetative health and longevity with self-management and guided therapy. We recently introduced a Cyber-Physical System (CPS) to facilitate this process. CPS is a mobile technology integrating sensory data from various mobile devices into individualized dynamic mathematical models of physiological processes, allowing for analysis and prediction and maximizing user control and supported by the primary provider. Methods: Closely mimicking HOMA-IR (a practical laboratory measurement of insulin resistance) is our metric allowing for the noninvasive observation of insulin resistance changes by estimating R or Rw-ratio which are defined as R=ΔL/ΔF and Rw=ΔW/ΔF where ΔL, ΔW and ΔF are lean mass, weight and fat mass change over 24 hrs. We can estimate R or Rw-ratio either with use of our Self-Adaptive Model of the Energy Metabolism (SAM-HEM) demanding precise calorie counting or with our Weight, Fat weight, Energy balance (WFE) model without mandatory calorie counting by serially measuring weight, fat weight, and energy balance. The verification of this concept was performed using data from 12 clinical studies with 39 clinical study arms and with total number of patients n=2010. Results: The correlation between changes of HOMA-IR and changes of daily WFE calculated Rw-ratio was -0.6745 with a P value of 0.0000024. Conclusion: Our cyber-physical system along with a sensor system can provide a truly individualized strategy for estimation, measurement, and prediction of physiological variables of the metabolism including changes of insulin resistance which are essential for prevention and treatment diabetes and cardiovascular disease in primary care. Keywords Medical cybernetics; Machine learning; Self-adaptive individualized mathematical modeling; Non-invasive monitoring; Observing aging health; Risk prediction; Metabolic health; Insulin resistance; Cardiorespiratory fitness; Cardio-vegetative stress
... These shifts have inadvertently contributed to increased sedentary behavior, with up to 70% of individuals reportedly engaging in insufficient physical activity (3). Over time, these trends have not only led to a rise in obesity rates (4) but also exacerbated the prevalence of cardiovascular diseases, diabetes, and other chronic conditions (5,6), posing severe threats to public health and diminishing overall wellbeing. Consequently, in the context of fast-paced modern life, the question of how to provide more accessible opportunities for physical exercise, thereby enhancing public health and subjective well-being, has become a critical issue for both the Chinese government and the academic community. ...
Background
Communities are the main places where the public spend their daily activities, and suitable community environments can help improve their subjective well-being. However, there is still limited evidence on how fitness environments in communities affect the public’s subjective well-being. In recent years, Chinese governments have been created the 15-min fitness circle in communities to provide the public with convenient fitness facilities and venues. Whether this policy is effective in improving the public’s subjective well-being and the mechanisms that how this policy affects it has not been fully explored. To answer this question, we further focus on the mediating role of sports participation between the 15-min fitness circle and public subjective well-being.
Methods
This study utilizes data from the 2021 China General Social Survey (CGSS) to integrate the 15-min fitness circle , public sports participation, and subjective well-being into a unified analytical framework. A three-step regression model was used to analyse their relationship and the mediating effect of sport participation. And SPSS Macro PROCESS was used to test the robustness of their mediating effects.
Result
Our research findings indicate the following: (1) the 15-min fitness circle has a significant positive predictive effect on the subjective well-being of the Chinese public ( β = 0.080, p < 0.001), (2) The 15-min fitness circles have a significant positive impact on sports participation (β = 0.234, p < 0.001), and (3) sports participation serves as a crucial mediator in the relationship between the 15-min fitness circle and subjective well-being [Bootstrap 95% CI: 0.008, 0.019].
Conclusion
The study concludes that community fitness facilities are of great relevance in improving the subjective well-being of the public. The results of the study provide empirical support for the rationalization of the 15-min fitness circle in China, and provide theoretical and practical references for other developing countries in exploring ways to improve the subjective well-being of the public.
... Previous research has also suggested that exercise capacity may be more sensitive to other markers of physical fitness, rather than body composition alone (32). Finally, this study has several limitations that should be considered. ...
... Since the parameters used to assess NEE-CRF are often closely related to an individual's lifestyle (e.g., diet, weight), which also significantly influence hypertension, this further underscores the connection between the two (4, 26). Lee et al.'s research pointed out that higher NEE-CRF in middle-aged Europeans was associated with lower subclinical atherosclerosis and vascular stiffness (27), both of which are highrisk factors for the development of hypertension (28). Moreover, studies have shown that good cardiorespiratory fitness implies a stronger ability to adapt to daily activities and environmental changes, thereby reducing mortality risk due to various factors (29,30). In summary, existing literature confirms that an increase in NEE-CRF can reduce the risk of hypertension and all-cause mortality, which aligns with our study findings. ...
Background
The Non-Exercise Estimated Cardiorespiratory Fitness (NEE-CRF) method has gained attention in recent years due to its simplicity and effectiveness. Hypertension and all-cause mortality are significant public health issues worldwide, highlighting the importance of exploring the association between NEE-CRF and these two conditions.
Methods
The data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS) were utilized to validate the association between NEE-CRF and hypertension as well as all-cause mortality. NEE-CRF was calculated using a sex-specific longitudinal non-exercise equation. To investigate the relationship between hypertension and all-cause mortality, multivariable regression analysis, generalized additive models, smooth curve fittings, and threshold effect analysis were employed. Logistic regression was used for hypertension analysis, while Cox proportional hazards regression was applied for all-cause mortality. Additionally, we conducted stratified analyses and interaction tests among different groups.
Results
In the NHANES, after fully adjusting for covariates, each unit increase in NEE-CRF was associated with a 24% reduction in the risk of hypertension (OR: 0.76, 95% CI: 0.74–0.78) and a 12% reduction in the risk of all-cause mortality (HR: 0.88, 95% CI: 0.79–0.86). Subgroup analyses showed that the relationship between NEE-CRF and both hypertension and all-cause mortality remained negatively correlated across different subgroups. The negative association was also validated in the CHARLS.
Conclusions
Higher NEE-CRF levels may reduce the risk of developing hypertension and all-cause mortality.
... [19][20][21][22][23][24] However, they are not routinely assessed and remain overlooked when compared with other major risk factors. 25 In addition, few studies investigated the relationship between CRF and body composition in patients with CVD involved in cardiac rehabilitation and secondary prevention interventions. In particular, one paper focused on the combined effects of CRF and adiposity in patients with coronary artery disease attending a traditional cardiac rehabilitation program. ...
Purpose
Both cardiorespiratory fitness (CRF) and obesity have been well-established as predictors of cardiometabolic risk and mortality. This study sought to investigate the joint association of CRF and adiposity measures with all-cause and cardiovascular (CVD) mortality in a cohort of patients with stable CVD.
Methods
Data were extracted from the ITER registry. The sample was composed of 2860 cardiac patients involved in an exercise-based secondary prevention program between 1997 and 2023. Patient CRF was estimated using the 1-km treadmill walking test, and measures of body mass index (BMI) and predicted body fat percentage (pBF%) were determined. Cox proportional hazard models were used to determine associations with mortality. All results were adjusted for demographic and clinical confounders.
Results
A total of 1034 deaths (463 of CVD) occurred over a median of 11 years. Each of the fitness-fatness combinations was associated with an increased risk of mortality as compared with normal weight-fit or low pBF%-fit groups. As regards BMI, compared to the reference group, higher mortality risks were observed for overweight-unfit (HR = 1.93: 95% CI, 1.55-2.41; P < .0001), and obese-unfit patients (HR = 1.63: 95% CI, 1.28-2.08; P < .0001). Similar magnitudes were detected in the moderate pBF%-unfit (HR = 2.47: 95% CI, 1.99-3.06) and high pBF%-unfit (HR = 2.07: 95% CI, 1.69-2.54; P < .0001) groups. A similar pattern was observed for CVD mortality.
Conclusion
While overweight and obesity have been associated with an increased risk of death, maintaining CRF can mitigate this risk. These findings support the fundamental role of CRF in exercise assessment and prescription in secondary prevention programs.
... Obesity is associated with a decline in cardiorespiratory fitness and an excessive accumulation of visceral fat, both of which are independent risk factors for cardiovascular disease (CVD) [3]. CRF is a critical marker of cardiovascular risk and mortality [4]. VO 2 max is one of the core indicators of CRF [5]. ...
This systematic review and meta-analysis aims to comprehensively evaluate the effects of hypoxic training (HT) versus normoxic training (NT) on cardiometabolic health parameters in overweight or obese adults. Searches were performed in PubMed, Web of Science, Embase, Scopus, and the Cochrane Library. A meta-analysis was performed using Stata 18 and RevMan 5.4 software. Seventeen randomized controlled studies involving 517 participants were included. HT significantly improved cardiorespiratory fitness (CRF) and reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP). Compared with NT, HT demonstrated a significant difference in CRF, but no significant differences were observed in SBP and DBP. The subgroup analysis of CRF revealed that HT significantly outperformed NT in six aspects: participants aged < 45 years (Hedges’ g = 0.50), an intervention duration of 8 weeks (Hedges’ g = 0.43), three sessions per week (Hedges’ g = 0.40), each session lasting < 45 min (Hedges’ g = 0.23), FiO2 levels > 15% (Hedges’ g = 0.69), and high-load-intensity exercise (Hedges’ g = 0.57). HT demonstrated favorable effects in improving cardiometabolic health among overweight or obese adults. Compared with NT, this advantage was primarily reflected in CRF while the impacts on SBP and DBP were similar.
... These include Body Mass Index (BMI) [11,12], body composition [13,14] and Waistto-Height Ratio (WHtR) [13,15,16]. Moreover, performance and hemodynamic parameters are also linked to PA and serve additionally as a reliable indicator for overall health [17][18][19][20][21][22][23]. ...
Background: Short Physical Activity Questionnaires (PAQs) offer significant value for various reasons, particularly in assessing physical activity while minimizing participant burden. Short English language PAQs have shown validity and reliability. However, a validated short PAQ does not exist in German. Therefore, this study validated a short German PAQ using various validation measures including anthropometric, physiological, and psychological indicators.
... The majority of this heightened risk is linked to an increased prevalence of established risk factors, including hypertension, dyslipidemia, and obesity, among these individuals. In the last decade, substantial data has been accumulated to support the significant value of treating conventional risk factors in patients with T2DM to reduce the risk of CVD [5,6]. The inadequate management of a significant proportion of cardiovascular risk factors in individuals with diabetes underscores the need for a more proactive approach to addressing modifiable cardiovascular risk factors, particularly in patients with a history of cardiovascular disease. ...
Background: Cardiovascular illness is a prominent contributor to mortality, characterised by a lack of effective therapeutic interventions tailored to specific clinical requirements. Fibroblast growth factor 23 (FGF-23) is a protein hormone that was first characterised for its involvement in mineral metabolism. FGF-23 is mostly produced by osteocytes and has a pivotal function in suppressing the reabsorption of phosphate in the renal proximal convoluted tubule. The aim: Comparison between Cardiovascular Diseases in Patients With Type 2 Diabetes and without DM regarding serum level of FGF23. Study the relation between serum FGF23 level and insulin resistance in Cardiovascular Diseases in Patients With Type 2 Diabetes. Material and Method: The present study included 60 patients with Diabetes Mellitus (DM) with a mean age of 56.02±1.395 years and an age range of (40-80) years and 60 patients with cardiovascular diseases and diabetes (CVD and DM) with a mean age of 59.20±1.478 and an age range of (40-80) years, Who visited Al-Basrah Teaching Hospital in Basrah. in addition, the study included 60 healthy controls mean age of healthy control subjects was 54.72±1.405years. All patients in this study were diagnosed by specialized doctors and the diagnosis was verified by clinical and laboratory tests, during the period from September 2022 to September 2023. All Subjects signed a written informed consent form. The BMI was calculated as body weight (kg) and was divided by squared height in meters. Results: The results of this study showed an increase in the level of Triglycerides, Cholesterol, LDL Cholesterol and VLDL Cholesterol in CVD and DM patients as compared with DM and Control, while The results of this study showed a decrease in the level of HDL Cholesterol and there was a significant difference in concentrations among study groups (p-value <0.0001). Also, The results of this study showed an increase in the level of fibroblast growth factor 23 in CVD and DM patients as compared with DM and control and there was a significant difference in concentrations of FGF23 among study groups (p-value <0.0001). Conclusion: From this study, it could be concluded that FGF23, CRP, may be a clinically useful and simple index for predicting the concomitant presence of Cardiovascular Diseases insulin resistance and dysglycemia among apparently healthy, young (<50 years) Al-Basra populations.
... In recent years, there has been an increased call for recognition of CRF as a modifiable risk factor for CAD that should be incorporated into national Cardiology and Cardiothoracic Surgery disease prevention guidelines [10]. Several studies have already shown that CRF is inversely associated with worse cardiac biomarkers, increased risk for the development of heart failure, MACVEs, CVDassociated mortality, and all-cause mortality [32][33][34][35][36][37]. In a 2009 meta-analysis evaluating 33 studies with over 100,000 participants, Kodama et al. [33] reported that compared to the most-fit participants, the least-fit quintile of patients was associated with a 56% higher risk of CVD related mortality. ...
Background: Regular physical activity is widely recommended to reduce the risk of coronary heart disease. Coronary artery bypass grafting is the gold standard treatment for severe multi-vessel coronary artery disease that has failed medical management. However, there is limited information on the relationship between cardiorespiratory fitness (CRF) and the likelihood of undergoing coronary bypass. This study aims to determine the association between CRF and the likelihood of requiring future coronary artery bypass in a US Veteran population. Methods: From a cohort of 740,075 United States Veterans who completed an exercise treadmill test between October 1, 1999, and September 3, 2020, with no evidence of cardiovascular disease, we identified 14,860 individuals who underwent a bypass more than six months after their fitness assessment. To assess the association between CRF and the risk of coronary bypass, we divided participants into CRF quintiles based on peak workload achieved: Least-fit: 4.7 ± 1.5 metabolic equivalents (METs) (n = 141,893); Low-fit: 7.2 ± 0.9 METs (n = 181,550), Moderate-fit: 8.5 ± 1.3 METs (n = 142,895), Fit: 10.5 ± 1.0 METs (n = 192,061) and High-fit: 13.5 ± 1.8 METs (n = 81,676). Cox proportional hazard models were used to calculate the risk of bypass across fitness categories. The models were adjusted for age, body mass index, race, cardiovascular medications, and cardiovascular risk factors. Results: The association between cardiorespiratory fitness and coronary artery bypass was inverse, independent, and graded. For every 1-MET increase in exercise capacity the risk of surgery was 10% lower (HR = 0.90; 95% CI: 0.89–0.91; p < 0.001). Comparisons across CRF quintiles revealed that the risk for surgery was lower by 29% in the Low-fit group (HR = 0.71; 95% CI: 0.68–0.74; p < 0.001), 37% in the Moderate-fit group (HR = 0.63; 95% CI: 0.60–0.66; p < 0.001), 47% in the Fit group (HR = 0.53; 95% CI: 0.54–0.60; p < 0.001), and 53% in the High-fit group (HR = 0.47; 95% CI: 0.43–0.50; p < 0.001). Conclusions: Our findings support a graded, inverse relationship between CRF and the likelihood of undergoing future coronary bypass surgery. A moderate CRF level, achievable by most older individuals engaging in age-appropriate physical activity, was associated with a 40% lower likelihood of undergoing future coronary bypass.
... Nevertheless, physical fitness has been declining over the last several decades [25,26], and ensuring adequate physical fitness during childhood and adolescence is crucial for the prevention of chronic diseases and maintenance of overall health [19]. Given its association with physical activity [24,27], physical fitness is further considered an important indicator for adolescents' lifestyles. Similarly, dietary habits have been associated with improved quality of life, cognitive functions, and mental health as well as reduced risk of various diseases [28][29][30][31]. ...
Background/Objectives: Physical fitness and diet along with body weight are key determinants of health. Excess body weight, poor dietary choices, and low physical fitness, however, are becoming increasingly prevalent in adolescents. In order to develop adequate intervention strategies, additional research on potential interaction effects of these entities is needed. Therefore, this study examined the combined association of physical fitness and diet with body weight in Austrian adolescents. Methods: A total of 164 (56% male) adolescents between 11 and 14 years of age completed the German Motor Test, which consists of eight items that assess cardiorespiratory endurance, muscular endurance and power, speed and agility, flexibility, and balance, along with body weight and height measurements. Additionally, participants completed a standardized food frequency questionnaire. Results: Spearman correlation analyses showed an inverse association between physical fitness and processed foods consumption (rho = −0.25, p < 0.01), while sweet consumption was positively associated with physical fitness (rho = 0.17, p = 0.03). No significant interaction effects between diet and physical fitness on body weight were observed. However, both higher physical fitness and greater sweet consumption were associated with lower body weight (p < 0.01). Conclusions: The present study emphasizes the independent and combined interactions of key correlates of health. It also suggests that high fitness may offset detrimental effects of poor dietary choices. In order to address potential health risks early in life and facilitate future health and well-being, it is important to monitor and control physical fitness, diet, and body weight during adolescence.
... Therefore, maintaining good HS was necessary to improve HRQOL status. This supported previous results that maintaining good HS could provide positive benefits for PA (Myers et al., 2015). However, demographic characteristics and illness-related factors such as age, gender, job, marital status, religion, education, Hgb, BMI, length of diagnostic HF, and comorbidities did not correlate with HRQOL. ...
Introduction: This study aimed to describe self-reported PA performance and determine predictors regarding health-related quality of life (HRQOL) among heart failure (HF) patients. Methods: A cross-sectional design was adopted, and data were collected using a questionnaire comprising demographic characteristics, illness-related factors, self-report health status (SRHS) questionnaire, international PA questionnaire, and Minnesota Living with Heart Failure questionnaire. Subsequently, data were analyzed using Pearson correlation coefficient, t-test, one-way ANOVA, and hierarchical multiple regression. Results: The mean age for the total participants of 180 HF patients was 59.92 ± 11.90 years, with 60% being male, and the mean HRQOL score was 42.96 ± 20.47. HRQOL had significant correlations with HF medication (r= 0.20, p< 0.01), health status (HS) (r= 0.35, p< 0.01), PA (r= -0.52, p< 0.01), and HRQOL was associated with the New York Heart Association (NYHA) classification (F= 94.57, p< 0.001). Meanwhile, age, gender, job, marital status, religion, level of education, hemoglobin, body mass index, length of diagnostic HF, and comorbidities did not have a significant relationship with HRQOL. Three variables were significant predictors of HRQOL, namely HS (β= 0.21, p< 0.01), NYHA Class III (β= 0.15, p< 0.05), and PA (β= -0.31, p< 0.001). Conclusions: Regular PA is crucial in improving HRQOL of HF patients. In addition, HS, HF medication, and NYHA Class should be considered in providing care for HF patients aimed at improving HRQOL.
... The WHO recommends that patients with chronic conditions do at least 150 minutes per week of moderate-intensity aerobic exercises or their equivalent [2]. For every increase in 1metabolic equivalent (MET), there is a reduction in premature mortality of 10-25% [5]. Exercise also has a preventive role in breast, colorectal, lung, and prostate cancers and increases survival after diagnosis [2]. ...
This comprehensive review examines exercise as a therapeutic intervention for managing chronic diseases. It explores the physiological mechanisms behind physical activity's beneficial effects and its impact on various conditions, including cardiovascular disease, diabetes mellitus, obesity, and mental health disorders. Drawing from current literature and research findings, this review highlights how regular exercise significantly reduces mortality rates, improves disease outcomes, and enhances the overall quality of life for those with chronic illnesses. It discusses specific exercise recommendations for different conditions, emphasizing the importance of tailored physical activity programs. The review also addresses exercise's potential as a cost-effective and accessible treatment option, which may complement or, in some cases, reduce the need for pharmacological interventions. Ultimately, this review aims to equip healthcare professionals with a thorough understanding of exercise's therapeutic potential in chronic disease management, supporting the integration of physical activity into comprehensive treatment plans.
... High physical fitness during childhood and adolescence, therefore, is crucial for the prevention of chronic diseases and maintenance of overall health [15]. Given its association with physical activity [20,22], physical fitness is further considered an important indicator for adolescents' lifestyle. Similarly, dietary habits have been associated with quality of life and overall health [23][24][25]. ...
Background/Objectives: Physical fitness and diet along with body weight are key determinants of health. Excess body weight, poor dietary choices, and low physical fitness, however, are becoming increasingly prevalent in adolescents. In order to develop adequate intervention strategies additional research on potential interaction effects of these entities is needed. Therefore, this study examined the combined association of physical fitness and diet with body weight in Austrian adolescents. Methods: A total of 164 (56% male) adolescents between 11 and 14 years of age completed the German Motor Test, which consists of 8 items that assess cardiorespiratory endurance, muscular endurance and power, speed and agility, flexibility and balance, along with body weight and height measurements. Additionally, participants completed a standardized food frequency questionnaire. Results: Spearman correlation analyses showed an inverse association between physical fitness and processed foods consumption (rho = -0.25, p
... Additionally, PA contributes to the reduction and management of risk factors associated with heart disease, including high blood pressure, elevated cholesterol levels, and obesity [69][70][71][72][73]. Furthermore, PA has been shown to improve cardiac risk factors such as blood pressure, cardiovascular fitness, flexibility, and body fat percentage, as indicated by multiple research studies [73][74][75][76][77][78]. This is particularly crucial for firefighters who regularly face sleep deprivation and high-stress situations, as regular PA plays a significant role in mitigating stress levels [73-78]. ...
Background
The development of atherosclerosis in firefighters is affected by various cardiovascular risk factors, such as smoking, poor dietary choices, and lack of physical activity. Together, these elements lead to obesity, high blood pressure, unhealthy cholesterol, and increased blood sugar levels. Continuous exposure to these risks raises the chances of worsening atherosclerosis, which can impede blood circulation to essential organs like the heart and brain. As a result, sudden cardiac death is the leading cause of fatalities while on duty in the fire service.
Aim
This study aimed to explore and describe the perceptions, experiences, and challenges associated with physical activity among firefighters with risk factors for coronary heart disease in the City of Cape Town Fire and Rescue Services.
Methods
A purposive sample of nine full-time active career firefighters from the City of Cape Town Fire and Rescue Services, representing three different ranks, was employed, using a descriptive qualitative study design. The semi-structured interview responses were recorded and transcribed verbatim. The participants were free to leave the study at any time and without penalty, and their rights to confidentiality were protected. The thematic analysis was then used to examine the transcripts.
Results
The results revealed that firefighters were not physically active enough to meet the suggested minimum levels of physical activity and were physically inactive. Sedentary lifestyles have numerous detrimental effects on the human body, such as elevated rates of dyslipidemia, hypertension, diabetes mellitus, cardiovascular disease mortality, and all-cause death. Therefore, it is essential to reduce sedentary behavior and increase physical exercise to improve the health and well-being of firefighters.
Conclusion
Policy strategies should be designed to introduce physical activities at low-moderate intensity levels and accommodate firefighters with coronary heart disease risk factors. Implementing team-based physical activity interventions has demonstrated positive impacts on individual behavior changes within the fire service.
... For instance, research has shown that prolonged sedentary behavior is closely linked to an increased risk of obesity, cardiovascular diseases, and mental health issues such as anxiety and depression (Nogueira et al. 2018;Lavie et al. 2019). Furthermore, insufficient physical activity has been associated with diminished cardiorespiratory fitness and overall health deterioration (Myers et al. 2015). Chronic sleep deprivation has also been proven to exacerbate these issues, further compromising the physical and mental well-being of college students (Moussa-Chamari et al. 2024). ...
Objective: The aims of this study were to investigate the effects and mechanisms of physical exercise input, sports emotional intelligence, and sports self-efficacy on exercise adherence, and to examine the chain-mediating role of sports emotional intelligence→sports self-efficacy. Methods: The Physical Exercise Input Scale, Exercise Adherence Scale, Sports Emotional Intelligence Scale, and Sports Self-Efficacy Scale were used to investigate 1390 college students in three universities in the Henan Province. Results: (1) Physical exercise input was a significant positive predictor of exercise adherence (β = 0.29, t = 5.78, p < 0.001); (2) sports emotional intelligence and sports self-efficacy mediated the relationship between physical exercise input and exercise adherence; (3) physical exercise input influenced exercise adherence through the separate mediating role of sports emotional intelligence (β = 0.10, t = 5.98, p < 0.001), the separate mediating role of sports self-efficacy (β = 0.13, t = 2.64, p < 0.01), and the chain mediating role of sports emotional intelligence→sports self-efficacy (β = 0.09, t = 2.80, p < 0.01). Conclusions: (1) Physical exercise input can positively predict the level of sports emotional intelligence and sports self-efficacy of college students; (2) Physical exercise input can not only directly influence college students’ exercise adherence but can also indirectly influence it through sports emotional intelligence or sports self-efficacy levels alone, as well as through the chain mediation of the two.
... however, despite a robust and growing body of data to support the importance of physical activity, the vast majority of individuals in the uSa and throughout the western world remain largely physically inactive. [1][2][3][4][5][6][7][8]13 Greater efforts to reduce sedentary behavior, promote physical activity, and enhance CRF by public health organizations and healthcare systems are needed to reduce the risk of chronic disease. ...
Cardiorespiratory fitness (CRF) has been increasingly recognized in recent years as an important predictor of risk for adverse outcomes in numerous chronic conditions. In fact, a growing body of epidemiological and clinical evidence demonstrates that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, hyperlipidemia, and type 2 diabetes. Moreover, adding CRF to these traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The utility of CRF now extends far beyond all-cause and cardiovascular mortality to include the prevention and treatment of numerous other chronic conditions; CRF has been demonstrated to have a mitigating influence in as many as 40 such conditions. Herein we discuss the impact of CRF in the prevention of chronic disease in both adults and children. This discussion includes recent data on interactions between CRF and aging, obesity, statin use, incidence of diabetes, and the impact of CRF and physical activity patterns in adolescents including mental health, scholastic achievement, and cardiometabolic health. Finally, we discuss how CRF, as an essential vital sign, can be implemented in clinical practice.
... PF can be divided into the two dimensions of cardiorespiratory fitness (CRF) and muscular fitness (MF) (Caspersen et al., 1985). Physical fitness is seen as an important marker of overall physical health status (Myers et al., 2015), and it has also been shown to have a positive impact on mental health according to a recent meta-analysis (Cadenas-Sanchez et al., 2021). A few studies have examined the link between PF and job strain, and the evidence is still quite scarce. ...
Job strain is a major concern in the workplace. Work-related stress is an increasing challenge worldwide as it is the leading cause of long-term sickness absences, disability pensions and lower productivity. Rarely studied simultaneously, both leisure-time physical activity (LTPA) and physical fitness (PF), which comprises cardiorespiratory fitness (CRF) and muscular fitness (MF), may have potential in preventing and managing job strain. The current study aimed to investigate whether LTPA, CRF and MF predict perceived job strain. In addition, the study examines reverse associations, that is, whether job strain predicts LTPA, CRF and MF. We used longitudinal population-based data from a Northern Finland birth cohort of 1966 (n = 5363) to analyse LTPA, CRF and MF as well as job strain and its components, job demands and job control, at age 31 years (1997) and 46 years (2012). Leisure-time physical activity was measured with a self-reported questionnaire whereas CRF and MF were measured as part of clinical examination. Linear regression analyses were used to analyse the data. In both men (n = 2548) and women (n = 2815), higher baseline MF predicted lower job strain and job demands 15 years later. In women, higher baseline total LTPA predicted higher job demands, whereas in men, higher CRF predicted lower job strain and higher job control. These associations remained significant , also when adjusted for education and occupational status. In the analyses on This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
... G*Power 3.1 (Heinrich Heine University Düsseldorf, Düsseldorf, Germany) was used to determine the number of participants needed [16]. Based on an expected difference in the VO 2max increase of 3.5 mL/kg/min in the intervention group [17][18][19][20], the effect size of 0.875 was derived from the mean power and standard deviation from a previous study [21]. To achieve an α of 0.05 and a power of 80%, at least 22 patients were required for each group. ...
Background: Despite the effectiveness of cardiac rehabilitation (CR), the actual participation rate in CR is low. While home-based CR offers a viable alternative, it faces challenges in participation due to factors such as a lack of self-motivation and fear of exercising without supervision. Utilizing a mobile healthcare application (app) during counseling may be an effective strategy for patients. Therefore, the aim of this study was to assess whether 6 weeks of home-based CR with exercise readjustment using a mobile app is an effective therapy for patients with acute myocardial infarction (AMI). Methods: Post-AMI patients eligible for home-based CR were randomized into the intervention group (CR-Mobile) and the control group, which followed the usual home-based CR protocol (CR-Usual). Both groups participated in a 6-week home-based CR program, with exercise readjustment and encouragement carried out every 2 weeks. The CR-Mobile group was supervised using data recorded in the mobile app, while the CR-Usual group was supervised via phone consultations. The primary outcome measured was maximal oxygen consumption (VO2max). Results: Within-group comparisons showed significant improvements in VO2max (PCR-Mobile = 0.011 vs. PCR-Usual = 0.020) and METs (PCR-Mobile = 0.011 vs. PCR-Usual = 0.011) for both groups. Conclusions: These findings suggest that a 6-week home-based CR program with exercise readjustment using a mobile app can potentially enhance exercise capacity as effectively as verbal supervision.
... The term obesity paradox refers to the observation that, although being obese is a major risk factor in the development of diseases, such as cardiovascular disease (CVD), adults having obesity coupled with CVD or type 2 diabetes mellitus (T2DM) may have a survival advantage against succumbing to CVD-and T2DM-related health outcomes compared to non-obese adults [1]. Physical activity (PA) is a potent regulator of energy balance (i.e., energy intake relative to energy expenditure) involved in maintaining a healthy weight or losing excess body weight [2,3], which improves cardiorespiratory fitness (CRF), an important indicator of overall health [4,5]. As such, in this broad review, we aim to update the evidence on the relationship between PA, CRF, and the obesity paradox. ...
Despite decades of extensive research and clinical insights on the increased risk of all-cause and disease-specific morbidity and mortality due to obesity, the obesity paradox still presents a unique perspective, i.e., having a higher body mass index (BMI) offers a protective effect on adverse health outcomes, particularly in people with known cardiovascular disease (CVD). This protective effect may be due to modifiable factors that influence body weight status and health, including physical activity (PA) and cardiorespiratory fitness (CRF), as well as non-modifiable factors, such as race and/or ethnicity. This article briefly reviews the current knowledge surrounding the obesity paradox, its relationship with PA and CRF, and compelling considerations for race and/or ethnicity concerning the obesity paradox. As such, this review provides recommendations and a call to action for future precision medicine to consider modifiable and non-modifiable factors when preventing and/or treating obesity.
... For example, Rall et al. showed that a 12-weeks period of resistance training did not reduce TNF-α and IL-6 levels in elderly subjects (16). Several studies have shown that endurance exercise improves immune function and risk factors for chronic diseases in elderly individuals (17)(18)(19)(20). However, nothing is known about the effect of concurrent training with different orders, Libardi et al. showed that 16 weeks of combined training in middle-age men has no effect on IL-6, TNF-α, and CRP levels (21). ...
Introduction: Aging is associated with elevated levels of some proinflammatory factors and exercise is a non-invasive intervention to improve immune function among older adults .The aim of the study was to compare resistance training effects on interlukine-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) levels in older-aged women. Methods: The study was quasi-experimental and forty healthy females were selected and randomly assigned to one of four groups: strength after endurance training (endurance + strength (E + S), n = 9), strength prior to endurance training (strength + endurance (S + E), n = 10), interval resistance-endurance training (Int, n = 12), and control (n = 9) groups. The training program was performed for eight weeks, three times per week. Human TNF-α and IL-6 sandwich ELISA Kit were used. Within-group differences were analyzed using a paired samples t-test and between-group differences were analyzed using one-way analysis of variance. Results: The intra-session order had not significantly influence on the adaptive response of waist-to-hip ratio (p = 0.55), IL-6 (p = 0.55) and hs-CRP (p = 0.55) throughout the study. However, significant differences were shown following combined training between the S + E, E + S and Int groups for Vo2 max (p = 0.029), body mass (p = 0.016) and BMI (p = 0.023) when comparing pre and posttests. Conclusion: This study confirmed that adaptations to a combination of endurance and resistance training appear to be independent of whether resistance training occurs prior to or following endurance training. Citation: Mardanpour Shahrekordi Z, Banitalebi E, Faramarzi M. The effect of resistance training on levels of interlukine-6 and high-sensitivity c-reactive protein in older-aged women.
... The explanation is to be found in the progressive loss of lean mass, such that obese subjects of normal weight, overweight, and with Class I obesity present a greater cardiovascular risk compared to more serious conditions (Class II, III, and above Class III) [55]. Undoubtedly, overweight and obesity increase the onset of heart failure as they influence the structure and function of the heart, ventricular and diastolic [24,56]. Certainly, excess weight is related to the dysregulation of physiological parameters that lead to the development and worsening of cardiovascular disease, including dyslipidemia, elevated blood sugar, lowgrade systemic inflammation, metabolic syndrome, and type 2 diabetes mellitus [24]. ...
The prevalence of obesity has become a global health concern, with significant impacts on quality of life and mortality rates. Recent research has highlighted the role of ultra-processed foods (UPFs) in driving the obesity epidemic. UPFs undergo extensive processing, often containing high levels of sugars, fats, and additives, while lacking essential nutrients. Studies have linked UPF consumption to obesity and cardiometabolic diseases, underscoring the importance of dietary patterns rich in whole foods. Thus, the aim of this narrative review is to elucidate the correlation between ultra-processed foods and the increased trend of obesity and its related complications. These foods, prevalent in modern diets, contribute to nutritional deficiencies and excessive caloric intake, exacerbating obesity rates. Lifestyle factors such as busy schedules and quick meal management further drive UPF consumption, disrupting hunger regulation and promoting overeating. UPF consumption correlates with adverse health outcomes, including dyslipidemia, hypertension, and insulin resistance. Promoting whole, minimally processed foods and implementing school-based nutrition education programs are crucial steps. Also, numerous challenges exist, including unequal access to healthy foods, the industry’s influence, and behavioral barriers to dietary change. Future research should explore innovative approaches, such as nutrigenomics and digital health technologies, to personalize interventions and evaluate policy effectiveness. Collaboration across disciplines and sectors will be vital to develop comprehensive solutions and improve public health outcomes globally.
... In this study, both VO 2 peak/max (ml･kg -1 ·min -1 ) and absolute VO 2 (L･min -1 ) significantly increased at moderate and vigorous intensities after [30]. Oxidative stress and exercise capacity are the parameters to predict an individual's cardiovascular risk [31]. Maintaining a regular exercise setting the optimal exercise intensity would benefit the body's anti-oxidative potential [23]. ...
OBJECTIVES This study aimed to compare the effects of different intensities of aerobic exercise on cardiorespiratory fitness (CRF), plasma malondialdehyde (MDA), and superoxide dismutase (SOD) levels before and after an 8-week exercise.METHODS Twenty-seven male university students were randomly divided into three intensity groups: light intensity (LI; 30-39% HRR), moderate intensity (MI; 40-59% HRR), and vigorous intensity (VI; 60-89% HRR). The study variables measured CRF factors such as maximal/peak oxygen uptake, ventilation, exercise time, and oxidative stress. MDA and SOD levels at rest, and following a graded exercise cessation before and after an 8-week exercise. Statistical analysis conducted two-way ANOVA with repeated measures after testing the normality of variables among groups using the Levene test.RESULTS The results showed significant increases in CRF factors, such as VO2 peak/max, absolute VO2, and exercise time at both moderate and vigorous intensities after 8 weeks. Furthermore, there were significant increases including ventilation at all three intensities after the 8-week exercise. The SOD level showed a significant difference in the low intensity exercise group, but there was no significant difference at the three intensities after exercise. Plasma MDA differed significantly at low and moderate intensities after exercise.CONCLUSIONS Based on these results, this study concluded significant improvements in cardiorespiratory fitness (CRF) factors such as VO2peak/max, absolute VO2, and exercise time in both moderate and vigorous intensities exercise groups after exercise of 8 weeks. There were significant increases at three intensities after exercise of 8 weeks in ventilation. SOD levels also showed an increase in the low-intensity exercise group, while plasma MDA decreased in low and moderate-intensity exercise groups.
... Cardiorespiratory fitness is in part a consequence of regular physical activity (11). In recent years, cardiorespiratory fitness has been demonstrated to be a powerful predictor of risk for mortality and other adverse health outcomes (4,(10)(11)(12). A growing body of research has demonstrated that higher levels of cardiorespiratory fitness reduce the risk of many highly prevalent noncommunicable diseases, including CVD, diabetes, and several site-specific cancers. ...
... It encompasses a range of physical attributes such as cardiorespiratory endurance, muscle strength and power, speed, agility, coordination, flexibility, and body composition. Better physical fitness is associated with a longer lifespan and a reduced risk of premature death, as it helps lower the risk of developing cardiovascular and other chronic diseases (Bouchard et al., 2012;Kvaavik et al., 2009;Laukkanen et al., 2016;Myers et al., 2015;Warburton & Bredin, 2017). ...
Physical activity and physical fitness are well-documented contributors to overall health, affecting various physiological and psychological outcomes. While some studies have reported a positive impact on academic performance, others have not found significant effects. Given these mixed results, the aim of this meta-analysis is to explore the effects of physical activity and physical fitness specifically on academic performance. Aadditionally, the research will examine whether the competencies of teachers delivering the physical activity interventions significantly influence the implementation of the intervention and how this impact manifests in the academic performance of children and adolescents. The Meta-Analysis will include searches in PubMed, Scopus, and ScienceDirect. The results will be crucial for understanding how measured physical fitness, in addition to increased physical activity, influences the academic performance of children and adolescents. By identifying the most effective types of interventions and the critical role of instructor competence, we can guide the development of more targeted and effective physical activity programs.
... VO 2 max is also often used as a performance measure [5,6]. Previous research concludes that VO 2 max is closely related to all-cause mortality and underscores the importance of enhancing VO 2 max to reduce the risks of developing cardiovascular diseases [7][8][9][10]. ...
Background
Determining maximum oxygen uptake (VO2max) is essential for evaluating cardiorespiratory fitness. While laboratory-based testing is considered the gold standard, sports watches or fitness trackers offer a convenient alternative. However, despite the high number of wrist-worn devices, there is a lack of scientific validation for VO2max estimation outside the laboratory setting.
Objective
This study aims to compare the Apple Watch Series 7’s performance against the gold standard in VO2max estimation and Apple’s validation findings.
Methods
A total of 19 participants (7 female and 12 male), aged 18 to 63 (mean 28.42, SD 11.43) years were included in the validation study. VO2max for all participants was determined in a controlled laboratory environment using a metabolic gas analyzer. Thereby, they completed a graded exercise test on a cycle ergometer until reaching subjective exhaustion. This value was then compared with the estimated VO2max value from the Apple Watch, which was calculated after wearing the watch for at least 2 consecutive days and measured directly after an outdoor running test.
Results
The measured VO2max (mean 45.88, SD 9.42 mL/kg/minute) in the laboratory setting was significantly higher than the predicted VO2max (mean 41.37, SD 6.5 mL/kg/minute) from the Apple Watch (t18=2.51; P=.01) with a medium effect size (Hedges g=0.53). The Bland-Altman analysis revealed a good overall agreement between both measurements. However, the intraclass correlation coefficient ICC(2,1)=0.47 (95% CI 0.06-0.75) indicated poor reliability. The mean absolute percentage error between the predicted and the actual VO2max was 15.79%, while the root mean square error was 8.85 mL/kg/minute. The analysis further revealed higher accuracy when focusing on participants with good fitness levels (mean absolute percentage error=14.59%; root-mean-square error=7.22 ml/kg/minute; ICC(2,1)=0.60 95% CI 0.09-0.87).
Conclusions
Similar to other smartwatches, the Apple Watch also overestimates or underestimates the VO2max in individuals with poor or excellent fitness levels, respectively. Assessing the accuracy and reliability of the Apple Watch’s VO2max estimation is crucial for determining its suitability as an alternative to laboratory testing. The findings of this study will apprise researchers, physical training professionals, and end users of wearable technology, thereby enhancing the knowledge base and practical application of such devices in assessing cardiorespiratory fitness parameters.
... However, the association between CRF and cardiometabolic health remain strong also when controlling for body weight. 44 Since CRF was only measured in participants without cardiovascular disease, the studied sample displays slightly more favourable cardiometabolic health indicators compared with the general population, which limits the generalisability of the results. 45 Furthermore, using CS to represent cardiometabolic health is a simplified representation of multiple risk factors. ...
Objectives
To investigate the physical activity (PA) intensity associated with cardiometabolic health when considering the mediating role of cardiorespiratory fitness (CRF).
Methods
A subsample of males and females aged 50–64 years from the cross-sectional Swedish CArdioPulmonary bioImage Study was investigated. PA was measured by accelerometry and CRF by a submaximal cycle test. Cardiometabolic risk factors, including waist circumference, systolic blood pressure, high-density lipoprotein, triglycerides and glycated haemoglobin, were combined to a composite score. A mediation model by partial least squares structural equation modelling was used to analyse the role of CRF in the association between PA and the composite score.
Results
The cohort included 4185 persons (51.9% female) with a mean age of 57.2 years. CRF mediated 82% of the association between PA and the composite score. The analysis of PA patterns revealed that moderate intensity PA explained most of the variation in the composite score, while vigorous intensity PA explained most of the variation in CRF. When including both PA and CRF as predictors of the composite score, the importance of vigorous intensity increased.
Conclusion
The highly interconnected role of CRF in the association between PA and cardiometabolic health suggests limited direct effects of PA on cardiometabolic health beyond its impact on CRF. The findings highlight the importance of sufficient PA intensity for the association with CRF, which in turn is linked to better cardiometabolic health.
... Following the between group comparison, results showed that HIIT regimen exhibited pronounced efficacy in enhancing maximal oxygen consumption in our cohort characterized by severe obesity. It is postulated that this enhancement plays a pivotal role in their metabolic processes and overall well-being as reported in other studies (Myers et al., 2015). In their study, Meng et al. (2022), observed that an HIIT regimen led to a significant elevation in Maximal Oxygen Uptake. ...
Interval-training is widely implemented among populations with obesity to decrease metabolic-disorders; however, high-intensity-interval-training (HIIT) has rarely been studied in severely obese adolescent girls. Therefore, the aim of this study was to compare the effects of 8 weeks of (HIIT) or moderate-intensity interval-training (MIIT), on cardiometabolic risk factors and hormonal-ratios in severely-obese-girls. For this aim, 35 female-adolescents (14.4 ± 1.4 years) were assigned randomly into HIIT (n = 12) and MIIT (n = 12), groups and a control group (CG, n = 11). Both training groups significantly improved (p < 0.05): the body-mass, body-mass-index (BMIp95), body-fat (BF%), waist-circumference (WC), mean-arterial-pressure (MAP), with a slight increase in the HIIT group. However, HIIT induced greater improvements on the maximal oxygen uptake (VO 2MAX) and the speed related (24.7 and 11.8%) compared to MIIT. Higher improvements occurred in HIIT group related to leptin and adiponectin concentrations and the A/L ratio at (p < 0.001). In conclusion, the findings indicate that both HIIT and MIIT can positively influence body composition and cardio-respiratory fitness. Given the significant correlation noted between the A/L ratio, BMIp95, BF%, and MAP post-HIIT, this training modality may be considered a more advantageous approach over MIIT for mitigating cardio-metabolic issues in severely obese adolescent girls. ARTICLE HISTORY
... The assessment of physical fitness is pivotal in understanding the health status of both healthy individual and patients. Parameters related to exercise capacity, such as muscle strength and endurance (Strassmann et al. 2013), or cardiorespiratory fitness (Myers et al. 2015), are frequently measured in different populations to provide valuable insights into overall well-being, to aid in the development of personalized exercise regimens and assess their effectiveness. ...
Purpose
The performance metric associated with the execution of the 1-min sit-to-stand (1STS) typically relies on the number repetitions completed in 1 min. This parameter presents certain limitations (e.g., ceiling effect, motivational factors) which can impede its interpretation. Introducing additional parameters, such as neuromuscular fatigability level, could enhance the informative value of the 1STS and facilitate its interpretation. This study aimed to assess (i) whether the 1STS induces fatigability and (ii) the reliability of the fatigability level.
Methods
Forty young, healthy, and active participants underwent the 1STS twice during the same session. Isolated sit-to-stand maneuvers were performed before, immediately, and 1 min after completing the 1STS. A mobile app was utilized to obtain time (STST), velocity (STSV), and muscle power (STSP) from these sit-to-stand maneuvers. The pre–post change in these parameters served as the fatigability marker. Reliability was assessed using the intra-class correlation coefficient (ICC) and the coefficient of variation (CV).
Results
The mean number of repetitions during the 1STS was 63 ± 9. Significant decline in performance was observed for STST (13 ± 8%), STSV (−11.2 ± 6%), and STSP (−5.2 ± 3%), with more than 74% of participants exhibiting a decline beyond the minimal detectable change. Excellent between-session reliability (ICC ≥ 0.9; CV ≤ 5.3) was observed for the mobile app variables.
Conclusion
The 1STS induces significant levels of fatigability. The fatigability indicators derived from the mobile app demonstrated remarkable reliability. Utilizing this user-friendly interface for computing fatigability may empower professionals to acquire insightful complementary indicators from the 1STS.
Background/Objectives: The COVID-19 pandemic has notably disrupted K–12 education globally, significantly impacting physical education and student health outcomes. This qualitative study investigates how the pandemic affected student physical fitness, motivation, and equitable access to fitness opportunities, particularly from the perspective of physical education teachers. Guided by the Social Ecological Model, the research addresses how intrapersonal, interpersonal, organizational, community, and policy factors collectively influenced student physical fitness outcomes post-pandemic. Methods: A phenomenological methodology was employed, utilizing semi-structured interviews conducted via Zoom with eleven K–12 physical education teachers in Ventura County, Southern California. Participants were selected using criterion sampling, targeting educators experienced in teaching before, during, and after the pandemic. Thematic analysis with initial in vivo coding was used to authentically capture participant perspectives, supported by strategies like peer debriefing and member checking to enhance analytical rigor. Results: Findings highlighted significant declines in student physical fitness post-pandemic, including reduced endurance, flexibility, and strength, accompanied by increased sedentary behaviors. Teachers reported pronounced decreases in student motivation and engagement, with heightened resistance to structured physical activities. Socioeconomic disparities deepened, disproportionately impacting economically disadvantaged students’ access to fitness opportunities and nutrition. Additionally, physical education experienced systemic undervaluation, resulting in inadequate resources, inconsistent policy enforcement, and difficulties in accurately assessing students’ fitness levels. Conclusions: This study underscores the urgent necessity for systemic reforms to rejuvenate physical education programs and promote equitable health outcomes. Recommendations include increased funding, improved facilities, reduced class sizes, consistent policy enforcement, and enhanced administrative support.
Background
Adherence to healthy behaviors initiated or adapted during cardiac rehabilitation (CR) remains a significant challenge, with few patients meeting guideline standards for secondary prevention. The use of mobile health (mHealth) interventions has been proposed as a potential solution to improve adherence to healthy behaviors after CR. In particular, app-based interventions have shown promise due to their ability to provide monitoring and feedback anytime and anywhere. Growing evidence supports the use of apps in post-CR settings to enhance adherence. In 2020, we demonstrated that individualized follow-up via an app increased adherence to healthy behaviors 1 year after CR. However, it remains uncertain whether these effects persist once the follow-up is discontinued.
Objective
This study aims to evaluate the long-term effects of individualized follow-up using an app, assessed 4 years after the intervention.
Methods
A single-blinded multicenter randomized controlled trial was conducted. Patients were recruited from 2 CR centers in eastern Norway. The intervention group (IG) received individualized follow-up through an app for 1 year, while the control group (CG) received usual care. After the 1-year follow-up, the app-based follow-up was discontinued for the IG, and both groups were encouraged to maintain or improve their healthy behaviors based on their individual risk profiles. The primary outcome was the difference in peak oxygen uptake (VO2peak). The secondary outcomes included exercise performance, body weight, blood pressure, lipid profile, exercise habits, health-related quality of life, health status, cardiac events, and physical activity. Linear mixed models for repeated measurements were used to analyze differences between groups. All tests were 2-sided, and P values ≤0.05 were considered statistically significant.
Results
At the 5-year follow-up, 101 out of the initial 113 randomized participants were reassessed. Intention-to-treat analyses, using a mixed model for repeated measurements, revealed a statistically significant difference (P=.04) in exercise habits in favor of the IG, with a mean difference of 0.67 (95% CI 0.04-1.29) exercise sessions per week. Statistically significant differences were also observed in triglycerides (mean difference 0.40, 95% CI 0.00-0.79 mmol/l, P=.048) and walking (P=.03), but these were in favor of the CG. No differences were found between the groups for other evaluated outcomes.
Conclusions
Most of the benefits derived from the app-based follow-up diminished by 4 years after the intervention. Although the IG reported statistically significantly higher levels of exercise, this did not translate into improved VO2peak or exercise performance. Our study highlights the need for follow-up from health care providers to enhance adherence to healthy behaviors in the long term following CR.
Trial Registration
ClinicalTrials.gov NCT03174106; https://clinicaltrials.gov/ct2/show/NCT03174106 (original study protocol) and NCT05697120; https://clinicaltrials.gov/ct2/show/NCT05697120 (updated study protocol)
Aims
Cardiorespiratory fitness (CRF), measured by peak oxygen uptake (VO2peak), is a strong predictor of mortality. Despite its widespread clinical use, current reference equations for VO2peak show distorted calibration in obese individuals. Using data from the Fitness Registry and the Importance of Exercise National Database (FRIEND), we sought to develop novel reference equations for VO2peak better calibrated for overweight/obese individuals—in both males and females, by considering body composition metrics.
Methods and results
Graded treadmill tests from 6836 apparently healthy individuals were considered in data analysis. We used the National Health and Nutrition Examination Survey equations to estimate lean body mass (eLBM) and body fat percentage (eBF). Multivariable regression was used to determine sex-specific equations for predicting VO2peak considering age terms, eLBM, and eBF. The resultant equations were expressed as VO2peak (male) = 2633.4 + 48.7 × eLBM (kg) − 63.6 × eBF (%) − 0.23 × Age2 (R2 = 0.44) and VO2peak (female) = 1174.9 + 49.4 × eLBM (kg) − 21.7 × eBF (%) − 0.158 × Age2 (R2 = 0.53). These equations were well-calibrated in subgroups based on sex, age, and body mass index (BMI), in contrast to the Wasserman equation. In addition, residuals for the percent-predicted VO2peak (ppVO2) were stable over the predicted VO2peak range, with low CRF defined as <70% ppVO2 and average CRF defined between 85 and 115%.
Conclusion
The derived VO2peak reference equations provided physiologically explainable and were well calibrated across the spectrum of age, sex, and BMI. These equations will yield more accurate VO2peak evaluation, particularly in obese individuals.
Background: Physical activity and cardiorespiratory fitness (CRF) research often overrepresents White, affluent groups. Of additional concern, standard CRF testing can be inaccessible given the specialized equipment and heightened participant burden required for maximal effort fitness assessments. To address these barriers, we partnered with community-based fitness professionals and conducted field-based, submaximal effort CRF assessments among a sample of young adults enrolled in the Project EAT (Eating and Activity over Time) study. Participants were diverse in ethnicity, race, socioeconomic status, and weight; these groups are underrepresented in physical activity research. Objectives: (1) Describe the community-informed study procedures our cross-sector team used, and (2) identify community translation lessons learned from conducting accessible CRF assessments among a sample of underrepresented young adults. Methods: Using a train-the-trainer model, community-based fitness professionals taught university-based research staff how to conduct inclusive CRF assessments. Data collection, including low-burden field tests of CRF, occurred at recreational facilities in participants’ neighborhoods. Post-data collection, community-university partners co-created study takeaways that fitness entities and researchers can use to inform future community-centered projects. Our team adapted the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to present five lessons learned from this project. Lessons Learned: Train-the-trainer models and accessible, community-informed practices prepare research staff to evaluate CRF among participants from diverse backgrounds in a respectful, inclusive manner. Moreover, our adapted RE-AIM framework can inform future community-centered CRF assessment research. Conclusions: The expertise of community can honor professionals’ expertise and leverage community assets to support feasible fitness assessments for underrepresented community members.
RESUMENLa salud es una parte esencial del ser humanoy se define como el completo bienestar bio-psicosocial del ser humano. En profesores universitarios se ha reportado que entre el 40% y el80% deellos, se encuentran con alteraciones de la salud, tales como enfermedades cardiometabólicas, alteraciones posturales, trastornos neurológicos sensoriales, defectos en la alimentación, malos hábitos de sueño, estrésy bajo nivel de aptitud física. Esto afecta su salud y su desempeño como docentes. Se documenta que es por susinadecuados hábitos de vida. Participaron voluntariamente 248 de 516 profesores(99mujeres y 149 hombres)quienes respondieron a lainvitación que se hizo por laCoordinación de RecursosHumanosde la Universidad. Se encontraronprevalencias elevadas de alteraciones de sueño, estrésy riesgo cardiometabólicoen la población estudiada;asociadas a patologías como obesidad,hipertensión arterial,hábitosinadecuadosde alimentacióny un bajonivel de capacidadfísica, lo que afecta su salud, disminuyesusaños de vida productiva, y su desempeño como docentes. Nueve de cada diez participantes en el estudiomanifestaron su deseo de participar de manera continua y permanente en programas para la adopción de estilos de vida saludables. Estudios complementarios son necesarios para la intervención en la prevención de estados ulteriores de daño en la salud.Palabras clave:profesores universitarios, salud, riesgo cardiometabólico, salud muscular, actividad físicaRecibido: 25-octubre-2024 / Aprobado: 27-noviembre-2024
Background
The association between physical fitness and autistic traits in adolescents remains under explored, especially in adolescents. Understanding this relationship can provide strategies to improve the quality of life of these people.
Objective
To identify the association between cluster characteristics derived from levels of self-perceived physical fitness and the occurrences of individual levels of autistic traits in Brazilian adolescents.
Method
This descriptive study employed an analytical, quantitative approach involving 515 adolescents aged 11 to 18 (245 boys and 270 girls). Autistic traits were assessed using the Autism Quotient (AQ50), while physical fitness was measured with the Self-Reported Physical Fitness Questionnaire (QAPA). Cluster analysis using descriptive statistics with bootstrapping and generalized estimating equations was performed.
Results
Boys reported higher physical fitness levels than girls, with significant differences in General Power Strength (QAPA 4) and Physical Fitness in Sports (QAPA 7). Girls scored slightly higher on social skills. AQ50 scores indicated that girls had higher aggregated difficulties in imagination, attention, communication, and social skills compared to boys. Higher self-perceived physical fitness was associated with lower levels of autistic traits in both genders. Girls with higher QAPA scores showed significant decreases in autistic traits related to social skills and overall AQ50 scores. Boys with higher physical fitness demonstrated reduced autistic traits in the domains of imagination and communication. Age-adjusted analyses confirmed these findings.
Conclusion
There is a significant association between self-perceived physical fitness and autistic traits in adolescents. Higher physical fitness levels are linked to fewer autistic traits, highlighting the importance of promoting physical fitness to mitigate challenges associated with autistic traits and improve adolescents' well-being.
Objective
This study aimed to develop machine learning (ML) models to predict peak cardiorespiratory fitness (CRF) before and after cardiac rehabilitation (CR).
Methods and Results
Data from 162 patients with cardiovascular disease were analyzed. Two predictive tasks were employed: Task 1 estimated peak oxygen consumption (VO2 peak) using baseline clinical and functional data and Task 2 predicted changes in VO2 peak after CR by additionally considering inter-visit exercise quantities and pre-CR cardiopulmonary exercise test (CPET) results. Four linear regression models and six ML models were trained and validated through 5-fold cross-validation technique. Both tasks demonstrated that the CatBoost and XGBoost models exhibited the highest predictive performance, effectively forecasting VO2 peak values before and after CR. Task 1 highlighted the importance of the six-minute walk distance (6MWD), Korean Activity Scale Index (KASI), and hand grip strength (HGS) in predicting the initial VO2 peak. Task 2 suggested a ceiling effect in the recovery of VO2 peak following CR and emphasized the importance of resistance exercise.
Conclusion
The application of ML models provides a powerful tool for predicting the peak CRF in patients with CVD undergoing CR, both at the initial assessment and after completing rehabilitation programs.
Purpose
Cardiorespiratory fitness (CRF) declines with age, and greater declines increase the risk for adverse health outcomes. Understanding factors that attenuate age-related decreases in CRF can help extend healthy life. We sought to determine the longitudinal associations of aerobic physical activity, muscle-strengthening activity (MSA), and adiposity with CRF.
Methods
Study participants were enrolled in the Cooper Center Longitudinal Study and had ≥3 preventive medical examinations at the Cooper Clinic (Dallas, Texas) during 1987-2019. Aerobic activity and MSA were self-reported, and three measures of adiposity were clinically assessed: body mass index (BMI), body fat percentage, and waist circumference. CRF, expressed as metabolic equivalents (METs), was estimated by a maximal treadmill test. The longitudinal associations of aerobic activity, MSA, and adiposity with CRF were estimated using multivariable mixed linear regression models.
Results
The study included 6,105 participants who were followed for a median of 7.1 years. Most participants were men (83.6%), and their average age at baseline was 47.0 (SD: 8.7) years. Mean CRF at baseline was 12.2 (SD: 2.3) METs. Increasing aerobic activity (per 500 MET-minutes/week, β: 0.069, 95% CI: 0.064, 0.074 METs) or MSA (per days/week, β: 0.066, 95% CI: 0.058, 0.073 METs) was associated with increased CRF over time. Increasing BMI, body fat percentage, or waist circumference were each associated with decreased CRF over time.
Conclusions
These data offer longitudinal evidence on how changes in aerobic activity, MSA, and various measures of adiposity (beyond BMI) independently correlate with CRF over time. Healthy lifestyle behaviors that include increasing aerobic and muscle-strengthening activity and limiting adiposity may positively influence the retention of fitness with age and improve downstream health outcomes.
The relationship between sedentary lifestyle and chronic diseases is well known. This study examined the prevalence and factors associated with reduced physical activity (PA) among internal medicine inpatients on admission. In this single-center, cross-sectional study, inpatients aged 50 years or older were prospectively enrolled at a tertiary care facility in Ankara, Türkiye. PA was assessed using the International Physical Activity Questionnaire (IPAQ). Care and performance indicators, quality of life (EQ-5D 3L), nutritional status, timed up-and-go test, muscle strength, and cognitive status were assessed. Participants were classified into 3 groups of PA levels as low, moderate, and high. Study end points were the prevalence of low PA level and associated factors. Of the 240 participants (mean age: 62.7 ± 8.0 years; women: 50%), 47.1% (n = 113), 40.8% (n = 98) and 12.1% (n = 29) had low, moderate, and high PA, respectively. Type 2 diabetes mellitus (45.1%), hypertension (66.4%), coronary artery disease (41.6%), dementia (8.8%), and multimorbidity (53.1%) were more common in the low PA group. Outdoor walking < 3 days per week (OR: 4.44, 95% CI 1.55 to 12.74, p = 0.006, functional dependence in and outside home (OR: 4.25, 95% CI 1.13 to 15.92, p = 0.032) and EQ-5D VAS score (OR: 0.97, 95% CI 0.95 to 0.99, p = 0.011) were independently associated with low PA level on multivariable logistic regression analysis. This study found low or medium levels of PA in almost nine out of ten admissions to an internal medicine clinic. On the other hand, low PA level was not associated with most classical comorbidities but with altered performance and care indicators.
Aquatic high-intensity interval training deep water running (AHIIT-DWR) has the potential to improve cardiometabolic health and cognitive psychological responses, offering a reduced risk of injuries and greater affordability for inactive elderly women.
Purpose
To investigate the effects of an 8-wk AHIIT-DWR intervention compared with land-based HIT training (LHIIT) on cardiometabolic health, cognitive, and psychological outcomes in inactive elderly women.
Methods
Seventy inactive elderly women aged 60 yr or above were randomly assigned into two groups: AHIIT-DWR and LHIIT. The AHIIT-DWR group engaged in DWR sessions comprising 30 min of interval training, consisting of ten 2-min exercise bouts at 80%–90% of their maximal heart rate (HR max ), with 1-min active recovery at 70% HR max between bouts, for two sessions per week, for 8 wk. The LHIIT group performed treadmill running at the same intensity.
Results
Both groups showed similar cardiovascular fitness, maximal aerobic capacity (V̇O 2max ), HR max , and RER improvement ( P > 0.05), whereas AHIIT-DWR showed a significant improvement in aerobic capacity minute ventilation (V̇E), metabolic equivalents (METs), and O 2 pulse ( P < 0.05) over the 8-wk intervention. Both AHIIT-DWR and LHIIT significantly decreased triglycerides, total cholesterol, HDL, and LDL postintervention ( P < 0.05). No significant group differences were observed for cognitive function assessed by MMSE and MOCA ( P > 0.05). Both groups showed similar enjoyment levels, self-efficacy scores, and high adherence rates (>90%).
Conclusions
Our study suggests that AHIIT-DWR can elicit a similar improvement in cardiorespiratory health, metabolic blood markers, cognitive function assessed by MMSE and MOCA, and psychological responses as LHIIT in inactive elderly women.
Objective:
To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.
Participants:
A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented.
Evidence:
The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles.
Consensus process:
Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine.
Conclusion:
Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.
Background:
Mortality risk decreases beyond a certain fitness level. However, precise definition of this threshold is elusive and varies with age. Thus, fitness-related mortality risk assessment is difficult.
Methods and results:
We studied 18 102 male veterans (8305 blacks and 8746 whites). All completed an exercise test between 1986 and 2011 with no evidence of ischemia. We defined the peak metabolic equivalents (METs) level associated with no increase in all-cause mortality risk (hazard ratio, 1.0) for the age categories of <50, 50 to 59, 60 to 69, and ≥70 years. We used this as the threshold group to form additional age-specific fitness categories based on METs achieved below and above it: least-fit (>2 METs below threshold; n=1692), low-fit (2 METs below threshold; n=4884), moderate-fit (2 METs above threshold; n=4646), fit (2.1-4 METs above threshold; n=1874), and high-fit (>4 METs above threshold; n=1301) categories. Multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality across fitness categories. During follow-up (median=10.8 years), 5102 individuals died. Mortality risk for the cohort and each age category increased for the least-fit and low-fit categories (HR, 1.51; 95% CI, 1.37-1.66; and HR, 1.21; 95% CI, 1.12-1.30, respectively) and decreased for the moderate-fit; fit and high-fit categories (HR, 0.71; 95% CI, 0.65-0.78; HR, 0.63; 95% CI, 0.56-0.78; and HR, 0.49; 95% CI, 0.41-0.58, respectively). The trends were similar for 5- and 10-year mortality risk.
Conclusion:
We defined age-specific exercise capacity thresholds to guide assessment of mortality risk in individuals undergoing a clinical exercise test.
2/e000582 World Wide Web at: The online version of this article, along with updated information and services, is located on the for more information. I t is well established that the cardiovascular (CV) risk of obesity is more strongly associated with visceral rather than subcutaneous adiposity. 1–3 Anthropometric variables that account for visceral adiposity, such as body mass index (BMI) and waist circumference (WC), have limited sensitivity and specificity. Furthermore, there is increasing recognition of "normal weight obese" persons (ie, those with increased visceral adipose but normal WC) who are prone to the same risk of the metabolic syndrome. 4 These patients are detected only through abdominal computed tomography (CT) or mag-netic resonance imaging (MRI). Rapid advancements in non-invasive cardiac imaging techniques have fostered interest in the imaging of perivascular and epicardial fat as proxy measures of visceral adiposity and, hence, more sensitive and specific indicators of cardiometabolic risk. 5,6 The idea that these fat depots may not only be representative of abdominal visceral adipose tissue (VAT) but perhaps independently causal of CV disease (CVD) is an attractive one that is rapidly gaining traction. The potential roles of perivascular and epicardial fat in obesity-associated CVD are best understood in the context of the pathophysiology of obesity-induced insulin resistance. Basic Mechanisms
To determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes.
Metaepidemiological study.
Meta-analyses of randomised controlled trials with mortality outcomes comparing the effectiveness of exercise and drug interventions with each other or with control (placebo or usual care).
Medline and Cochrane Database of Systematic Reviews, May 2013.
Mortality.
We combined study level death outcomes from exercise and drug trials using random effects network meta-analysis.
We included 16 (four exercise and 12 drug) meta-analyses. Incorporating an additional three recent exercise trials, our review collectively included 305 randomised controlled trials with 339 274 participants. Across all four conditions with evidence on the effectiveness of exercise on mortality outcomes (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of diabetes), 14 716 participants were randomised to physical activity interventions in 57 trials. No statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. Physical activity interventions were more effective than drug treatment among patients with stroke (odds ratios, exercise v anticoagulants 0.09, 95% credible intervals 0.01 to 0.70 and exercise v antiplatelets 0.10, 0.01 to 0.62). Diuretics were more effective than exercise in heart failure (exercise v diuretics 4.11, 1.17 to 24.76). Inconsistency between direct and indirect comparisons was not significant.
Although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.
Hypertension often coexists with dyslipidemia, accentuating cardiovascular risk. Statins are often prescribed in hypertensive individuals to lower cardiovascular risk. Higher fitness is associated with lower mortality, but exercise capacity may be attenuated in hypertension. The combined effects of fitness and statin therapy in hypertensive individuals have not been assessed. Thus, we assessed the combined health benefits of fitness and statin therapy in hypertensive male subjects.
Peak exercise capacity was assessed in 10,202 hypertensive male subjects (mean age = 60.4±10.6 years) in 2 Veterans Affairs Medical Centers. We established 4 fitness categories based on peak metabolic equivalents (METs) achieved and 8 categories based on fitness status and statin therapy.
During the follow-up period (median = 10.2 years), there were 2,991 deaths. Mortality risk was 34% lower (hazard ratio (HR) = 0.66; 95% confidence interval (CI) = 0.59-0.74; P < 0.001) among individuals treated with statins compared with those not on statins. The fitness-related mortality risk association was inverse and graded regardless of statin therapy status. Risk reduction associated with exercise capacity of 5.1-8.4 METs was similar to that observed with statin therapy. However, those achieving ≥8.5 METs had 52% lower risk (HR = 0.48; 95% CI = 0.37-0.63) when compared with the least-fit subjects (≤5 METs) on statin therapy.
The combination of statin therapy and higher fitness lowered mortality risk in hypertensive individuals more effectively than either alone. The risk reduction associated with moderate increases in fitness was similar to that achieved by statin therapy. Higher fitness was associated with 52% lower mortality risk when compared with the least fit subjects on statin therapy.
Objective.
—To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.
Background:
Statins are commonly prescribed for management of dyslipidaemia and cardiovascular disease. Increased fitness is also associated with low mortality and is recommended as an essential part of promoting health. However, little information exists about the combined effects of fitness and statin treatment on all-cause mortality. We assessed the combined effects of statin treatment and fitness on all-cause mortality risk.
Methods:
In this prospective cohort study, we included dyslipidaemic veterans from Veterans Affairs Medical Centers in Palo Alto, CA, and Washington DC, USA, who had had an exercise tolerance test between 1986, and 2011. We assigned participants to one of four fitness categories based on peak metabolic equivalents (MET) achieved during exercise test and eight categories based on fitness status and statin treatment. The primary endpoint was all-cause mortality adjusted for age, body-mass index, ethnic origin, sex, history of cardiovascular disease, cardiovascular drugs, and cardiovascular risk factors. We assessed mortality from Veteran's Affairs' records on Dec 31, 2011. We compared groups with Cox proportional hazard model.
Findings:
We assessed 10,043 participants (mean age 58·8 years, SD 10·9 years). During a median follow-up of 10·0 years (IQR 6·0-14·2), 2318 patients died, with an average yearly mortality rate of 22 deaths per 1000 person-years. Mortality risk was 18·5% (935/5046) in people taking statins versus 27·7% (1386/4997) in those not taking statins (p<0·0001). In patients who took statins, mortality risk decreased as fitness increased; for highly fit individuals (>9 MET; n=694), the hazard ratio (HR) was 0·30 (95% CI 0·21-0·41; p<0·0001) compared with least fit (≤5 METs) patients (HR 1; n=1060). For those not treated with statins, the HR for least fit participants (n=1024) was 1·35 (95% CI 1·17-1·54; p<0·0001) and progressively decreased to 0·53 (95% CI 0·44-0·65; p<0·0001) for those in the highest fitness category (n=1498).
Interpretation:
Statin treatment and increased fitness are independently associated with low mortality among dyslipidaemic individuals. The combination of statin treatment and increased fitness resulted in substantially lower mortality risk than either alone, reinforcing the importance of physical activity for individuals with dyslipidaemia.
Funding:
None.
ACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including aerobic and resistance training, and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that aerobic endurance training of fewer than 2 d·wk-1, at less than 40-50% of V˙O2R, and for less than 10 min-1 is generally not a sufficient stimulus for developing and maintaining fitness in healthy adults. Even so, many health benefits from physical activity can be achieved at lower intensities of exercise if frequency and duration of training are increased appropriately. In this regard, physical activity can be accumulated through the day in shorter bouts of 10-min durations.
In the interpretation of this position stand, it must be recognized that the recommendations should be used in the context of participant's needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for the cardiorespiratory, muscular strength and endurance, and flexibility components of the program. An appropriate warm-up and cool-down period, which would include flexibility exercises, is also recommended. The important factor is to design a program for the individual to provide the proper amount of physical activity to attain maximal benefit at the lowest risk. Emphasis should be placed on factors that result in permanent lifestyle change and encourage a lifetime of physical activity.
OBJECTIVE--To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. PARTICIPANTS--A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. EVIDENCE--The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. CONSENSUS PROCESS--Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise \"public health message was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. CONCLUSION--Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the weekType: CONSENSUS DEVELOPMENT CONFERENCEType: JOURNAL ARTICLEType: REVIEWLanguage: Eng
The true causes of the obesity epidemic are not well understood and there are few longitudinal population-based data published examining this issue. The objective of this analysis was to examine trends in occupational physical activity during the past 5 decades and explore how these trends relate to concurrent changes in body weight in the U.S.
Analysis of energy expenditure for occupations in U.S. private industry since 1960 using data from the U.S. Bureau of Labor Statistics. Mean body weight was derived from the U.S. National Health and Nutrition Examination Surveys (NHANES). In the early 1960's almost half the jobs in private industry in the U.S. required at least moderate intensity physical activity whereas now less than 20% demand this level of energy expenditure. Since 1960 the estimated mean daily energy expenditure due to work related physical activity has dropped by more than 100 calories in both women and men. Energy balance model predicted weights based on change in occupation-related daily energy expenditure since 1960 for each NHANES examination period closely matched the actual change in weight for 40-50 year old men and women. For example from 1960-62 to 2003-06 we estimated that the occupation-related daily energy expenditure decreased by 142 calories in men. Given a baseline weight of 76.9 kg in 1960-02, we estimated that a 142 calories reduction would result in an increase in mean weight to 89.7 kg, which closely matched the mean NHANES weight of 91.8 kg in 2003-06. The results were similar for women.
Over the last 50 years in the U.S. we estimate that daily occupation-related energy expenditure has decreased by more than 100 calories, and this reduction in energy expenditure accounts for a significant portion of the increase in mean U.S. body weights for women and men.
The association between physical activity and health was recognized as early as the fifth century BC by the Greek physician Hippocrates, who wrote the following: “All parts of the body, if used in moderation and exercised in labors to which each is accustomed, become thereby healthy and well developed and age slowly; but if they are unused and left idle, they become liable to disease, defective in growth and age quickly.”
With the decline of the Hellenic civilization, this concept faded. For centuries, physical activity and fitness were considered largely for military purposes and associated with youth sports and athletics even through the post–World War II era.
The landmark work by Morris and coworkers1 changed modern views of the relationship between physical activity, fitness, and health and inspired a new era in which the association between physical activity and human health, disease, and mortality was scrutinized scientifically. For more than half a century, a plethora of evidence has accumulated from large, long-term epidemiological studies that support a strong, inverse, and independent association between physical activity, health, and cardiovascular and overall mortality in apparently healthy individuals2,–,23 and in patients with documented cardiovascular disease.8 The exercise-related health benefits are related in part to favorable modulations in both the traditional and novel cardiovascular risk factors that have been observed with increased physical activity patterns or structured exercise programs.10 In this review, we present a synopsis of some of the most influential studies examining the association between physical activity, fitness, and health. The studies cited represent only a small number of the many studies available, and more in-depth reviews are available on each of the topics discussed in the present review. In addition, the favorable effects of physical activity on the traditional and novel cardiovascular risk …
To evaluate the association of physical activity with left ventricular structure and function in the general population in a community setting.
Cross-sectional study.
The Multi-Ethnic Study of Atherosclerosis (MESA), a population-based study of subclinical atherosclerosis.
A multiethnic sample of 4992 participants (aged 45-84 years; 52% female) free of clinically apparent cardiovascular disease.
Physical activity induces beneficial physiological cardiac remodelling in a cross-sectional study of non-athlete individuals.
Left ventricular mass, volumes and function were assessed by cardiac magnetic resonance imaging. Physical activity, defined as intentional exercise and total moderate and vigorous physical activity, was assessed by a standard semiquantitative questionnaire.
Left ventricular mass and end-diastolic volume were positively associated with physical activity (eg, 1.4 g/m(2) (women) and 3.1 g/m(2) (men) greater left ventricular mass in the highest category of intentional exercise compared with individuals reporting no intentional exercise; p = 0.05 and p<0.001, respectively). Relationships were non-linear, with stronger positive associations at lower levels of physical activity (test for non-linearity; p = 0.02 and p = 0.03, respectively). Cardiac output and ejection fraction were unchanged with increased physical activity levels. Resting heart rate was lower in women and men with higher physical activity levels (eg, -2.6 beats/minute lower resting heart rate in the highest category of intentional exercise compared with individuals reporting no intentional exercise; p<0.001).
In a community-based population free of clinically apparent cardiovascular disease, higher physical activity levels were associated with proportionally greater left ventricular mass and end-diastolic volume and lower resting heart rate.
Obesity is an established risk factor for chronic disease and premature death, but losing weight and keeping it off is difficult. Therefore, although obese individuals may know that they are at higher risk of disease and early death, they still may not be able to lose weight and maintain weight loss. Perhaps health professionals should focus less on weight and more on how to enhance and maintain health for people of all sizes and shapes.
Risk of first heart attack was found to be related inversely to energy expenditure reported by 16,936 Harvard male alumni, aged 35–74 years, of whom 572 experienced heart attacks in 117,680 person-years of followup. Stairs climbed, blocks walked, strenuous sports played, and a composite physical activity index all opposed risk. Men with index below 2000 kilocalories per week were at 64% higher risk than classmates with higher Index. Adult exercise was independent other influences on heart attack risk, and peak exertion as strenuous sports play enhanced the effect of total energy expenditure. Notably, alumni physical activity supplanted student athleticisn; assessed in college 16–50 years earlier. If it is postulated that varsity athlete status implies selective cardiovascular fitness, such selection alone is insufficient to explain lower heart attack risk in later adult years. Ex-varsity athletes retained lower risk only if they maintained high physical activity Index as alumni.
Background
The influence of higher physical activity on the relationship between adiposity and cardiometabolic risk is not completely understood.
Methods
Between 2000–2002, data were collected on 6795 Multi-Ethnic Study of Atherosclerosis (MESA) participants. Self-reported intentional physical activity in the lowest quartile (0–105 MET-minutes/week) was categorized as inactive and the upper three quartiles (123–37,260 MET-minutes/week) as active. Associations of body mass index (BMI) and waist circumference categories, stratified by physical activity status (inactive or active) with cardiometabolic risk factors (dyslipidemia, hypertension, upper quartile of homeostasis model assessment of insulin resistance [HOMA-IR] for population, and impaired fasting glucose or diabetes) were assessed using logistic regression analysis adjusting for age, gender, race/ethnicity, and current smoking.
Results
Among obese participants, those who were physically active had reduced odds of insulin resistance (47% lower; P < .001) and impaired fasting glucose/diabetes (23% lower; P = .04). These associations were weaker for central obesity. However, among participants with a normal waist circumference, those who were inactive were 63% more likely to have insulin resistance (OR [95% CI] 1.63 [1.24–2.15]) compared with the active reference group.
Conclusions
Physical activity was inversely related to the cardiometabolic risk associated with obesity and central obesity.
Background
Although running is a popular leisure-time physical activity, little is known about the long-term effects of running on mortality. The dose-response relations between running, as well as the change in running behaviors over time, and mortality remain uncertain.
Objectives
We examined the associations of running with all-cause and cardiovascular mortality risks in 55,137 adults, 18 to 100 years of age (mean age 44 years).
Methods
Running was assessed on a medical history questionnaire by leisure-time activity.
Results
During a mean follow-up of 15 years, 3,413 all-cause and 1,217 cardiovascular deaths occurred. Approximately 24% of adults participated in running in this population. Compared with nonrunners, runners had 30% and 45% lower adjusted risks of all-cause and cardiovascular mortality, respectively, with a 3-year life expectancy benefit. In dose-response analyses, the mortality benefits in runners were similar across quintiles of running time, distance, frequency, amount, and speed, compared with nonrunners. Weekly running even <51 min, <6 miles, 1 to 2 times, <506 metabolic equivalent-minutes, or <6 miles/h was sufficient to reduce risk of mortality, compared with not running. In the analyses of change in running behaviors and mortality, persistent runners had the most significant benefits, with 29% and 50% lower risks of all-cause and cardiovascular mortality, respectively, compared with never-runners.
Conclusions
Running, even 5 to 10 min/day and at slow speeds <6 miles/h, is associated with markedly reduced risks of death from all causes and cardiovascular disease. This study may motivate healthy but sedentary individuals to begin and continue running for substantial and attainable mortality benefits.
Obesity has been increasing in epidemic proportions, with a disproportionately higher increase in morbid or class III obesity, and obesity adversely impacts cardiovascular (CV) hemodynamics, structure and function, as well as increases the prevalence of most CV diseases. Progressive declines in physical activity over 5 decades have occurred and have primarily caused the obesity epidemic. Despite the potential adverse impact of overweightness and obesity, recent epidemiological data have demonstrated an association of mild obesity and, particularly, overweightness on improved survival. We review in detail the obesity paradox in CV diseases where overweight and at least mildly obese with most CV diseases seem to have a better prognosis than do their leaner counterparts. The implications of cardiorespiratory fitness with prognosis are discussed, along with the joint impact of fitness and adiposity on the obesity paradox. Finally, in light of the obesity paradox, the potential value of purposeful weight loss and increased physical activity to impact levels of fitness are reviewed.
Objective
To assess the association between cardiorespiratory fitness (CRF) and outcomes in a cardiac rehabilitation (CR) cohort.Patients and Methods
We conducted a retrospective study of 5641 patients (4282 men [76%] and 1359 women [24%]; mean ± SD age, 60.0±10.3 years) with coronary artery disease who participated in CR between July 1, 1996, and February 28, 2009. Based on peak metabolic equivalents (METs), patients were classified as low fitness (LFit) (<5 METs), moderate fitness (5-8 METs), or high fitness (>8 METs).ResultsBaseline fitness predicted long-term mortality: relative to the LFit group, patients with moderate fitness had an adjusted hazard ratio of 0.54 (95% CI, 0.42-0.69), and those with high fitness a hazard ratio of 0.32 (95% CI, 0.24-0.44). Improvement in CRF at 12 weeks was associated with decreased overall mortality, with a 13% point reduction with each MET increase (P<.001) and a 30% point reduction in those who started with LFit. At 1 year, each MET increase in CRF was associated with a 25% point reduction in overall mortality in the whole group (P<.001).Conclusion
In this study of contemporary CR patients, higher baseline fitness predicted lower mortality. The novel finding was that improvement in fitness during a CR program and improvements that persisted at 1 year were also associated with decreased mortality, most strongly in patients who start with LFit.
Objective:
Visceral (VAT) and abdominal subcutaneous (SAT) adipose tissues contribute to obesity but may have different metabolic and atherosclerosis risk profiles. We sought to determine the associations of abdominal VAT and SAT mass with markers of cardiac and metabolic risk in a large, multiethnic, population-based cohort of obese adults.
Design and methods:
Among obese participants in the Dallas Heart Study, we examined the cross-sectional associations of abdominal VAT and SAT mass, assessed by magnetic resonance imaging (MRI) and indexed to body surface area (BSA), with circulating biomarkers of insulin resistance, dyslipidemia, and inflammation (n = 942); and with aortic plaque and liver fat by MRI and coronary calcium by computed tomography (n = 1200). Associations of VAT/BSA and SAT/BSA were examined after adjustment for age, sex, race, menopause, and body mass index.
Results:
In multivariable models, VAT significantly associated with the homeostasis model assessment of insulin resistance (HOMA-IR), lower adiponectin, smaller LDL and HDL particle size, larger VLDL size, and increased LDL and VLDL particle number (p < 0.001 for each). VAT also associated with prevalent diabetes, metabolic syndrome, hepatic steatosis, and aortic plaque (p < 0.001 for each). VAT independently associated with C-reactive protein but not with any other inflammatory biomarkers tested. In contrast, SAT associated with leptin and inflammatory biomarkers, but not with dyslipidemia or atherosclerosis. Associations between SAT and HOMA-IR were significant in univariable analyses but attenuated after multivariable adjustment.
Conclusion:
VAT associated with an adverse metabolic, dyslipidemic, and atherogenic obesity phenotype. In contrast, SAT demonstrated a more benign phenotype, characterized by modest associations with inflammatory biomarkers and leptin, but no independent association with dyslipidemia, insulin resistance, or atherosclerosis in obese individuals. These findings suggest that abdominal fat distribution defines distinct obesity sub-phenotypes with heterogeneous metabolic and atherosclerosis risk.
Background:
The influence of higher physical activity on the relationship between adiposity and cardiometabolic risk is not completely understood.
Methods:
Between 2000-2002, data were collected on 6795 Multi-Ethnic Study of Atherosclerosis (MESA) participants. Self-reported intentional physical activity in the lowest quartile (0-105 MET-minutes/week) was categorized as inactive and the upper three quartiles (123-37,260 MET-minutes/week) as active. Associations of body mass index (BMI) and waist circumference categories, stratified by physical activity status (inactive or active) with cardiometabolic risk factors (dyslipidemia, hypertension, upper quartile of homeostasis model assessment of insulin resistance [HOMA-IR] for population, and impaired fasting glucose or diabetes) were assessed using logistic regression analysis adjusting for age, gender, race/ethnicity, and current smoking.
Results:
Among obese participants, those who were physically active had reduced odds of insulin resistance (47% lower; P < .001) and impaired fasting glucose/diabetes (23% lower; P = .04). These associations were weaker for central obesity. However, among participants with a normal waist circumference, those who were inactive were 63% more likely to have insulin resistance (OR [95% CI] 1.63 [1.24-2.15]) compared with the active reference group.
Conclusions:
Physical activity was inversely related to the cardiometabolic risk associated with obesity and central obesity.
Objective:
To determine the impact of cardiorespiratory fitness (FIT) on survival in relation to the obesity paradox in patients with systolic heart failure (HF).
Patients and methods:
We studied 2066 patients with systolic HF (body mass index [BMI] ≥18.5 kg/m(2)) between April 1, 1993 and May 11, 2011 (with 1784 [86%] tested after January 31, 2000) from a multicenter cardiopulmonary exercise testing database who were followed for up to 5 years (mean ± SD, 25.0±17.5 months) to determine the impact of FIT (peak oxygen consumption <14 vs ≥14 mL O2 ∙ kg(-1) ∙ min(-1)) on the obesity paradox.
Results:
There were 212 deaths during follow-up (annual mortality, 4.5%). In patients with low FIT, annual mortality was 8.2% compared with 2.8% in those with high FIT (P<.001). After adjusting for age and sex, BMI was a significant predictor of survival in the low FIT subgroup when expressed as a continuous (P=.03) and dichotomous (<25.0 vs ≥25.0 kg/m(2)) (P=.01) variable. Continuous and dichotomous BMI expressions were not significant predictors of survival in the overall and high FIT groups after adjusting for age and sex. In patients with low FIT, progressively worse survival was noted with BMI of 30.0 or greater, 25.0 to 29.9, and 18.5 to 24.9 (log-rank, 11.7; P=.003), whereas there was no obesity paradox noted in those with high FIT (log-rank, 1.72; P=.42).
Conclusion:
These results indicate that FIT modifies the relationship between BMI and survival. Thus, assessing the obesity paradox in systolic HF may be misleading unless FIT is considered.
Epidemiological, clinical, and mechanistic preclinical studies conducted in the field of cardiovascular medicine have led to remarkable progress in our understanding of nonmodifiable and modifiable risk factors for cardiovascular disease (CVD). For instance, although the prevalence of CVD had reached devastating levels in the 1950s, proper focus on the major CVD risk factors first identified at the time, such as smoking, hypertension, and high cholesterol levels, has allowed these risk factors to be targeted both at the clinical level and through public health policies.1 As a consequence, coronary heart disease mortality has decreased by ≈50% over the past 50 years.2 Ford et al2 have suggested that better screening and medical management of these CVD risk factors and the medical procedures developed to treat the various acute manifestations of CVD have had a favorable impact on its related mortality rates. However, the current overconsumption of processed and energy-dense food products of poor nutritional value combined with our sedentary lifestyle have contributed to the emergence of new drivers of CVD risk: obesity and type 2 diabetes mellitus (Figure 1).3,4 It has been proposed that our medical progress at tackling CVD could be offset, at least to a certain extent, by the dramatic consequences of our toxic lifestyle, which includes poor nutrition or excess caloric consumption and a sedentary lifestyle, both leading to obesity and type 2 diabetes mellitus.2
Figure 1.
Some of the alterations in the metabolic risk profile that have been found to be related to abdominal obesity assessed by anthropometry and later to excess visceral adiposity/ectopic fat assessed by imaging techniques. This constellation of metabolic abnormalities increases the risk of type 2 diabetes mellitus and of various cardiovascular outcomes. CVD indicates cardiovascular disease; HDL, high-density lipoprotein; LDL, low-density lipoprotein.
Thus, the mosaic of modifiable …
Technology linked with reduced physical activity (PA) in occupational work, home/domestic work, and travel and increased sedentary activities, especially television viewing, dominates the globe. Using detailed historical data on time allocation, occupational distributions, energy expenditures data by activity, and time-varying measures of metabolic equivalents of task (MET) for activities when available, we measure historical and current MET by four major PA domains (occupation, home production, travel and active leisure) and sedentary time among adults (>18 years). Trends by domain for the United States (1965-2009), the United Kingdom (1961-2005), Brazil (2002-2007), China (1991-2009) and India (2000-2005) are presented. We also project changes in energy expenditure by domain and sedentary time (excluding sleep and personal care) to 2020 and 2030 for each of these countries. The use of previously unexplored detailed time allocation and energy expenditures and other datasets represents a useful addition to our ability to document activity and inactivity globally, but highlights the need for concerted efforts to monitor PA in a consistent manner globally, increase global PA and decrease sedentary behavior. Given the potential impact on weight gain and other cardiometabolic health risks, the differential declines in MET of activity and increases in sedentary time across the globe represent a major threat to global health.
To investigate associations of cardiorespiratory fitness (CRF) and different measures of adiposity with cardiovascular disease (CVD) and all-cause mortality in men with known or suspected coronary heart disease (CHD).
We analyzed data from 9563 men (mean age, 47.4 years) with documented or suspected CHD in the Aerobics Center Longitudinal Study (August 13, 1977, to December 30, 2002) using baseline body mass index (BMI) and CRF (quantified as the duration of a symptom-limited maximal treadmill exercise test). Waist circumference (WC) and percent body fat (BF) were measured using standard procedures.
There were 733 deaths (348 of CVD) during a mean follow-up of 13.4 years. After adjustment for age, examination year, and multiple baseline risk factors, men with low fitness had a higher risk of all-cause mortality in the BMI categories of normal weight (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.24-2.05), obese class I (HR, 1.38; 95% CI, 1.04-1.82), and obese class II/III (HR, 2.43; 95% CI, 1.55-3.80) but not overweight (HR, 1.09; 95% CI, 0.88-1.36) compared with the normal-weight and high-fitness reference group. We observed a similar pattern for WC and percent BF tertiles and for CVD mortality. Among men with high fitness, there were no significant differences in CVD and all-cause mortality risk across BMI, WC, and percent BF categories.
In men with documented or suspected CHD, CRF greatly modifies the relation of adiposity to mortality. Using adiposity to assess mortality risk in patients with CHD may be misleading unless fitness is considered.
Visceral adiposity is an important correlate of cardiometabolic risk, yet its association after the diagnosis of type 2 diabetes remains unclear.
Our objective was to assess the independent and combined associations of visceral adiposity and type 2 diabetes to cardiometabolic risk. The INternational Study of Prediction of Intra-abdominal adiposity and its RElationships with cardioMEtabolic risk/Intra-Abdominal Adiposity (INSPIRE ME IAA) is a cross-sectional computed tomography imaging study with data collected from June 2006 to May 2008. General physicians, cardiologists, and diabetologists (n = 297) in 29 countries recruited 4144 (51.8% men) men (39-71 yr) and women (44-71 yr). Patients were categorized according to visceral adiposity tertiles, type 2 diabetes status, and sex. All results were adjusted for age, body mass index, region, and physician's specialty.
Markers of insulin resistance, lipid/lipoproteins, inflammatory markers, and liver fat increased with visceral adiposity in men and women with and without type 2 diabetes. Prevalent cardiovascular disease increased with visceral adiposity tertiles, regardless of type 2 diabetes status. Visceral adiposity [odds ratio = 1.25 (1.09-1.44) for men and 1.78 (1.50-2.12) for women] was positively associated with type 2 diabetes, whereas liver attenuation (inversely related to liver fat) was negatively associated with type 2 diabetes [odds ratio = 0.66 (0.59-0.75) for men and 0.63 (0.55-0.72) for women]. Subcutaneous adipose tissue was inversely related to type 2 diabetes in women [0.76 (0.0.66-0.88)] and not associated with type 2 diabetes in men [0.97 (0.85-1.11)].
Visceral, but not sc, abdominal adiposity is strongly related to cardiometabolic risk factors and to the prevalence of cardiovascular disease and may be an important driver of cardiometabolic risk in patients regardless of type 2 diabetes status.
This study sought examine the independent and combined associations of changes in fitness and fatness with the subsequent incidence of the cardiovascular disease (CVD) risk factors of hypertension, metabolic syndrome, and hypercholesterolemia.
The relative and combined contributions of fitness and fatness to health are controversial, and few studies are available on the associations of changes in fitness and fatness with the development of CVD risk factors.
We followed up 3,148 healthy adults who received at least 3 medical examinations. Fitness was determined by using a maximal treadmill test. Fatness was expressed by percent body fat and body mass index. Changes in fitness and fatness between the first and second examinations were categorized into loss, stable, or gain groups.
During the 6-year follow-up after the second examination, 752, 426, and 597 adults developed hypertension, metabolic syndrome, and hypercholesterolemia, respectively. Maintaining or improving fitness was associated with lower risk of developing each outcome, whereas increasing fatness was associated with higher risk of developing each outcome, after adjusting for possible confounders and fatness or fitness for each other (all p for trend <0.05). In the joint analyses, the increased risks associated with fat gain appeared to be attenuated, although not completely eliminated, when fitness was maintained or improved. In addition, the increased risks associated with fitness loss were also somewhat attenuated when fatness was reduced.
Both maintaining or improving fitness and preventing fat gain are important to reduce the risk of developing CVD risk factors in healthy adults.
Sedentary behavior is associated with adiposity and cardiometabolic risk.
To determine the associations between sedentary behavior and measures of adiposity-associated inflammation.
Between 2002 and 2005, a total of 1543 Multi-Ethnic Study of Atherosclerosis participants completed detailed health history questionnaires, underwent physical measurements, and had blood assayed for adiponectin, leptin, tumor necrosis factor-alpha (TNF-α) and resistin. Analyses included linear regression completed in 2010. The mean age was 64.3 years and nearly 50% were female. Forty-one percent were non-Hispanic white, 24% Hispanic-American, 20% African-American, and 14% Chinese-American.
In linear regression analyses and with adjustment for age, gender, ethnicity, education, BMI, smoking, alcohol consumption, hypertension, diabetes mellitus, dyslipidemia, hormone therapy and waist circumference, sedentary behavior was associated with higher natural log ("ln") of leptin and ln TNF-α but a lower ln adiponectin-to-leptin ratio (β=0.07, β=0.03 and -0.07, p<0.05 for all). Compared to the first tertile, and after the same adjustment, the second and third tertiles of sedentary behavior were associated with higher levels of ln leptin (β=0.11 and β=0.12, respectively; p<0.05 for both) but lower levels of the adiponectin-to-leptin ratio (β=-0.09 and -0.11, respectively; p<0.05 for both).
Sedentary behavior is associated with unfavorable levels of adiposity-associated inflammation.
The combined associations of changes in cardiorespiratory fitness and body mass index (BMI) with mortality remain controversial and uncertain.
We examined the independent and combined associations of changes in fitness and BMI with all-cause and cardiovascular disease (CVD) mortality in 14 345 men (mean age 44 years) with at least 2 medical examinations. Fitness, in metabolic equivalents (METs), was estimated from a maximal treadmill test. BMI was calculated using measured weight and height. Changes in fitness and BMI between the baseline and last examinations over 6.3 years were classified into loss, stable, or gain groups. During 11.4 years of follow-up after the last examination, 914 all-cause and 300 CVD deaths occurred. The hazard ratios (95% confidence intervals) of all-cause and CVD mortality were 0.70 (0.59-0.83) and 0.73 (0.54-0.98) for stable fitness, and 0.61 (0.51-0.73) and 0.58 (0.42-0.80) for fitness gain, respectively, compared with fitness loss in multivariable analyses including BMI change. Every 1-MET improvement was associated with 15% and 19% lower risk of all-cause and CVD mortality, respectively. BMI change was not associated with all-cause or CVD mortality after adjusting for possible confounders and fitness change. In the combined analyses, men who lost fitness had higher all-cause and CVD mortality risks regardless of BMI change.
Maintaining or improving fitness is associated with a lower risk of all-cause and CVD mortality in men. Preventing age-associated fitness loss is important for longevity regardless of BMI change.
We investigated the association between physical activity, metabolic syndrome (MS), and the risk of future coronary heart disease (CHD) and mortality due to CHD in middle-aged men and women.
Prospective cohort study.
A total of 10,134 men and women aged 45-79 years at baseline, were selected from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort. Cardiovascular risk factors and physical activity levels were recorded at baseline. Rates of CHD and CHD mortality were recorded during a follow-up of 10.9 years.
The prevalence of MS was 37.6% in men and 30.2% in women. Hazard ratios (HRs) for future CHD were 1.95 (95% CI 1.65-2.31) for men with MS and 3.17 (95% CI 2.53-3, 97) for women with MS, compared to those without MS. HRs adjusted for age and smoking were 1.52 (95% CI 1.29-1.81) for men and 1.76 (95% CI 1.39-2.23) for women. Additional adjustment for physical activity did not attenuate these risk estimates further [HRs 1.51 (95% CI 1.27-1.79) and 1.74 (95% CI 1.38-2.21), respectively]. CHD risk associated with MS was substantially lower among participants who were physically active. There was no longer a significant difference in CHD event rate between men with MS who were active and men without MS who were inactive (11.5% vs. 12.8%). For women, similar associations were observed (5.3% vs. 5.6%). We found evidence for significant effect modification (p for interaction = 0.006) such that physical activity affected the association between MS and CHD risk.
Middle-aged men and women with MS have an increased risk for future CHD. This CHD risk associated with MS is substantially lower among those who are physically active. Participants with MS who were physically active had a lower CHD risk than people without MS who were physically inactive.
In 1953, Morris et al1,2 published the findings from a study showing that bus conductors in London, who spent their working hours walking the length of the buses as well as climbing up and down the stairs of the English double-decker buses to collect fares, experienced half the coronary heart disease (CHD) mortality rates of their driver counterparts, who spent their day sitting behind the wheel. Investigators hypothesized that it was the physical activity of work that protected the conductors from developing CHD, at the same time realizing that other factors may also play a role because the conductors were smaller in size, as evidenced by their smaller uniform sizes. Thus was born the field of “physical activity epidemiology”: formal epidemiological investigations into the associations of physical activity with many health outcomes.4
Since the initial observations of Morris et al, many other studies have been conducted, yielding similar results: Active people have lower rates of CHD and cardiovascular disease (CVD) than inactive ones.5–7 These findings have been supported by plausible biological mechanisms, which are detailed in other articles in this review series. The collective body of evidence led the American Heart Association in 1992 to recognize physical inactivity as a risk factor for CHD and CVD8 and led the Surgeon General in 1996 to conclude that “regular physical activity or cardiorespiratory fitness decreases the risk of CVD … and CHD.”9 The basis for these conclusions was derived primarily from studies in men and in white populations; for example, in a 1990 meta-analysis of physical activity in the prevention of CHD10 that included 33 studies, women were subjects in 5 studies, and racial/ethnic minorities were the focus of 2 studies.
In 2008, the federal government issued its first-ever physical activity guidelines for Americans11 based …
Insulin resistance has long been associated with obesity. More than 40 years ago, Randle and colleagues postulated that lipids impaired insulin-stimulated glucose use by muscles through inhibition of glycolysis at key points. However, work over the past two decades has shown that lipid-induced insulin resistance in skeletal muscle stems from defects in insulin-stimulated glucose transport activity. The steatotic liver is also resistant to insulin in terms of inhibition of hepatic glucose production and stimulation of glycogen synthesis. In muscle and liver, the intracellular accumulation of lipids-namely, diacylglycerol-triggers activation of novel protein kinases C with subsequent impairments in insulin signalling. This unifying hypothesis accounts for the mechanism of insulin resistance in obesity, type 2 diabetes, lipodystrophy, and ageing; and the insulin-sensitising effects of thiazolidinediones.
Insulin resistance is associated with central obesity and an increased risk of cardiovascular disease. Our objective is to examine the association between abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) and insulin resistance, to determine which fat depot is a stronger correlate of insulin resistance, and to assess whether there was an interaction between SAT, VAT, and age, sex, or BMI. Participants without diabetes from the Framingham Heart Study (FHS), who underwent multidetector computed tomography to assess SAT and VAT (n = 3,093; 48% women; mean age 50.4 years; mean BMI 27.6 kg/m(2)), were evaluated. Insulin resistance was measured using the homeostasis model and defined as HOMA(IR) ≥75th percentile. Logistic regression models, adjusted for age, sex, smoking, alcohol, menopausal status, and hormone replacement therapy use, were used to assess the association between fat measures and insulin resistance. The odds ratio (OR) for insulin resistance per standard deviation increase in SAT was 2.5 (95% confidence interval (CI): 2.2-2.7; P < 0.0001), whereas the OR for insulin resistance per standard deviation increase in VAT was 3.5 (95% CI: 3.1-3.9; P < 0.0001). Overall, VAT was a stronger correlate of insulin resistance than SAT (P < 0.0001 for SAT vs. VAT comparison). After adjustment for BMI, the OR of insulin resistance for VAT was 2.2 (95% CI: 1.9-2.5; P < 0.0001). We observed an interaction between VAT and BMI for insulin (P interaction = 0.0004), proinsulin (P interaction = 0.003), and HOMA(IR) (P interaction = 0.003), where VAT had a stronger association in obese individuals. In conclusion, SAT and VAT are both correlates of insulin resistance; however, VAT is a stronger correlate of insulin resistance than SAT.
To test the hypothesis that for any given body mass index (BMI) category, active individuals would have a smaller waist circumference than inactive individuals. Our second objective was to examine the respective contribution of waist circumference and physical inactivity on coronary heart disease (CHD) risk.
Prospective, population-based study with an 11.4-year follow-up.
A total of 21 729 men and women aged 45-79 years, residing in Norfolk, UK.
During follow-up, 2191 CHD events were recorded. Physical activity was evaluated using a validated lifestyle questionnaire that takes into account both leisure-time and work-related physical activity. Waist circumference was measured and BMI was calculated for each participant.
For both men and women, we observed that within each BMI category (<25.0, 25-30 and >or=30.0 kg m(-2)), active participants had a lower waist circumference than inactive participants (P<0.001). In contrast, within each waist circumference tertile, BMI did not change across physical activity categories (except for women with an elevated waist circumference). Compared with active men with a low waist circumference, inactive men with an elevated waist circumference had a hazard ratio (HR) for future CHD of 1.74 (95% confidence interval (CI), 1.34-2.27) after adjusting for age, smoking, alcohol intake and parental history of CHD. In the same model and after further adjusting for hormone replacement therapy use, compared with active women with a low waist circumference, inactive women with an elevated waist circumference had an HR for future CHD of 4.00 (95% CI, 2.04-7.86).
In any BMI category, inactive participants were characterized by an increased waist circumference, a marker of abdominal adiposity, compared with active individuals. Physical inactivity and abdominal obesity were both independently associated with an increased risk of future CHD.
Obesity increases the risk of morbidity and mortality and reduces quality of life independent of age, sex or ethnicity. Leading health authorities recommend weight loss as a primary treatment strategy for obesity reduction--weight loss goals range from 5% to 10% of initial body weight. Intentional weight loss in most adults is associated with a reduction in many of the health complications of obesity. Nonetheless, emerging evidence supports the notion that a lifestyle-modification program characterized by an increase in physical activity and a balanced diet can reduce obesity and the risk of obesity-related comorbid conditions despite minimal or no weight loss. The benefits of such an approach include appreciable reductions in abdominal obesity, visceral fat and cardiometabolic risk factors, and increases in both skeletal muscle mass and cardiorespiratory fitness. Individuals with obesity face a serious challenge if they are to attain even modest weight loss in today's obesogenic environment. Clinicians could encourage positive lifestyle changes in their patients by counseling them that obesity and its associated health risks can be reduced in response to an increase in physical activity with or without weight loss.