Advertisement
Mayo Clinic Proceedings Home

Cardiorespiratory Fitness and Health Outcomes: A Call to Standardize Fitness Categories

Published:November 22, 2017DOI:https://doi.org/10.1016/j.mayocp.2017.10.011

      Abstract

      An inverse association between physical activity or fitness status and health outcomes has been reported by several cohort studies. When fitness categories are established in quartiles or quintiles based on the peak exercise capacity achieved, the association is graded. Although significant health benefits of increased cardiorespiratory fitness (CRF) have been uniformly reported, the degree of protection has varied substantially between studies. This variability is likely due to varying methods used to define CRF categories, and not considering age, despite its strong effect on CRF. To ameliorate these methodological discrepancies, we propose standardized guidelines by which age-specific CRF categories should be defined.

      Abbreviations and Acronyms:

      CRF (cardiorespiratory fitness), MET (metabolic equivalent)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Morris J.N.
        • Heady J.A.
        • Raffle P.A.
        • Roberts C.G.
        • Parks J.W.
        Coronary heart-disease and physical activity of work.
        Lancet. 1953; 265: 1111-1120
        • Blair S.N.
        • Kohl III, H.W.
        • Paffenbarger Jr., R.S.
        • Clark D.G.
        • Cooper K.H.
        • Gibbons L.W.
        Physical fitness and all-cause mortality: a prospective study of healthy men and women.
        JAMA. 1989; 262: 2395-2401
        • Kokkinos P.
        • Myers J.
        Exercise and physical activity: clinical outcomes and applications.
        Circulation. 2010; 122: 1637-1648
        • Boden W.E.
        • Franklin B.A.
        • Wenger N.K.
        Physical activity and structured exercise for patients with stable ischemic heart disease.
        JAMA. 2013; 309: 143-144
        • Wei M.
        • Kampert J.B.
        • Barlow C.E.
        • et al.
        Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men.
        JAMA. 1999; 282: 1547-1553
        • Wickramasinghe C.D.
        • Ayers C.R.
        • Das S.
        • de Lemos J.A.
        • Willis B.L.
        • Berry J.D.
        Prediction of 30-year risk for cardiovascular mortality by fitness and risk factor levels: the Cooper Center Longitudinal Study.
        Circ Cardiovasc Qual Outcomes. 2014; 7: 597-602
        • Kokkinos P.
        • Faselis C.
        • Myers J.
        • et al.
        Statin therapy, fitness, and mortality risk in middle-aged hypertensive male veterans.
        Am J Hypertens. 2014; 27: 422-430
        • Kokkinos P.
        • Myers J.
        • Faselis C.
        • et al.
        Exercise capacity and mortality in older men: a 20-year follow-up study.
        Circulation. 2010; 122: 790-797
        • Kokkinos P.F.
        • Faselis C.
        • Myers J.
        • Panagiotakos D.
        • Doumas M.
        Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: a cohort study.
        Lancet. 2013; 381: 394-399
        • Mora S.
        • Redberg R.F.
        • Cui Y.
        • et al.
        Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study.
        JAMA. 2003; 290: 1600-1607
        • Myers J.
        • McAuley P.
        • Lavie C.J.
        • Despres J.P.
        • Arena R.
        • Kokkinos P.
        Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status.
        Prog Cardiovasc Dis. 2015; 57: 306-314
        • Myers J.
        • Nead K.T.
        • Chang P.
        • Abella J.
        • Kokkinos P.
        • Leeper N.J.
        Improved reclassification of mortality risk by assessment of physical activity in patients referred for exercise testing.
        Am J Med. 2015; 128: 396-402
        • Lee D.C.
        • Sui X.
        • Ortega F.B.
        • et al.
        Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women.
        Br J Sports Med. 2011; 45: 504-510
        • Franklin B.A.
        • de Jong A.
        • Kahn J.K.
        • McCullough P.A.
        Fitness and mortality in the primary and secondary prevention of coronary artery disease: does the effort justify the outcome?.
        Am J Med Sports. 2004; 6: 23-27
        • Ross R.
        • Blair S.N.
        • Arena R.
        • et al.
        • American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health
        • Council on Clinical Cardiology
        • Council on Epidemiology and Prevention
        • Council on Cardiovascular and Stroke Nursing
        • Council on Functional Genomics and Translational Biology
        • Stroke Council
        Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association.
        Circulation. 2016; 134: e653-e699
        • Al-Mallah M.H.
        • Qureshi W.T.
        • Keteyian S.J.
        • et al.
        Racial differences in the prognostic value of cardiorespiratory fitness (results from the Henry Ford Exercise Testing Project).
        Am J Cardiol. 2016; 117: 1449-1454
        • Kodama S.
        • Saito K.
        • Tanaka S.
        • et al.
        Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis.
        JAMA. 2009; 301: 2024-2035
        • Faselis C.
        • Doumas M.
        • Pittaras A.
        • et al.
        Exercise capacity and all-cause mortality in male veterans with hypertension aged ≥70 years.
        Hypertension. 2014; 64: 30-35
        • Church T.S.
        • Cheng Y.J.
        • Earnest C.P.
        • et al.
        Exercise capacity and body composition as predictors of mortality among men with diabetes.
        Diabetes Care. 2004; 27: 83-88
        • Myers J.
        • Kaykha A.
        • George S.
        • et al.
        Fitness versus physical activity patterns in predicting mortality in men.
        Am J Med. 2004; 117: 912-918
        • Morris C.K.
        • Ueshima K.
        • Kawaguchi T.
        • Hideg A.
        • Froelicher V.F.
        The prognostic value of exercise capacity: a review of the literature.
        Am Heart J. 1991; 122: 1423-1431
        • Weiner D.A.
        • Ryan T.J.
        • McCabe C.H.
        • et al.
        Prognostic importance of a clinical profile and exercise test in medically treated patients with coronary artery disease.
        J Am Coll Cardiol. 1984; 3: 772-779
        • Blair S.N.
        • Kohl III, H.W.
        • Barlow C.E.
        • Paffenbarger Jr., R.S.
        • Gibbons L.W.
        • Macera C.A.
        Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men.
        JAMA. 1995; 273: 1093-1098
        • Fleg J.L.
        • Morrell C.H.
        • Bos A.G.
        • et al.
        Accelerated longitudinal decline of aerobic capacity in healthy older adults.
        Circulation. 2005; 112: 674-682
        • Jackson A.S.
        • Sui X.
        • O'Connor D.P.
        • et al.
        Longitudinal cardiorespiratory fitness algorithms for clinical settings.
        Am J Prev Med. 2012; 43: 512-519
        • Kokkinos P.
        • Faselis C.
        • Myers J.
        • Sui X.
        • Zhang J.
        • Blair S.N.
        Age-specific exercise capacity threshold for mortality risk assessment in male veterans.
        Circulation. 2014; 130: 653-658
        • Sui X.
        • LaMonte M.J.
        • Blair S.N.
        Cardiorespiratory fitness and risk of nonfatal cardiovascular disease in women and men with hypertension.
        Am J Hypertens. 2007; 20: 608-615
        • Sui X.
        • LaMonte M.J.
        • Blair S.N.
        Cardiorespiratory fitness as a predictor of nonfatal cardiovascular events in asymptomatic women and men.
        Am J Epidemiol. 2007; 165: 1413-1423
        • Faselis C.
        • Kokkinos P.
        • Tsimploulis A.
        • et al.
        Exercise capacity and atrial fibrillation risk in veterans: a cohort study.
        Mayo Clin Proc. 2016; 91: 558-566
        • Kokkinos P.
        • Faselis C.
        • Myers J.
        • et al.
        Exercise capacity and risk of chronic kidney disease in US veterans: a cohort study.
        Mayo Clin Proc. 2015; 90: 461-468
        • Myers J.
        • Kokkinos P.
        • Chan K.
        • et al.
        Cardiorespiratory fitness and reclassification of risk for incidence of heart failure: the Veterans Exercise Testing Study.
        Circ Heart Fail. 2017; 10: e003780
        • Kokkinos P.
        • Faselis C.
        • Myers J.
        • et al.
        Cardiorespiratory fitness and incidence of major adverse cardiovascular events in US Veterans: a cohort study.
        Mayo Clin Proc. 2017; 92: 39-48
        • Kokkinos P.
        • Faselis C.
        • Narayan P.
        • et al.
        Cardiorespiratory fitness and incidence of type 2 diabetes in United States veterans on statin therapy.
        Am J Med. 2017; 130: 1192-1198