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

Kodama, Satoru; Saito, Kazumi; Tanaka, Shiro; Maki, Miho; Yachi, Yoko; Asumi, Mihoko; Sugawara, Akiko; Totsuka, Kumiko; Shimano, Hitoshi; Ohashi, Yasuo; Yamada, Nobuhiro; Sone, Hirohito

doi:10.1001/jama.2009.681

Cited by 2,608 publications

(2,115 citation statements)

References 63 publications

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“…Among participants with ≥2 metabolic risk factors at baseline, those who reported engaging in moderate‐to‐vigorous physical activity ≥3 times per week had an HR for CVD mortality of 0.63 (95% CI, 0.40–0.99) compared with those who reported none. Similar findings have been reported in a few other cohort studies for physical activity23, 24, 25 as well as for physical fitness 26. In a meta‐analysis examining cardiorespiratory fitness as a predictor of all‐cause mortality and CHD/CVD, results from 8 cohort studies indicated that each MET higher level of maximal aerobic capacity correlated with an 11% (95% CI, 7%–15%) lower risk of CHD/CVD among individuals with >3 metabolic factors 26…”

Section: Discussionsupporting

confidence: 82%

Physical Activity and Incident Cardiovascular Disease in Women: Is the Relation Modified by Level of Global Cardiovascular Risk?

Chomistek

Cook

Rimm

et al. 2018

JAHA

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BackgroundThe inverse association between physical activity and cardiovascular disease (CVD) is well‐ established and has previously been shown in people with and without single CVD risk factors. We examined whether level of global cardiovascular risk, on the basis of the pooled cohort equation or Reynolds risk score, which include multiple risk factors, modified the physical activity–CVD association.Methods and ResultsParticipants in the prospective WHS (Women's Health Study; n=27 536) reported their leisure‐time physical activity at study entry (1992–1995) and during follow‐up through 2013. Participants were divided into 10‐year cardiovascular risk groups on the basis of the pooled cohort equation and Reynolds risk score. The primary outcome was incident total CVD. The CVD hazard ratio for active (≥500 kcal/wk of physical activity) compared with inactive (<500 kcal/wk) individuals was 0.73 (95% confidence interval, 0.66–0.80) in multivariable models. This association was not modified by level of cardiovascular risk; physical activity was inversely associated with CVD within all pooled cohort equation and Reynolds risk score groups (P=0.17 and P=0.66 for interaction, respectively). When the joint association of physical activity and level of cardiovascular risk was examined, women with higher risk on the basis of either the pooled cohort equation or Reynolds risk score had higher CVD rates compared with those at low risk, regardless of physical activity. However, among women at both high and low risk, being physically active was associated with lower risk of CVD events.ConclusionsIn this large prospective cohort of women, level of global cardiovascular risk did not modify the inverse association between leisure‐time physical activity and incident CVD. Thus, promoting physical activity is important in women at both low and high cardiovascular risk.

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Section: Discussionsupporting

confidence: 82%

Physical Activity and Incident Cardiovascular Disease in Women: Is the Relation Modified by Level of Global Cardiovascular Risk?

Chomistek

Cook

Rimm

et al. 2018

JAHA

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“…Sustaining regular physical activity over the long term is associated with a more favorable circulating metabolome19 and decreased markers of inflammation 20. Benefits of cardiorespiratory fitness may extend to non‐CVD diseases, such as cancer, depression, and dementia, with a dose‐dependent reduction in all‐cause mortality 21, 22, 23, 24…”

Section: Discussionmentioning

confidence: 99%

mActive: A Randomized Clinical Trial of an Automated mHealth Intervention for Physical Activity Promotion

Martin

Feldman

Blumenthal

et al. 2015

JAHA

253

360

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BackgroundWe hypothesized that a fully automated mobile health (mHealth) intervention with tracking and texting components would increase physical activity.Methods and Results mActive enrolled smartphone users aged 18 to 69 years at an ambulatory cardiology center in Baltimore, Maryland. We used sequential randomization to evaluate the intervention's 2 core components. After establishing baseline activity during a blinded run‐in (week 1), in phase I (weeks 2 to 3), we randomized 2:1 to unblinded versus blinded tracking. Unblinding allowed continuous access to activity data through a smartphone interface. In phase II (weeks 4 to 5), we randomized unblinded participants 1:1 to smart texts versus no texts. Smart texts provided smartphone‐delivered coaching 3 times/day aimed at individual encouragement and fostering feedback loops by a fully automated, physician‐written, theory‐based algorithm using real‐time activity data and 16 personal factors with a 10 000 steps/day goal. Forty‐eight outpatients (46% women, 21% nonwhite) enrolled with a mean±SD age of 58±8 years, body mass index of 31±6 kg/m2, and baseline activity of 9670±4350 steps/day. Daily activity data capture was 97.4%. The phase I change in activity was nonsignificantly higher in unblinded participants versus blinded controls by 1024 daily steps (95% confidence interval [CI], −580 to 2628; P=0.21). In phase II, participants receiving texts increased their daily steps over those not receiving texts by 2534 (95% CI, 1318 to 3750; P<0.001) and over blinded controls by 3376 (95% CI, 1951 to 4801; P<0.001).ConclusionsAn automated tracking‐texting intervention increased physical activity with, but not without, the texting component. These results support new mHealth tracking technologies as facilitators in need of behavior change drivers.Clinical Trial Registration URL: http://ClinicalTrials.gov/. Unique identifier: NCT01917812.

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“…The proportion of adolescents in this study with low cardiorespiratory fitness may be a reflection of lower cardiorespiratory fitness levels observed worldwide. These data are alarming considering the exposure of young individuals to cardiovascular risk factors during adolescence7 and adulthood 8…”

Section: Discussionmentioning

confidence: 99%

“…The low level of cardiorespiratory fitness is associated with increased cardiovascular risk factors and metabolic syndrome in young individuals,7 as well as to increased cardiovascular risk in adulthood 8. A meta-analysis showed that the overall risk of death from all causes or from cardiovascular disease was two-fold higher in individuals with low cardiorespiratory fitness levels, compared to those with high levels 8.…”

Section: Introductionmentioning

confidence: 99%

“…A meta-analysis showed that the overall risk of death from all causes or from cardiovascular disease was two-fold higher in individuals with low cardiorespiratory fitness levels, compared to those with high levels 8. According to Azambuja et al,9 in 2004 the annual cost to public funds for the treatment of cardiovascular disease was R$ 30.8 billion (36.4% for health, 8.4% for social security and reimbursement by employers and 55.2% as a result of lost productivity).…”

Section: Introductionmentioning

confidence: 99%

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Association between cardiorespiratory fitness and body fat in girls

Minatto

Sousa

Carvalho

et al. 2016

Revista Paulista de Pediatria (English Edition)

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Objective:To estimate the prevalence of low cardiorespiratory fitness and its association with excess body fat, considering the sexual maturation and economic level in female adolescents.Methods:Cross-sectional, epidemiological study of 1223 adolescents (10-17 years) from the public school system of Cascavel, PR, Brazil, in 2006. We analyzed the self-assessed sexual maturation level (prepubertal, pubertal and post-pubertal), the economic level (high and low) through a questionnaire and body fat (normal and high) through triceps and subscapular skinfolds. The 20-meter back-and-forth test was applied to estimate maximum oxygen consumption. Cardiorespiratory fitness was assessed according to reference criteria and considered low when the minimum health criterion for age and sex was not met. Chi-square test and logistic regression were applied, with a significance level of 5%.Results:The prevalence of low cardiorespiratory fitness was 51.3%, being associated with all study variables (p<0.001). At the crude analysis, adolescents with high body fat were associated with low cardiorespiratory fitness, when compared to those with normal body fat (OR=2.76; 95%CI: 2.17-3.52). After adjustment by sexual maturation, this association remained valid and showed an effect that was 1.8-fold higher (95%CI: 1.39-2.46) and after adjusting by economic level, the effect was 1.9-fold higher (95%CI: 1.45-2.61).Conclusions:Approximately half of the assessed girls showed unsatisfactory levels of cardiorespiratory fitness for health, which was associated with high body fat, regardless of sexual maturation level and economic level. Effective public health measures are needed, with particular attention to high-risk groups.

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

Cited by 2,608 publications

References 63 publications

Physical Activity and Incident Cardiovascular Disease in Women: Is the Relation Modified by Level of Global Cardiovascular Risk?

Physical Activity and Incident Cardiovascular Disease in Women: Is the Relation Modified by Level of Global Cardiovascular Risk?

mActive: A Randomized Clinical Trial of an Automated mHealth Intervention for Physical Activity Promotion

Association between cardiorespiratory fitness and body fat in girls

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