Moderate Cardiorespiratory Fitness Research Articles

Longitudinal development and tracking of cardiorespiratory fitness from childhood to adolescence.

Cardiorespiratory fitness (CRF) is an important indicator of health in childhood and adolescence but longitudinal studies on the development and tracking of CRF from childhood to adolescence are scarce. The objectives of this study were (1) to assess longitudinal development and track CRF over 10 years from childhood to adolescence, and (2) to examine potential sex differences in the development and tracking of CRF during this period. Participants were Icelandic children born in 1999, measured at the age of 7 (n = 190, 106 girls), 9 (n = 163, 95 girls), 15 (n = 239, 134 girls), and 17 (n = 202, 119 girls). CRF was assessed with a maximal cycle ergometer test and expressed as maximal power output (Max W) and maximal power output relative to lean mass (W/kgLM). Multilevel regression models were used to study the longitudinal development of CRF, and tracking was assessed with Spearman's rank correlation, logistic regression, and the percentage of participants remaining in low, moderate, or high CRF categories between measurements. Max W and W/kgLM increased for both boys and girls up to age 15. Max W plateaued for both boys and girls while W/kgLM plateaued for girls but declined for boys from age 15 to 17. Boys had higher Max W than girls from age 15 and higher W/kgLM from age 9. CRF tracked at low to moderate levels from childhood to adolescence and at high levels in adolescence, with higher values observed for boys than girls. Age 15 was a critical time point in the development of CRF, with values starting to plateau for girls and decline for boys. The results support early intervention for improved CRF in later years, with interventions targeting all children, regardless of their CRF level.

Cardiorespiratory fitness in midlife and subsequent incident depression, long-term sickness absence, and disability pension due to depression in 330,247 men and women

ObjectiveSpecific information for whom and when cardiorespiratory fitness (CRF) is associated with depression risk is lacking. We aimed to study the association between adulthood CRF and incident depression, long-term sickness absence, and disability pension due to depression, as well as examine moderation of sex, age, education, and occupation on associations. MethodsA large prospective cohort study follows participants over time with Swedish occupational health screenings data. The study includes 330,247 individuals (aged 16–79 years, 46% women) without a depression diagnosis at baseline. CRF was estimated from a submaximal cycle test. ResultsCRF was associated beneficially from low to higher levels with incident depression and long-term sickness absence due to depression. Further, CRF at high levels (≥46 ml/min/kg) was associated with a decreased risk of receiving disability pension due to depression. The associations remained after adjustment for age and sex, but not lifestyle-related factors and co-morbidity. Participants with moderate and high CRF had 16% and 21%, respectively, lower risk for incident depression, and participants with high CRF had 11% lower risk for long-term sickness absence due to depression. Associations between higher CRF and the outcomes were mainly evident in men, younger participants, and individuals with low education. ConclusionIn a large sample of adults without a depression diagnosis at baseline, higher CRF was shown to be beneficially related to the risk of incident depression and, to some extent, long-term sickness absence due to depression. If causal, targeted interventions focusing on increasing CRF in these sub-groups should be prioritized.

Influence of cardiorespiratory fitness and body composition on resting and post-exercise indices of vascular health in young adults

Poor cardiorespiratory fitness may mediate vascular impairments at rest and following an acute bout of exercise in young healthy individuals. This study aimed to compare flow mediated dilation (FMD) and vascular augmentation index (AIx75) between young adults with low, moderate, and high levels of cardiorespiratory fitness before and after an acute bout of aerobic exercise. Forty-three participants (22 men; 21 women) between 18 and 29 years of age completed the study. Participants were classified into low, moderate, and high health-related cardiorespiratory fitness groups according to age- and sex-based relative maximal oxygen consumption (V˙O2 max) percentile rankings. FMD was performed using Doppler ultrasound and AIx75 was performed using pulse wave analysis at baseline and 60-min after a 30-min bout of treadmill running at 70% V˙O2 max. A significant interaction (p ​= ​0.047; ηp2 ​= ​0.142) was observed, with the moderate fitness group exhibiting a higher FMD post-exercise compared with baseline ([6.7% ​± ​3.1%] vs. [8.5% ​± ​2.8%], p ​= ​0.028; d ​= ​0.598). We found a significant main effect of group for AIx75 (p ​= ​0.023; ηp2 ​= ​0.168), with the high fitness group exhibiting lower AIx75 compared to low fitness group ([−10% ​± ​10%] vs. [2% ​± ​10%], respectively, p ​= ​0.019; g ​= ​1.07). This was eliminated after covarying for body fat percentage (p ​= ​0.489). Our findings suggest that resting FMD and AIx75 responses are not significantly influenced by cardiorespiratory fitness, but FMD recovery responses to exercise may be enhanced in individuals with moderate cardiorespiratory fitness levels.

35 Impact of Cardiorespiratory Fitness and White Matter Lesions on Processing Speed with Age

Objective:Processing speed declines with age and is a strong predictor of age-related cognitive decline in other domains, and in predicting who will need help with tasks of daily living in later years. Higher cardiorespiratory fitness (CRF) reflects better cardiopulmonary health and is related to maintenance of processing speed and cognition into late life. On the other hand, white matter lesions (WML) are reflective of age-related brain network disconnections from damage to white matter tracts in the brain. Lower CRF and higher WML burden have each been related to poorer cognitive performance. Although higher CRF provides a protective effect on cognition, the combined effects of CRF and WML on processing speed have yet to be determined. Specifically, whether CRF and WML independently affect processing speed or if WML moderates the effect of CRF on processing speed is yet to be established. We predicted WML may moderate CRF benefits on cognitive aging if CRF-related cognitive benefits are weakened by high WML load. Here, we test this question with the gold-standard measure of CRF, maximal exercise oxygen uptake (relative VO2 max, mL/kg/min) during a graded exercise test, and a validated neuropsychological measure of processing speed, the Digit Symbol Substitution Test (DSST).Participants and Methods:CRF, DSST scores, and WML volumes of cognitively normal adults (n=91) aged 55-80 years were included in this analysis. The WML data was corrected for total intracranial volume and was log transformed. A linear regression model included the number of accurately completed items on the DSST as the dependent variable and age, sex, relative VO2 max, WML volumes and the interaction between relative VO2 max and WML volume as the predictor variables.Results:Main effects of age, sex, VO2 max and WML volume on the DSST were observed. Greater age, higher WML volume, and lower relative VO2 max were associated with poorer performance on the DSST. In addition, females (n=55) performed better than males (n=36) on the DSST. No significant interaction was observed between VO2 max and WML volume on DSST scores.Conclusions:Our results show that 1) WML and relative VO2 max independently contribute to processing speed performance in older adults as measured by the DSST, and 2) WML do not moderate the relation between VO2 max and the DSST. Strengths of this study include gold-standard measurement of CRF and WML volumes as predictors of performance on the DSST in older adults. Further research is warranted to understand how vascular aging and brain health indicators interactively or interdependently impact cognition in aging.

Association Between Cardiorespiratory Fitness and Cancer Incidence and Cancer-Specific Mortality of Colon, Lung, and Prostate Cancer Among Swedish Men

Cardiorespiratory fitness (CRF) levels appear to be an important risk factor for cancer incidence and death. To examine CRF and prostate, colon, and lung cancer incidence and mortality in Swedish men, and to assess whether age moderated any associations between CRF and cancer. A prospective cohort study was conducted in a population of men who completed an occupational health profile assessment between October 1982 and December 2019 in Sweden. Data analysis was performed from June 22, 2022, to May 11, 2023. Cardiorespiratory fitness was assessed as maximal oxygen consumption, estimated using a submaximal cycle ergometer test. Data on prostate, colon, and lung cancer incidence and mortality were derived from national registers. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression. Data on 177 709 men (age range, 18-75 years; mean [SD] age, 42 [11] years; mean [SD] body mass index, 26 [3.8]) were analyzed. During a mean (SD) follow-up time of 9.6 (5.5) years, a total of 499 incident cases of colon, 283 of lung, and 1918 of prostate cancer occurred, as well as 152 deaths due to colon cancer, 207 due to lung cancer, and 141 deaths due to prostate cancer. Higher levels of CRF (maximal oxygen consumption as milliliters per minute per kilogram) were associated with a significantly lower risk of colon (HR, 0.98, 95% CI, 0.96-0.98) and lung cancer (HR, 0.98; 95% CI, 0.96-0.99) incidence, and a higher risk of prostate cancer incidence (HR, 1.01; 95% CI, 1.00-1.01). Higher CRF was associated with a lower risk of death due to colon (HR, 0.98; 95% CI, 0.96-1.00), lung (HR, 0.97; 95% CI, 0.95-0.99), and prostate (HR, 0.95; 95% CI, 0.93-0.97) cancer. After stratification into 4 groups and in fully adjusted models, the associations remained for moderate (>35-45 mL/min/kg), 0.72 (0.53-0.96) and high (>45 mL/min/kg), 0.63 (0.41-0.98) levels of CRF, compared with very low (<25 mL/min/kg) CRF for colon cancer incidence. For prostate cancer mortality, associations remained for low (HR, 0.67; 95% CI, 0.45-1.00), moderate (HR, 0.57; 95% CI, 0.34-0.97), and high (HR, 0.29; 95% CI, 0.10-0.86) CRF. For lung cancer mortality, only high CRF (HR, 0.41; 95% CI, 0.17-0.99) was significant. Age modified the associations for lung (HR, 0.99; 95% CI, 0.99-0.99) and prostate (HR, 1.00; 95% CI, 1.00-1.00; P < .001) cancer incidence, and for death due to lung cancer (HR, 0.99; 95% CI, 0.99-0.99; P = .04). In this cohort of Swedish men, moderate and high CRF were associated with a lower risk of colon cancer. Low, moderate, and high CRF were associated with lower risk of death due to prostate cancer, while only high CRF was associated with lower risk of death due to lung cancer. If evidence for causality is established, interventions to improve CRF in individuals with low CRF should be prioritized.

Association between cardiorespiratory fitness and low back pain is anxiety-dependent: A prospective cohort study among adults and older adults

ABSTRACT To investigate the relationship between low back pain and cardiorespiratory fitness (CRF) among participants with and without self-report anxiety. Participants were 13,080 individuals (86.6% men; 44.7 ± 9.3 years). CRF was quantified as maximal treadmill test duration and was grouped for analysis as low (lowest 20% of treadmill test duration), moderate (middle 40%), and high (upper 40%). Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) between low back pain and CRF according to the presence/absence of self-report anxiety. During an average of 5.7 ± 5.1 years of follow-up, 2,965 cases of low back pain were identified. Participants with self-report anxiety and low CRF had 3.7 times (HR: 3.7; 95%CI: 1.7–8.2) more risk for having low back pain when compared with participants with self-report anxiety and high CRF. Additionally, among participants with self-reported anxiety, moderate CRF was associated with an 70% greater risk of having low back pain than those with high CRF (HR: 1.7; 95%CI: 1.1–3.2). For participants without self-reported anxiety, no association was found between the risk of having low back pain and CRF. According to the results identified in the present study, participants with self-reported anxiety who had low and moderate CRF had higher risks of low back pain than those with high CRF.

Association between Estimated Cardiorespiratory Fitness and Depression among Middle-income Country Adults: Evidence from National Health Survey.

Objective:This study assessed the relationship between cardiorespiratory fitness (CRF) and depression in adults.Methods:A total of 52,611 individuals aged between 18-59 years old were evaluated for symptoms of depression and CRF. The presence of depressive symptoms was self-report through the Patient Health Questionnaire (PHQ-9), and the CRF was predicted from a non-exercise equation. The association between CRF and the presence of depression was determined by crude and multivariable-adjusted logistic regressions.Results:The associations were identified between symptoms of depression and CRF in both unadjusted and adjusted models. After adjusting for age categories, sex, body mass index categories, educational level, marital status, smoking, and alcohol use, the individuals with moderate CRF had 18% lower odds of depression (OR: 0.82, CI 95%: 0.71 – 0.95) compared to individuals with low CRF.Conclusion:Depressive symptoms are inversely related to CRF levels in adults.

Relationship Between Cardiorespiratory Fitness, Baseline Blood Pressure and Hypertensive Response to Exercise in the Ferrari Corporate Population.

To evaluate the incidence and clinical significance of impaired cardiorespiratory fitness (CRF) and the association with baseline blood pressure (BP) levels and hypertensive response to exercise (HRE). A cross-sectional study was conducted on a total sample of 2058 individuals with a mean age of 38±9years, enrolled for the first time at the Ferrari corporate wellness program "Formula Benessere", including a maximal exercise stress testing (EST). BP and heart rate (HR) values were obtained from EST at rest, during exercise and recovery time. CRF was arbitrarily classified according to estimated VO2 max in optimal, normal, mildly and moderately reduced. One-hundred and thirty-nine individuals of 2058 (6.7%) showed a moderate CRF reduction assessed by EST. Subjects with elevated resting and/or exercise BP showed a worse CRF than those with normal BP levels, also after the adjustment for age, sex, body mass index, smoking habits, peak SBP and DBP. Seventy-seven individuals (3.7%) showed an HRE during EST, with normal baseline BP levels. About 7% of a corporate population showed a significantly reduced CRF, assessed by EST. Individuals with lower levels of CRF have higher resting and/or peak exercising BP values after adjusting for co-variables. This study expands the role of EST outside of traditional ischemic CVD evaluation, towards the assessment of reduced CRF and HRE in the general population, as a possible not evaluated CV risk factor.

Cardiorespiratory fitness, white blood cell count, and mortality in men and women

BackgroundWe examined the associations of cardiorespiratory fitness (CRF) and white blood cell count (WBC) with mortality outcomes. MethodsA total of 52,056 apparently healthy adults completed a comprehensive health examination, including a maximal treadmill test and blood chemistry analyses. CRF was categorized as high, moderate, or low by age and sex; WBC was categorized as sex-specific quartiles. ResultsDuring 17.8 ± 9.5 years (mean ± SD) of follow-up, a total of 4088 deaths occurred. When regressed jointly, significantly decreased all-cause mortality across CRF categories was observed within each quartile of WBC in men. Within WBC Quartile 1, all-cause mortality hazard ratios (HRs) with a 95% confidence interval (95%CI) were 1.0 (referent), 1.29 (95%CI: 1.06‒1.57), and 2.03 (95%CI: 1.42‒2.92) for high, moderate, and low CRF categories, respectively (p for trend < 0.001). Similar trends were observed in the remaining 3 quartiles. With the exception of cardiovascular disease (CVD) mortality within Quartile 1 (p for trend = 0.743), there were also similar trends across CRF categories within WBC quartiles in men for both CVD and cancer mortality (p for trend < 0.01 for all). For women, there were no significant trends across CRF categories for mortality outcomes within Quartiles 1–3. However, we observed significantly decreased all-cause mortality across CRF categories within WBC Quartile 4 (HR = 1.05 (95%CI: 0.76‒1.44), HR = 1.63 (95%CI:1.20‒2.21), and HR = 1.87 (95%CI:1.29‒2.69) for high, moderate, and low CRF, respectively (p for trend = 0.002)). Similar trends in women were observed for CVD and cancer mortality within WBC Quartile 4 only. ConclusionThere are strong joint associations between CRF, WBC, and all-cause, CVD, and cancer mortality in men; these associations are less consistent in women.

Ratings of perceived exertion at the ventilatory anaerobic threshold in people with coronary heart disease: A CARE CR study.

Exercise prescription guidelines for individuals undergoing cardiovascular rehabilitation (CR) are often based on heart rate training zones and rating of perceived exertion (RPE). United Kingdom guidelines indicate that patients should exercise at an intensity of RPE 11 to 14. We aimed to determine the accuracy of this approach by comparing this RPE range with an objectively measured marker of exercise intensity, the ventilatory anaerobic threshold (VAT), and examine whether baseline directly determined cardiorespiratory fitness (CRF) affects the association between VAT and RPE. Participants underwent a maximal cardiopulmonary exercise test before an 8-week community-based CR programme. Peak oxygen uptake (V̇O2peak) and VAT were recorded, and RPE at the workload at which VAT was identified was recorded. Data were then split into tertiles, based on VO2peak, to determine whether RPE at the VAT differed in participants with low, moderate or higher CRF. We included 70 individuals [mean (SD) age 63.1 (10.0) years; body mass index 29.4 (4.0)kg/m2; 86% male]. At baseline, the mean RPE at the VAT (RPE@VAT) was 11.8 (95% confidence interval 11.0-12.6) and significantly differed between low and high CRF groups (P<0.001). The mean RPE@VAT was 10.1 (8.7-11.5), 11.8 (10.5-13.0), and 13.7 (12.5-14.9) for low, moderate and high CRF groups, respectively. When using RPE to guide exercise intensity in CR populations, one must consider the effect of baseline CRF. Mean RPEs of ∼10, 12 and 14 correspond to the VAT in low, moderate and higher-fit patients, respectively.

Cardiorespiratory Fitness, Serum Vitamin D, and Prevalence of Metabolic Syndrome in Men.

Low cardiorespiratory fitness (CRF), vitamin D deficiency, and metabolic syndrome (MetSyn) are prevalent among U.S. adults. Joint associations among these variables are not well described. Between 2006 and 2018, 14,353 apparently healthy men completed a comprehensive health examination, including CRF based on a maximal treadmill test, components of MetSyn, and serum vitamin D levels [25(OH)D]. Participants were classified into groups of low (category 1), moderate (categories 2-3), and high (categories 4-5) CRF by age-group, as well as by clinical cut points for MetSyn and 25(OH)D. We calculated odds ratios (OR) of MetSyn across levels of CRF and 25(OH)D and also examined joint associations among these three variables. Mean 25(OH)D levels were 30.9 ± 11.6 and 26.3 ± 10.7 ng·mL in men without and with MetSyn, respectively (P < 0.001). The prevalence of MetSyn was inversely associated with ordered categories of CRF and 25(OH)D (Ptrend < 0.001 for both). Men with normal 25(OH)D had significantly lower odds of MetSyn than men who were vitamin D deficient (OR = 0.29, 95% confidence interval = 0.26-0.33). Men with moderate (OR = 0.31, 0.27-0.35) or high CRF (OR = 0.08, 0.07-0.09) had significantly lower odds of MetSyn than men with low CRF. Joint associations between CRF, 25(OH)D, and MetSyn revealed significantly greater prevalence of MetSyn in unfit men compared with fit men within each category of 25(OH)D (P < 0.001). Each 5 ng·mL increment of 25(OH)D and 1 MET increment of CRF was associated with a 16.0% and 31.3% lower prevalence of MetSyn, respectively. There are strong individual and joint associations between CRF, 25(OH)D, and MetSyn. Prospective studies are needed to evaluate these joint associations with regard to mortality outcomes.

Association of Cardiorespiratory Fitness and Hemodynamic Responses to Submaximal Exercise Testing With the Incidence of Chronic Kidney Disease: The Framingham Heart Study

ObjectiveTo relate cardiorespiratory fitness (CRF) and hemodynamic responses to exercise to the incidence of chronic kidney disease (CKD). MethodsWe evaluated 2715 Framingham Offspring Study participants followed up (mean, 24.8 years) after their second examination (1979-1983) until the end of their ninth examination (2011-2014). Participants (mean age, 43 years; 1397 women [51.5%]) without prevalent CKD or cardiovascular disease at baseline were included. We examined the associations of CRF and hemodynamic response to exercise with incident CKD using multivariable Cox proportional hazards regression with discrete intervals. ResultsCompared with low CRF (first tertile), participants with moderate (second tertile) or high (third tertile) CRF had a lower risk of CKD (hazard ratios [95% CIs]: 0.74 [0.61-0.91] and 0.73 [0.59-0.91], respectively). Participants with chronotropic incompetence (hazard ratio, 1.38 [95% CI, 1.06 to 1.79]), higher exercise systolic blood pressure (hazard ratio per SD, 1.20 [95% CI, 1.07 to 1.34]), and impaired heart rate recovery (hazard ratio, 1.51 [95% CI, 1.08 to 2.10]) had a higher risk of CKD compared with those with chronotropic competence, lower exercise systolic blood pressure, and normal heart rate recovery, respectively. These associations remained robust when the exercise variables were mutually adjusted for. The third tertile of a standardized exercise test score comprising the statistically significant variables was associated with a higher risk of CKD compared with the first tertile (hazard ratio, 1.85; 95% CI, 1.45 to 2.36). ConclusionHigher CRF and favorable hemodynamic responses to submaximal exercise in young adulthood may be markers of lower risk of CKD in later life.

Cardiorespiratory Fitness, Smoking Status, and Risk of Incidence and Mortality From Cancer: Findings From the Veterans Exercise Testing Study

To assess the joint and stratified associations between cardiorespiratory fitness (CRF), incidence, and mortality from cancer in never, former, and current male smokers. CRF (treadmill exercise test) was assessed in 4694 men (never smokers [n = 1715]; former smokers [n = 1602], 32.4 [30.5] pack-years; and current smokers [n = 1377], 40.3 [26] pack-years) aged 58.1 (17.3) years, and prospectively followed for 12.7 (7.5)years. Multivariable Cox hazard models were analyzed. In joint analyses, where high CRF in never smokers was used as a reference, hazard ratios and 95% (confidence intervals) for cancer incidence and cancer mortality were as follows: moderate CRF 1.41 (1.0-1.9) and 3.0 (1.7-5.5) in never smokers, 1.65 (1.3-2.2) and 3.7 (2.1-6.6) in former smokers, and 1.3 (0.9-1.7) and 3.4 (1.9-6.1) in current smokers, respectively. The corresponding values for low CRF were 1.53 (1.1-2.2) and 5.1 (2.7-9.5), 1.84 (1.3-2.5) and 6.6 (3.7-11.8), and 1.5 (1.1-2.2) and 5 (2.7-9.3), respectively. In stratified analyses by smoking status, compared with low CRF, moderate and high CRF were associated with a 32% to 78% reduction in cancer mortality risk (P trend for all <.001). Higher CRF is associated with lower risk of incidence and mortality from cancer regardless of smoking status, supporting the potential preventive benefits for public health.

Short-Term Changes in Cardiorespiratory Fitness in Response to Exercise Training and the Association with Long-Term Cardiorespiratory Fitness Decline: The STRRIDE Reunion Study.

BackgroundSubstantial heterogeneity exists in the cardiorespiratory fitness (CRF) change in response to exercise training, and its long‐term prognostic implication is not well understood. We evaluated the association between the short‐term supervised training‐related changes in CRF and CRF levels 10 years later.Methods and ResultsSTRRIDE (Studies of a Targeted Risk Reduction Intervention Through Defined Exercise) trial participants who were originally randomized to exercise training for 8 months and participated in the 10‐year follow‐up visit were included. CRF levels were measured at baseline, after training (8 months), and at 10‐year follow‐up as peak oxygen uptake (vo 2, mL/kg per min) using the maximal treadmill test. Participants were stratified into low, moderate, and high CRF response groups according to the training regimen–specific tertiles of CRF change. The study included 80 participants (age: 52 years; 35% female). At 10‐year follow‐up, the high‐response CRF group had the least decline in CRF compared with the moderate‐ and low‐response CRF groups (−0.35 versus −2.20 and −4.25 mL/kg per minute, respectively; P=0.02). This result was largely related to the differential age‐related changes in peak oxygen pulse across the 3 groups (0.58, −0.23, and −0.86 mL/beat, respectively; P=0.03) with no difference in the peak heart rate change. In adjusted linear regression analysis, high response was significantly associated with greater CRF at follow‐up independent of other baseline characteristics (high versus low [reference] CRF response: standard β=0.25; P=0.004).ConclusionsGreater CRF improvement in response to short‐term training is associated with higher CRF levels 10 years later. Lack of CRF improvements in response to short‐term training may identify individuals at risk for exaggerated CRF decline with aging.

Improved Survival With Higher Pre-diagnosis Cardiorespiratory Fitness in Men Who Developed Digestive System Cancers: A Prospective Pilot Study

Digestive system cancers are the leading cause of cancer mortality and have poor survival particularly in men. The study aimed to assess the association between pre-diagnosis cardiorespiratory fitness (CRF) and cancer mortality in a pilot sample of men who developed digestive system cancers. Pre-diagnosis CRF (treadmill exercise test) was assessed in 342 men (68.9±21.8 years) who developed digestive system cancers during 6.7±5 years from baseline evaluation. Cox multivariable hazard models were analyzed for total cancer mortality. During 7.2±5 years follow-up from baseline, 120 participants died from cancer. Compared to low CRF, moderate and high CRF levels were associated with 57% [0.43, 95%CI=0.24-0.74] and 73% [0.27, 95%CI=0.12-0.59] reduced risks for cancer mortality, respectively (p trend=0.002). Survival time from baseline was longer among those with moderate [13.5 (range=12.1-14.9) years] and high [16.1 (range=14.0-18.2) years] compared to low CRF [7.9 (range=5.7-10.1) years]. Higher pre-diagnosis CRF is independently associated with lower risk of cancer mortality and longer survival in men who later developed digestive system cancers.

Cardiorespiratory Fitness, Lung Cancer Incidence, and Cancer Mortality in Male Smokers

The preventive role of cardiorespiratory fitness in lung cancer among smokers is unknown. This study aims to evaluate the association between cardiorespiratory fitness and lung cancer incidence and cancer mortality in former and current male smokers. From 1987 to 2014, cardiorespiratory fitness (quantified from treadmill exercise testing) was assessed in 2,979 men (former smokers, n=1,602; current smokers, n=1,377) aged 59.1 (SD=17.4) years and prospectively followed up for 11.6 (SD=7) years. Multivariable Cox hazard models and population attributable fraction of low cardiorespiratory fitness (<5 METs) for cancer outcomes were analyzed during 2018. Of the 99 case patients diagnosed with lung cancer, 79 died of cancer 3.6 (SD=4.6) years after diagnosis. Among former smokers, 1-MET increase and categories of moderate and high cardiorespiratory fitness were associated with 13% (p=0.016), 51%, and 77% (p-trend=0.015) reductions in lung cancer incidence, respectively. Among current smokers who were later diagnosed with lung cancer, 1-MET increase and categories of moderate and high cardiorespiratory fitness were associated with 18% (p=0.008), 84%, and 85% (p-trend<0.001) reductions in cancer mortality, respectively. The population attributable fraction for lung cancer incidence was 10.8% among former smokers and 22.3% for cancer mortality among current smokers. Higher cardiorespiratory fitness is associated with lower risk of lung cancer incidence in former smokers and reduced risk of cancer mortality in current smokers who were diagnosed with lung cancer. Screening for low cardiorespiratory fitness and achieving at least moderate cardiorespiratory fitness could potentially reduce lung cancer morbidity and mortality, providing a preventive strategy for smokers.

The Association of Cardiorespiratory Fitness and Ideal Cardiovascular Health in the Aerobics Center Longitudinal Study.

This study examined the cross-sectional and longitudinal associations of cardiorespiratory fitness (CRF) and ideal cardiovascular health (CVH). CRF and the 7 CVH components were measured in 11,590 (8865 males; 2725 females) adults at baseline and in 2532 (2160 males; 372 females) adults with at least one follow-up examination from the Aerobics Center Longitudinal Study. Ideal CVH score was calculated as a composite of 7 measures, each scored 0 to 2. CVH groups were based on participant point score: ≤7 (poor), 8 to 11 (intermediate), and 12 to 14 (ideal). Analyses included general linear, logistic regression, and linear mixed models. At baseline, participants in the high CRF category had 21% and 45% higher mean CVH scores than those in the moderate and poor CRF categories (P < .001). The adjusted odds (95% confidence interval) of being in the poor CVH group at baseline were 4.9 (4.4-5.4) and 16.9 (14.3-19.9) times greater for individuals with moderate and low CRF, respectively, compared with those with high CRF (P < .001). Longitudinal analysis found that for every 1-minute increase in treadmill time, CVH score increased by 0.23 units (P < .001) independent of age, sex, exam number, and exam year. Higher CRF is associated with better CVH profiles, and improving CRF over time is independently associated with greater improvements in CVH.

Cardiorespiratory Fitness, Different Measures of Adiposity, and Cardiovascular Disease Mortality Risk in Women.

Background: Associations among cardiorespiratory fitness (CRF), different adiposity exposures, and cardiovascular disease (CVD) mortality in women are not well defined. Materials and Methods: A total of 19,838 women completed a baseline examination between 1971 and 2013. Measures included body mass index (BMI), waist circumference (WC), waist-to-height (W:HT) ratio, skinfold-derived percent body fat (% Fat), and CRF estimated from a maximal treadmill test. CRF categories were low (quintile 1), moderate (quintiles 2-3), and high (quintiles 4-5); standard cut points were used for adiposity exposures. Hazard ratios (HRs) were estimated using Cox regression. Results: During a mean follow-up period of 19.2 ± 10.3 years, 391 cardiovascular deaths occurred. HRs (95% confidence interval) for CVD in moderate and low CRF groups, using high CRF as the referent, were 1.87 (1.46-2.38) and 2.54 (1.93-3.35), respectively (p trend <0.001). HRs of obese women within each adiposity exposure were higher when compared with normal-weight women (p ≤ 0.03). Joint associations of CRF × adiposity showed a positive trend in CVD mortality across decreasing categories of CRF within each category of W:HT and % Fat, as well as within the normal and overweight BMI categories and the normal WC category (p ≤ 0.03 for each). Conclusion: Higher levels of CRF are associated with lower CVD mortality risk in women, and predict lower risk of CVD mortality in normal-weight women and in obese women. Using different measures of adiposity to predict CVD mortality risk in women may be misleading unless CRF is taken into account. These results support the American Heart Association (AHA) recommendation for including CRF as a clinical vital sign.

Circulating microRNAs and endothelial cell migration rate are associated with metabolic syndrome and fitness level in postmenopausal African American women.

Postmenopausal African American women are at elevated risk for metabolic syndrome (MetS), which predisposes them to cardiovascular disease and other chronic diseases. Circulating microRNAs (ci‐miR) are potential mediators of cardiometabolic diseases also impacted by cardiorespiratory fitness (CRF) level. Using real‐time quantitative PCR, we compared the expression of vascular‐related ci‐miRs (miR‐21‐5p, miR‐92a‐3p, miR‐126‐5p, miR‐146a‐5p, miR‐150‐5p, miR‐221‐3p) in sedentary, overweight/obese, postmenopausal African American women based on 1) presence (n = 31) or absence (n = 42) of MetS and 2) CRF level (VO2peak) (Very Low < 18.0 mL·kg−1·min−1 [n = 31], Low = 18.0–22.0 mL·kg−1·min−1 [n = 24], or Moderate >22.0 mL·kg−1·min−1 [n = 18]). Endothelial migration rate in response to subjects’ serum was assessed to determine the effect of circulating blood‐borne factors on endothelial repair. Ci‐miR‐21‐5p was the only ci‐miR that differed between women with MetS compared to those without MetS (0.93 ± 0.43 vs. 1.28 ± 0.71, P = 0.03). There were borderline significant differences (P = 0.06–0.09) in ci‐miR‐21‐5p, 126‐5p, and 221‐3p levels between the CRF groups, and these three ci‐miRs correlated with VO2peak (r = −0.25 to −0.28, P < 0.05). Endothelial migration rate was impaired in response to serum from women with MetS compared to those without after 16–24 h. Serum from women with Moderate CRF induced greater endothelial migration than the Very Low and Low CRF groups after 4 and 16–24 h, that was also not different from a young, healthy reference group. Ci‐miR‐21‐5p is lower in postmenopausal African American women with MetS, while ci‐miRs‐21‐5p, 126‐5p, and 221‐3p are associated with CRF. Factors which impair endothelial cell migration rate are present in serum of women with MetS, though having Moderate CRF may be protective.

Cardiorespiratory Fitness, Serum 25-hydroxyvitamin D, and Risk of Metabolic Syndrome Among Men: The Cooper Center Longitudinal Study

PURPOSE: We examined the individual and joint associations among cardiorespiratory fitness (CRF), serum vitamin D [25(OH)D], and metabolic syndrome (MetSyn). METHODS: Between 2006 and 2018, 14349 apparently healthy men completed a comprehensive health examination. Measures included CRF based on a maximal treadmill exercise test, components of MetSyn, and 25(OH)D. Participants were classified into categories of low (quintile 1), moderate (quintiles 2-3), and high (quintiles 4-5) CRF by age group, as well as by clinical cut points for MetSyn and 25(OH)D. We examined mean 25(OH)D levels in men with and without MetSyn. We calculated odds ratios (OR) of MetSyn across levels of CRF and 25(OH)D, and also examined joint associations among these three variables. RESULTS: The prevalence of 25(OH)D deficiency and MetSyn was 16.9% and 22.2%, respectively. Mean 25(OH)D levels were 30.9 + 11.6 and 26.3 + 10.7 ng/mL in men without and with MetSyn, respectively (p<.001). Prevalence of MetSyn was inversely associated with ordered categories of CRF and 25(OH)D (p for trend <0.001 for both). Men with normal 25(OH)D had lower odds of MetSyn than men who were vitamin D deficient (OR=0.29, 95% CI=0.26-0.33). Men with moderate (OR=0.31, 0.27-0.35) or high CRF (OR=0.08, 0.07-0.09) had lower odds of MetSyn than men with low CRF. Joint associations between CRF, 25(OH)D, and MetSyn revealed significantly greater prevalence of MetSyn in unfit men when compared to fit men within each category of 25(OH)D (p<0.001). Each 5 ng/mL increment of 25(OH)D, and 1 MET increment of CRF was associated with a 16.0% and 31.3% lower prevalence of MetSyn, respectively. CONCLUSION: There are strong individual and joint associations between CRF, 25(OH)D, and MetSyn. Although these observed associations are cross-sectional, it seems prudent to recommend increased levels of physical activity and vitamin D intake in men with low CRF, vitamin D deficiency, and/or MetSyn.