Comparison of objectively measured and estimated cardiorespiratory fitness to predict all-cause and cardiovascular disease mortality in adults: A systematic review and meta-analysis of 42 studies representing 35 cohorts and 3.8 million observations

Ben Singh; Cristina Cadenas-Sanchez; Bruno G G da Costa; José Castro-Piñero; Jean-Philippe Chaput; Magdalena Cuenca-García; Carol Maher; Nuria Marín-Jiménez; Ryan McGrath; Pablo Molina-Garcí; Jonathan Myers; Bethany Gower; Francisco B Ortega; Justin J Lang; Grant R Tomkinson

doi:10.1016/j.jshs.2024.100986

Comparison of objectively measured and estimated cardiorespiratory fitness to predict all-cause and cardiovascular disease mortality in adults: A systematic review and meta-analysis of 42 studies representing 35 cohorts and 3.8 million observations

J Sport Health Sci. 2024 Sep 11:100986. doi: 10.1016/j.jshs.2024.100986. Online ahead of print.

Authors

Affiliations

¹ Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia. Electronic address: ben.singh@unisa.edu.au.
² Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18071, Spain; Department of Cardiology, Stanford University, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Granada 18071, Spain.
³ Department of Kinesiology and Physical Education, McGill University, Montreal, QC H2W 1S4, Canada.
⁴ GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real 11519, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz 11009, Spain.
⁵ Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.
⁶ Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia.
⁷ Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18071, Spain; GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real 11519, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz 11009, Spain.
⁸ Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Healthy Aging North Dakota (HAND), North Dakota State University, Fargo, ND 58102, USA; Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA; Fargo VA Healthcare System, Fargo, ND 58102, USA; Department of Geriatrics, University of North Dakota, Grand Forks, ND 58202, USA.
⁹ Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18071, Spain; Instituto de Investigación Biosanitaria ibs. Granada, Granada 18014, Spain.
¹⁰ Department of Cardiology, Stanford University, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.
¹¹ Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18071, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Granada 18071, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä 40014, Finland.
¹² Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.

PMID: 39271056
DOI: 10.1016/j.jshs.2024.100986

Abstract

Background: Cardiorespiratory fitness (CRF) is a powerful health marker recommended by the American Heart Association as a clinical vital sign. Comparing the predictive validity of objectively measured CRF (the "gold standard") and estimated CRF is clinically relevant because estimated CRF is more feasible. Our objective was to meta-analyze cohort studies to compare the associations of objectively measured, exercise-estimated, and non-exercise-estimated CRF with all-cause and cardiovascular disease (CVD) mortality in adults.

Methods: Systematic searches were conducted in 9 databases (MEDLINE, SPORTDiscus, Embase, Scopus, PsycINFO, Web of Science, PubMed, CINAHL, and the Cochrane Library) up to April 11, 2024. We included full-text refereed cohort studies published in English that quantified the association (using risk estimates with 95% confidence intervals (95%CIs)) of objectively measured, exercise-estimated, and non-exercise-estimated CRF with all-cause and CVD mortality in adults. CRF was expressed as metabolic equivalents (METs) of task. Pooled relative risks (RR) for all-cause and CVD mortality per 1-MET (3.5 mL/kg/min) higher level of CRF were quantified using random-effects models.

Results: Forty-two studies representing 35 cohorts and 3,813,484 observations (81% male) (362,771 all-cause and 56,471 CVD deaths) were included. The pooled RRs for all-cause and CVD mortality per higher MET were 0.86 (95%CI: 0.83-0.88) and 0.84 (95%CI: 0.80-0.87), respectively. For both all-cause and CVD mortality, there were no statistically significant differences in RR per higher MET between objectively measured (RR range: 0.86-0.90) and maximal exercise-estimated (RR range: 0.85-0.86), submaximal exercise-estimated (RR range: 0.91-0.94), and non-exercise-estimated CRF (RR range: 0.81-0.85).

Conclusion: Objectively measured and estimated CRF showed similar dose-response associations for all-cause and CVD mortality in adults. Estimated CRF could provide a practical and robust alternative to objectively measured CRF for assessing mortality risk across diverse populations. Our findings underscore the health-related benefits of higher CRF and advocate for its integration into clinical practice to enhance risk stratification.

Keywords: Adult; Cardiorespiratory fitness; Cardiovascular diseases; Cohort studies; Risk assessment.

Publication types

Review