Downloads

Kokkinos, P. Current Concepts on Cardiorespiratory Fitness, and Health Outcomes: A brief Review. Journal of Cardiovascular and Metabolic Disease Epidemiology. 2025. doi: Retrieved from https://www.sciltp.com/journals/jcmde/article/view/603
Volume 1, Issue 1, 2025
Copyright (c) 2025 by the authors.
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Mini Review

Current Concepts on Cardiorespiratory Fitness, and Health Outcomes: A Brief Review

Peter Kokkinos 1,2

1 Department of Kinesiology and Health 70 Lipman Drive, Rutgers University, New Brunswick, NJ 08901, USA; peter.kokkinos@va.gov

2 Veterans Affairs Medical Center, Washington, DC 20422, USA

Received: 16 November 2024; Revised: 09 March 2025; Accepted: 10 March 2025; Published: 14 March 2025

Abstract: The link between a physically active lifestyle and human health, first described by Hippocrates, was scientifically scrutinized for the last seven decades. The cumulative evidence from large and well-designed epidemiologic studies strongly supports a physically active lifestyle that leads to improved cardiorespiratory fitness (CRF) which confers significant health benefits across the age, gender, and race spectra. The health benefits are evident beyond an exercise volume threshold and increase progressively with higher exercise volumes and are independent of comorbidities. Specifically, increased CRF is strongly and inversely associated with the incidence of chronic cardiometabolic diseases, and the risk of premature mortality. In dyslipidemic populations, CRF is equally effective with statin therapy in lowering mortality risk. However, the combination of the two therapies (CRF and statin treatment) were more effective than either therapy alone. In non-diabetic patients the incidence of diabetes mellitus (T2DM) was amplified by obesity and statins and was attenuated by high CRF. In T2DM patients treated with statins the progression to insulin therapy (worsening of T2DM) was amplified by obesity and statins and was attenuated by high CRF. There is also evidence that excessive amounts of physical activity (work volume) are counterproductive and even harmful. The recommended exercise volume an intensity necessary for health benefits is relatively moderate and achievable by most middle-aged and older individuals engaging in such activities as brisk walk 30–50 min per day most days of the week. Nevertheless, exercise prescriptions should be personalized.

Keywords:

physical activity fitness health outcomes

References

  1. Blair, S.N.; Kohl, H.W.; Paffenbarger, R.S.; et al. Physical fitness and all-cause mortality: A prospective study of healthy men and women. JAMA 1989, 262, 2395–2401.
  2. Blair, S.N.; Kohl, H.W., III; Barlow, C.E.; et al. Changes in physical fitness and all-cause mortality: A prospective study of healthy and unhealthy men. JAMA 1995, 273, 1093–1098.
  3. Blair, S.N.; Kampert, J.B.; Kohl, H.W., III; et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996, 276, 205–210.
  4. Lloyd-Jones, D.M.; Allen, N.B.; Anderson, C.A.; et al. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory from the American Heart Association. Circulation 2022, 146, e18–e43. https://doi.org/10.1161/CIR.0000000000001078.
  5. Joyce, B.T.; Gao, T.; Zheng, Y.; et al. Epigenetic age acceleration reflects long-term cardiovascular health. Circ. Res. 2021, 129, 770–781. https://doi.org/10.1161/CIRCRESAHA.121.318965.
  6. Pottinger, T.D.; Khan, S.S.; Zheng, Y.; et al. Association of cardiovascular health and epigenetic age acceleration. Clin. Epigenetics 2021, 13, 42. https://doi.org/10.1186/s13148-021-01028-2.
  7. Lloyd-Jones, D.M. Cardiovascular health and protection against CVD: More than the sum of the parts? Circulation 2014, 130, 1671–1673. https://doi.org/10.1161/CIRCULATIONAHA.114.012869.
  8. Ross, R.; Arena, R.; Myers, J.; et al. Update to the 2016 American Heart Association cardiorespiratory fitness statement. Prog. Cardiovasc. Dis. 2024, 83, 10–15.
  9. Isatha, A.; Koziol, K.J.; Martinez, M.W.; et al. Exercise and cardiovascular health: A state-of-the-art review. Prog. Progress. Cardiovasc. Dis. 2023, 79, 44–52.
  10. Kokkinos, P. Cardiorespiratory Fitness, Exercise, and Blood Pressure. Hypertension 2014, 64, 1160–1164.
  11. Lavie, C.J.; Schutter, A.D.; Parto, P.; et al. Obesity and Prevalence of Cardiovascular Diseases and Prognosis-The Obesity Paradox Updated. Prog. Progress. Cardiovasc. Dis. 2016, 58, 537–547.
  12. Laviel, C.J.; Ortega, F.B.; Kokkinos, P. Impact of Physical Activity and Fitness in Metabolically Healthy Obesity. J. Am. Coll. Cardiol. 2018, 71, 812–813.
  13. Kokkinos, P.; Myers, J. Exercise and Physical Activity: Clinical Outcomes and Applications. Circulation 2010, 112, 1637–1648.
  14. Faselis, C.; Doumas, M.; Kokkinos, J.P.; et al. Exercise capacity and progression from prehypertension to hypertension. Hypertension 2012, 60, 333–338.
  15. Kokkinos, P.; Faselis, C.; Narayan, P.; et al. Cardiorespiratory Fitness and Incidence of Type 2 Diabetes in US Veterans on Statin Therapy. Am. J. Med. 2017, 130, 1192–1198. https://doi.org/10.1016/j.amjmed.2017.04.042.
  16. Kokkinos, P.; Nylen, E.; Faselis, C.; et al. Progression to Insulin Therapy in Patients with Type 2 Diabetes According to Cardiorespiratory Fitness, Body Mass Index, and Statin Therapy. Mayo Clin. Proc. 2024, 99, 249–259.
  17. Kokkinos, P.; Faselis, C.; Franklin, B.; et al. Cardiorespiratory fitness, body mass index and heart failure incidence. Eur. J. Heart Fail. 2019, 21, 436–444. https://doi.org/10.1002/ejhf.1433.
  18. Jonathan, M.; 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. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003780.
  19. Pandey, A.; Patel, K.V.; Vaduganathan, M.; et al. Physical activity, fitness, and obesity in heart failure with preserved ejection fraction. JACC Heart Fail. 2018, 6, 975–982.
  20. Hales, C.M.; Carroll, M.D.; Fryar, C.D.; et al. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief 2020, 2020, 1–8.
  21. Lavie, C.J.; Alpert, M.A.; Arena, R.; et al. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail. 2013, 1, 93–102.
  22. Nelson, M.E.; Rejeski, W.J.; Blair, S.N.; et al. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007, 116, 1094–1105. https://doi.org/10.1249/mss.0b013e3180616aa2.
  23. Kokkinos, P.; Faselis, C.; Pittaras, A.; et al. Cardiorespiratory fitness, and risk of heart failure with preserved ejection fraction. Eur. J. Heart Fail. 2024, 26, 1163–1171. https://doi.org/10.1002/ejhf.3117.
  24. Heidenreich, P.A.; Bozkurt, B.; Aguilar, D.; et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation 2022, 145, e895–e1032. https://doi.org/10.1161/CIR.0000000000001062.
  25. 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.
  26. Kokkinos, P.; Faselis, C.; Myers, J.; et al. Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: A cohort study. Lancet 2013, 381, 394–399.
  27. Myers, J.; Prakash, M.; Froelicher, V.; et al. Exercise capacity and mortality among men referred for exercise testing. N. Engl. J. Med. 2002, 346, 793–801.
  28. Kokkinos, P.; Faselis, C.; Samuel, I.B.H.; et al. Changes in Cardiorespiratory Fitness and Survival in Patients with or without Cardiovascular Disease. J. Am. Coll. Cardiol. 2023, 81, 1137–1147.
  29. Mandsager, K.; Harb, S.; Cremer, P.; et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Netw. Open 2018, 1, e183605.
  30. Kokkinos, P.; Faselis, C.; Samuel, I.B.H.; et al. Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex. J. Am. Coll. Cardiol. 2022, 80, 598–609.
  31. 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.
  32. Gulati, M.; Pandey, D.K.; Arnsdorf, M.F.; et al. Exercise capacity and the risk of death in women: The St James Women Take Heart Project. Circulation 2003, 108, 1554–1559.
  33. Kokkinos, P.; Faselis, C.; Myers, J.; et al. Age-Specific Exercise Capacity Threshold for Mortality Risk Assessment in Male Veterans. Circulation 2014, 130, 653–658.