An Update on the Role of Cardiorespiratory Fitness, Structured Exercise and Lifestyle Physical Activity in Preventing Cardiovascular Disease and Health Risk☆
Introduction
Cardiorespiratory fitness (CRF) is now viewed as an important vital sign, providing valuable insight into health and prognosis.1., 2., 3., 4. Participating in structured exercise and lifestyle physical activity (PA) have long been held as behaviors that may protect against the development of cardiovascular (CV) diseases (CVD) or prevent recurrent CVD related events independent of an individual's age, sex, and race. The collective investigative efforts, starting with the seminal works by Morris et al.5 and Paffenbarger et al.,6,7 have produced high quality epidemiological, randomized controlled, and observational investigations that refined our understanding of the minimal and potentially upper limits of PA volume required to reduce CVD risk. All forms of PA, whether structured or unstructured, promote enhancing physical and physiologic function, and CRF, and ultimately protect against CVD and CVD related events. This review provides an update on the latest results from investigations reporting on the effects of CRF, structured exercise and PA volume on the risk of developing CVD and suffering untoward events across the health spectrum.
Section snippets
Cardiorespiratory fitness
The measure of an individual's peak/maximal capacity to perform physical, aerobic work is dependent on the synergistic working of key organ systems that deliver oxygen from the ambient air to the mitochondria, while effectively removing metabolic byproducts that when accumulated, impair efforts to sustain or increase intensity. This process is a primary reflection of an individual's CRF, which can be objectively assessed by quantifying the volume of oxygen consumed per minute (i.e., VO2) or
Exercise training (ET)
Regular, purposeful aerobic and/or strength ET confers multi-systemic adaptations that optimize physiologic function, CRF, and expands the life- and healthspan.39 The accumulation of health benefits associated with ET contributes to reducing the presence of CVD risk factors and CVD itself. Recently, several studies have provided insight into the long-term effects of ET. An examination of lifelong exercise participation according to quintiles (Q) of exercise dose (Q1: ≤491, Q2: 492–771, Q3:
Summary
The latest studies reporting on the associations between CRF, structured ET and leisure PA with risk for CVD and poor health outcomes, discussed in this review, confirm and extend previous findings by providing greater insight into the effects of long-term maintenance of CRF, exercise training and PA on CVD outcomes in large scale studies. Despite the robust associations between these measures and reduced risk of CVD, physical inactivity and associated healthcare costs remains high. Promising
Statement of Conflict of Interest
None of the authors have any conflicts of interests with regard to this publication.
References (105)
- et al.
Impact of changes in cardiorespiratory fitness on hypertension, dyslipidemia and survival: an overview of the epidemiological evidence
Prog Cardiovasc Dis
(2017) - et al.
Global fitness levels: findings from a web-based surveillance report
Prog Cardiovasc Dis
(2017) - et al.
Reference equation for Normal standards for VO2 max: analysis from the Fitness Registry and the Importance of Exercise National Database (FRIEND Registry)
Prog Cardiovasc Dis
(2017) - et al.
Coronary heart-disease and physical activity of work
Lancet
(1953) - et al.
Prediction of cardiovascular mortality by estimated cardiorespiratory fitness independent of traditional risk factors: the HUNT study
Mayo Clin Proc
(2017) - et al.
Cardiorespiratory fitness and risk of sudden cardiac death in men and women in the United States: a prospective evaluation from the Aerobics Center Longitudinal Study
Mayo Clin Proc
(2016) - et al.
Cardiorespiratory fitness versus physical activity as predictors of all-cause mortality in men
Am Heart J
(2018) - et al.
Cardiovascular fitness and mortality after contemporary cardiac rehabilitation
Mayo Clin Proc
(2013) - et al.
Cardiorespiratory fitness and incidence of major adverse cardiovascular events in US veterans: a cohort study
Mayo Clin Proc
(2017) - et al.
Cardiorespiratory fitness and exercise training in African Americans
Prog Cardiovasc Dis
(2017)
Taking physical activity, exercise, and fitness to a higher level
Prog Cardiovasc Dis
Impact of cardiorespiratory fitness on all-cause and disease-specific mortality: advances since 2009
Prog Cardiovasc Dis
Cardiorespiratory fitness and health outcomes: a call to standardize fitness categories
Mayo Clin Proc
Reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing: data from the Fitness Registry and the Importance of Exercise National Database
Mayo Clin Proc
Nomogram based on metabolic equivalents and age for assessing aerobic exercise capacity in men
J Am Coll Cardiol
Association between cardiorespiratory fitness and health care costs: the veterans exercise testing study
Mayo Clin Proc
Survival of the fittest-promoting fitness throughout the life span
Mayo Clin Proc
Cardiorespiratory fitness cutoff points for early detection of present and future cardiovascular risk in children: a 2-year follow-up study
Mayo Clin Proc
Moderate to high levels of cardiorespiratory fitness attenuate the effects of triglyceride to high-density lipoprotein cholesterol ratio on coronary heart disease mortality in men
Mayo Clin Proc
The interaction of cardiorespiratory fitness with obesity and the obesity paradox in cardiovascular disease
Prog Cardiovasc Dis
Obesity, body composition and cardiorespiratory fitness in heart failure with preserved ejection fraction
Future Cardiol
Combined association of cardiorespiratory fitness and body fatness with cardiometabolic risk factors in older Norwegian adults: the generation 100 study
Mayo Clin Proc Innov Qual Outcomes
Cardiopulmonary exercise testing is equally prognostic in young, middle-aged and older individuals diagnosed with heart failure
Int J Cardiol
A neural network approach to predicting outcomes in heart failure using cardiopulmonary exercise testing
Int J Cardiol
Using machine learning to define the association between cardiorespiratory fitness and all-cause mortality (from the Henry Ford Exercise Testing project)
Am J Cardiol
Healthy living: the universal and timeless medicine for Healthspan
Prog Cardiovasc Dis
Lifelong exercise patterns and cardiovascular health
Mayo Clin Proc
Physical activity in U.S.: adults compliance with the physical activity guidelines for Americans
Am J Prev Med
Epidemiology of physical activity and exercise training in the United States
Prog Cardiovasc Dis
Let us talk about moving: reframing the exercise and physical activity discussion
Curr Probl Cardiol
MicroRNAs as important regulators of exercise adaptation
Prog Cardiovasc Dis
Impact of lifelong exercise “dose” on left ventricular compliance and distensibility
J Am Coll Cardiol
The combined association of skeletal muscle strength and physical activity on mortality in older women: the HUNT2 study
Mayo Clin Proc
Association of resistance exercise, independent of and combined with aerobic exercise, with the incidence of metabolic syndrome
Mayo Clin Proc
Cardiac rehabilitation and healthy life-style interventions: rectifying program deficiencies to improve patient outcomes
J Am Coll Cardiol
Impact of cardiac rehabilitation and exercise training programs in coronary heart disease
Prog Cardiovasc Dis
Exercise training for prevention and treatment of heart failure
Prog Cardiovasc Dis
Association between early cardiac rehabilitation and long-term survival in cardiac transplant recipients
Mayo Clin Proc
Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the million hearts cardiac rehabilitation collaborative
Mayo Clin Proc
Enhancing participation in cardiac rehabilitation: a question of proximity and integration of outpatient services
Curr Probl Cardiol
Assessing the value of moving more-the integral role of qualified health professionals
Curr Probl Cardiol
Public park spaces as a platform to promote healthy living: introducing a HealthPark concept
Prog Cardiovasc Dis
The importance of vigorous-intensity leisure-time physical activity in reducing cardiovascular disease mortality risk in the obese
Mayo Clin Proc
Personal Activity Intelligence (PAI), sedentary behavior and cardiovascular risk factor clustering - the HUNT study
Prog Cardiovasc Dis
Personal activity intelligence and mortality in patients with cardiovascular disease: the HUNT study
Mayo Clin Proc
Personalized activity intelligence (PAI) for prevention of cardiovascular disease and promotion of physical activity
Am J Med
Running as a key lifestyle medicine for longevity
Prog Cardiovasc Dis
High intensity interval training for maximizing health outcomes
Prog Cardiovasc Dis
Running and mortality: is more actually worse?
Mayo Clin Proc
Potential adverse cardiovascular effects from excessive endurance exercise
Mayo Clin Proc
Cited by (144)
Using cardiorespiratory fitness assessment to identify pathophysiology in long COVID – Best practice approaches
2024, Progress in Cardiovascular DiseasesTracking of Cardiorespiratory Fitness from Childhood to Mid-adulthood
2024, Journal of PediatricsThe Impact of COVID-19 on the Social Determinants of Cardiovascular Health
2023, Canadian Journal of CardiologyDevelopment of a tool for quantifying need-supportive coaching in technology-mediated exercise classes
2023, Psychology of Sport and ExerciseLow aerobic capacity in McArdle disease: A role for mitochondrial network impairment?
2022, Molecular Metabolism
- ☆
Statement of Conflict of Interest: see page 488.