Correlates and Determinants of Cardiorespiratory Fitness in Adults: a Systematic Review

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Abstract

Background

Enhanced cardiorespiratory fitness (CRF) is now a well-established predictor of numerous adverse health outcomes. Knowledge about the pathways leading to enhanced CRF is essential for developing appropriate interventions. Hence, the aim of this review was to provide a detailed overview of the current state of research regarding individual factors associated with or influencing CRF among the general adult population.

Methods

We searched the PubMed, EMBASE, and Cochrane Library databases and also conducted a search for grey literature (Google Scholar). Eligible indicators of CRF were objectively assessed measures of CRF by submaximal or maximal exercise testing measured using treadmill or cycle ergometer tests. We included quantitative observational studies of the general adult population. Using a semi-quantitative approach, we compiled summary tables aggregating the study results for each potential correlate or determinant of CRF.

Results

We identified 3005 studies, 78 of which met the inclusion criteria. Almost all of these studies were conducted in high-income countries. Study quality scores assessing the risk of bias in the individual studies ranged from 40 to 100%. Male sex, age (inverse), education, socioeconomic status, ethnicity, body mass index (inverse), body weight (inverse), waist circumference, body fat (inverse), resting heart rate (inverse), C-reactive protein (inverse), smoking (inverse), alcohol consumption, and multiple measures of leisure-time physical activity were independently and consistently associated with CRF.

Conclusions

In synthesizing the current research on the correlates and determinants of CRF among adults, this systematic review identified gaps in the current understanding of factors influencing CRF. Beyond the scope of this review, environmental and interpersonal determinants should be further investigated.

Systematic Review Registration

PROSPERO, CRD42017055456.

Electronic supplementary material

The online version of this article (10.1186/s40798-019-0211-2) contains supplementary material, which is available to authorized users.

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Most cited references 130

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The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis.

Youfa Wang, May Beydoun (2007)

This review of the obesity epidemic provides a comprehensive description of the current situation, time trends, and disparities across gender, age, socioeconomic status, racial/ethnic groups, and geographic regions in the United States based on national data. The authors searched studies published between 1990 and 2006. Adult overweight and obesity were defined by using body mass index (weight (kg)/height (m)(2)) cutpoints of 25 and 30, respectively; childhood "at risk for overweight" and overweight were defined as the 85th and 95th percentiles of body mass index. Average annual increase in and future projections for prevalence were estimated by using linear regression models. Among adults, obesity prevalence increased from 13% to 32% between the 1960s and 2004. Currently, 66% of adults are overweight or obese; 16% of children and adolescents are overweight and 34% are at risk of overweight. Minority and low-socioeconomic-status groups are disproportionately affected at all ages. Annual increases in prevalence ranged from 0.3 to 0.9 percentage points across groups. By 2015, 75% of adults will be overweight or obese, and 41% will be obese. In conclusion, obesity has increased at an alarming rate in the United States over the past three decades. The associations of obesity with gender, age, ethnicity, and socioeconomic status are complex and dynamic. Related population-based programs and policies are needed.

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Physical fitness in childhood and adolescence: a powerful marker of health.

F. Ortega, J. Ruiz, M. J. Castillo … (2008)

This review aims to summarize the latest developments with regard to physical fitness and several health outcomes in young people. The literature reviewed suggests that (1) cardiorespiratory fitness levels are associated with total and abdominal adiposity; (2) both cardiorespiratory and muscular fitness are shown to be associated with established and emerging cardiovascular disease risk factors; (3) improvements in muscular fitness and speed/agility, rather than cardiorespiratory fitness, seem to have a positive effect on skeletal health; (4) both cardiorespiratory and muscular fitness enhancements are recommended in pediatric cancer patients/survivors in order to attenuate fatigue and improve their quality of life; and (5) improvements in cardiorespiratory fitness have positive effects on depression, anxiety, mood status and self-esteem, and seem also to be associated with a higher academic performance. In conclusion, health promotion policies and physical activity programs should be designed to improve cardiorespiratory fitness, but also two other physical fitness components such us muscular fitness and speed/agility. Schools may play an important role by identifying children with low physical fitness and by promoting positive health behaviors such as encouraging children to be active, with special emphasis on the intensity of the activity.

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Physical fitness and all-cause mortality. A prospective study of healthy men and women.

S N Blair, H W Kohl, R S Paffenbarger … (1989)

We studied physical fitness and risk of all-cause and cause-specific mortality in 10,224 men and 3120 women who were given a preventive medical examination. Physical fitness was measured by a maximal treadmill exercise test. Average follow-up was slightly more than 8 years, for a total of 110,482 person-years of observation. There were 240 deaths in men and 43 deaths in women. Age-adjusted all-cause mortality rates declined across physical fitness quintiles from 64.0 per 10,000 person-years in the least-fit men to 18.6 per 10,000 person-years in the most-fit men (slope, -4.5). Corresponding values for women were 39.5 per 10,000 person-years to 8.5 per 10,000 person-years (slope, -5.5). These trends remained after statistical adjustment for age, smoking habit, cholesterol level, systolic blood pressure, fasting blood glucose level, parental history of coronary heart disease, and follow-up interval. Lower mortality rates in higher fitness categories also were seen for cardiovascular disease and cancer of combined sites. Attributable risk estimates for all-cause mortality indicated that low physical fitness was an important risk factor in both men and women. Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer.

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Author and article information

Contributors

Johannes Zeiher:

ORCID: http://orcid.org/0000-0003-1992-1777

0049 30 18754 3775 , zeiherj@rki.de

Katherine J. Ombrellaro: ombrellarok@rki.de

Nita Perumal: perumaln@rki.de

Thomas Keil: thomas.keil@charite.de

Gert B. M. Mensink: mensinkg@rki.de

Jonas D. Finger: fingerj@rki.de

Journal

Journal ID (nlm-ta): Sports Med Open

Journal ID (iso-abbrev): Sports Med Open

Title: Sports Medicine - Open

Publisher: Springer International Publishing (Cham )

ISSN (Print): 2199-1170

ISSN (Electronic): 2198-9761

Publication date (Electronic): 3 September 2019

Publication date PMC-release: 3 September 2019

Publication date Collection: December 2019

Volume: 5

Electronic Location Identifier: 39

Affiliations

[1 ]ISNI 0000 0001 0940 3744, GRID grid.13652.33, Department of Epidemiology and Health Monitoring, Robert Koch Institute, ; General-Pape-Straße 62-66, 12101 Berlin, Germany

[2 ]ISNI 0000 0001 0940 3744, GRID grid.13652.33, Department of Infectious Disease Epidemiology, Robert Koch Institute, ; Berlin, Germany

[3 ]ISNI 0000 0001 1958 8658, GRID grid.8379.5, Institute for Clinical Epidemiology and Biometry, , University of Würzburg, ; Würzburg, Germany

[4 ]Institute for Health Resort Medicine and Health Promotion, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany

[5 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Institute for Social Medicine, Epidemiology and Health Economics, , Charité - Universitätsmedizin Berlin, ; Berlin, Germany

Author information

Johannes Zeiher http://orcid.org/0000-0003-1992-1777

Article

Publisher ID: 211

DOI: 10.1186/s40798-019-0211-2

PMC ID: 6722171

PubMed ID: 31482208

SO-VID: 1ad83f6b-fc4e-4589-afb1-1fdb25a58cf7

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 24 April 2019

Date accepted : 5 August 2019

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Keywords: cardiorespiratory fitness,aerobic fitness,risk factors,individual factors,vo2max,health behavior,systematic review

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Keywords: cardiorespiratory fitness, aerobic fitness, risk factors, individual factors, vo2max, health behavior, systematic review

Correlates and Determinants of Cardiorespiratory Fitness in Adults: a Systematic Review

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Conclusions

Systematic Review Registration

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Annual Reviews Child Development

Most cited references 130

The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis.

Physical fitness in childhood and adolescence: a powerful marker of health.

Physical fitness and all-cause mortality. A prospective study of healthy men and women.

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