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
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 f...
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2025-12-01
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| author | 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-García Jonathan Myers Bethany Gower Francisco B. Ortega Justin J. Lang Grant R. Tomkinson |
| author_facet | 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-García Jonathan Myers Bethany Gower Francisco B. Ortega Justin J. Lang Grant R. Tomkinson |
| author_sort | Ben Singh |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-96393591090d4c89a9e1611e1af420e9 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-12-01 |
| publisher | Elsevier |
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| spelling | doaj-art-96393591090d4c89a9e1611e1af420e92025-01-26T05:03:43ZengElsevierJournal of Sport and Health Science2095-25462025-12-0114100986Comparison 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 observationsBen Singh0Cristina Cadenas-Sanchez1Bruno G.G. da Costa2José Castro-Piñero3Jean-Philippe Chaput4Magdalena Cuenca-García5Carol Maher6Nuria Marín-Jiménez7Ryan McGrath8Pablo Molina-García9Jonathan Myers10Bethany Gower11Francisco B. Ortega12Justin J. Lang13Grant R. Tomkinson14Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Corresponding author.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, SpainDepartment of Kinesiology and Physical Education, McGill University, Montreal, QC H2W 1S4, CanadaGALENO 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, SpainHealthy 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, CanadaGALENO 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, SpainAlliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, AustraliaDepartment 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, SpainAlliance 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, USADepartment 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, SpainDepartment of Cardiology, Stanford University, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USAAlliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, AustraliaDepartment 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, FinlandAlliance 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, CanadaAlliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, AustraliaBackground: 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.http://www.sciencedirect.com/science/article/pii/S209525462400142XCardiorespiratory fitnessCardiovascular diseasesCohort studiesRisk assessmentAdult |
| spellingShingle | 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-García Jonathan Myers Bethany Gower Francisco B. Ortega Justin J. Lang Grant R. Tomkinson 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 Journal of Sport and Health Science Cardiorespiratory fitness Cardiovascular diseases Cohort studies Risk assessment Adult |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Cardiorespiratory fitness Cardiovascular diseases Cohort studies Risk assessment Adult |
| url | http://www.sciencedirect.com/science/article/pii/S209525462400142X |
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