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Ross R, Arena R, Myers J, Kokkinos P, Kaminsky LA. Update to the 2016 American Heart Association cardiorespiratory fitness statement. Prog Cardiovasc Dis 2024; 83:10-15. [PMID: 38387825 DOI: 10.1016/j.pcad.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024]
Abstract
In 2016 the American Heart Association published a scientific statement that summarized a large body of evidence concluding that cardiorespiratory fitness (CRF) was a powerful marker of cardiovascular disease (CVD) and CVD-mortality risk; its association with morbidity and mortality was independent of commonly obtained risk factors, and consequently, that it should be a routine measure in all health care settings. Since 2016 the interest in CRF as a prognostic for human health and performance has increased exponentially. This review will summarize a growing body of evidence that reinforces the notion that the assessment of CRF improves patient/client management. Feasible means of CRF assessment in health care settings is considered, and the expected response of CRF to exercise consistent with consensus recommendations is reviewed. The association between CRF and health care costs is also explored. The evidence reviewed will reinforce the conclusions drawn in 2016; that overwhelming evidence demands that CRF should be a routine assessment in all health care settings - a vital sign.
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Affiliation(s)
- Robert Ross
- School of Kinesiology and Health Studies, School of Medicine, Division of Endocrinology and Metabolism, Queen's University, Kingston, Ontario, Canada.
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Jonathan Myers
- Veterans Administration Palo Alto Health Care System and Stanford University, Palo Alto, CA, USA
| | - Peter Kokkinos
- Veterans Affairs Medical Center, Cardiology, Washington, DC, USA; Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Leonard A Kaminsky
- Clinical Exercise Physiology, College of Health, Ball State University, Muncie, IN, USA
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Liu Y, Zhu J, Yu J, Zhang X. Cardiorespiratory fitness and metabolic risk in Chinese population: evidence from a prospective cohort study. BMC Public Health 2024; 24:522. [PMID: 38378502 PMCID: PMC10877742 DOI: 10.1186/s12889-024-17742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Studies on the association between estimated cardiorespiratory fitness (CRF) and changes in metabolic risk in the Chinese population are limited. This study aims to examine the associations between CRF and changes in metabolic risk. SUBJECTS AND METHODS We included 4,862 and 2,700 participants recruited from 28 provinces in the China Health and Retirement Longitudinal Study (CHARLS) in the baseline (Wave 1) and follow-up (Wave 4) analyses, respectively. CRF was calculated using sex-specific longitudinal non-exercise equations. Metabolic indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose (FPG) levels. The metabolic score was calculated as the number of changes in the above metabolic indicators above the 75th percentile of the distribution of changes (equal to or below the 25th percentile for HDL-C). RESULTS In the baseline analysis, CRF was negatively associated with SBP, DBP, TG, and FPG, and positively correlated with HDL-C after adjusting for age, smoking status, and drinking status (all P < 0.0001) in both males and females. In the follow-up analysis, higher baseline CRF was significantly related to a decrease in SBP, DBP, TG, FPG, and metabolic score (all P < 0.0005), and increased HDL-C (P < 0.0001) after further adjustment for corresponding baseline metabolic indicators. The associations remained significant after stratification by sex, except for the changes in HDL-C levels in females. Furthermore, improved CRF was associated with favorable changes in DBP, TG, HDL-C, FPG, and metabolic scores in all populations and males. Significant associations between changes in CRF and DBP, TG, and FPG levels were found in females. CONCLUSION Higher baseline CRF and improved CRF were associated with favorable changes in metabolic indicators.
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Affiliation(s)
- Yuanjiao Liu
- Department of Epidemiology & Biostatistics, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinghan Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiazhou Yu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Xuhui Zhang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
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Liu Y, Zhu J, Guo Z, Yu J, Zhang X, Ge H, Zhu Y. Estimated cardiorespiratory fitness and incident risk of cardiovascular disease in China. BMC Public Health 2023; 23:2338. [PMID: 38001416 PMCID: PMC10675970 DOI: 10.1186/s12889-023-16864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/29/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Limited evidence is available on the association between estimated cardiorespiratory fitness (e-CRF) and incidence of cardiovascular disease (CVD) in Chinese population. METHODS A total of 10,507 adults including 5084 men (48.4%) and 5423 (51.6%) women with a median age of 56.0 (25% quantile: 49, 75% quantile 63) years from the China Health and Retirement Longitudinal Study (CHARLS) was recruited in 2011 as baseline. The CVD incident events were followed-up until 2018. e-CRF was calculated from sex-specific longitudinal non-exercise equations and further grouped into quartiles. Cox proportional models were used to calculate hazard ratio (HR) and 95% confidence interval (CI) for incidence risks of CVD, heart disease and stroke. RESULTS During a median follow-up of 7 years, a total of 1862 CVD, 1409 heart disease and 612 stroke events occurred. In fully adjusted models, each one MET increment of e-CRF was associated with lower risk of CVD (HR = 0.91, 95%CI = 0.85-0.96 for males, HR = 0.87, 95%CI = 0.81-0.94 for females). Compared with the Quartile (Q)1 group, the HRs (95%CI) of the Q2, Q3 and Q4 groups were 0.84 (0.63-1.03), 0.72 (0.57-0.91) and 0.66 (0.51-0.87) for CVD in males. Females had HRs of 0.79 (0.66-0.96) in Q2, 0.71 (0.57-0.88) in Q3 and 0.58 (0.45-0.75) in Q4 for CVD. The associations between e-CRF and heart disease and stroke were slightly weaker than that for CVD in both males and females. CONCLUSIONS Higher e-CRF decreases the incident risk of CVD, heart disease and stroke.
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Affiliation(s)
- Yuanjiao Liu
- Department of Epidemiology & Biostatistics, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinghan Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Ziye Guo
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiazhou Yu
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | - Xuhui Zhang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China.
| | - Huiqing Ge
- Department of Respiratory Care of Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- Cancer Center, Zhejiang University, Zhejiang, China.
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Wu S, Li G, Shi B, Ge H, He Q. The association between physical activity and fear of falling among community-dwelling older women in China: the mediating role of physical fitness. Front Public Health 2023; 11:1241668. [PMID: 37645705 PMCID: PMC10461811 DOI: 10.3389/fpubh.2023.1241668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
Background This study aimed to explore the association between physical activity (PA) and fear of falling (FOF) and to determine whether this relationship was mediated by physical fitness (PF) in community-dwelling older women. Methods For this cross-sectional study, a total of 1,108 older women were recruited. Moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) were objectively measured by accelerometers. Physical fitness indicators including body mass index (BMI), forced vital capacity, choice reaction time, grip strength, sit and reach, and five times sit-to-stand were measured. FOF was evaluated by the Chinese version of the activities-specific balance confidence scale. A stepwise linear regression model analysis was used for mediation analysis, and bootstrap analysis was used to verify the mediation effects. Result The Pearson correlation coefficient results suggested that MVPA was significantly and negatively correlated with FOF while LPA was not correlated with FOF. Logistic regression analysis suggested a significant association between MVPA, BMI, forced vital capacity, choice reaction time, sit and reach, grip strength, five times sit-to-stand, and FOF. The mediation analysis showed a negative relationship between MVPA and FOF. BMI completely mediated the relationship between MVPA and FOF while sit and reach, five times sit-to-stand, and forced vital capacity partially mediated the relationship between MVPA and FOF. Conclusion Accumulation of more daily MVPA was associated with reducing the odds of FOF in community-dwelling older women. PF indicators fully or partially mediate the relationship between MVPA and FOF. Therefore, more intervention efforts should focus on the promotion of MVPA to improve PF and thus reduce FOF among older women.
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Affiliation(s)
| | | | | | | | - Qiang He
- School of Physical Education, Shandong University, Jinan, China
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Caamaño-Navarrete F, Jerez-Mayorga D, Alvarez C, Del-Cuerpo I, Cresp-Barría M, Delgado-Floody P. Muscle Quality Index in Morbidly Obesity Patients Related to Metabolic Syndrome Markers and Cardiorespiratory Fitness. Nutrients 2023; 15:nu15112458. [PMID: 37299421 DOI: 10.3390/nu15112458] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Muscle quality index (MQI) is an emerging health indicator obtained by dividing handgrip strength by body mass index (BMI) that needs to be studied in morbidly obese patients (defined by BMI ≥ 35 kg/m2). OBJECTIVE To determine the association between MQI, metabolic syndrome (MetS) markers, and cardiorespiratory fitness (CRF), and as a second objective to determine the potential mediation role of MQI in the relationship between abdominal obesity and systolic blood pressure (SBP) in this sample. METHODS This cross-sectional study included 86 severely/morbidly obese patients (age = 41.1 ± 11.9 y, nine men). MQI, metabolic syndrome markers, CRF, and anthropometric parameters were measured. Two groups were developed according to MQI; High-MQI (n = 41) and Low-MQI (n = 45). RESULTS The Low-MQI group reported higher abdominal obesity (High-MQI: 0.7 ± 0.1 vs. Low-MQI: 0.8 ± 0.1 WC/height; p = 0.011), SBP (High-MQI: 133.0 ± 17.5 vs. Low-MQI: 140.1 ± 15.1 mmHg; p = 0.048), and lower CRF (High-MQI; 26.3 ± 5.9 vs. Low-MQI; 22.4 ± 6.1 mL/kg/min, p = 0.003) than the High-MQI group. Waist-to-height ratio (β: -0.07, p = 0.011), SBP (β: -18.47, p = 0.001), and CRF (β: 5.21, p = 0.011) were linked to MQI. In a mediation model, the indirect effect confirms that MQI is a partial mediator of the association between abdominal obesity with SBP. CONCLUSIONS MQI in morbidly obesity patients reported an inverse association with MetS markers and a positive association with CRF (VO2max). It mediates the relationship between abdominal obesity and SBP.
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Affiliation(s)
| | - Daniel Jerez-Mayorga
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
- Strength & Conditioning Laboratory, CTS-642 Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
| | - Cristian Alvarez
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
| | - Indya Del-Cuerpo
- Strength & Conditioning Laboratory, CTS-642 Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
| | - Mauricio Cresp-Barría
- Departamento de Educación e Innovación, Facultad de Educación, Universidad Católica de Temuco, Temuco 4780000, Chile
| | - Pedro Delgado-Floody
- Department of Physical Education, Sport and Recreation, Universidad de La Frontera, Temuco 4811230, Chile
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
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Sun XY, Ma RL, He J, Ding YS, Rui DS, Li Y, Yan YZ, Mao YD, Liao SY, He X, Guo SX, Guo H. Updating Framingham CVD risk score using waist circumference and estimated cardiopulmonary function: a cohort study based on a southern Xinjiang population. BMC Public Health 2022; 22:1715. [PMID: 36085029 PMCID: PMC9463829 DOI: 10.1186/s12889-022-14110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To explore the association between waist circumference (WC), estimated cardiopulmonary function (eCRF), and cardiovascular disease (CVD) risk in southern Xinjiang. Update the Framingham model to make it more suitable for the southern Xinjiang population. Methods Data were collected from 7705 subjects aged 30–74 years old in Tumushuke City, the 51st Regiment of Xinjiang Production and Construction Corps. CVD was defined as an individual's first diagnosis of non-fatal acute myocardial infarction, death from coronary heart disease, and fatal or non-fatal stroke. The Cox proportional hazards regression analysis was used to analyze the association between WC, eCRF and CVD risk. Restricted cubic spline plots were drawn to describe the association of the two indicators with CVD risk. We update the model by incorporating the new variables into the Framingham model and re-estimating the coefficients. The discrimination of the model is evaluated using AUC, NRI, and IDI metrics. Model calibration is evaluated using pseudo R2 values. Results WC was an independent risk factor for CVD (multivariate HR: 1.603 (1.323, 1.942)), eCRF was an independent protective factor for CVD (multivariate HR: 0.499 (0.369, 0.674)). There was a nonlinear relationship between WC and CVD risk (nonlinear χ2 = 12.43, P = 0.002). There was a linear association between eCRF and CVD risk (non-linear χ2 = 0.27, P = 0.6027). In the male, the best risk prediction effect was obtained when WC and eCRF were added to the model (AUC = 0.763((0.734,0.792)); pseudo R2 = 0.069). In the female, the best risk prediction effect was obtained by adding eCRF to the model (AUC = 0.757 (0.734,0.779); pseudo R2 = 0.107). Conclusion In southern Xinjiang, WC is an independent risk factor for CVD. eCRF is an independent protective factor for CVD. We recommended adding WC and eCRF in the male model and only eCRF in the female model for better risk prediction. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14110-y.
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