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Cardio fitness is a strong, consistent predictor of morbidity and mortality

Objective To examine and summarise evidence from meta-analyses of cohort studies that evaluated the predictive associations between baseline cardiorespiratory fitness (CRF) and health outcomes among adults. Design Overview of systematic reviews. Data source Five bibliographic databases were searched from January 2002 to March 2024. Results From the 9062 papers identified, we included 26 systematic reviews. We found eight meta-analyses that described five unique mortality outcomes among general populations. CRF had the largest risk reduction for all-cause mortality when comparing high versus low CRF (HR=0.47; 95% CI 0.39 to 0.56). A dose–response relationship for every 1-metabolic equivalent of task (MET) higher level of CRF was associated with a 11%–17% reduction in all-cause mortality (HR=0.89; 95% CI 0.86 to 0.92, and HR=0.83; 95% CI 0.78 to 0.88). For incident outcomes, nine meta-analyses described 12 unique outcomes. CRF was associated with the largest risk reduction in incident heart failure when comparing high versus low CRF (HR=0.31; 95% CI 0.19 to 0.49). A dose–response relationship for every 1-MET higher level of CRF was associated with a 18% reduction in heart failure (HR=0.82; 95% CI 0.79 to 0.84). Among those living with chronic conditions, nine meta-analyses described four unique outcomes in nine patient groups. CRF was associated with the largest risk reduction for cardiovascular mortality among those living with cardiovascular disease when comparing high versus low CRF (HR=0.27; 95% CI 0.16 to 0.48). The certainty of the evidence across all studies ranged from very low-to-moderate according to Grading of Recommendations, Assessment, Development and Evaluations. Conclusion We found consistent evidence that high CRF is strongly associated with lower risk for a variety of mortality and incident chronic conditions in general and clinical populations. Data are available on reasonable request.

The certainty of the evidence for mortality in those living with a chronic condition was rated as very low-to-low largely due to risk of bias, indirectness and imprecision (ie, low-quality studies, mainly male participants and small sample sizes). In those with low CRF (defined based on age, sex and health status), large relative improvements can be attained through additional moderate physical activity (ie, brisk walking at a heart rate of 50% of peakO 2). In addition to the need for higher-quality studies with greater samples in more diverse populations including females, we did not identify any systematic reviews that explored the association between CRF and breast cancer 48 or mental health outcomes beyond incident depression and dementia, as an example.

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