A2 Review article, Literature review, Systematic review
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 (2025)
Singh, B., Cadenas-Sanchez, C., da Costa, B. G., Castro-Piñero, J., Chaput, J.-P., Cuenca-García, M., Maher, C., Marín-Jiménez, N., McGrath, R., Molina-Garcí, P., Myers, J., Gower, B., Ortega, F. B., Lang, J. J., & Tomkinson, G. R. (2025). 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, 14, Article 100986. https://doi.org/10.1016/j.jshs.2024.100986
JYU authors or editors
Publication details
All authors or editors: Singh, Ben; Cadenas-Sanchez, Cristina; da Costa, Bruno G.G.; Castro-Piñero, José; Chaput, Jean-Philippe; Cuenca-García, Magdalena; Maher, Carol; Marín-Jiménez, Nuria; McGrath, Ryan; Molina-Garcí, Pablo; et al.
Journal or series: Journal of Sport and Health Science
ISSN: 2095-2546
eISSN: 2213-2961
Publication year: 2025
Publication date: 11/09/2024
Volume: 14
Article number: 100986
Publisher: Elsevier
Publication country: Netherlands
Publication language: English
DOI: https://doi.org/10.1016/j.jshs.2024.100986
Publication open access: Openly available
Publication channel open access: Open Access channel
Publication is parallel published (JYX): https://jyx.jyu.fi/handle/123456789/99975
Abstract
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.
Keywords: adults; physical fitness; aerobic capacity; cardiovascular diseases; mortality; risk assessment; cohort study
Free keywords: adult; cardiorespiratory fitness; cardiovascular diseases; cohort studies; risk assessment.
Contributing organizations
Ministry reporting: Yes
VIRTA submission year: 2024
Preliminary JUFO rating: 1
