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Role of Lifestyle and Aging on the Longitudinal Change in Cardiorespiratory Fitness
Open accessAbstract
BACKGROUND: Cardiorespiratory fitness (CRF) in adults decreases with age and is influenced by lifestyle. Low CRF is associated with risk of diseases and the ability of older persons to function independently. We defined the longitudinal rate of CRF decline with aging and the association of aging and lifestyle with CRF. METHODS: We studied a cohort of 3429 women and 16 889 men, aged 20 to 96 years, from the Aerobics Center Longitudinal Study who completed 2 to 33 health examinations from 1974 to 2006. The lifestyle variables were body mass index, self-reported aerobic exercise, and smoking behavior. Cardiorespiratory fitness was measured by a maximal Balke treadmill exercise test. RESULTS: Linear mixed models regression analysis stratified by sex showed that the decline in CRF with age was not linear. After 45 years of age, CRF declined at an accelerated rate. For each unit of increase in body mass index, the CRF of women declined 0.20 metabolic equivalents (METs) (95% confidence interval, -0.21 to -0.19); that of men, 0.32 METs (-0.33 to -0.20). Current smokers of both sexes also had lower CRF (-0.29 METs [95% confidence interval, -0.40 to -0.19] for women and -0.41 METS [-0.44 to -0.38] for men). Cardiorespiratory fitness was positively associated with self-reported physical activity. CONCLUSIONS: Cardiorespiratory fitness in men and women declines at a nonlinear rate that accelerates after 45 years of age. Maintaining a low BMI, being physically active, and not smoking are associated with higher CRF across the adult life span.
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“Based on longitudinal35 36 and cross sectional studies,37 we expected an age dependent decline in peak oxygen uptake of at least 3.5 mL/kg/min over the five year period.”
From Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial (2020) · cites this paper as [36]
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Criterion validity of the Ekblom-Bak and the Åstrand submaximal test in an elderly population
Väisänen, D., Ekblom, Ö. B., Ekblom‐Bak, E., Andersson, E. A., Nilsson, J., & Ekblom, M. (2019) · European Journal of Applied Physiology · doi:10.1007/s00421-019-04275-7 · Cited by 12
The impact of different step rate threshold methods on physical activity intensity in older adults
O'Brien, M. W., Petterson, J. L., Johns, J. A., Mekary, S., & Kimmerly, D. S. (2022) · Gait & Posture · doi:10.1016/j.gaitpost.2022.02.030 · Cited by 8
Vajda, M., Oreská, Ľ., Černáčková, A., Čupka, M., Tirpáková, V., Cvečka, J., Hamar, D., Protasi, F., Šarabon, N., Zampieri, S., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013184 · Cited by 8
“On the other hand, it has been shown that reaching and maintaining a high level of both physical fitness and activity during the life span could be an effective strategy to reduce the age-related decline in physiological functions [4].”
BackgroundIs the Veterans Specific Activity Questionnaire Valid to Assess Older Adults Aerobic Fitness?
Bastone, A. D. C., Moreira, B. D. S., Teixeira, C. P., Dias, J. M. D., & Dias, R. C. (2015) · Journal of Geriatric Physical Therapy · doi:10.1519/jpt.0000000000000062 · Cited by 8
Men, J., Yu, Z., An, W., Wang, P., Hou, X., Zhang, Y., Wu, S., Zhu, G., Wang, P., Cui, C., et al. (2025) · BMC Public Health · doi:10.1186/s12889-025-25254-y · Cited by 9
Fear of falling and associated factors in older adults with heart failure
Unes, M., Taşar, P. T., Karaşahin, Ö., Birdal, O., Sevinç, C., & Şahin, S. (2023) · Psychogeriatrics · doi:10.1111/psyg.13062 · Cited by 7
Nylén, E. (2024) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2507263 · Cited by 7
“However, aging overall impacts CRF in a non-linear fashion as shown in the Aerobics Center Longitudinal Study [17].”
BackgroundResultBarriers and facilitators to dog walking in New England
Schneider, K. L., Guggina, P., Murphy, D. A., Ferrara, C. M., Panza, E. A., Oleski, J. L., Bozzella, B., Gada, K., Savage, C. P., & Lemon, S. C. (2015) · Comparative Exercise Physiology · doi:10.3920/cep140020 · Cited by 7
“Participant age and gender were selected as covariates given that they are frequently associated with physical activity among humans (Jackson et al., 2009; Martin et al., 2000).”
BackgroundExercise Testing Reveals Everyday Physical Challenges of Bariatric Surgery Candidates
Creel, D. B., Schuh, L. M., Newton, R. L., Stote, J. J., & Cacucci, B. M. (2017) · Journal of Physical Activity and Health · doi:10.1123/jpah.2017-0128 · Cited by 7
Santana, E. J., Kim, D. S., Christle, J. W., Cauwenberghs, N., Celestin, B. E., Tso, J., Wheeler, M. T., Ashley, E. A., Peterman, J. E., Gardner, C. D., et al. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf045 · Cited by 6
Lauretani, F., Maggio, M. G., Pilotto, A., Ansaldo, M., Brusco, C. M., Carbonaro, M., Amendola, C., Nabacino, M., Testa, C., Ciuni, A., et al. (2025) · Journal of the American Geriatrics Society · doi:10.1111/jgs.70005 · Cited by 6
Cauwenberghs, N., Sente, J., Sabovčik, F., Ntalianis, E., Hedman, K., Claes, J., Goetschalckx, K., Cornelissen, V., & Kuznetsova, T. (2023) · Clinical Physiology and Functional Imaging · doi:10.1111/cpf.12842 · Cited by 6
“Furthermore, CRF decreases with ageing (Fleg et al., 2005; Myers et al., 2017; Zeiher et al., 2019), as mediated by physiological changes, such as muscle atrophy, changes in lifestyle, and increased disease burden and medication associated with ageing (Jackson et al., 2009; Zeiher et al., 2019).”
BackgroundSullivan, A., Parsons, S., Ploubidis, G. B., Green, F., & Wiggins, R. D. (2020) · British Journal of Sociology · doi:10.1111/1468-4446.12776 · Cited by 6
Grannell, A., Hallson, H., Gunlaugsson, B., & Jónsson, H. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1250979 · Cited by 8
Ageing in patients with chronic HIV infection: impact of hypercoagulation
Kent, S. J., & Flexner, C. W. (2018) · AIDS Research and Therapy · doi:10.1186/s12981-018-0211-1 · Cited by 6
Association of Dietary and Lifestyle Inflammation Score With Cardiorespiratory Fitness
Farazi, M., Jayedi, A., Noruzi, Z., Janbozorgi, N., Djafarian, K., & Shab‐Bidar, S. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.730841 · Cited by 6
Badrov, M. B., Keir, D. A., Notarius, C. F., O’Donnell, E., Millar, P. J., Kimmerly, D. S., Shoemaker, J. K., & Floras, J. S. (2022) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00450.2022 · Cited by 6
Bieleman, A., Stewart, R. E., Reneman, M. F., van Ittersum, W. M., van der Schans, C. P., Drossaers-Bakker, K. W., & Oosterveld, F. G. J. (2018) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-018-9809-3 · Cited by 6
Garcia, R. E., Cawthon, P. M., Nicklas, B. J., Goodpaster, B. H., Coen, P. M., Forman, D. E., Cummings, S. R., Newman, A. B., & Glynn, N. W. (2023) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18713 · Cited by 5
Manca, A., Ventura, L., Martinez, G., Morrone, M., Boi, A., Fiorito, G., Mercante, B., Cano, A., Catte, M. G., Cruciani, S., et al. (2024) · GeroScience · doi:10.1007/s11357-024-01125-z · Cited by 5
“It has been shown that those who preserve PF while aging are at lower risk for morbidity and tend to live longer [6] [7].”
BackgroundAhn, C., Tamburini, I. J., Sanford, J. A., Zhou, M., Gamie, F., Yeo, R. X., Filho, C., Pino, M., Whytock, K. L., Oberlin, L. E., et al. (2025) · Molecular Metabolism · doi:10.1016/j.molmet.2025.102213 · Cited by 5
“Declining muscle mass, strength, gait speed, cardiorespiratory fitness, and cognitive function are typical with age and can lead to disability and death [1 — 3].”
Gas Exchange Threshold in Male Speed–Power versus Endurance Athletes Ages 20–90 Years
Kusy, K., Król-Zielińska, M., Domaszewska, K., Kryściak, J., Podgórski, T., & Zieliński, J. (2012) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318267c36f · Cited by 5
Phongchin, W., Tingsabhat, S., Trongjitpituk, R., Reun-arom, T., Poon, E. T., & Wongpipit, W. (2025) · European Journal of Clinical Nutrition · doi:10.1038/s41430-025-01575-4 · Cited by 7
Aging, Fitness, and Marathon Times in a 91 Year-old Man Who Competed in 627 Marathons
Addison, O. R., Steinbrenner, G. M., Goldberg, A., & Katzel, L. I. (2015) · Journal of Advances in Medicine and Medical Research · doi:10.9734/bjmmr/2015/17946 · Cited by 5
“Factors underlying this age-associated reduction in VO2max may include decreased muscle mass [2], declines in skeletal muscle mitochondrial function [10], reduced cardiac output [11], and decreased physical activity [7].”
BackgroundMyette‐Côté, É., Archambault-Therrien, C., Brochu, M., Dionne, I. J., & Riesco, É. (2016) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000000677 · Cited by 5
ExerStart: helping seniors be active and independent for less
van Esch, P., Duffy, S. M., Teufel, J. A., Northey, G., Elder, E., Frethey‐Bentham, C., Cook, T. B., & Heller, J. (2019) · Journal of Social Marketing · doi:10.1108/jsocm-06-2018-0065 · Cited by 5
Assessing cardiorespiratory fitness relative to sex improves surgical risk stratification
Rose, G. A., Davies, R. G., Torkington, J., Berg, R. M. G., Appadurai, I. R., Poole, D. C., & Bailey, D. M. (2023) · European Journal of Clinical Investigation · doi:10.1111/eci.13981 · Cited by 5
Poffé, C., Koppo, K., Jaspers, A., Boen, F., Helsen, W. F., & Roie, E. V. (2023) · Journal of Sports Science and Medicine · doi:10.52082/jssm.2023.345 · Cited by 5
“More specifically, cardiovascular fitness declines with age at a nonlinear rate that accelerates after 45 years of age (Jackson et al., 2009).”
BackgroundEfecto de la actividad física en la condición física saludable del adulto mayor
Castro, N. A. B., Zamora, A. A. C., Castruita, R. M. C., & García, R. L. (2024) · Revista Iberoamericana de Ciencias de la Actividad Física y el Deporte · doi:10.24310/riccafd.13.1.2024.17859 · Cited by 5
Metadata
- Authors
- Jackson, A. S., Sui, X., Hébert, J. R., Church, T. S., & Blair, S. N.
- Affiliations
- University of Houston (US)
- Pennington Biomedical Research Center (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2009-10-26
- Volume
- 169
- Issue
- 19
- Pages
- 1781-7
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC3379873
- OpenAlex
- W2145173489
- Cited by
- 329
- References
- 37
- Citations by year
- 2026: 12 · 2025: 28 · 2024: 29 · 2023: 22 · 2022: 34 · 2021: 25 · 2020: 19 · 2019: 21 · 2018: 14 · 2017: 16 · 2016: 15 · 2015: 15 · 2014: 20 · 2013: 18 · 2012: 20
- FWCI
- 33.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Scholar Commons (University of South Carolina) (submittedVersion)
- Funders
- National Institute on Aging (R37AG006945, AG06945, R01AG006945)
- National Heart, Lung, and Blood Institute (HL62508, R01HL062508)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Performance
- Keywords
- cardiorespiratory fitness, aging, lifestyle factors, body mass index, physical activity, smoking, aerobic exercise, sex differences, Aerobics Center Longitudinal Study, treadmill exercise testing
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Aging, Exercise Test, Female, Humans, Life Style, Longitudinal Studies, Male, Middle Aged, Oxygen Consumption, Physical Fitness, Sex Factors, Smoking, Exercise, Body Mass Index, Linear Models
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