Changes in Fitness and Fatness on the Development of Cardiovascular Disease Risk Factors
Open accessAbstract
Objectives This study sought examine the independent and combined associations of changes in fitness and fatness with the subsequent incidence of the cardiovascular disease (CVD) risk factors of hypertension, metabolic syndrome, and hypercholesterolemia.Background The relative and combined contributions of fitness and fatness to health are controversial, and few studies are available on the associations of changes in fitness and fatness with the development of CVD risk factors.Methods We followed up 3,148 healthy adults who received at least 3 medical examinations. Fitness was determined by using a maximal treadmill test. Fatness was expressed by percent body fat and body mass index. Changes in fitness and fatness between the first and second examinations were categorized into loss, stable, or gain groups.Results During the 6-year follow-up after the second examination, 752, 426, and 597 adults developed hypertension, metabolic syndrome, and hypercholesterolemia, respectively. Maintaining or improving fitness was associated with lower risk of developing each outcome, whereas increasing fatness was associated with higher risk of developing each outcome, after adjusting for possible confounders and fatness or fitness for each other (all p for trend <0.05). In the joint analyses, the increased risks associated with fat gain appeared to be attenuated, although not completely eliminated, when fitness was maintained or improved. In addition, the increased risks associated with fitness loss were also somewhat attenuated when fatness was reduced.Conclusions Both maintaining or improving fitness and preventing fat gain are important to reduce the risk of developing CVD risk factors in healthy adults.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Every −1% body fat reduction is associated with −3%, −4%, and −8% lower risks of developing CVD risk factors of hypertension, hypercholesterolaemia, and metabolic syndrome, respectively, in the authors' early study.
“every −1% body fat reduction is associated with −3%, −4%, and −8% lower risks of developing CVD risk factors of hypertension, hypercholesterolaemia, and metabolic syndrome, respectively, in our early study.42”
From Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial (2024) · cites this paper as [42]
The Results report that each unit increase in percent body fat was associated with 4%, 5%, and 10% higher risks of hypertension, hypercholesterolemia, and metabolic syndrome, respectively. This supports the direction of the claimed association, but the paper does not report the stated 3%, 4%, and 8% risk reductions for a one-unit decrease; reversing an increase does not yield the same percentages. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
(2014) · Medical Entomology and Zoology · Cited by 9,400 · see citing works
Prevalence and Trends in Obesity Among US Adults, 1999-2008
Flegal, K. M. (2010) · JAMA · doi:10.1001/jama.2009.2014 · Cited by 7,580 · see citing works
Heart Disease and Stroke Statistics—2011 Update: A Report From the American Heart Association
Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Adams, R. J., Berry, J. D., Brown, T. M., Carnethon, M. R., Dai, S., de Simone, G., Ford, E. S., et al. (2011) · Circulation · doi:10.1161/cir.0b013e3182009701 · Cited by 6,149 · see citing works
Grundy, S. M., Brewer, H. B., Cleeman, J. I., Smith, S. C., & Lenfant, C. (2004) · Circulation · doi:10.1161/01.cir.0000111245.75752.c6 · Cited by 5,982 · see citing works
American College of Sports Medicine position stand
Otis, C. L. (1997) · Medical Entomology and Zoology · Cited by 4,407 · see citing works
Abdominal obesity and metabolic syndrome
Després, J.-P., & Lemieux, I. (2006) · Nature · doi:10.1038/nature05488 · Cited by 4,354 · see citing works
Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., Jones, D. W., Kurtz, T., Sheps, S. G., & Roccella, E. J. (2005) · Circulation · doi:10.1161/01.cir.0000154900.76284.f6 · Cited by 3,985 · see citing works
Generalized equations for predicting body density of men
Jackson, A. S., & Pollock, M. L. (1978) · British Journal Of Nutrition · doi:10.1079/bjn19780152 · Cited by 3,205 · see citing works
Self-citationKodama, S. (2009) · JAMA · doi:10.1001/jama.2009.681 · Cited by 3,035 · see citing works
Obesity and Cardiovascular Disease
Lavie, C. J., Milani, R. V., & Ventura, H. O. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.12.068 · Cited by 2,326 · see citing works
Self-citationBody-mass index and mortality among 1.46 million white adults
Berrington de Gonzalez, A., Hartge, P., Cerhan, J. R., Flint, A. J., Hannan, L., MacInnis, R. J., Moore, S. C., Tobias, G. S., Anton-Culver, H., Freeman, L. B., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1000367 · Cited by 2,317 · see citing works
Effect of Aerobic Exercise on Blood Pressure: A Meta-Analysis of Randomized, Controlled Trials
Whelton, S. P., Chin, A., Xin, X., & He, J. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-136-7-200204020-00006 · Cited by 1,970 · see citing works
Pescatello, L. S., Franklin, B. A., Fagard, R. H., Farquhar, W. B., Kelley, G. A., & Ray, C. A. (2004) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000115224.88514.3a · Cited by 1,918 · see citing works
Effects of the amount and intensity of exercise on plasma lipoproteins
Kraus, W. E., Houmard, J. A., Duscha, B. D., Knetzger, K. J., Wharton, M. B., McCartney, J. S., Bales, C. W., Henes, S., Samsa, G. P., Otvos, J. D., et al. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa020194 · Cited by 1,554 · see citing works
ACSM's guidelines for exercise testing and prescription
Kenney, W. L., Humphrey, R. H., Bryant, C. X., & Mahler, D. A. (1995) · Williams & Wilkins eBooks · Cited by 1,475 · see citing works
Okorodudu, D. O., Jumean, M. F., Montori, V. M., Romero‐Corral, A., Somers, V. K., Erwin, P. J., & López-Jiménez, F. A. (2010) · International Journal of Obesity · doi:10.1038/ijo.2010.5 · Cited by 1,183 · see citing works
Lee, C. D., Blair, S. N., & Jackson, A. S. (1999) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/69.3.373 · Cited by 1,027 · see citing works
Self-citationAn experimental study of physical fitness of Air Force personnel.
Balke, B., & Ware, R. W. (1959) · PubMed · Cited by 878 · see citing works
Adiposity as Compared with Physical Activity in Predicting Mortality among Women
Hu, F. B., Willett, W. C., Li, T., Stampfer, M. J., Colditz, G. A., & Manson, J. E. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa042135 · Cited by 798 · see citing works
Carnethon, M. R. (2003) · JAMA · doi:10.1001/jama.290.23.3092 · Cited by 691 · see citing works
Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults
Sui, X., LaMonte, M. J., Laditka, J. N., Hardin, J. W., Chase, N., Hooker, S. P., & Blair, S. N. (2007) · JAMA · doi:10.1001/jama.298.21.2507 · Cited by 640 · see citing works
Self-citationLee, D.-C., Sui, X., Ortega, F. B., Kim, Y.-S., Church, T. S., Winett, R. A., Ekelund, U., Katzmarzyk, P. T., & Blair, S. N. (2010) · British Journal of Sports Medicine · doi:10.1136/bjsm.2009.066209 · Cited by 435 · see citing works
Self-citationHu, G., Barengo, N. C., Tuomilehto, J. O., Lakka, T. A., Nissinen, A. M., & Jousilahti, P. (2003) · Hypertension · doi:10.1161/01.hyp.0000107400.72456.19 · Cited by 393 · see citing works
Stevens, J. (2002) · American Journal of Epidemiology · doi:10.1093/aje/kwf114 · Cited by 370 · see citing works
Wessel, T. R. (2004) · JAMA · doi:10.1001/jama.292.10.1179 · Cited by 367 · see citing works
Role of Lifestyle and Aging on the Longitudinal Change in Cardiorespiratory Fitness
Jackson, A. S., Sui, X., Hébert, J. R., Church, T. S., & Blair, S. N. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.312 · Cited by 329 · cited 1× · see citing works
“Fitness and fatness change over time, and the patterns of change vary among individuals (16).”
Self-citationA prospective study of cardiorespiratory fitness and risk of type 2 diabetes in women
Sui, X., Hooker, S. P., Lee, I.-M., Church, T. S., Colabianchi, N., Lee, C.-D., & Blair, S. N. (2008) · Diabetes Care · doi:10.2337/dc07-1870 · Cited by 185 · see citing works
Self-citationNorman, J. E., Bild, D. E., Lewis, C. E., Liu, K., & West, D. S. (2003) · International Journal of Obesity · doi:10.1038/sj.ijo.0802243 · Cited by 180 · see citing works
Lee, D.-C., Sui, X., Church, T. S., Lee, I.-M., & Blair, S. N. (2009) · Diabetes Care · doi:10.2337/dc08-1377 · Cited by 169 · see citing works
Self-citationSURROGATE MEASURES OF PHYSICAL ACTIVITY AND PHYSICAL FITNESS
Blair, S. N., Kannel, W. B., Kohl, H. W., Goodyear, N. N., & Wilson, P. W. F. (1989) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115236 · Cited by 143 · see citing works
Self-citationChristou, D. D., Gentile, C. L., DeSouza, C. A., Seals, D. R., & Gates, P. E. (2005) · Circulation · doi:10.1161/01.cir.0000161818.28974.1a · Cited by 130 · see citing works
Does physical activity ameliorate the health hazards of obesity?: Figure 1
Lee, D. C., Sui, X., & Blair, S. N. (2009) · British Journal of Sports Medicine · doi:10.1136/bjsm.2008.054536 · Cited by 98 · see citing works
Self-citationThe role of obesity in the pathogenesis of hypertension
Bogaert, Y. E., & Linas, S. L. (2008) · Nature Reviews Nephrology · doi:10.1038/ncpneph1022 · Cited by 95 · see citing works
The "fit but fat" concept revisited: population-based estimates using NHANES
Duncan, G. E. (2010) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-7-47 · Cited by 91 · see citing works
Hillier, T. A., Fagot‐Campagna, A., Eschwège, É., Vol, S., Cailleau, M., & Balkau, B. (2005) · International Journal of Epidemiology · doi:10.1093/ije/dyi281 · Cited by 81 · see citing works
Weight change, body weight and mortality: the impact of smoking and ill health
Wannamethee, S. G., Shaper, A. G., & Walker, M. (2001) · International Journal of Epidemiology · doi:10.1093/ije/30.4.777 · Cited by 67 · see citing works
Intentional weight loss and mortality among initially healthy men and women
Simonsen, M. K., Hundrup, Y. A., Obel, E. B., Grønbæk, M., & Heitmann, B. L. (2008) · Nutrition Reviews · doi:10.1111/j.1753-4887.2008.00047.x · Cited by 45 · see citing works
Rainwater, D. L., Mitchell, B. D., Comuzzie, A. G., VandeBerg, J. L., Stern, M. P., & MacCluer, J. W. (2000) · American Journal of Epidemiology · doi:10.1093/aje/152.10.974 · Cited by 40 · see citing works
Cardiorespiratory fitness and metabolic risk factors in obesity
Hamer, M., & O’Donovan, G. (2010) · Current Opinion in Lipidology · doi:10.1097/mol.0b013e328331dd21 · Cited by 38 · see citing works
Chen, P., Sung, F., Su, T., Chien, K., Hsu, H., & Lee, Y. (2009) · Journal of Hypertension · doi:10.1097/hjh.0b013e32832af6d4 · Cited by 32 · see citing works
Impact of obesity in primary hyperlipidemias.
Carmena, R., Ascaso, J. F., & Real, J. T. (2001) · PubMed · Cited by 29 · see citing works
Competing Impact of Excess Weight Versus Cardiorespiratory Fitness on Cardiovascular Risk
Díaz, V. A., Player, M. S., Mainous, A. G., Carek, P. J., & Geesey, M. E. (2006) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2006.06.048 · Cited by 29 · see citing works
Williams, P. T. (2008) · Obesity · doi:10.1038/oby.2008.299 · Cited by 25 · see citing works
Terminology for Describing the Elastic Behavior of Arteries
Seward, J. B., & O’Rourke, M. F. (2004) · Hypertension · doi:10.1161/01.hyp.0000120967.97445.fb · Cited by 18 · see citing works
Metabolic Syndrome Status Changes with Fitness Level Change: A Retrospective Analysis
Maxwell, M. S., Goslin, B. R., Gellish, R. L., Hightower, K. R., Olson, R. E., Moudgil, V. K., & Russi, G. D. (2008) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2007.0013 · Cited by 15 · see citing works
Incident Hypercholesterolemia in Relation to Changes in Vigorous Physical Activity
Williams, P. T. (2008) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181831417 · Cited by 9 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Leisure-time running reduces all-cause and cardiovascular mortality risk.
Lee, D.-C., Pate, R. R., Lavie, C. J., Sui, X., Church, T. S., & Blair, S. N. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.04.058 · Cited by 819 · see citing works
Self-citationExercise and the Cardiovascular System: Clinical Science and Cardiovascular Outcomes
Lavie, C. J., Arena, R., Swift, D. L., Johannsen, N. M., Sui, X., Lee, D.-C., Earnest, C. P., Church, T. S., O’Keefe, J. H., Milani, R. V., et al. (2015) · Circulation Research · doi:10.1161/circresaha.117.305205 · Cited by 782 · see citing works
Self-citationPhysical Activity and the Prevention of Hypertension
Diaz, K. M., & Shimbo, D. (2013) · Current Hypertension Reports · doi:10.1007/s11906-013-0386-8 · Cited by 528 · see citing works
Regensteiner, J. G., Golden, S., Huebschmann, A. G., Barrett-Connor, E., Chang, A. Y., Chyun, D., Fox, C. S., Kim, C., Mehta, N., Reckelhoff, J. F., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000343 · Cited by 334 · see citing works
Schroeder, E. C., Franke, W. D., Sharp, R. L., & Lee, D.-C. (2019) · PLoS ONE · doi:10.1371/journal.pone.0210292 · Cited by 295 · see citing works
Self-citationHealthy obese versus unhealthy lean: the obesity paradox
Lavie, C. J., De Schutter, A., & Milani, R. V. (2015) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2014.165 · Cited by 266 · see citing works
Self-citationCardiovascular fitness and mortality after contemporary cardiac rehabilitation
Martin, B.-J., Arena, R., Haykowsky, M., Hauer, T., Austford, L. D., Knudtson, M., Aggarwal, S., & Stone, J. A. (2013) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2013.02.013 · Cited by 231 · see citing works
Ross, R., de Lannoy, L., & Stotz, P. J. (2015) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2015.07.024 · Cited by 224 · see citing works
Physical Activity and Sarcopenic Obesity: Definition, Assessment, Prevalence and Mechanism
Lee, D.-C., Shook, R. P., Drenowatz, C., & Blair, S. N. (2016) · Future Science OA · doi:10.4155/fsoa-2016-0028 · Cited by 177 · see citing works
Self-citationEarnest, C. P., Artero, E. G., Sui, X., Lee, D.-C., Church, T. S., & Blair, S. N. (2013) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.11.006 · Cited by 170 · see citing works
Self-citationContribution of Cardiorespiratory Fitness to the Obesity Paradox
McAuley, P. A., & Beavers, K. M. (2014) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2013.09.006 · Cited by 127 · see citing works
Lee, D.-C., Brellenthin, A. G., Lanningham-Foster, L. M., Kohut, M. L., & Li, Y. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehad827 · Cited by 89 · see citing works
“42 Considering the growing global epidemic of obesity and its strong associations with CVD progression, 6 the improvements in per cent body fat and CVD risk profile through exercise with minimal weight loss may be important given that weight loss is challenging, especially in individuals with…”
BackgroundSelf-citationExercise Training and Insulin Resistance: A Current Review
Keshel, T. E. (2015) · Journal of Obesity & Weight Loss Therapy · doi:10.4172/2165-7904.s5-003 · Cited by 76 · see citing works
Changing the Endpoints for Determining Effective Obesity Management
Ross, R., Blair, S., de Lannoy, L., Després, J.-P., & Lavie, C. J. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2014.10.002 · Cited by 55 · see citing works
Self-citationJohannsen, N. M., Swift, D. L., Lavie, C. J., Earnest, C. P., Blair, S. N., & Church, T. S. (2013) · Diabetes Care · doi:10.2337/dc12-2194 · Cited by 43 · see citing works
Self-citationChow, L. S., Odegaard, A. O., Bosch, T. A., Bantle, A. E., Wang, Q., Hughes, J., Carnethon, M., Ingram, K. H., Durant, N., Lewis, C. E., et al. (2016) · Diabetologia · doi:10.1007/s00125-016-3969-5 · Cited by 39 · see citing works
Cheng, C., Zhang, D., Chen, S., & Duan, G. (2022) · Journal of Human Hypertension · doi:10.1038/s41371-021-00567-8 · Cited by 28 · see citing works
Kline, C. E., Reboussin, D. M., Foster, G. D., Rice, T. B., Strotmeyer, E. S., Jakicic, J. M., Millman, R. P., Pi-Sunyer, F. X., Newman, A. B., Wadden, T. A., et al. (2016) · Sleep · doi:10.5665/sleep.5436 · Cited by 24 · see citing works
Martínez-Vizcaíno, V., Amaro-Gahete, F. J., Fernández-Rodríguez, R., Garrido-Miguel, M., Cavero-Redondo, I., & Pozuelo-Carrascosa, D. P. (2022) · Sports Medicine · doi:10.1007/s40279-021-01607-6 · Cited by 24 · see citing works
- Authors
- Lee, D.-C., Sui, X., Church, T. S., Lavie, C. J., Jackson, A. S., & Blair, S. N.
- Affiliations
- University of South Carolina (US)
- Pennington Biomedical Research Center (US)
- Ochsner Health System (US)
- University of Houston (US)
- Corresponding author
- Lee, Duck-chul
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 59
- Issue
- 7
- Pages
- 665-672
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC3293498
- OpenAlex
- W105412638
- Cited by
- 285
- References
- 46
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 16 · 2023: 16 · 2022: 14 · 2021: 21 · 2020: 20 · 2019: 18 · 2018: 18 · 2017: 18 · 2016: 27 · 2015: 26 · 2014: 33 · 2013: 27 · 2012: 13
- FWCI
- 21.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (AG06945, HL62508, DK088195)
- The Coca-Cola Company
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- cardiovascular risk factors, physical fitness, adiposity, fat gain, fitness loss, hypertension, metabolic syndrome, hypercholesterolemia, body mass index, body fat percentage, healthy adults
- MeSH terms
- Adipose Tissue, Adult, Exercise Test, Female, Follow-Up Studies, Humans, Hypercholesterolemia, Hypertension, Male, Middle Aged, Physical Fitness, Prospective Studies, Risk Factors, Metabolic Syndrome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
