Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex
Open accessAbstract
Background Cardiorespiratory fitness (CRF) is inversely associated with all-cause mortality. However, the association of CRF and mortality risk for different races, women, and elderly individuals has not been fully assessed.Objectives The aim of this study was to evaluate the association of CRF and mortality risk across the spectra of age, race, and sex.Methods A total of 750,302 U.S. veterans aged 30 to 95 years (mean age 61.3 ± 9.8 years) were studied, including septuagenarians (n = 110,637), octogenarians (n = 26,989), African Americans (n = 142,798), Hispanics (n = 35,197), Native Americans (n = 16,050), and women (n = 45,232). Age- and sex-specific CRF categories (quintiles and 98th percentile) were established objectively on the basis of peak METs achieved during a standardized exercise treadmill test. Multivariable Cox models were used to estimate HRs and 95% CIs for mortality across the CRF categories.Results During follow-up (median 10.2 years, 7,803,861 person-years of observation), 174,807 subjects died, averaging 22.4 events per 1,000 person-years. The adjusted association of CRF and mortality risk was inverse and graded across the age spectrum, sex, and race. The lowest mortality risk was observed at approximately 14.0 METs for men (HR: 0.24; 95% CI: 0.23-0.25) and women (HR: 0.23; 95% CI: 0.17-0.29), with no evidence of an increase in risk with extremely high CRF. The risk for least fit individuals (20th percentile) was 4-fold higher (HR: 4.09; 95% CI: 3.90-4.20) compared with extremely fit individuals.Conclusions The association of CRF and mortality risk across the age spectrum (including septuagenarians and octogenarians), men, women, and all races was inverse, independent, and graded. No increased risk was observed with extreme fitness. Being unfit carried a greater risk than any of the cardiac risk factors examined.
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The association of cardiorespiratory fitness levels and mortality risk is observed across the entire age spectrum, including septuagenarians and octogenarians, and remains consistently inverse, independent, and graded across men, women, and all races.
“This association of CRF levels and mortality risk was also observed across the entire age spectrum, including septuagenarians and octogenarians, and remained consistently inverse, independent, and graded across men, women, and all races [51]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [51]
In 750,302 adults, cardiorespiratory fitness was inversely associated with mortality risk irrespective of age, sex, or race.
“a study in 750 302 adults supported an inverse association between CRF and mortality risk irrespective of age (including very old people), sex, or race.20”
From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [20]
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References 48 · Cited by 259
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- Authors
- Kokkinos, P., Faselis, C., Samuel, I. B. H., Pittaras, A., Doumas, M., Murphy, R., Heimall, M. S., Sui, X., Zhang, J., & Myers, J.
- Affiliations
- Rutgers, The State University of New Jersey (US)
- George Washington University (US)
- Henry M. Jackson Foundation (US)
- Aristotle University of Thessaloniki (GR)
- Washington DC VA Medical Center (US)
- University of South Carolina (US)
- VA Palo Alto Health Care System (US)
- Corresponding author
- Kokkinos, Peter
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2022-08
- Volume
- 80
- Issue
- 6
- Pages
- 598-609
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W4289262085
- Cited by
- 259
- References
- 48
- Citations by year
- 2026: 47 · 2025: 76 · 2024: 78 · 2023: 45 · 2022: 13
- FWCI
- 55.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- cardiorespiratory fitness, all-cause mortality, age differences, sex differences, racial differences, African Americans, Hispanic veterans, Native American veterans, octogenarians, septuagenarians, treadmill exercise testing, veterans, sex differences in mortality, age differences in mortality risk
- MeSH terms
- Cardiorespiratory Fitness, Aged, Aged, 80 and over, Exercise Test, Female, Humans, Male, Middle Aged, Physical Fitness, Risk Factors, Exercise, Proportional Hazards Models
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