Physical activity, fitness and fatness: relations to mortality, morbidity and disease risk factors. A systematic review
Abstract
Summary: The purpose of this systematic review was to study the relative health risks of poor cardio‐respiratory fitness (or physical inactivity) in normal‐weight people vs. obesity in individuals with good cardio‐respiratory fitness (or high physical activity). The core inclusion criteria were: publication year 1990 or later; adult participants; design prospective follow‐up, case–control or cross‐sectional; data on cardio‐respiratory fitness and/or physical activity; data on BMI (body mass index), waist circumference or body composition; outcome data on all‐cause mortality, cardiovascular disease mortality, cardiovascular disease incidence, type 2 diabetes or cardiovascular and type 2 diabetes risk factors. Thirty‐six publications filled the criteria for inclusion. The data indicate that the risk for all‐cause and cardiovascular mortality was lower in individuals with high BMI and good aerobic fitness, compared with individuals with normal BMI and poor fitness. In contrast, having high BMI even with high physical activity was a greater risk for the incidence of type 2 diabetes and the prevalence of cardiovascular and diabetes risk factors, compared with normal BMI with low physical activity. The conclusions of the present review may not be applicable to individuals with BMI > 35.
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Poor fitness or low physical activity in physically unfit individuals is a greater all-cause and cardiovascular mortality risk than obesity in physically fit individuals.
“Poor fitness or low PA in physically unfit individuals is a greater all-cause and cardiovascular mortality risk than obesity in physically fit individual (185).”
From Lack of Exercise Is a Major Cause of Chronic Diseases (2012) · cites this paper as [185]
For individuals with BMI 25-35, high BMI even with high physical activity is associated with greater risk of incident type 2 diabetes and greater prevalence of cardiovascular and diabetes risk factors than normal BMI with low physical activity.
“for individuals with BMI of 25–35 having high BMI even with high physical activity were at a greater risk for the incidence of T2D and the prevalence of cardiovascular and diabetes risk factors, compared with normal BMI with low physical activity.”
From Lack of Exercise Is a Major Cause of Chronic Diseases (2012) · cites this paper as [185]
One likely mechanism by which physical fitness and activity reduce health risk associated with high BMI is decreasing the fat-to-lean mass ratio and the visceral-to-subcutaneous fat ratio.
“one of the mechanisms by which physical fitness and activity reduce health risk associated with high BMI is by decreasing fat-to-lean mass ratio and also by decreasing visceral-to-subcutaneous fat ratio.”
From Lack of Exercise Is a Major Cause of Chronic Diseases (2012) · cites this paper as [185]
Decreasing visceral adipose tissue is particularly important for BMIs between 25 and 30.
“decreasing VAT is particularly important for BMIs between 25 and 30 (185).”
From Lack of Exercise Is a Major Cause of Chronic Diseases (2012) · cites this paper as [185]
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- Authors
- Fogelholm, M.
- Affiliations
- Research Council of Finland (FI)
- Corresponding author
- Fogelholm, M.
- ORCID
- Fogelholm, M.
- Venue
- Obesity Reviews
- Publisher
- Wiley
- Published
- 2010-02-22
- Volume
- 11
- Issue
- 3
- Pages
- 202-221
- ISSN
- 1467-7881 (ISSN-L)
- 1467-789X
- OpenAlex
- W2041545551
- Cited by
- 517
- References
- 63
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 13 · 2023: 24 · 2022: 22 · 2021: 24 · 2020: 22 · 2019: 31 · 2018: 43 · 2017: 37 · 2016: 31 · 2015: 44 · 2014: 43 · 2013: 54 · 2012: 50
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obesity Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- cardiorespiratory fitness, physical activity, obesity, body mass index, all-cause mortality, cardiovascular mortality, cardiovascular disease incidence, type 2 diabetes, diabetes risk factors, cardiovascular risk factors, physical inactivity, waist circumference, body composition
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Morbidity, Obesity, Physical Fitness, Risk Factors, Exercise, Body Mass Index, Overweight
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