Longitudinal Algorithms to Estimate Cardiorespiratory Fitness: Associations with Nonfatal Cardiovascular Disease and Disease-specific Mortality

Overview

Journal J Am Coll Cardiol

Specialty Cardiology & Vascular Diseases

Date 2014 Apr 8

PMID 24703924

Citations 49

Authors

Enrique G Artero

Andrew S Jackson

Xuemei Sui

Duck-Chul Lee

Daniel P OConnor

Carl J Lavie

Timothy S Church

Steven N Blair

Affiliations

Soon will be listed here.

Abstract

Objectives: This study sought to determine the capacity of cardiorespiratory fitness (CRF) algorithms without exercise testing to predict the risk for nonfatal cardiovascular disease (CVD) events and disease-specific mortality.

Background: Cardiorespiratory fitness (CRF) is not routinely measured, as it requires trained personnel and specialized equipment.

Methods: Participants were 43,356 adults (21% women) from the Aerobics Center Longitudinal Study, followed up between 1974 and 2003. Estimated CRF was determined on the basis of sex, age, body mass index, waist circumference, resting heart rate, physical activity level, and smoking status. Actual CRF was measured by a maximal treadmill test. Risk reduction per 1-metabolic equivalent increase, discriminative ability (c statistic), and net reclassification improvement were determined.

Results: During a median follow-up of 14.5 years, 1,934 deaths occurred, 627 due to CVD. In a subsample of 18,095 participants, 1,049 cases of nonfatal CVD events were ascertained. After adjustment for potential confounders, both measured and estimated CRF were inversely associated with risks for all-cause mortality, CVD-related mortality and nonfatal CVD events in men, and all-cause mortality and nonfatal CVD events in women. The risk reduction per 1-metabolic equivalent increase ranged from approximately 10% to 20%. Measured CRF had a slightly better discriminative ability (c statistic) than did estimated CRF, and the net reclassification improvement values in measured CRF versus estimated CRF were 12.3% in men (p < 0.05) and 19.8% in women (p < 0.001).

Conclusions: These CRF algorithms utilized information routinely collected to obtain an estimate of CRF, which provides a valid indication of health status. In addition to identifying people at risk, this method can provide more appropriate exercise recommendations that reflect initial CRF levels.

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References

Pollock M, Foster C, Schmidt D, Hellman C, Linnerud A, Ward A . Comparative analysis of physiologic responses to three different maximal graded exercise test protocols in healthy women. Am Heart J. 1982; 103(3):363-73. DOI: 10.1016/0002-8703(82)90275-7. View

Pencina M, DAgostino Sr R, DAgostino Jr R, Vasan R . Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2007; 27(2):157-72. DOI: 10.1002/sim.2929. View

Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood J . Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002; 346(11):793-801. DOI: 10.1056/NEJMoa011858. View

Myers G, COOPER G, Winn C, Smith S . The Centers for Disease Control-National Heart, Lung and Blood Institute Lipid Standardization Program. An approach to accurate and precise lipid measurements. Clin Lab Med. 1989; 9(1):105-35. View

Laukkanen J, Kurl S, Salonen R, Rauramaa R, Salonen J . The predictive value of cardiorespiratory fitness for cardiovascular events in men with various risk profiles: a prospective population-based cohort study. Eur Heart J. 2004; 25(16):1428-37. DOI: 10.1016/j.ehj.2004.06.013. View

Carnethon M, Gidding S, Nehgme R, Sidney S, Jacobs Jr D, Liu K . Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. JAMA. 2003; 290(23):3092-100. DOI: 10.1001/jama.290.23.3092. View

. Physical Activity Guidelines Advisory Committee report, 2008. To the Secretary of Health and Human Services. Part A: executive summary. Nutr Rev. 2009; 67(2):114-20. DOI: 10.1111/j.1753-4887.2008.00136.x. View

Balke B, WARE R . An experimental study of physical fitness of Air Force personnel. U S Armed Forces Med J. 1959; 10(6):675-88. View

LaMonte M, Barlow C, Jurca R, Kampert J, Church T, Blair S . Cardiorespiratory fitness is inversely associated with the incidence of metabolic syndrome: a prospective study of men and women. Circulation. 2005; 112(4):505-12. DOI: 10.1161/CIRCULATIONAHA.104.503805. View

10.

Evenson K, Stevens J, Cai J, Thomas R, Thomas O . The effect of cardiorespiratory fitness and obesity on cancer mortality in women and men. Med Sci Sports Exerc. 2003; 35(2):270-7. DOI: 10.1249/01.MSS.0000053511.02356.72. View

11.

Sui X, Hooker S, Lee I, Church T, Colabianchi N, Lee C . A prospective study of cardiorespiratory fitness and risk of type 2 diabetes in women. Diabetes Care. 2007; 31(3):550-5. PMC: 3410433. DOI: 10.2337/dc07-1870. View

12.

Luepker R, Apple F, Christenson R, Crow R, Fortmann S, Goff D . Case definitions for acute coronary heart disease in epidemiology and clinical research studies: a statement from the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and.... Circulation. 2003; 108(20):2543-9. DOI: 10.1161/01.CIR.0000100560.46946.EA. View

13.

Stamatakis E, Hamer M, ODonovan G, Batty G, Kivimaki M . A non-exercise testing method for estimating cardiorespiratory fitness: associations with all-cause and cardiovascular mortality in a pooled analysis of eight population-based cohorts. Eur Heart J. 2012; 34(10):750-8. PMC: 3590456. DOI: 10.1093/eurheartj/ehs097. View

14.

Gulati M, Black H, Shaw L, Arnsdorf M, Merz C, Lauer M . The prognostic value of a nomogram for exercise capacity in women. N Engl J Med. 2005; 353(5):468-75. DOI: 10.1056/NEJMoa044154. View

15.

Mailey E, White S, Wojcicki T, Szabo A, Kramer A, McAuley E . Construct validation of a non-exercise measure of cardiorespiratory fitness in older adults. BMC Public Health. 2010; 10:59. PMC: 2831835. DOI: 10.1186/1471-2458-10-59. View

16.

Jurca R, Jackson A, LaMonte M, Morrow Jr J, Blair S, Wareham N . Assessing cardiorespiratory fitness without performing exercise testing. Am J Prev Med. 2005; 29(3):185-93. DOI: 10.1016/j.amepre.2005.06.004. View

17.

Kaminsky L, Arena R, Beckie T, Brubaker P, Church T, Forman D . The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association. Circulation. 2013; 127(5):652-62. DOI: 10.1161/CIR.0b013e31827ee100. View

18.

Balady G, Arena R, Sietsema K, Myers J, Coke L, Fletcher G . Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010; 122(2):191-225. DOI: 10.1161/CIR.0b013e3181e52e69. View

19.

Maslow A, Sui X, Colabianchi N, Hussey J, Blair S . Muscular strength and incident hypertension in normotensive and prehypertensive men. Med Sci Sports Exerc. 2009; 42(2):288-95. PMC: 2809142. DOI: 10.1249/MSS.0b013e3181b2f0a4. View

20.

Pollock M, BOHANNON R, COOPER K, Ayres J, Ward A, White S . A comparative analysis of four protocols for maximal treadmill stress testing. Am Heart J. 1976; 92(1):39-46. DOI: 10.1016/s0002-8703(76)80401-2. View