Clinical Perspectives on Incorporating Cardiorespiratory Fitness in Clinical Practice
Main Article Content
Abstract
Cardiorespiratory fitness (CRF) has been documented as a strong, independent predictor of non-communicable disease and mortality in both clinical and apparently healthy populations. This well-established relationship has impelled organizations, including the American Heart Association, to release scientific statements highlighting the importance of accurate quantification of CRF. Current knowledge of the relationship between CRF and mortality is predominantly based on estimated CRF obtained from varying indirect methods. Cardiopulmonary exercise testing (CPX), the gold standard method of CRF measurement, provides a more accurate and reliable quantification of CRF compared to estimated methods. This review provides support for the diagnostic and prognostic use of CRF based on the current literature and makes a case for the use of CPX when available, as well as the need for standardization of normative values defining CRF levels to increase the efficacy of the risk assessment. Further, clinical applications of CPX-derived CRF are discussed, providing clinicians with recommendations on how to use and interpret this measure in practice to guide clinical decisions and improve patient outcomes.
Keywords:
Cardiopulmonary exercise testing, Aerobic capacity, Exercise, Physical Fitness
Article Details
How to Cite
IMBODEN, Mary T. et al.
Clinical Perspectives on Incorporating Cardiorespiratory Fitness in Clinical Practice.
Medical Research Archives, [S.l.], v. 6, n. 2, feb. 2018.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1699>. Date accessed: 26 dec. 2024.
doi: https://doi.org/10.18103/mra.v6i2.1699.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Ross R, Blair SN, Arena R, Church TS, Despres JP, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: A case for fitness as a clinical vital sign: A scientific statement from the American Heart Association. Circulation. 2016;134:e653-e699.
2. Myers J, Prakash M, Froelicher V, Do D, Partington S and Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793-801.
3. Blair SN, Kohl HW , Paffenbarger RS, Jr., Clark DG, Cooper KH and Gibbons LW. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989;262:2395-401.
4. Jensen MT, Holtermann A, Bay H and Gyntelberg F. Cardiorespiratory fitness and death from cancer: a 42-year follow-up from the Copenhagen Male Study. Br J Sports Med. 2016.
5. Martin BJ, Arena R, Haykowsky M, Hauer T, Austford LD, Knudtson M, et al. Cardiovascular fitness and mortality after contemporary cardiac rehabilitation. Mayo Clin Proc. 2013;88:455-63.
6. Myers J, Kaykha A, George S, Abella J, Zaheer N, Lear S, et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med. 2004;117:912-8.
7. Al-Mallah MH, Juraschek SP, Whelton S, Dardari ZA, Ehrman JK, Michos ED, et al. Sex differences in cardiorespiratory fitness and all-cause mortality: The Henry Ford ExercIse Testing (FIT) Project. Mayo Clin Proc. 2016;91:755-62.
8. Ekelund LG, Haskell WL, Johnson JL, Whaley FS, Criqui MH and Sheps DS. Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study. N Engl J Med. 1988;319:1379-84.
9. Park MS, Chung SY, Chang Y and Kim K. Physical activity and physical fitness as predictors of all-cause mortality in Korean men. J Korean Med Sci. 2009;24:13-9.
10. Sawada SS, Lee IM, Naito H, Kakigi R, Goto S, Kanazawa M, et al. Cardiorespiratory fitness, body mass index, and cancer mortality: a cohort study of Japanese men. BMC Public Health. 2014;14:1012.
11. Ladenvall P, Persson CU, Mandalenakis Z, Wilhelmsen L, Grimby G, Svardsudd K, et al. Low aerobic capacity in middle-aged men associated with increased mortality rates during 45 years of follow-up. Eur J Prev Cardiol. 2016;23:1557-64.
12. Nes BM, Vatten LJ, Nauman J, Janszky I and Wisloff U. A simple nonexercise model of cardiorespiratory fitness predicts long-term mortality. Med Sci Sports Exerc. 2014;46:1159-65.
13. Holtermann A, Marott JL, Gyntelberg F, Sogaard K, Mortensen OS, Prescott E, et al. Self-reported occupational physical activity and cardiorespiratory fitness: Importance for cardiovascular disease and all-cause mortality. Scand J Work Environ Health. 2016;42:291-8.
14. Stamatakis E, Hamer M, O'Donovan G, Batty GD and 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. 2013;34:750-8.
15. Edwards MK and Loprinzi PD. The Association of estimated cardiorespiratory fitness on mortality risk among those with an elevated gamma gap. Int J Cardiol. 2017;227:508-510.
16. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301:2024-35.
17. Harber MP, Kaminsky LA, Arena R, Blair SN, Franklin BA, Myers J, et al. Impact of cardiorespiratory fitness on all-cause and disease-specific mortality: Advances since 2009. Prog Cardiovasc Dis. 2017.
18. Kokkinos P, Myers J, Franklin B, Narayan P, Lavie CJ and Faselis C. Cardiorespiratory Fitness and Health Outcomes: A Call to Standardize Fitness Categories. Mayo Clin Proc. 2017.
19. Kokkinos P, Myers J, Faselis C, Panagiotakos DB, Doumas M, Pittaras A, et al. Exercise capacity and mortality in older men: a 20-year follow-up study. Circulation. 2010;122:790-7.
20. Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R and Rodahl K. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med. 1993;328:533-7.
21. Hung RK, Al-Mallah MH, Qadi MA, Shaya GE, Blumenthal RS, Nasir K, et al. Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy: The Henry Ford ExercIse Testing Project. Am Heart J. 2015;170:390-9.
22. Kaminsky LA, Arena R and Myers J. Reference standards for cardiorespiratory fitness measured With cardiopulmonary exercise testing: Data from the fitness registry and the importance of exercise national database. Mayo Clin Proc. 2015;90:1515-23.
23. ACSM’s guidelines for exercise testing and prescription. 10 ed. Philadelphia, PA: Wolters Kluwer; 2017.
24. Myers J. Essentials for cardiopulmonary exercise testing. Champaign, IL: Human Kinetics; 1996.
25. Blair SN, Kohl HW, Barlow CE, Paffenbarger RS, Jr., Gibbons LW and Macera CA. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995;273:1093-8.
26. Guazzi M, Arena R, Halle M, Piepoli MF, Myers J and Lavie CJ. 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J. 2016.
27. Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, et al. EACPR/AHA Joint Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J. 2012;33:2917-27.
28. Forman DE, Myers J, Lavie CJ, Guazzi M, Celli B and Arena R. Cardiopulmonary exercise testing: relevant but underused. Postgrad Med. 2010;122:68-86.
29. Myers J, Arena R, Dewey F, Bensimhon D, Abella J, Hsu L, et al. A cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure. Am Heart J. 2008;156:1177-83.
30. Arena R, Myers J and Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review. Heart Fail Rev. 2008;13:245-69.
31. Guazzi M, Myers J and Arena R. Optimizing the clinical application of cardiopulmonary exercise testing in patients with heart failure. Int J Cardiol. 2009;137:e18-22.
32. Laukkanen JA, Lakka TA, Rauramaa R, Kuhanen R, Venalainen JM, Salonen R, et al. Cardiovascular fitness as a predictor of mortality in men. Arch Intern Med. 2001;161:825-31.
33. Laukkanen JA, Makikallio TH, Rauramaa R, Kiviniemi V, Ronkainen K and Kurl S. Cardiorespiratory fitness is related to the risk of sudden cardiac death: a population-based follow-up study. J Am Coll Cardiol. 2010;56:1476-83.
34. Laukkanen JA, Rauramaa R, Salonen JT and Kurl S. The predictive value of cardiorespiratory fitness combined with coronary risk evaluation and the risk of cardiovascular and all-cause death. J Intern Med. 2007;262:263-72.
35. Laukkanen JA, Zaccardi F, Khan H, Kurl S, Jae SY and Rauramaa R. Long-term Change in Cardiorespiratory Fitness and All-Cause Mortality: A Population-Based Follow-up Study. Mayo Clin Proc. 2016;91:1183-8.
36. Laukkanen JA, Pukkala E, Rauramaa R, Makikallio TH, Toriola AT and Kurl S. Cardiorespiratory fitness, lifestyle factors and cancer risk and mortality in Finnish men. Eur J Cancer. 2010;46:355-63.
37. Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS, Forman DE, et al. 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;127:652-62.
2. Myers J, Prakash M, Froelicher V, Do D, Partington S and Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793-801.
3. Blair SN, Kohl HW , Paffenbarger RS, Jr., Clark DG, Cooper KH and Gibbons LW. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989;262:2395-401.
4. Jensen MT, Holtermann A, Bay H and Gyntelberg F. Cardiorespiratory fitness and death from cancer: a 42-year follow-up from the Copenhagen Male Study. Br J Sports Med. 2016.
5. Martin BJ, Arena R, Haykowsky M, Hauer T, Austford LD, Knudtson M, et al. Cardiovascular fitness and mortality after contemporary cardiac rehabilitation. Mayo Clin Proc. 2013;88:455-63.
6. Myers J, Kaykha A, George S, Abella J, Zaheer N, Lear S, et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med. 2004;117:912-8.
7. Al-Mallah MH, Juraschek SP, Whelton S, Dardari ZA, Ehrman JK, Michos ED, et al. Sex differences in cardiorespiratory fitness and all-cause mortality: The Henry Ford ExercIse Testing (FIT) Project. Mayo Clin Proc. 2016;91:755-62.
8. Ekelund LG, Haskell WL, Johnson JL, Whaley FS, Criqui MH and Sheps DS. Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study. N Engl J Med. 1988;319:1379-84.
9. Park MS, Chung SY, Chang Y and Kim K. Physical activity and physical fitness as predictors of all-cause mortality in Korean men. J Korean Med Sci. 2009;24:13-9.
10. Sawada SS, Lee IM, Naito H, Kakigi R, Goto S, Kanazawa M, et al. Cardiorespiratory fitness, body mass index, and cancer mortality: a cohort study of Japanese men. BMC Public Health. 2014;14:1012.
11. Ladenvall P, Persson CU, Mandalenakis Z, Wilhelmsen L, Grimby G, Svardsudd K, et al. Low aerobic capacity in middle-aged men associated with increased mortality rates during 45 years of follow-up. Eur J Prev Cardiol. 2016;23:1557-64.
12. Nes BM, Vatten LJ, Nauman J, Janszky I and Wisloff U. A simple nonexercise model of cardiorespiratory fitness predicts long-term mortality. Med Sci Sports Exerc. 2014;46:1159-65.
13. Holtermann A, Marott JL, Gyntelberg F, Sogaard K, Mortensen OS, Prescott E, et al. Self-reported occupational physical activity and cardiorespiratory fitness: Importance for cardiovascular disease and all-cause mortality. Scand J Work Environ Health. 2016;42:291-8.
14. Stamatakis E, Hamer M, O'Donovan G, Batty GD and 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. 2013;34:750-8.
15. Edwards MK and Loprinzi PD. The Association of estimated cardiorespiratory fitness on mortality risk among those with an elevated gamma gap. Int J Cardiol. 2017;227:508-510.
16. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301:2024-35.
17. Harber MP, Kaminsky LA, Arena R, Blair SN, Franklin BA, Myers J, et al. Impact of cardiorespiratory fitness on all-cause and disease-specific mortality: Advances since 2009. Prog Cardiovasc Dis. 2017.
18. Kokkinos P, Myers J, Franklin B, Narayan P, Lavie CJ and Faselis C. Cardiorespiratory Fitness and Health Outcomes: A Call to Standardize Fitness Categories. Mayo Clin Proc. 2017.
19. Kokkinos P, Myers J, Faselis C, Panagiotakos DB, Doumas M, Pittaras A, et al. Exercise capacity and mortality in older men: a 20-year follow-up study. Circulation. 2010;122:790-7.
20. Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R and Rodahl K. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med. 1993;328:533-7.
21. Hung RK, Al-Mallah MH, Qadi MA, Shaya GE, Blumenthal RS, Nasir K, et al. Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy: The Henry Ford ExercIse Testing Project. Am Heart J. 2015;170:390-9.
22. Kaminsky LA, Arena R and Myers J. Reference standards for cardiorespiratory fitness measured With cardiopulmonary exercise testing: Data from the fitness registry and the importance of exercise national database. Mayo Clin Proc. 2015;90:1515-23.
23. ACSM’s guidelines for exercise testing and prescription. 10 ed. Philadelphia, PA: Wolters Kluwer; 2017.
24. Myers J. Essentials for cardiopulmonary exercise testing. Champaign, IL: Human Kinetics; 1996.
25. Blair SN, Kohl HW, Barlow CE, Paffenbarger RS, Jr., Gibbons LW and Macera CA. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995;273:1093-8.
26. Guazzi M, Arena R, Halle M, Piepoli MF, Myers J and Lavie CJ. 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J. 2016.
27. Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, et al. EACPR/AHA Joint Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J. 2012;33:2917-27.
28. Forman DE, Myers J, Lavie CJ, Guazzi M, Celli B and Arena R. Cardiopulmonary exercise testing: relevant but underused. Postgrad Med. 2010;122:68-86.
29. Myers J, Arena R, Dewey F, Bensimhon D, Abella J, Hsu L, et al. A cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure. Am Heart J. 2008;156:1177-83.
30. Arena R, Myers J and Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review. Heart Fail Rev. 2008;13:245-69.
31. Guazzi M, Myers J and Arena R. Optimizing the clinical application of cardiopulmonary exercise testing in patients with heart failure. Int J Cardiol. 2009;137:e18-22.
32. Laukkanen JA, Lakka TA, Rauramaa R, Kuhanen R, Venalainen JM, Salonen R, et al. Cardiovascular fitness as a predictor of mortality in men. Arch Intern Med. 2001;161:825-31.
33. Laukkanen JA, Makikallio TH, Rauramaa R, Kiviniemi V, Ronkainen K and Kurl S. Cardiorespiratory fitness is related to the risk of sudden cardiac death: a population-based follow-up study. J Am Coll Cardiol. 2010;56:1476-83.
34. Laukkanen JA, Rauramaa R, Salonen JT and Kurl S. The predictive value of cardiorespiratory fitness combined with coronary risk evaluation and the risk of cardiovascular and all-cause death. J Intern Med. 2007;262:263-72.
35. Laukkanen JA, Zaccardi F, Khan H, Kurl S, Jae SY and Rauramaa R. Long-term Change in Cardiorespiratory Fitness and All-Cause Mortality: A Population-Based Follow-up Study. Mayo Clin Proc. 2016;91:1183-8.
36. Laukkanen JA, Pukkala E, Rauramaa R, Makikallio TH, Toriola AT and Kurl S. Cardiorespiratory fitness, lifestyle factors and cancer risk and mortality in Finnish men. Eur J Cancer. 2010;46:355-63.
37. Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS, Forman DE, et al. 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;127:652-62.