Fitness vs. fatness on all-cause mortality: a meta-analysis

Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):382-90. doi: 10.1016/j.pcad.2013.09.002. Epub 2013 Oct 11.


The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.

Keywords: All-cause mortality; BMI; Body mass index; CRF; Cardiorespiratory fitness; Fitness and fatness; Obesity paradox; PA; body mass index; cardiorespiratory fitness; physical activity.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Body Mass Index*
  • Cardiovascular Diseases / mortality*
  • Cardiovascular Diseases / physiopathology
  • Cause of Death*
  • Exercise Test
  • Female
  • Health Status
  • Heart Function Tests
  • Humans
  • Male
  • Obesity / mortality*
  • Obesity / physiopathology
  • Physical Fitness / physiology*
  • Proportional Hazards Models
  • Reference Values
  • Risk Assessment
  • Survival Analysis