Objectively Assessed Cardiorespiratory Fitness and All-Cause Mortality Risk: An Updated Meta-analysis of 37 Cohort Studies Involving 2,258,029 Participants

Abstract

Objective: To detail the magnitude and specificity of the association between cardiorespiratory fitness (CRF) and all-cause mortality risk.

Methods: Cohort studies with at least 1 year of follow-up were sought from inception until December 2021 in MEDLINE, Embase, Web of Science, and a manual search of relevant articles. Relative risks (RRs) with 95% CIs were pooled using random-effects models. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.

Results: A total of 37 unique studies comprising of 2,258,029 participants with 108,613 all-cause mortality events were eligible. The pooled multivariable-adjusted RR for all-cause mortality comparing the top vs bottom tertiles of CRF levels was 0.55 (95% CI, 0.50 to 0.61). When CRF was expressed in metabolic equivalent task (MET) units, the corresponding pooled RR was 0.56 (95% CI, 0.50 to 0.62). For every 1-MET increase in CRF, the RR for all-cause mortality was 0.89 (95% CI, 0.86 to 0.92). Strength of the association did not differ by publication year, age, sex, follow-up duration, CRF assessment method, or risk of bias.

Conclusion: Aggregate analysis of observational cohort studies confirms a strong inverse and independent association between CRF and all-cause mortality risk. The results suggest that guideline bodies should consider the inclusion of CRF in standard risk panels for mortality risk assessment.