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Better Cardiorespiratory Fitness Related To Lower Risk Of Death, Cardiovascular Disease

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Persons with higher levels of cardiorespiratory fitness have a lower risk of all-cause death and coronary heart disease and cardiovascular disease compared to persons with lower levels of cardiorespiratory fitness, according to an debate of preceding studies appearing in the May 20 query of JAMA.
Physical fitness is typically expressed as cardiorespiratory fitness (CRF) and is assessed by exercise tolerance testing; however, it is rare for clinicians to chew over CRF when evaluating future risk of coronary heart disease (CHD). "A larger instigation for depletion of consideration of CRF as a marker of CHD risk may be that the quantitative company of CRF for cardiovascular risk is not blooming established. The measure of risk diminution associated with everyone incremental higher continuous of CRF, the criteria for low CRF, and the magnitude of risk associated with low CRF obtain been inconsistent among studies," the authors write.
Satoru Kodama, M.D., Ph.D., of the University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan, and colleagues conducted a meta-analysis to systematically display the quantitative affair between CRF and all-cause mortality and CHD or cardiovascular disease (CVD) events in healthy individuals. The researchers identified 33 studies for inclusion in the analysis, which included: all-cause mortality, 102,980 participants and 6,910 cases; CHD/CVD, 84,323 participants and 4,485 cases.
CRF was estimated as maximal aerobic capacity (MAC) expressed in metabolic equivalent (MET; measured via o2 consumption) units. Participants were categorized as low CRF (less than 7.9 METs), intermediate CRF (7.9 - 10.8 METs), or high CRF (10.9 METs or greater).
Compared with participants with big CRF, those with low CRF had a 70 percent higher risk for all-cause curtains and a 56 percent higher risk for CHD/CVD events. Compared with participants with intermediate CRF, those with low CRF had a 40 percent higher risk for all-cause death and a 47 percent increased risk for CHD/CVD events.
"These analyses propose that a minimal CRF of 7.9 METs may be influential for facund prevention of all-cause mortality and CHD/CVD," the researchers write. They add that expressed in terms of walking speed, men encompassing 50 second childhood of period must be capable of non-stop walking at a rapidity of 4 m.p.h. and women, 3 m.p.h.
"It is imaginable that concern of low CRF as a big coronary risk factor could be situate into practical operate in the clinical setting completed identification of low manipulate tolerance by exercise stress testing or in daily life by the celerity at which a mortal can walk before experiencing exhaustion," the researchers write.
The analysis also indicated that a 1-MET higher level of MAC (corresponding to 0.6 mile/hour higher running/jogging speed) was associated with a decrease of 13 percent in risk of all-cause mortality, and a 15 percent shorten in risk of CHD/CVD.
"Based on the findings of our meta-analysis, we suggest for impending evaluation (1) further transaction of a CHD prediction algorithm (e.g., Framingham Scores) that would favor both CRF and the classical coronary risk factors to allow physicians to use CRF as a major risk constituent in clinical settings; (2) cost-effectiveness of handle testing for assessing CRF from the viewpoint of relevant prevention of all-cause mortality and CHD; and (3) a clinical proof to decide if an intervention that improves CRF by exercise reduces the risk of all-cause mortality and CHD," the authors write.
JAMA 2009;301[19]:2024-2035.
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