Vo2max

Reference values for estimated VO2max by two submaximal cycle tests: the Åstrand-test and the Ekblom-Bak test

Type of study: non-rct observational study

Number of citations: 2

Year: 2024

Authors: Daniel Väisänen, Björn Ekblom, Peter Wallin, Gunnar Andersson, E. Ekblom-Bak

Journal: European Journal of Applied Physiology

Journal ranking: Q1

Key takeaways: Sex- and age-specific reference values for estimated VO2max using the strand-test and Ekblom-Bak test show that age, exercise level, and BMI influence VO2 max estimations.

Abstract: Aims Submaximal tests estimating VO2max have inherent biases; hence, using VO2max estimations from the same test is essential for reducing this bias. This study aimed to establish sex- and age-specific reference values for estimated VO2max using the Åstrand-test (Å-test) and the Ekblom-Bak test (EB-test). We also assessed the effects of age, exercise level, and BMI on VO2max estimations. Methods We included men and women (20–69 years) from the Swedish working population participating in Health Profile Assessments between 2010 and 2020. Excluding those on heart rate-affecting medicines and smokers, n = 263,374 for the Å-test and n = 95,043 for the EB-test were included. VO2max reference values were based on percentiles 10, 25, 40, 60, 75, and 90 for both sexes across 5-year age groups. Results Estimated absolute and relative VO2max were for men 3.11 L/min and 36.9 mL/min/kg using the Å-test, and 3.58 L/min and 42.4 mL/min/kg using the EB-test. For women, estimated absolute and relative VO2max were 2.48 L/min and 36.6 mL/min/kg using the Å-test, and 2.41 L/min and 35.5 mL/min/kg using the EB-test. Higher age (negative), higher exercise level (positive), and higher BMI (negative) were associated with estimated VO2max using both tests. However, explained variance by exercise on estimated VO2max was low, 10% for the Å-test and 8% for the EB-test, and moderate for BMI, 23% and 29%. Conclusion We present reference values for estimated VO2max from two submaximal cycle tests. Age, exercise, and BMI influenced estimated VO2max. These references can be valuable in clinical evaluations using the same submaximal tests. Supplementary Information The online version contains supplementary material available at 10.1007/s00421-023-05398-8.

Development of Global Reference Standards for Directly Measured Cardiorespiratory Fitness: A Report From the Fitness Registry and Importance of Exercise National Database (FRIEND).

Type of study:

Number of citations: 36

Year: 2019

Authors: J. Peterman, R. Arena, J. Myers, S. Marzolini, R. Ross, C. Lavie, U. Wisløff, D. Stensvold, L. Kaminsky

Journal: Mayo Clinic proceedings

Journal ranking: Q1

Key takeaways: This report begins to establish global reference standards for cardiorespiratory fitness, with significant differences between sex and age groups and differences between countries.

Cardiorespiratory Fitness: Reference on the Six-Minute Walk Test and Oxygen Consumption in Adolescents from South-Central Chile

Type of study: non-rct observational study

Number of citations: 4

Year: 2021

Authors: J. Vásquez-Gómez, Nelson Gatica Salas, Pedro Jiménez Villarroel, L. Rojas-Araya, César Faúndez-Casanova, M. Castillo-Retamal

Journal: International Journal of Environmental Research and Public Health

Journal ranking: Q2

Key takeaways: Chilean adolescents can guide physical fitness with reference values and a predictive model that incorporates gender, heart rate, height, waist-to-height ratio, and distance in the six-minute walk test.

Abstract: Cardiorespiratory fitness (CRF) provides oxygen to the exercising muscles and is related to body adiposity, with cardiometabolic variables. The aim was to develop reference values and a predictive model of CRF in Chilean adolescents. A total of 741 adolescents of both genders (15.7 years old) participated in a basic anthropometry, performance in the six-minute walk test (SMWT), and in Course Navette was measured. Percentiles were determined for the SMWT, for the V̇O2max, and an equation was developed to estimate it. The validity of the equation was checked using distribution assumptions and the Bland–Altman diagram. The STATA v.14 program was used (p < 0.05). The 50th percentile values for males and females in the SMWT and in the V̇O2max of Course Navette were, respectively, from 607 to 690 and from 630 to 641 m, and from 43.9 to 45 and from 37.5 to 31.5 mlO2·kg·min−1, for the range of 13 to 17 years. For its part, the model to predict V̇O2max incorporated gender, heart rate, height, waist-to-height ratio (WHR), and distance in the SMWT (R2 = 0.62; estimation error = 0.38 LO2·min−1; p <0.001). Reference values can guide physical fitness in Chilean adolescents, and V̇O2max was possible to predict from morphofunctional variables.

Reference values for maximum oxygen uptake relative to body mass in Dutch/Flemish subjects aged 6–65 years: the LowLands Fitness Registry

Type of study: non-rct observational study

Number of citations: 34

Year: 2021

Authors: Geertje E van der Steeg, T. Takken

Journal: European Journal of Applied Physiology

Journal ranking: Q1

Key takeaways: This study provides reference values for maximum oxygen uptake per kilogram of body mass in Dutch/Flemish individuals aged 6-65 years, with males having higher values and females having a small but significant difference compared to females.

Abstract: The maximum oxygen uptake (VO2max) during cardiopulmonary exercise testing (CPET) is considered the best measure of cardiorespiratory fitness. To provide up-to-date reference values for the VO2max per kilogram of body mass (VO2max/kg) obtained by CPET in the Netherlands and Flanders. The Lowlands Fitness Registry contains data from health checks among different professions and was used for this study. Data from 4612 apparently healthy subjects, 3671 males and 941 females, who performed maximum effort during cycle ergometry were analysed. Reference values for the VO2max/kg and corresponding centile curves were created according to the LMS method. Age had a negative significant effect (p < .001) and males had higher values of VO2max/kg with an overall difference of 18.0% compared to females. Formulas for reference values were developed: Males: VO2max/kg = − 0.0049 × age2 + 0.0884 × age + 48.263 (R2 = 0.9859; SEE = 1.4364) Females: VO2max/kg = − 0.0021 × age2 − 0.1407 × age + 43.066 (R2 = 0.9989; SEE = 0.5775). Males: VO2max/kg = − 0.0049 × age2 + 0.0884 × age + 48.263 (R2 = 0.9859; SEE = 1.4364) Females: VO2max/kg = − 0.0021 × age2 − 0.1407 × age + 43.066 (R2 = 0.9989; SEE = 0.5775). Cross-validation showed no relevant statistical mean difference between measured and predicted values for males and a small but significant mean difference for females. We found remarkable higher VO2max/kg values compared to previously published studies. This is the first study to provide reference values for the VO2max/kg based on a Dutch/Flemish cohort. Our reference values can be used for a more accurate interpretation of the VO2max in the West-European population.

Modeling Percentile Rank of Cardiorespiratory Fitness Across the Lifespan

Type of study: non-rct observational study

Number of citations: 12

Year: 2015

Authors: Rasinio S. Graves, J. Mahnken, R. Perea, S. Billinger, E. Vidoni

Journal: Cardiopulmonary Physical Therapy Journal

Journal ranking: brak

Key takeaways: A continuous sex-specific model of VO2 max percentile rank across the lifespan can accurately predict fitness percentile rank for adults aged 20 to 99.

Abstract: Purpose:The purpose of this investigation was to create an equation for continuous percentile rank of maximal oxygen consumption (VO2 max) from ages 20 to 99. Methods:We used a 2-staged modeling approach with existing normative data from the American College of Sports Medicine for VO2 max. First, we estimated intercept and slope parameters for each decade of life as a logistic function. We then modeled change in intercept and slope as functions of age (stage 2) using weighted least squares regression. The resulting equations were used to predict fitness percentile rank based on age, sex, and VO2 max, and included estimates for individuals older than 79 years. Results:We created a continuous sex specific model of VO2 max percentile rank across the lifespan. Conclusions:Percentile ranking of VO2 max can be made continuous and account for adults aged 20 to 99 with reasonable accuracy, improving the use of this normalization procedure in practical and research settings, particularly in aging populations.

Reference Values for Body Composition, Graded Exercise Testing, Hemodynamics, and Pulmonary Function in Male and Female Firefighters.

Type of study: non-rct observational study

Number of citations: 0

Year: 2025

Authors: G. Tinsley, J. A. Mota, Michael J Conner, Alex Jesko, Kealey J. Wohlgemuth, Christian Rodriguez

Journal: Journal of occupational and environmental medicine

Journal ranking: Q2

Key takeaways: This study establishes reference values for body composition, graded exercise testing, hemodynamics, and pulmonary function in male and female firefighters, aiding in performance evaluations and occupational readiness discussions.

Abstract: OBJECTIVE This analysis establishes reference values for health and performance indicators in a large sample of U.S. firefighters. METHODS Data from 3,867 firefighters (3,651 males and 216 females) were analyzed to establish percentiles for anthropometrics, body composition, graded exercise, hemodynamics, and pulmonary function. RESULTS The median characteristics of all male firefighters included: age, 38 years; body mass index, 29.2 kg/m2; body fat percentage, 24%; and VO2max 32 mL/kg/min. The median characteristics of all female firefighters included: age, 33 years; body mass index, 25.7 kg/m2; body fat percentage, 29%; and VO2max, 31 mL/kg/min. Reference values stratified by decade of age were also established. CONCLUSIONS The presented values can be used to contextualize the performance of individual firefighters and fire departments and to promote evidence-based discussions regarding physical evaluations and standards for occupational readiness.

Sex-based differences in masters athletes: insights from CPET and cardiac MRI analysis

Type of study:

Number of citations: 0

Year: 2025

Authors: R. Tomoaia, S. Fyyaz, W. Javed, A. Merghani, S. Papatheodorou, G. Parry-Williams, R. Bhatia, N. Chatrath, H. Maclachlan, J. Lipscombe, M. Bolat, J. O'driscoll, M. Papadakis, S. Sharma, P. Swoboda

Journal: European Journal of Preventive Cardiology

Journal ranking: Q1

Key takeaways: Male and female masters athletes have distinct cardiovascular profiles and VO2max determinants, with structural factors dominating in men and performance and body composition being stronger determinants in women.

Abstract: Sex-based differences in cardiovascular and performance parameters among masters athletes are incompletely characterized. This study aimed to explore differences in cardiac structure and function, exercise performance, and predictors of maximal oxygen consumption (VO2max) during cardiopulmonary exercise testing (CPET) in asymptomatic male and female masters athletes. A total of 681 masters athletes (aged over 40 years with more than 10 years of endurance exercise) from UK running, cycling, and triathlon clubs were included, with 466 (68.4%) male and 215 (31.6%) female athletes, all matched for age and years of training. CPET, cardiac magnetic resonance (CMR) imaging, electrocardiograms, and clinical data were collected and analysed. VO2max was estimated using the Hansen formula. Linear regression was performed in each group to identify predictors of VO2max with between-sex comparisons. Male athletes had higher VO2max, more frequent cycling participation, and larger left and right ventricular volumes compared to females. They also exhibited higher resting and peak systolic blood pressures (SBP), lower left ventricular ejection fraction (LVEF), and similar right ventricular ejection fraction (RVEF). Left and right atrial dilatation was more common in men. In men, VO2max was positively associated with age, cycling participation, LV mass and ventricular volumes, while resting SBP/DBP and LVEF/RVEF were negative predictors. In women, VO2max was positively associated with triathlon participation, LV hypertrophy on ECG, LV mass, peak exercise heart rate and SBP, while BMI negatively affected VO2max. Notably, cycling and age predicted VO2max in men only, while peak heart rate and SBP were significant in women only. LV mass was a stronger predictor in men. Male and female masters athletes have distinct cardiovascular profiles and VO2max determinants. Structural factors dominate in men, while performance and body composition are stronger determinants in women, highlighting the need for sex-specific strategies in athlete evaluation and training.Sex-based differencesLinear regression for VO2max prediction

A reference equation for maximal aerobic power for treadmill and cycle ergometer exercise testing: Analysis from the FRIEND registry

Type of study: non-rct observational study

Number of citations: 79

Year: 2018

Authors: Christina G de Souza e Silva, L. Kaminsky, R. Arena, J. Christle, C. Araujo, R. Lima, E. Ashley, J. Myers

Journal: European Journal of Preventive Cardiology

Journal ranking: Q1

Key takeaways: The developed equation provides a more accurate reference for VO2max measurements on treadmills and cycle ergometers than traditional methods, particularly for women and individuals 60 years old.

Abstract: Background Maximal oxygen uptake (VO2max) is a powerful predictor of health outcomes. Valid and portable reference values are integral to interpreting measured VO2max; however, available reference standards lack validation and are specific to exercise mode. This study was undertaken to develop and validate a single equation for normal standards for VO2max for the treadmill or cycle ergometer in men and women. Methods Healthy individuals (N = 10,881; 67.8% men, 20–85 years) who performed a maximal cardiopulmonary exercise test on either a treadmill or a cycle ergometer were studied. Of these, 7617 and 3264 individuals were randomly selected for development and validation of the equation, respectively. A Brazilian sample (1619 individuals) constituted a second validation cohort. The prediction equation was determined using multiple regression analysis, and comparisons were made with the widely-used Wasserman and European equations. Results Age, sex, weight, height and exercise mode were significant predictors of VO2max. The regression equation was: VO2max (ml kg–1 min–1) = 45.2 – 0.35*Age – 10.9*Sex (male = 1; female = 2) – 0.15*Weight (pounds) + 0.68*Height (inches) – 0.46*Exercise Mode (treadmill = 1; bike = 2) (R = 0.79, R2 = 0.62, standard error of the estimate = 6.6 ml kg–1 min–1). Percentage predicted VO2max for the US and Brazilian validation cohorts were 102.8% and 95.8%, respectively. The new equation performed better than traditional equations, particularly among women and individuals ≥60 years old. Conclusion A combined equation was developed for normal standards for VO2max for different exercise modes derived from a US national registry. The equation provided a lower average error between measured and predicted VO2max than traditional equations even when applied to an independent cohort. Additional studies are needed to determine its portability.

Influence Of Cardiorespiratory Fitness On Ventilatory Threshold

Type of study:

Number of citations: 0

Year: 2023

Authors: Nicholas A Carlini, Anna Souzis, Ryan P. Hughes, J. Peterman, L. Kaminsky, M. Whaley, Bradley S. Fleenor, M. Harber

Journal: Medicine &amp; Science in Sports &amp; Exercise

Journal ranking: brak

Key takeaways: Low fit individuals have a higher ventilatory threshold as a percentage of VO2max, potentially allowing for higher ranges of moderate intensity exercise compared to higher fitness levels.

Abstract: BACKGROUND: Reference standards for ventilatory threshold (VT) have recently been established by the Fitness Registry Importance of Exercise National Database (FRIEND) registry based on age and sex. Based on these values, on average VT occurs at 51-74% of VO2max. The reason for variability in these values is unknown and may be influenced by fitness level. PURPOSE: To examine the impact of fitness level on VT expressed as a percentage of VO2max in apparently healthy men and women of varying fitness levels. METHODS: Participants included 1,784 self-referred male and female participants from the Ball State Adult Fitness Longitudinal Lifestyle STudy (BALL ST) cohort that performed resting health measurements and a maximal cardiopulmonary exercise test (CPET) between 1992 and 2020. Percentage of VT to VO2max was determined by dividing the confirmed VT by the confirmed VO2max derived from the CPET. Fitness level was determined by using the FRIEND registry percentiles with low fit being 33rd percentile, moderate fit 33rd-66th percentile, and high fit >66th percentile. An ANCOVA was performed to determine the differences between fitness levels controlling for age and sex. RESULTS: The mean percentage for VT to VO2max was higher in low fit (65.2 ± 10.4%) than the moderate (61.3 ± 10.9%) and high fit populations (60.8 ± 10.9%) (p < 0.05). CONCLUSION: Low fit individuals have a higher VT when expressed as a percentage of VO2max, and thus likely have a higher range for moderate intensity exercise compared to higher fitness level populations relative to their own exercise capacity. Exercise physiologists should take this information into consideration when prescribing exercise to this population.

Role of muscle loss in the age-associated reduction in VO2 max.

Type of study: non-rct observational study

Number of citations: 614

Year: 1988

Authors: J. Fleg, E. Lakatta

Journal: Journal of applied physiology

Journal ranking: Q1

Key takeaways: In both sexes, a large portion of the age-associated decline in VO2max is due to the loss of muscle mass, which occurs with advancing age.

Abstract: A progressive decline in maximal O2 consumption (VO2max) expressed traditionally as per kilogram body weight generally occurs with advancing age. To investigate the extent to which this decline could be attributable to the age-associated loss of metabolically active tissue, i.e., muscle, we measured 24-h urinary creatinine excretion, an index of muscle mass, in 184 healthy nonobese volunteers, ages 22-87 yr, from the Baltimore Longitudinal Study of Aging who had achieved a true VO2max during graded treadmill exercise. A positive correlation was found between VO2max and creatinine excretion in both men (r = 0.64, P less than 0.001) and women (r = 0.47, P less than 0.001). As anticipated, VO2max showed a strong negative linear relationship with age in both men and women. Creatinine excretion also declined with age in men and women. When VO2max was normalized for creatinine excretion, the variance in the VO2max decline attributable to age declined from 60 to 14% in men and from 50 to 8% in women. Thus comparing the standard age regression of VO2max per kilogram body weight with that in which VO2max is normalized per milligram creatinine excretion, the decline in VO2max between a hypothetical 30 yr old and a 70 yr old was reduced from 39 to 18% in men and from 30 to 14% in women. We conclude that in both sexes, a large portion of the age-associated decline in VO2max in non-endurance-trained individuals is explicable by the loss of muscle mass, which is observed with advancing age.

Effects of gender, age, and fitness level on response of VO2max to training in 60-71 yr olds.

Type of study: non-rct experimental

Number of citations: 422

Year: 1991

Authors: W. Kohrt, M. Malley, A. Coggan, R. Spina, T. Ogawa, A. Ehsani, R. Bourey, W. Martin, J. Holloszy

Journal: Journal of applied physiology

Journal ranking: Q1

Key takeaways: In healthy individuals aged 60-71, VO2max adapts to endurance exercise training to the same relative extent as young people, regardless of gender, age, or initial fitness level.

Abstract: The adaptive response of maximal aerobic power (VO2max) to endurance exercise training was compared in 53 men and 57 women, aged 60-71 yr. The subjects were healthy and had been sedentary for at least 2 yr. Pretraining VO2max was measured during graded treadmill walking on two occasions. These values were reproducible (24.4 +/- 4.7 vs. 24.4 +/- 4.6 (SD) ml.min-l.kg-1; r = 0.96). Subjects trained primarily by walking and running for 9-12 mo, averaging 3.9 +/- 0.6 days/wk and 45 +/- 5 min/day at 80 +/- 5% of maximal heart rate (HRmax). Average improvement in VO2max (ml.min-1.kg-1) was 24 +/- 12% (range 0-58%). Relative improvement was not significantly different in men and women (26 +/- 12 vs. 23 +/- 12%, ml.min-1.kg-1; 21 +/- 10 vs 19 +/- 10%, l/min). When subjects were divided into three groups by age (60-62, 63-66, 67-71 yr), there were no significant differences among the groups in the relative increase in VO2max (21% vs. 19% vs. 18%, 1/min). Correlation analysis also yielded a nonsignificant relationship between improvement and age (r = -0.13). To examine the effect of initial fitness level on the adaptive response to exercise, pretraining VO2max was correlated with the absolute improvement in VO2max. This relationship was not significant in either men (r = 0.04) or women (r = -0.23). In conclusion, in healthy people aged 60-71 yr, VO2max adapts to endurance exercise training to the same relative extent as in young people, and this adaptation is independent of gender, age, and initial level of fitness.

A longitudinal assessment of change in VO2max and maximal heart rate in master athletes.

Type of study: non-rct observational study

Number of citations: 117

Year: 2001

Authors: S. Hawkins, T. Marcell, S. Victoria Jaque, R. Wiswell

Journal: Medicine and science in sports and exercise

Journal ranking: Q1

Key takeaways: VO2max declines in master athletes at a rate similar to or greater than that of sedentary older adults, with maintenance of LBM and VO2max associated in men, and estrogen replacement and maintenance of training volume in women.

Abstract: PURPOSE The purpose of this study was to determine the longitudinal change in VO2max and HRmax in male and female master endurance runners and to compare these changes based upon gender, age, and change in training volume. METHODS Eighty-six male (53.9 +/- 1.1 yr) and 49 female (49.1 +/- 1.2 yr) master endurance runners were tested an average of 8.5 yr apart. Subjects were grouped by age at first visit, change in VO2max, and change in training volume. Measurements included body composition by hydrostatic weighing, maximal exercise testing on a treadmill, and training history by questionnaire. Data were analyzed by ANOVA and multiple regression. RESULTS VO2max and HRmax declined significantly regardless of gender or age group (P < 0.05). The rate of change in VO2max by age group ranged from -1% to -4.6% per year for men and -0.5% to 2.4% per year for women. Men with the greatest loss in VO2max had the greatest loss in LBM (-2.8 +/- 0.7 kg), whereas women with the greatest loss in VO2max demonstrated the greatest change in training volume (-24.1 +/- 3.0 km.wk-1). Additionally, women with the greatest loss in VO2max (-9.6 +/- 2.6 mL.kg-1.min-1) did not replace estrogen after menopause independent of age. HRmax change did not differ by VO2max change or training volume change in either gender. CONCLUSIONS In conclusion, these data suggest that VO2max declines in male and female master athletes at a rate similar to or greater than that expected in sedentary older adults. Additionally, these data suggest that maintenance of LBM and VO2max were associated in men, whereas in women, estrogen replacement and maintenance of training volume were associated with maintained VO2max.

Reference Standards for Cardiorespiratory Fitness Measured With Cardiopulmonary Exercise Testing: Data From the Fitness Registry and the Importance of Exercise National Database.

Type of study: non-rct observational study

Number of citations: 353

Year: 2015

Authors: L. Kaminsky, R. Arena, J. Myers

Journal: Mayo Clinic proceedings

Journal ranking: Q1

Key takeaways: The Fitness Registry and Importance of Exercise National Data Base (FRIEND) provides more accurate cardiorespiratory fitness reference data using cardiopulmonary exercise testing in the US compared to previous standards based on workload-derived estimations.

Changes in maximal cardiorespiratory capacity among aging municipal employees.

Type of study: non-rct observational study

Number of citations: 80

Year: 1991

Authors: J. Ilmarinen, V. Louhevaara, O. Korhonen, C. Nygård, T. Hakola, S. Suvanto

Journal: Scandinavian journal of work, environment & health

Journal ranking: Q1

Key takeaways: After four years, women's VO2max decreased 6%, while men's increased 8%, with women's 63% insufficient for physically demanding jobs.

Abstract: Before and after a four-year follow-up, maximal oxygen consumption (VO2max) was determined for 67 municipal employees (initial age about 51 years). The VO2max (ml.kg-1) decreased 6% among the women and increased 8% among the men, the greatest and smallest change occurring for employees doing mental and physical work, respectively. The men's increase was associated with an increase in leisure-time physical activity. Work content was not associated with the level of VO2max for either gender. After the four years the women's absolute VO2max was about 66% of the men's. There were marked changes in VO2max at the individual level, the most marked decreases being associated with the use of medication in some cases. After the four years the women's VO2max of 63% was insufficient according to current recommendations. Therefore physically demanding jobs are not generally recommended for older women.

Physical Workload and Work Capacity across Occupational Groups

Type of study: non-rct observational study

Number of citations: 42

Year: 2016

Authors: S. Brighenti-Zogg, J. Mundwiler, U. Schüpbach, T. Dieterle, D. Wolfer, J. Leuppi, D. Miedinger

Journal: PLoS ONE

Journal ranking: Q1

Key takeaways: The average workload limit is one third of VO2max, but this underestimates the actual physical work demands of specific occupational groups and fails to account for gender-related differences in relative workload.

Abstract: This study aimed to determine physical performance criteria of different occupational groups by investigating physical activity and energy expenditure in healthy Swiss employees in real-life workplaces on workdays and non-working days in relation to their aerobic capacity (VO2max). In this cross-sectional study, 337 healthy and full-time employed adults were recruited. Participants were classified (nine categories) according to the International Standard Classification of Occupations 1988 and merged into three groups with low-, moderate- and high-intensity occupational activity. Daily steps, energy expenditure, metabolic equivalents and activity at different intensities were measured using the SenseWear Mini armband on seven consecutive days (23 hours/day). VO2max was determined by the 20-meter shuttle run test. Data of 303 subjects were considered for analysis (63% male, mean age: 33 yrs, SD 12), 101 from the low-, 102 from the moderate- and 100 from the high-intensity group. At work, the high-intensity group showed higher energy expenditure, metabolic equivalents, steps and activity at all intensities than the other groups (p<0.001). There were no significant differences in physical activity between the occupational groups on non-working days. VO2max did not differ across groups when stratified for gender. The upper workload limit was 21%, 29% and 44% of VO2max in the low-, moderate- and high-intensity group, respectively. Men had a lower limit than women due to their higher VO2max (26% vs. 37%), when all groups were combined. While this study did confirm that the average workload limit is one third of VO2max, it showed that the average is misrepresenting the actual physical work demands of specific occupational groups, and that it does not account for gender-related differences in relative workload. Therefore, clinical practice needs to consider these differences with regard to a safe return to work, particularly for the high-intensity group.

Estimation of VO2max from a one-mile track walk, gender, age, and body weight.

Type of study: non-rct experimental

Number of citations: 564

Year: 1987

Authors: G. Kline, J. Porcari, R. Hintermeister, P. Freedson, A. Ward, R. McCarron, J. Ross, J. Rippe

Journal: Medicine and science in sports and exercise

Journal ranking: Q1

Key takeaways: A one-mile walk test provides a valid sub-maximum assessment for estimating maximal oxygen consumption (VO2max), with age, weight, and sex playing significant roles in the estimation process.

Abstract: The purpose of this investigation was to explore an alternative field test to estimate maximal oxygen consumption (VO2max) using a one-mile walk test. VO2max was determined in 343 healthy adult (males = 165, females = 178) subjects 30 to 69 yr using a treadmill protocol (mean +/- SD: VO2max = 37.0 +/- 10.7 ml X kg-1 X min-1). Each subject performed a minimum of two, one-mile track walks as fast as possible. The two fastest walks (T1, T2) with elapsed times within 30 s were used for subsequent analyses. Heart rates were monitored continuously and recorded every one-quarter mile. Multiple regression analysis (best sub-sets) to estimate VO2max (l X min-1) yielded the following predictor variables: track walk-1 time (T1); fourth quarter heart rate for track walk-1 (HR 1-4); age (yr); weight (lb); and sex (1 = male, 0 = female). The best equation (N = 174) was: VO2max = 6.9652 + (0.0091*WT) - (0.0257*AGE) + (0.5955*SEX) - (0.2240*T1) - (0.0115*HR1-4); r = 0.93, SEE = 0.325 l X min-1. Comparing observed and estimated VO2max values in a cross-validation group (N = 169) resulted in r = 0.92, SEE = 0.355 l X min-1. Generalized and sex-specific equations to estimate VO2max (ml X kg-1 X min-1) were also generated. The accuracy of estimation as expressed by SEE was similar among the equations. The results indicate that this one-mile walk test protocol provides a valid sub-maximum assessment for VO2max estimation.

Development Of Aerobic Fitness Norms In Collegiate Dancers: A 12 Year Prospective Longitudinal Study

Type of study: non-rct observational study

Number of citations: 0

Year: 2021

Authors: Jena Hansen-Honeycutt, A. M. Icaza, V. Fauntroy, S. Coogan, J. Ambegaonkar

Journal: Medicine & Science in Sports & Exercise

Journal ranking: Q1

Key takeaways: Collegiate dancers have generally higher aerobic fitness levels compared to healthy adults, with females showing higher estimates compared to men.

Abstract: PURPOSE: Dance is a physically demanding art form, requiring elevated aerobic fitness to support dancing. However, there are insufficient normative values to determine aerobic fitness in collegiate dancers. Understanding this information could help dancers and practitioners to recognize dancers' aerobic fitness needs and help enhance performance and decrease injury in dancers. Our purpose was to develop fitness norms in collegiate dancers. METHODS: In this prospective longitudinal study, 33 collegiate dancers(Females: n = 203, Males: n = 30; Age = 18.31 ± 0.73 years) across 12 cohorts(Academic-Years: 2008-2019) during their freshman year performed the 3-minute step test protocol. We recorded(Recovery Heart Rate, HR-rec; beats per minute, bpm) heart rate to derive estimated VO2max(Men: VO2max = 111.33-[0.42 x HRrec], Women: VO2max = 65.81-[0.1847 x HR-rec]). Descriptive statistics were used to analyze estimated VO2max and create percentiles for collegiate dancers. RESULTS: Dancers' VO2max was respectively superior(M ± SD, Male:70.7 ± 7.35) and excellent(Female:48.1 ± 3.81 ml·kg-1·min-1) using the American College of Sports Medicine(ACSM) classifications. Percentiles were calculated based upon the estimated VO2max (Males, 95% = 82.3, 90% = 79.9, 85% = 80.2, 80% = 78.0 ml·kg-1·min-1). Percentiles were calculated based upon the estimated VO2max (Females, 95% = 53.98, 90% = 52.5, 85% = 51.8 and 80% = 51.0 ml·kg-1·min-1). CONCLUSIONS: Female dancers had generally higher estimated VO2max when compared to ACSM classifications for healthy adults. We only had 30 males across our cohorts, warranting inclusion of more males to develop robust norms in male collegiate dancers. Our collegiate dancers participated primarily in modern/contemporary dance. Still, other styles of dance exist and more work is needed across genres and levels. Prior findings in collegiate dancers found aerobic fitness did not significantly change over the collegiate-academic career, the normative values we found in the current study can be used as baseline aerobic fitness norms in healthy collegiate dancers.

Sex Dimorphism of VO2max Trainability: A Systematic Review and Meta-analysis

Type of study: meta-analysis

Number of citations: 57

Year: 2019

Authors: C. Diaz-Canestro, D. Montero

Journal: Sports Medicine

Journal ranking: Q1

Key takeaways: Endurance training leads to greater improvements in VO2max in healthy men compared to women, indicating a sexual dimorphism in aerobic capacity trainability.

Abstract: Increases in maximal oxygen uptake (VO2max) are strongly associated with improved cardiovascular health. The aim was to perform a systematic review and meta-analysis to determine whether VO2max responses to endurance training (ET), the most effective intervention to improve VO2max, are influenced by sex. We conducted a systematic search of MEDLINE and Web of Science since their inceptions until February 2019 for articles assessing the VO2max response to a given sex-matched dose of ET in healthy age-matched men and women. Meta-analyses were performed to determine the mean difference between VO2max responses in men versus women. Subgroup and meta-regression analyses were used to assess potential moderating factors. After systematic review, eight studies met the inclusion criteria. All studies implemented common modalities of ET in healthy untrained individuals, comprising a total of 175 men and women (90 ♂, 85 ♀). ET duration and intensity were sex-matched in all studies. After data pooling, ET induced substantially larger increases in absolute VO2max in men compared with women (mean difference = + 191 ml·min−1, 95% CI 99, 283; P < 0.001). A greater effect of ET on relative VO2max was also observed in men versus women (mean difference = + 1.95 ml·min−1·kg−1, 95% CI 0.76, 3.15; P = 0.001). No heterogeneity was detected among studies (I2 = 0%, P ≥ 0.59); the meta-analytical results were robust to potential moderating factors. Pooled evidence demonstrates greater improvements in VO2max in healthy men compared with women in response to a given dose of ET, suggesting the presence of sexual dimorphism in the trainability of aerobic capacity.

Determining cardiovascular fitness normative reference values in a university aged Canadian population using maximal exercise testing

Type of study:

Number of citations: 2

Year: 2024

Authors: Adriana M. Duquette, Natalie A. Adam

Journal: Biomedical Human Kinetics

Journal ranking: Q3

Key takeaways: This study provides normative reference values for aerobic fitness in a university-aged Canadian population, with significant differences between sexes for maximal oxygen uptake values.

Abstract: Abstract Study aim: Maximal oxygen uptake (VO2max) is the greatest rate at which the body can use oxygen and is an indicator of aerobic power. Although aerobic fitness is such a valuable determinant of health, there is limited research with established normative values for a healthy young adult Canadian population. The purpose of the study was to develop normative reference values for a Canadian young-adult population. Material and methods: 550 undergraduate student (280 male and 270 female) participants, with a mean body mass (BM) of 72.08 ± 15.05 kg, mean age of 21.16 ± 1.26 years old and mean height of 171.95 ± 10.25 cm completed a VO2max test using the Bruce treadmill protocol. Male and female classifications were established for the total exercise time in minutes and for the measured VO2max using percentiles and a seven-category classification system. Results: There were statistically significant differences between the sexes for VO2max values (p < 0.001). The measured assessment for the healthy young Canadian adults showed a mean VO2max value of 40.90 ± 7.50 mL/kg/min for females and 49.89 ± 9.20 mL/kg/min for males. Females were able to withstand the exercise protocol for a mean of 11.92 ± 1.97 minutes, while males exercised for an average of 14.33 ± 2.40 minutes before the test was terminated. Conclusions: This study provides specific normative values for the aerobic fitness of a university aged Canadian population which can be used as reference values for cardiovascular health and fitness assessments.

VO2 Max Normative Values Using Queen’s College Step Test in Healthy Urban Indian Individuals of Age Group 20-50 Years

Type of study:

Number of citations: 2

Year: 2020

Authors: Raji Varghese, Ashwini A. Dangi, Ann Varghese

Journal:

Journal ranking: brak

Key takeaways: VO2max is best in the youngest age group and superior in males compared to females in healthy urban Indian individuals aged 20-50 years.

Abstract: Background: Physical Fitness has been defined as a set of attributes that people have or achieve that relates to physical activity and can be either health or skill related. This study aims at determining one of the crucial health related factorsCardiovascular endurance measured by standard parametermaximal uptake of oxygen (VO2max) and its association with gender in the Indian urban population. Methods: 501 individuals consisting of both males and females from 20 to 50 years of age were subjected to the Queens College Step Test (submaximal exercise test). The heart rate obtained immediately after the test was then substituted in the formula, based on gender, to predict the VO2max indirectly. Results: Normative VO2 values obtained for 501 individuals were in the range of 38.41+/-6.95ml/kg/min. VO2max was also found to have an association with age and gender (p<0.05). Conclusion: Normative range of VO2 max was established within the age group. Mean VO2max was seen to be best in the youngest age group of the study and superior in males when compared to females.

High-intensity interval training improves cardiovascular and physical health in patients with rheumatoid arthritis: a multicentre randomised controlled trial

Type of study: rct

Number of citations: 4

Year: 2024

Authors: A. Bilberg, K. Mannerkorpi, M. Borjesson, S. Svedlund, Jenny Sivertsson, E. Klingberg, J. Bjersing

Journal: British Journal of Sports Medicine

Journal ranking: Q1

Key takeaways: Supervised HIIT and strength exercise improves cardiovascular health, physical fitness, and overall health in patients with rheumatoid arthritis without deteriorating pain and disease activity.

Abstract: Objectives Patients with rheumatoid arthritis (RA) have substantially elevated risk for cardiovascular diseases, and low cardiorespiratory fitness (VO2max) is a major mediator. The aim of this assessor-blinded, two-armed multicentre randomised controlled trial was to evaluate the effects of high-intensity interval training (HIIT) and strength exercise on cardiovascular health, physical fitness and overall health in patients with RA. Methods In total, 87 patients (86% female; aged 20–60 years) were randomly assigned to an intervention group (IG) or a control group (CG). The IG performed HIIT and strength exercise for 12 weeks. The CG was instructed to be physically active on a moderately intensive level, ≥150 min/week. Primary outcome was change in VO2max. Secondary outcomes were changes in anthropometry measures, muscle strength, overall health (Visual Analogue Scale (VAS)-Global), Patient Global Impression of Change (PGIC), pain and disease activity (Disease Activity Score in 28 joints (DAS28)). Results There was a significant mean group difference of change on VO2max (3.71 mL/kg/min; 95% CI 2.16, 5.25) in favour of the IG. Significant mean group differences of change were also seen for O2-pulse (1.38; 95% CI 0.85 to 1.91), waist circumference (−2.6; 95% CI −5.09 to –0.18), 1-minute sit-to-stand (5.0; 95% CI 3.35 to 6.72), handgrip strength (28.5; 95% CI 3.80 to 52.8), overall health (−14.7; 95% CI –23.8 to –5.50) and PGIC (p<0.0001) in favour of the IG. No significant mean group differences of change were found for pain (−4.0; 95% CI −13.07 to 5.06), DAS28 (−0.25; 95% CI −0.60 to 0.10) and erythrocyte sedimentation rate (−0.64; 95% CI −3.23 to 1.90). Conclusion Supervised HIIT and strength exercise improved cardiovascular health, physical fitness and overall health without a deterioration in pain and disease activity and should be considered in patients with well-controlled RA. Trial registration number NCT05768165.

Cardiorespiratory fitness is a strong and consistent predictor of morbidity and mortality among adults: an overview of meta-analyses representing over 20.9 million observations from 199 unique cohort studies

Type of study: meta-analysis

Number of citations: 59

Year: 2024

Authors: J. J. Lang, Stephanie A. Prince, Katherine Merucci, C. Cadenas-Sánchez, J. Chaput, B. Fraser, Taru Manyanga, Ryan McGrath, Francisco B. Ortega, Ben Singh, Grant R Tomkinson

Journal: British Journal of Sports Medicine

Journal ranking: Q1

Key takeaways: High cardiorespiratory fitness is strongly associated with lower risk of various mortality and chronic conditions in both general and clinical populations.

Abstract: Objective To examine and summarise evidence from meta-analyses of cohort studies that evaluated the predictive associations between baseline cardiorespiratory fitness (CRF) and health outcomes among adults. Design Overview of systematic reviews. Data source Five bibliographic databases were searched from January 2002 to March 2024. Results From the 9062 papers identified, we included 26 systematic reviews. We found eight meta-analyses that described five unique mortality outcomes among general populations. CRF had the largest risk reduction for all-cause mortality when comparing high versus low CRF (HR=0.47; 95% CI 0.39 to 0.56). A dose–response relationship for every 1-metabolic equivalent of task (MET) higher level of CRF was associated with a 11%–17% reduction in all-cause mortality (HR=0.89; 95% CI 0.86 to 0.92, and HR=0.83; 95% CI 0.78 to 0.88). For incident outcomes, nine meta-analyses described 12 unique outcomes. CRF was associated with the largest risk reduction in incident heart failure when comparing high versus low CRF (HR=0.31; 95% CI 0.19 to 0.49). A dose–response relationship for every 1-MET higher level of CRF was associated with a 18% reduction in heart failure (HR=0.82; 95% CI 0.79 to 0.84). Among those living with chronic conditions, nine meta-analyses described four unique outcomes in nine patient groups. CRF was associated with the largest risk reduction for cardiovascular mortality among those living with cardiovascular disease when comparing high versus low CRF (HR=0.27; 95% CI 0.16 to 0.48). The certainty of the evidence across all studies ranged from very low-to-moderate according to Grading of Recommendations, Assessment, Development and Evaluations. Conclusion We found consistent evidence that high CRF is strongly associated with lower risk for a variety of mortality and incident chronic conditions in general and clinical populations.

Cardiorespiratory fitness, body composition, diabetes, and longevity: a two-sample Mendelian randomization study.

Type of study: non-rct observational study

Number of citations: 4

Year: 2024

Authors: A. D. Kjaergaard, Christina Ellervik, Niels Jessen, Sarah J Lessard

Journal: The Journal of clinical endocrinology and metabolism

Journal ranking: Q1

Key takeaways: VO2max can be improved by favorable body composition, physical activity, and performance enhancers, but is not causally associated with type 2 diabetes or longevity.

Abstract: CONTEXT Cardiorespiratory fitness, commonly assessed as maximal volume of oxygen consumption (VO2max), has emerged as an important predictor of morbidity and mortality. OBJECTIVE We investigated the causality and directionality of the associations of VO2max with body composition, physical activity, diabetes, performance enhancers, and longevity. METHODS Using publicly available summary statistics from the largest genome-wide association studies publicly available, we conducted a bidirectional two-sample Mendelian randomization (MR) study. Bidirectional MR tested directionality, and estimated the total causal effects, whereas multivariable MR (MVMR) estimated independent causal effects. Cardiorespiratory fitness (VO2max) was estimated from a submaximal cycle ramp test (N≈90,000) and scaled to total body weight, and in additional analyses to fat-free mass (mL/min/kg). RESULTS Genetically predicted higher (per one standard deviation increase) body fat percentage was associated with lower VO2max (β=-0.36 [95% CI: -0.40, -0.32], p=6E-77). Meanwhile, genetically predicted higher appendicular lean mass (0.10 [0.08,0.13] p=3E-16), physical activity (0.29 [0.07,0.52]), and performance enhancers (fasting insulin, hematocrit, and free testosterone in men) were all positively associated with VO2max (p<0.01). Genetic predisposition to diabetes had no effect on VO2max. MVMR showed independent causal effects of body fat percentage, appendicular lean mass, physical activity, and hematocrit on VO2max, as well as of body fat percentage and type 2 diabetes (T2D) on longevity. Genetically predicted VO2max showed no associations. CONCLUSION Cardiorespiratory fitness can be improved by favorable body composition, physical activity, and performance enhancers. Despite being a strong predictor of mortality, VO2max is not causally associated with T2D or longevity.

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

Type of study: meta-analysis

Number of citations: 137

Year: 2022

Authors: J. Laukkanen, N. Isiozor, S. Kunutsor

Journal: Mayo Clinic proceedings

Journal ranking: Q1

Key takeaways: Higher cardiorespiratory fitness levels are strongly associated with a lower all-cause mortality risk, suggesting that it should be included in standard risk panels for mortality risk assessment.

Effect of regular exercise training on changes in HbA1c, BMI and VO2max among patients with type 2 diabetes mellitus: an 8-year trial

Type of study:

Number of citations: 82

Year: 2017

Authors: F. Najafipour, M. Mobasseri, A. Yavari, H. Nadrian, A. Aliasgarzadeh, Naimeh Mashinchi Abbasi, M. Niafar, Jalil Houshyar Gharamaleki, Vahideh Sadra

Journal: BMJ Open Diabetes Research & Care

Journal ranking: Q1

Key takeaways: Regular exercise training for 8 years significantly improves glycemic control, body composition, and cardiovascular fitness in patients with type 2 diabetes mellitus.

Abstract: Objective The effects of regular exercise on the health promotion of patients with type 2 diabetes mellitus (T2DM) have been well documented. The present study investigated the long-term effects of regular exercise training on biological indicators among these patients. Methods In this quasi-experimental trial with pretest-post-test design, 65 patients with T2DM aged 33–69 years (experiment (35), control (30)) participated. After 8 years of conducting the program, the data on 30 patients (experiment (15), control (15)) were entered into analysis. The training program included aerobic exercise three sessions per week, 90 min, 50%–80% VO2max. Before and after the intervention, the biological indicators (hemoglobin A1c (HbA1c), body mass index (BMI) and VO2max) were measured. Data were analyzed using multivariate analysis of covariance. Results Our long-term exercise training program had a significant effect on HbA1C, BMI and Vo2max (P<0.05). Compared with patients in the control group, HbA1c was significantly reduced and BMI and VO2max were significantly improved among the experiment group. Conclusions Long-term regular physical activity training was found to be helpful in improving glycemic control, body composition and cardiovascular fitness among patients with T2DM. Long-term continuous physical activity offsets the deteriorations of biological indicators found in the control group. Further research, with a particular focus on practical and real-world programming, is needed to determine the responsive health outcomes of such long-term programs on the patients.

Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex.

Type of study: non-rct observational study

Number of citations: 143

Year: 2022

Authors: P. Kokkinos, C. Faselis, I. Samuel, A. Pittaras, M. Doumas, Rayelynn Murphy, M. Heimall, X. Sui, Jiajia Zhang, J. Myers

Journal: Journal of the American College of Cardiology

Journal ranking: Q1

Key takeaways: Higher cardiorespiratory fitness is associated with lower mortality risk across all age groups, races, and sexes, with unfit individuals at a greater risk than those with extreme fitness.

Smartphone-Assisted High-Intensity Interval Training in Inflammatory Rheumatic Disease Patients: Randomized Controlled Trial

Type of study: rct

Number of citations: 15

Year: 2021

Authors: Håvard Haglo, E. Wang, O. Berg, J. Hoff, J. Helgerud

Journal: JMIR mHealth and uHealth

Journal ranking: Q1

Key takeaways: Self-administered 44-min HIIT guided by a smartphone app (Myworkout GO) can improve VO2max and health-related quality of life in inflammatory rheumatic disease patients, potentially reducing costs.

Abstract: Background Patients with inflammatory rheumatic diseases (IRDs) experience disease-related barriers to physical training. Compared with the general population, IRD patients are reported to have reduced maximal oxygen uptake (VO2max) and physical activity levels. Supervised high-intensity interval training (HIIT) is documented to counteract the reduced VO2max and poor cardiovascular health associated with IRDs. However, supervised HIIT is resource demanding. Objective This study sought to investigate if self-administered 4×4-min HIIT guided by a smartphone app (Myworkout GO) could yield similar HIIT-induced effects as standard 4×4-min HIIT performed under the guidance and supervision of health care professionals. The effects studied were on VO2max and health-related quality of life (HRQoL). Methods Forty patients (33 female patients, mean age 48 years, SD 12 years; 7 male patients, mean age 52 years, SD 11 years) diagnosed with rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus were randomized to a supervised group (SG) or an app group (AG). Both groups were instructed to perform 4×4-min intervals with a rate of perceived exertion of 16 to 17, corresponding to 85% to 95% of the maximal heart rate, twice a week for 10 weeks. Treadmill VO2max and HRQoL measured using RAND-36 were assessed before and after the exercise period. Results VO2max increased (P<.001) in both groups after 10 weeks of HIIT, with improvements of 3.6 (SD 1.3) mL/kg/min in the SG and 3.7 (SD 1.5) mL/kg/min in the AG. This was accompanied by increases in oxygen pulse in both groups (P<.001), with no between-group differences apparent for either measure. Improvements in the HRQoL dimensions of bodily pain, vitality, and social functioning were observed for both groups (P<.001 to P=.04). Again, no between-group differences were detected. Conclusions High-intensity 4×4-min interval training increased VO2max and HRQoL, contributing to patients’ reduced cardiovascular disease risk, improved health and performance, and enhanced quality of life. Similar improvements were observed following HIIT when IRD patients were guided using perceived exertion by health care professionals or the training was self-administered and guided by the app Myworkout GO. Utilization of the app may help reduce the cost of HIIT as a treatment strategy in this patient population. Trial Registration ClinicalTrials.gov NCT04649528; https://clinicaltrials.gov/ct2/show/NCT04649528

Observational and genetic associations between cardiorespiratory fitness and age-related diseases: longitudinal analyses in the UK Biobank study.

Type of study: non-rct observational study

Number of citations: 0

Year: 2024

Authors: Huimin Lu, Haotian Wang, Cancan Li, Xiaoni Meng, Deqiang Zheng, Lijuan Wu, Youxin Wang

Journal: The EPMA journal

Journal ranking: Q1

Key takeaways: Higher cardiorespiratory fitness levels are associated with a decreased risk of cardiovascular disease, Alzheimer's disease, and Parkinson's disease.

Abstract: Observational studies have indicated that increased cardiorespiratory fitness is associated with a decreased risk of cardiovascular disease (CVD), Alzheimer's disease (AD), and Parkinson's disease (PD). However, the causal mechanisms remain unclear. The objective of this study was to assess the role of fitness in the early detection and reduction of disease risk within the framework of predictive, preventive, and personalized medicine (PPPM/3PM). The associations of fitness with CVD, AD, and PD were explored in a large cohort of up to 502,486 individuals between the ages of 40 and 69 years from the UK Biobank. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of CVD, AD, and PD among participants who completed a submaximal fitness test. Causality relationships were assessed via two-sample Mendelian randomization (MR). After a median of 11 years of follow-up, each 3.5 ml of O⋅min⋅kgincrease in total body mass (equivalent to 1 metabolic equivalent of task (MET), approximately 0.5 standard deviations (SDs)) was associated with decreased risks of CVD (20.0%, 95% CI 17.6-22.3%), AD (31.9%, 95% CI 26.7-33.6%), and PD (21.2%, 95% CI 11.2-31.8%). After adjusting for obesity, the observational associations were attenuated. According to the MR analyses, fitness was associated with PD (OR0.937, 95% CI 0.897-0.978) and small vessel stroke (OR0.964, 95% CI 0.933-0.995). Our results indicate that fitness has an effect on age-related diseases. Protective associations of higher fitness levels with the risk of CVD, AD, and PD were validated in this cohort study. These findings might be valuable for predicting, preventing, and reducing disease morbidity and mortality through primary prevention and healthcare in the context of PPPM. The online version contains supplementary material available at 10.1007/s13167-024-00382-4.

The effect of Tabata-style functional high-intensity interval training on cardiometabolic health and physical activity in female university students

Type of study: rct

Number of citations: 25

Year: 2023

Authors: Yining Lu, Huw Wiltshire, J. Baker, Qiaojun Wang, Shanshan Ying

Journal: Frontiers in Physiology

Journal ranking: Q2

Key takeaways: 12-week low-volume Tabata-style functional HIIT effectively improves cardiorespiratory fitness, body fat, and some cardiometabolic health outcomes in female university students.

Abstract: Introduction: The increasing prevalence of metabolic syndrome and physical inactivity enhances exposure to cardiometabolic risk factors in university students. High-intensity interval training (HIIT) improved cardiometabolic health in clinical adults but the evidence in the university setting is limited. Furthermore, few studies examined the effect of low-volume HIIT on habitual physical activity (PA). Therefore, the primary aim of this study was to evaluate the efficacy of 12-week Tabata-style functional HIIT for improving multiple cardiometabolic health outcomes and habitual PA. We also investigated whether changes in habitual PA over the intervention period had an impact on exercise-induced health outcomes. Methods: 122 female freshmen were randomized into the Tabata group (n = 60) and the control (n = 62). The Tabata training protocol involved 8 × 20 s maximal repeated functional exercises followed by 10 s rest with a frequency of 3 times per week for 12 weeks. Body composition, maximal oxygen uptake (VO2max), blood pressure (BP), blood lipids, fasting glucose and insulin, C-reactive protein and PA were objectively measured using standardized methods. Dietary intake was measured using a valid food frequency questionnaire. All variables were measured pre- and post-intervention. Results: Mixed linear modelling results showed that there were large intervention effects on VO2max (p < 0.001, d = 2.53, 95% CI: 2.03 to 3.00 for relative VO2max; p < 0.001, d = 2.24, 95% CI: 1.76 to 2.68 for absolute VO2max), resting heart rate (p < 0.001, d = −1.82, 95% CI: −2.23 to −1.37), systolic BP (p < 0.001, d = −1.24, 95% CI: −1.63 to −0.84), moderate-to-vigorous intensity physical activity (MVPA) (p < 0.001, d = 2.31, 95% CI: 1.83 to 2.77), total PA (p < 0.001, d = 1.98, 95% CI: 1.53 to 2.41); moderate effects on %BF (p < 0.001, d = -1.15, 95% CI: −1.53 to −0.75), FM (p < 0.001, d = −1.08, 95% CI: −1.46 to −0.69), high-density lipoprotein (HDL) (p < 0.001, d = 1.04, 95% CI: 0.65 to 1.42), total cholesterol (p = 0.001, d = −0.64, 95% CI: −1.00 to −0.26); small effects on BMI (p = 0.011, d = −0.48, 95% CI: −0.84 to 0.11), WC (p = 0.043, d = −0.37, 95% CI: −0.74 to −0.01), low-density lipoprotein (p = 0.003, d = −0.57, 95% CI: −0.93 to −0.19), HOMA-IR (p = 0.026, d = −0.42, 95% CI: −0.78 to −0.05) and fasting insulin (p = 0.035, d = −0.40, 95% CI: −0.76 to −0.03). Regression analysis showed that only the percentage change of HDL was associated with the change of MVPA (b = 0.326, p = 0.015) and TPA (b = 0.480, p = 0.001). Conclusion: From the findings of the study we can conclude that 12-week low-volume Tabata-style functional HIIT was highly effective for university female students to improve cardiorespiratory fitness, body fat, some cardiometabolic health outcomes and habitual PA.

Association of Cardiorespiratory Fitness Levels During Youth With Health Risk Later in Life: A Systematic Review and Meta-analysis.

Type of study: meta-analysis

Number of citations: 153

Year: 2020

Authors: A. García-Hermoso, R. Ramírez‐Vélez, Yesenia García-Alonso, A. Alonso-Martínez, M. Izquierdo

Journal: JAMA pediatrics

Journal ranking: Q1

Key takeaways: Higher cardiorespiratory fitness in youth is associated with better health parameters later in life, suggesting the importance of early intervention and prevention strategies.

Abstract: Importance Although the associations between cardiorespiratory fitness (CRF) and health in adults are well understood, to date, no systematic review has quantitatively examined the association between CRF during youth and health parameters later in life. Objectives To examine the prospective association between CRF in childhood and adolescence and future health status and to assess whether changes in CRF are associated with future health status at least 1 year later. Data Sources For this systematic review and meta-analysis, MEDLINE, Embase, and SPORTDiscus electronic databases were searched for relevant articles published from database inception to January 30, 2020. Study Selection The following inclusion criteria were used: CRF measured using a validated test and assessed at baseline and/or its change from baseline to the end of follow-up, healthy population with a mean age of 3 to 18 years at baseline, and prospective cohort design with a follow-up period of at least 1 year. Data Extraction and Synthesis Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects models were used to estimate the pooled effect size. Main Outcomes and Measures Anthropometric and adiposity measurements and cardiometabolic health parameters. Results Fifty-five studies were included with a total of 37 563 youths (46% female). Weak-moderate associations were found between CRF at baseline and body mass index (r = -0.11; 95% CI, -0.18 to -0.04; I2 = 59.03), waist circumference (r = -0.29; 95% CI, -0.42 to -0.14; I2 = 69.42), skinfold thickness (r = -0.34; 95% CI, -0.41 to -0.26; I2 = 83.87), obesity (r = -0.15; 95% CI, -0.23 to -0.06; I2 = 86.75), total cholesterol level (r = -0.12; 95% CI, -0.19 to -0.05; I2 = 75.81), high-density lipoprotein cholesterol (HDL-C) level (r = 0.11; 95% CI, 0.05-0.18; I2 = 69.06), total cholesterol to HDL-C ratio (r = -0.19; 95% CI, -0.26 to -0.13; I2 = 67.07), triglyceride levels (r = -0.10; 95% CI, -0.18 to -0.02; I2 = 73.43), homeostasis model assessment for insulin resistance (r = -0.12; 95% CI, -0.18 to -0.06; I2 = 68.26), fasting insulin level (r = -0.07; 95% CI, -0.11 to -0.03; I2 = 0), and cardiometabolic risk (r = -0.18; 95% CI, -0.29 to -0.07; I2 = 90.61) at follow-up. Meta-regression analyses found that early associations in waist circumference (β = 0.014; 95% CI, 0.002-0.026), skinfold thickness (β = 0.006; 95% CI, 0.002-0.011), HDL-C level (β = -0.006; 95% CI, -0.011 to -0.001), triglyceride levels (β = 0.009; 95% CI, 0.004-0.014), and cardiometabolic risk (β = 0.007; 95% CI, 0.003-0.011) from baseline to follow-up dissipated over time. Weak-moderate associations were found between change in CRF and body mass index (r = -0.17; 95% CI, -0.24 to -0.11; I2 = 39.65), skinfold thickness (r = -0.36; 95% CI, -0.58 to -0.09; I2 = 96.84), obesity (r = -0.21; 95% CI, -0.35 to -0.06; I2 = 91.08), HDL-C level (r = 0.05; 95% CI, 0.02-0.08; I2 = 0), low-density lipoprotein cholesterol level (r = -0.06; 95% CI, -0.11 to -0.01; I2 = 58.94), and cardiometabolic risk (r = -0.08; 95% CI, -0.15 to -0.02; I2 = 69.53) later in life. Conclusions and Relevance This study suggests that early intervention and prevention strategies that target youth CRF may be associated with maintaining health parameters in later life.

Effectiveness of High-Intensity Interval Training (HIT) and Continuous Endurance Training for VO2max Improvements: A Systematic Review and Meta-Analysis of Controlled Trials

Type of study: meta-analysis

Number of citations: 731

Year: 2015

Authors: Z. Milanović, G. Sporiš, M. Weston

Journal: Sports Medicine

Journal ranking: Q1

Key takeaways: High-Intensity Interval Training (HIT) and endurance training both significantly improve VO2max in healthy young to middle-aged adults, with HIT showing greater gains compared to endurance training.

Abstract: BackgroundEnhancing cardiovascular fitness can lead to substantial health benefits. High-intensity interval training (HIT) is an efficient way to develop cardiovascular fitness, yet comparisons between this type of training and traditional endurance training are equivocal.ObjectiveOur objective was to meta-analyse the effects of endurance training and HIT on the maximal oxygen consumption (VO2max) of healthy, young to middle-aged adults.MethodsSix electronic databases were searched (MEDLINE, PubMed, SPORTDiscus, Web of Science, CINAHL and Google Scholar) for original research articles. A search was conducted and search terms included ‘high intensity’, ‘HIT’, ‘sprint interval training’, ‘endurance training’, ‘peak oxygen uptake’, and ‘VO2max’. Inclusion criteria were controlled trials, healthy adults aged 18–45 years, training duration ≥2 weeks, VO2max assessed pre- and post-training. Twenty-eight studies met the inclusion criteria and were included in the meta-analysis. This resulted in 723 participants with a mean ± standard deviation (SD) age and initial fitness of 25.1 ± 5 years and 40.8 ± 7.9 mL·kg−1·min−1, respectively. We made probabilistic magnitude-based inferences for meta-analysed effects based on standardised thresholds for small, moderate and large changes (0.2, 0.6 and 1.2, respectively) derived from between-subject SDs for baseline VO2max.ResultsThe meta-analysed effect of endurance training on VO2max was a possibly large beneficial effect (4.9 mL·kg−1·min−1; 95 % confidence limits ±1.4 mL·kg−1·min−1), when compared with no-exercise controls. A possibly moderate additional increase was observed for typically younger subjects (2.4 mL·kg−1·min−1; ±2.1 mL·kg−1·min−1) and interventions of longer duration (2.2 mL·kg−1·min−1; ±3.0 mL·kg−1·min−1), and a small additional improvement for subjects with lower baseline fitness (1.4 mL·kg−1·min−1; ±2.0 mL·kg−1·min−1). When compared with no-exercise controls, there was likely a large beneficial effect of HIT (5.5 mL·kg−1·min−1; ±1.2 mL·kg−1·min−1), with a likely moderate greater additional increase for subjects with lower baseline fitness (3.2 mL·kg−1·min−1; ±1.9 mL·kg−1·min−1) and interventions of longer duration (3.0 mL·kg−1·min−1; ±1.9 mL·kg−1·min−1), and a small lesser effect for typically longer HIT repetitions (−1.8 mL·kg−1·min−1; ±2.7 mL·kg−1·min−1). The modifying effects of age (0.8 mL·kg−1·min−1; ±2.1 mL·kg−1·min−1) and work/rest ratio (0.5 mL·kg−1·min−1; ±1.6 mL·kg−1·min−1) were unclear. When compared with endurance training, there was a possibly small beneficial effect for HIT (1.2 mL·kg−1·min−1; ±0.9 mL·kg−1·min−1) with small additional improvements for typically longer HIT repetitions (2.2 mL·kg−1·min−1; ±2.1 mL·kg−1·min−1), older subjects (1.8 mL·kg−1·min−1; ±1.7 mL·kg−1·min−1), interventions of longer duration (1.7 mL·kg−1·min−1; ±1.7 mL·kg−1·min−1), greater work/rest ratio (1.6 mL·kg−1·min−1; ±1.5 mL·kg−1·min−1) and lower baseline fitness (0.8 mL·kg−1·min−1; ±1.3 mL·kg−1·min−1).ConclusionEndurance training and HIT both elicit large improvements in the VO2max of healthy, young to middle-aged adults, with the gains in VO2max being greater following HIT when compared with endurance training.

Causal associations between cardiorespiratory fitness and type 2 diabetes

Type of study: non-rct observational study

Number of citations: 27

Year: 2023

Authors: Lina Cai, Tomas I. Gonzales, E. Wheeler, N. Kerrison, F. Day, C. Langenberg, J. Perry, S. Brage, N. Wareham

Journal: Nature Communications

Journal ranking: Q1

Key takeaways: Higher genetically predicted cardiorespiratory fitness is causally associated with lower risk of type 2 diabetes, independent of adiposity, with potential mediators including N-terminal pro B-type natriuretic peptide, hepatocyte growth factor-like protein, and sex hormone-

Cardiorespiratory Fitness and Mortality in Healthy Men and Women.

Type of study: non-rct observational study

Number of citations: 211

Year: 2018

Authors: Mary T. Imboden, M. Harber, M. Whaley, W. H. Finch, D. Bishop, L. Kaminsky

Journal: Journal of the American College of Cardiology

Journal ranking: Q1

Key takeaways: High cardiorespiratory fitness (CRF) is associated with reduced mortality rates in all-cause, cardiovascular disease, and cancer in seemingly healthy individuals.

Effects of different protocols of high intensity interval training for VO2max improvements in adults: A meta-analysis of randomised controlled trials.

Type of study: meta-analysis

Number of citations: 173

Year: 2019

Authors: Daizong Wen, T. Utesch, Jun Wu, S. Robertson, John Liu, Guopeng Hu, Haichun Chen

Journal: Journal of science and medicine in sport

Journal ranking: Q1

Key takeaways: Short-interval, low-volume, and short-term HIIT effectively improve VO2max, while long-interval, high-volume, and moderate to long-term HIIT maximize VO2max training effects.

The Association between the Change in Directly Measured Cardiorespiratory Fitness across Time and Mortality Risk.

Type of study: non-rct observational study

Number of citations: 92

Year: 2019

Authors: Mary T. Imboden, M. Harber, M. Whaley, W. H. Finch, D. Bishop, Bradley S. Fleenor, Leonard A. Kaminsky

Journal: Progress in cardiovascular diseases

Journal ranking: Q1

Key takeaways: Increased cardiorespiratory fitness over time is inversely related to mortality outcomes, with subsequent tests being a better predictor of mortality than the initial test.

Pre-lung transplant VO2max predicts functional outcomes post-lung transplantation

Type of study:

Number of citations: 1

Year: 2023

Authors: Emma Bakelants, H. Beeckmans, Marius Brusselmans, G. Verleden, L. Dupont, L. Godinas, D. Van raemdonck, L. Ceulemans, Geert Celis, I. Coosemans, Wim Janssens, S. Everaerts, R. Vos

Journal: Transplantation

Journal ranking: Q1

Key takeaways: Pre-lung transplant VO2max during cardiopulmonary exercise testing predicts better post-lung transplant outcomes and can help identify frail patients for prehabilition programs.

Abstract: Functional testing is key in the work-up for lung transplantation. Six minute walk distance (6MWD) or cardiopulmonary exercise testing (CPET) are routinely used to assess the degree of functional impairment. We investigated whether pretransplant maximal oxygen consumption (VO2max) during CPET predicts outcomes after transplantation. Lung transplant recipients transplanted between January 2010 - December 2020 in our institution were included in this retrospective study (n=729). Impact of VO2max (percentile &lt;25 vs 25-75 vs &gt;75) on 6MWD and spirometry at year 1, 2 and 3 after transplantation was assessed in a joint model, correcting for lung allocation score covariates. Kaplan-Meier survival according to VO2max was assessed with log-rank test. Of the 729 included patients, 432 (59%) underwent CPET. Main transplant indications were obstructive disease (n=298), interstitial lung disease (n=102), pulmonary arterial hypertension (n=15) and redo transplantation (n=11). VO2max was significantly associated with posttransplant FEV1 (p=0.0008) and FVC (p=0.0001) in multivariate analysis. VO2max was associated with posttransplant 6MWD in univariate analysis (p=0.0055), however, unconfirmed in multivariate analysis. Posttransplant survival tended to be better in patients with the highest VO2max (p=0.086) (Figure 1). VO2max predicts post-lung transplant outcomes. CPET can help to identify frail patients to guide them into a prehabilition program.

Estimated Cardiorespiratory Fitness and Metabolic Risks

Type of study: systematic review

Number of citations: 7

Year: 2024

Authors: Robert A. Sloan

Journal: International Journal of Environmental Research and Public Health

Journal ranking: Q2

Key takeaways: Higher estimated cardiorespiratory fitness (eCRF) is associated with a lower incidence of metabolic risks, making it a promising indicator for metabolic health.

Abstract: This review focuses on the emerging evidence for the association between non-exercise fitness testing, estimated cardiorespiratory fitness (eCRF), and metabolic risk factors. Given the challenges associated with directly measuring cardiorespiratory fitness (CRF) in large populations, eCRF presents a practical alternative for predicting metabolic health risks. A literature search identified seven relevant cohort studies from 2020 to 2024 that investigated the association of eCRF with hypertension, hyperglycemia, dyslipidemia, and obesity. This review consistently demonstrates an inverse relationship between higher eCRF and a lower incidence of metabolic risks, which is in line with CRF cohort studies. It highlights the importance of low eCRF as a primordial indicator for metabolic risks and underscores the potential for broader application. Future research directions should include exploring eCRF’s predictive ability across diverse populations and health outcomes and testing its real-world applicability in healthcare and public health settings.

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

Type of study:

Number of citations: 1654

Year: 2016

Authors: R. Ross, S. Blair, R. Arena, T. Church, J. Despres, B. Franklin, W. Haskell, L. Kaminsky, B. Levine, C. Lavie, J. Myers, J. Niebauer, R. Sallis, S. Sawada, X. Sui, U. Wisløff

Journal: Circulation

Journal ranking: Q1

Key takeaways: Adding cardiorespiratory fitness (CRF) to traditional risk factors significantly improves risk prediction and patient management, enhancing prevention and treatment of cardiovascular disease.

Abstract: Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association’s 2020 goals.

Midlife Cardiorespiratory Fitness and the Long-Term Risk of Mortality: 46 Years of Follow-Up.

Type of study: non-rct observational study

Number of citations: 114

Year: 2018

Authors: J. Clausen, J. Marott, A. Holtermann, F. Gyntelberg, M. Jensen

Journal: Journal of the American College of Cardiology

Journal ranking: Q1

Key takeaways: Higher midlife cardiorespiratory fitness (CRF) is significantly associated with increased longevity in middle-aged, employed men free of cardiovascular disease.

Survival of the fittest: VO2max, a key predictor of longevity?

Type of study:

Number of citations: 108

Year: 2018

Authors: B. Strasser, M. Burtscher

Journal: Frontiers in bioscience

Journal ranking: Q2

Key takeaways: Regular exercise training promotes cardiorespiratory fitness, which in turn is a strong predictor of longevity and life expectancy in clinically referred populations.

Abstract: Cardiorespiratory fitness, as measured by maximal oxygen uptake (VO2max), is related to functional capacity and human performance and has been shown to be a strong and independent predictor of all-cause and disease-specific mortality. The purpose of this review is to emphasize age-related physiological adaptations occurring with regular exercise training, with specific reference to the main organs (lung, heart, skeletal muscles) involved in oxygen delivery and utilization as well as the importance of exercise training for promoting life expectancy in clinically referred populations. As yet, it is not possible to extend the genetically fixed lifespan with regular exercise training, but to give the years more life. This is where physical fitness plays an important role.

A Systematic Review and Meta-analysis Highlights a Link Between Aerobic Fitness and Telomere Maintenance

Type of study: meta-analysis

Number of citations: 1

Year: 2025

Authors: Clodagh Ryall, Joshua Denham

Journal: The Journals of Gerontology Series A: Biological Sciences and Medical Sciences

Journal ranking: Q1

Key takeaways: Regular endurance exercise can promote healthy biological ageing, with individuals having longer telomeres when their maximal oxygen uptake (VO2max) is in the 70th percentile or higher.

Abstract: Abstract Cardiorespiratory fitness declines with aging and is a major risk factor of cardiometabolic diseases and early death. Although the benefits of regular exercise are well established, whether maximal oxygen uptake (VO2max) is associated with biological aging remains unclear. Given that telomere shortening is a hallmark of aging, the purpose of this systematic review and meta-analysis was to determine the association between VO2max and telomere length. Articles were retrieved from PubMed, Scopus, and ScienceDirect and deemed eligible if they: (i) involved human participants with relatively low and high VO2max values objectively assessed by pulmonary analysis; (ii) quantified telomere length using an established technique; and (iii) were peer-reviewed journal articles written in English. Relative to individuals with below-average VO2max based on age- and sex-adjusted norms, fit participants with relative VO2max values in the 70th percentile or higher possessed longer telomeres (standardized mean difference [95% confidence interval {CI}]: 0.36 [0.14–0.59], p = .002). A similar difference was observed between individuals with below-average VO2max and those above the 90th percentile (0.28 [0.03–0.53], p = .03). However, no statistically significant telomere length differences were observed between individuals in the 70th to 90th percentile compared to those above the 90th (−0.08 [−0.40 to 0.24], p = .62). The findings provide evidence linking metabolism to telomere biology. They encourage individuals to regularly engage in endurance exercise to attenuate telomere attrition and promote healthy biological aging. Importantly, the results suggest that extensive endurance training may not be required to protect the telomeres, rather moderate amounts of training may be sufficient to reach more achievable VO2max targets.

Abstract 4137678: Maximal Oxygen Uptake Prediction From Resting and Submaximal Variables of Cardiopulmonary Exercise Testing by Using Machine Learning Methods

Type of study:

Number of citations: 0

Year: 2024

Authors: YongHun Lee, Jeffrey Feng, Al Rahrooh, Alex A T Bui, Christopher Cooper, Jeffrey J Hsu

Journal: Circulation

Journal ranking: Q1

Key takeaways: Our VO2max prediction model using resting and submaximal exercise variables is accurate in predicting maximal oxygen consumption in healthy, non-athlete individuals.

Abstract: Background: Cardiorespiratory fitness, as measured by maximal oxygen consumption (VO2max) during a cardiopulmonary exercise test (CPET), is a prognostic indicator for longevity and adverse cardiovascular event prevention. This study aims to formulate a regression model utilizing resting and submaximal variables during CPET evaluation in the general population to predict VO2max. Methods: We used 13,535 CPET results on cycle ergometer collected by the UCLA Exercise Physiology Research Laboratory over eight years. Patients were divided into a normal group (NG; n=1,400) and an other group (OG; n=12,135). The inclusion criteria for the NG were: the absence of any known clinical diagnosis, BMI <30, no current use of beta blocker, and VO2max >85% of the predicted value for age and sex (Wasserman equation). OG refers to all other patients not in NG. Models were trained and evaluated for each group using stratified 5-fold cross-validation. We also trained different models using only resting variables (R-VARS) and resting and submaximal exercise variables (R+S-VARS). Feature importance was assessed using Shapely additive explanations (SHAP) values to identify how the feature related to the VO2max prediction. Results: The regression models were trained on the NG, OG, and total (N+OG) groups. The optimal models were Bayesian Ridge for the NG and Light Gradient Boosting Machine for the other two groups. The mean (standard deviation) R2 when using only R-VARS was 0.67(0.037) for the NG, 0.54 (0.014) for the OG, and 0.55 (0.009) for the N+OG. When using R+S-VARS, performance increased to 0.82 (0.014) for the NG, 0.80 (0.010) for the OG, and 0.8 (0.008) for the N+OG. Chronotropic index (ci), body mass index (BMI), VO2 at the first ventilatory threshold (VO2h1kg), minute ventilation at the second ventilatory threshold (VEH2), and forced expiratory volume (FEV1) were important features across the models trained with R+S-VARS. CI, BMI, and VEH2 had a negative effect, while VO2h1kg, FEV1 had positive effect on VO2max prediction. Conclusion: Our VO2max prediction model demonstrated remarkable accuracy in this dataset representing a generally healthy, non-athlete population using R+S-VARS. Particularly noteworthy was the enhanced performance within subgroups exhibiting a lower VO2max. This methodology offers a means to assess VO2max for individuals who might not achieve maximal exhaustion during CPET due to non-cardiopulmonary reasons.

Genes to predict VO2max trainability: a systematic review

Type of study: systematic review

Number of citations: 118

Year: 2017

Authors: Camilla Williams, Mark Williams, N. Eynon, K. Ashton, J. Little, U. Wisløff, J. Coombes

Journal: BMC Genomics

Journal ranking: Q1

Key takeaways: Ninety-seven genes have been identified as potential predictors of VO2max trainability, with higher responders to exercise training having more positive response alleles.

Abstract: BackgroundCardiorespiratory fitness (VO2max) is an excellent predictor of chronic disease morbidity and mortality risk. Guidelines recommend individuals undertake exercise training to improve VO2max for chronic disease reduction. However, there are large inter-individual differences between exercise training responses. This systematic review is aimed at identifying genetic variants that are associated with VO2max trainability.MethodsPeer-reviewed research papers published up until October 2016 from four databases were examined. Articles were included if they examined genetic variants, incorporated a supervised aerobic exercise intervention; and measured VO2max/VO2peak pre and post-intervention.ResultsThirty-five articles describing 15 cohorts met the criteria for inclusion. The majority of studies used a cross-sectional retrospective design. Thirty-two studies researched candidate genes, two used Genome-Wide Association Studies (GWAS), and one examined mRNA gene expression data, in addition to a GWAS. Across these studies, 97 genes to predict VO2max trainability were identified. Studies found phenotype to be dependent on several of these genotypes/variants, with higher responders to exercise training having more positive response alleles than lower responders (greater gene predictor score). Only 13 genetic variants were reproduced by more than two authors. Several other limitations were noted throughout these studies, including the robustness of significance for identified variants, small sample sizes, limited cohorts focused primarily on Caucasian populations, and minimal baseline data. These factors, along with differences in exercise training programs, diet and other environmental gene expression mediators, likely influence the ideal traits for VO2max trainability.ConclusionNinety-seven genes have been identified as possible predictors of VO2max trainability. To verify the strength of these findings and to identify if there are more genetic variants and/or mediators, further tightly-controlled studies that measure a range of biomarkers across ethnicities are required.

Long-term Change in Cardiorespiratory Fitness and All-Cause Mortality: A Population-Based Follow-up Study.

Type of study: non-rct observational study

Number of citations: 170

Year: 2016

Authors: J. Laukkanen, F. Zaccardi, H. Khan, S. Kurl, S. Jae, R. Rauramaa

Journal: Mayo Clinic proceedings

Journal ranking: Q1

Key takeaways: Long-term reduction in cardiorespiratory fitness is associated with an increased risk of all-cause mortality, highlighting the importance of maintaining good fitness over time.

Long-Term Regular Exercise Increases V̇O2max for Cardiorespiratory Fitness

Type of study:

Number of citations: 10

Year: 2023

Authors: Devajit Mohajan, H. Mohajan

Journal: Innovation in Science and Technology

Journal ranking: brak

Key takeaways: Long-term regular exercise increases VO2max, which is the gold standard measure of cardiorespiratory fitness, improving cardiovascular health, morbidity, and all-cause mortality.

Abstract: This study tries to discuss maximum oxygen consumption (V̇O2max) strategy and its importance to build up a healthy society worldwide. V̇O2max is an important predictive factor of cardiovascular health, morbidity, and all-cause mortality; and consider it as the gold standard measure of cardiorespiratory fitness. Regular and long-time physical exercise, and exercise training are effective means of increasing V̇O2max. This research aims to increase V̇O2max and endurance capacity through the prolonged strenuous exercise, hardworking, and exercise training.

Impact of Cardiorespiratory Fitness on All-Cause and Disease-Specific Mortality: Advances Since 2009.

Type of study: literature review

Number of citations: 383

Year: 2017

Authors: M. Harber, L. Kaminsky, R. Arena, S. Blair, B. Franklin, J. Myers, R. Ross

Journal: Progress in cardiovascular diseases

Journal ranking: Q1

Key takeaways: Cardiorespiratory fitness (CRF) is a strong, independent predictor of all-cause and disease-specific mortality, with new knowledge and advances since 2009.

The Impact of Training on the Loss of Cardiorespiratory Fitness in Aging Masters Endurance Athletes

Type of study: non-rct observational study

Number of citations: 25

Year: 2022

Authors: J. Burtscher, B. Strasser, M. Burtscher, G. Millet

Journal: International Journal of Environmental Research and Public Health

Journal ranking: Q2

Key takeaways: Training volume significantly impacts cardiorespiratory fitness decline in masters endurance athletes, with training reduction or cessation leading to accelerated VO2max decline, potentially nullifying long-term training benefits.

Abstract: Elite masters endurance athletes are considered models of optimal healthy aging due to the maintenance of high cardiorespiratory fitness (CRF) until old age. Whereas a drop in VO2max in masters athletes has been broadly investigated, the modifying impact of training still remains a matter of debate. Longitudinal observations in masters endurance athletes demonstrated VO2max declines between −5% and −46% per decade that were closely related to changes in training volume. Here, using regression analyses, we show that 54% and 39% of the variance in observed VO2max decline in male and female athletes, respectively is explained by changes in training volume. An almost linear VO2max decrease was observed in studies on young and older athletes, as well as non-athletes, starting a few days after training cessation, with a decline of as much as −20% after 12 weeks. Besides a decline in stroke volume and cardiac output, training cessation was accompanied by considerable reductions in citrate synthase and succinate dehydrogenase activity (reduction in mitochondrial content and oxidative capacity). This reduction could largely be rescued within similar time periods of training (re)uptake. It is evident that training reduction or cessation leads to a considerably accelerated VO2max drop, as compared to the gradual aging-related VO2max decline, which can rapidly nullify many of the benefits of preceding long-term training efforts.

Cardiorespiratory fitness assessment using risk-stratified exercise testing and dose–response relationships with disease outcomes

Type of study: non-rct observational study

Number of citations: 33

Year: 2021

Authors: Tomas I. Gonzales, K. Westgate, T. Strain, Stefanie E. Hollidge, Justin Jeon, D. Christensen, Jørgen Jensen, N. Wareham, S. Brage

Journal: Scientific Reports

Journal ranking: Q1

Key takeaways: Higher cardiorespiratory fitness is associated with lower risk of all-cause mortality and cardiovascular mortality, suggesting previous methods may underestimate the importance of fitness for human health.

Intrinsic Aerobic Capacity Sets a Divide for Aging and Longevity

Type of study: non-rct experimental

Number of citations: 189

Year: 2011

Authors: L. Koch, O. Kemi, Nathan R. Qi, S. Leng, P. Bijma, L. Gilligan, J. Wilkinson, H. Wisløff, M. Høydal, N. Rolim, P. Abadir, E. M. van Grevenhof, Godfrey L. Smith, C. Burant, Ø. Ellingsen, S. Britton, U. Wisløff

Journal: Circulation Research

Journal ranking: Q1

Key takeaways: Genetic segregation for aerobic exercise capacity can be linked to longevity, with high aerobic capacity rats having better physical activity levels, energy expenditure, and lean body mass throughout aging.

Abstract: Rationale: Low aerobic exercise capacity is a powerful predictor of premature morbidity and mortality for healthy adults as well as those with cardiovascular disease. For aged populations, poor performance on treadmill or extended walking tests indicates closer proximity to future health declines. Together, these findings suggest a fundamental connection between aerobic capacity and longevity. Objectives: Through artificial selective breeding, we developed an animal model system to prospectively test the association between aerobic exercise capacity and survivability (aerobic hypothesis). Methods and Results: Laboratory rats of widely diverse genetic backgrounds (N:NIH stock) were selectively bred for low or high intrinsic (inborn) treadmill running capacity. Cohorts of male and female rats from generations 14, 15, and 17 of selection were followed for survivability and assessed for age-related declines in cardiovascular fitness including maximal oxygen uptake (VO2max), myocardial function, endurance performance, and change in body mass. Median lifespan for low exercise capacity rats was 28% to 45% shorter than high capacity rats (hazard ratio, 0.06; P<0.001). VO2max, measured across adulthood was a reliable predictor of lifespan (P<0.001). During progression from adult to old age, left ventricular myocardial and cardiomyocyte morphology, contractility, and intracellular Ca2+ handling in both systole and diastole, as well as mean blood pressure, were more compromised in rats bred for low aerobic capacity. Physical activity levels, energy expenditure (VO2), and lean body mass were all better sustained with age in rats bred for high aerobic capacity. Conclusions: These data obtained from a contrasting heterogeneous model system provide strong evidence that genetic segregation for aerobic exercise capacity can be linked with longevity and are useful for deeper mechanistic exploration of aging.

Telomere Length and Long-Term Endurance Exercise: Does Exercise Training Affect Biological Age? A Pilot Study

Type of study: non-rct observational study

Number of citations: 114

Year: 2012

Authors: I. B. Østhus, A. Sgura, F. Berardinelli, I. Alsnes, E. Brønstad, T. Rehn, Per Kristian Støbakk, Håvard Hatle, U. Wisløff, J. Nauman

Journal: PLoS ONE

Journal ranking: Q1

Key takeaways: Long-term endurance exercise training may have a protective effect on muscle telomere length in older people, with VO2max being positively associated with telomere length.

Abstract: Background Telomeres are potential markers of mitotic cellular age and are associated with physical ageing process. Long-term endurance training and higher aerobic exercise capacity (VO2max) are associated with improved survival, and dynamic effects of exercise are evident with ageing. However, the association of telomere length with exercise training and VO2max has so far been inconsistent. Our aim was to assess whether muscle telomere length is associated with endurance exercise training and VO2max in younger and older people. Methods Twenty men; 10 young (22–27 years) and 10 old (66–77 years), were studied in this cross-sectional study. Five out of 10 young adults and 5 out of 10 older were endurance athletes, while other halves were exercising at a medium level of activity. Mean telomere length was measured as telomere/single copy gene-ratio (T/S-ratio) using quantitative real time polymerase chain reaction. VO2max was measured directly running on a treadmill. Results Older endurance trained athletes had longer telomere length compared with older people with medium activity levels (T/S ratio 1.12±0.1 vs. 0.92±0.2, p = 0.04). Telomere length of young endurance trained athletes was not different than young non-athletes (1.47±0.2 vs. 1.33±0.1, p = 0.12). Overall, there was a positive association between T/S ratio and VO2max (r = 0.70, p = 0.001). Among endurance trained athletes, we found a strong correlation between VO2max and T/S ratio (r = 0.78, p = 0.02). However, corresponding association among non-athlete participants was relatively weak (r = 0.58, p = 0.09). Conclusion Our data suggest that VO2max is positively associated with telomere length, and we found that long-term endurance exercise training may provide a protective effect on muscle telomere length in older people.

Prognostic Relevance of Cardiorespiratory Fitness as Assessed by Submaximal Exercise Testing for All-Cause Mortality: A UK Biobank Prospective Study.

Type of study: non-rct observational study

Number of citations: 61

Year: 2020

Authors: J. Laukkanen, S. Kunutsor, T. Yates, P. Willeit, U. Kujala, H. Khan, F. Zaccardi

Journal: Mayo Clinic proceedings

Journal ranking: Q1

Key takeaways: Cardiorespiratory fitness, assessed through submaximal exercise testing, improves mortality risk prediction beyond conventional risk factors and has varying prognostic relevance across cardiovascular risk levels.

The MDM2 SNP309 differentially impacts cardiorespiratory fitness in young healthy women and men.

Type of study: non-rct observational study

Number of citations: 0

Year: 2024

Authors: Ghazal Haddadi, Brian Lam, Sokaina Akhtar, Loren Yavelberg, Veronica Jamnik, Emilie Roudier

Journal: European journal of applied physiology

Journal ranking: Q1

Key takeaways: MDM2 SNP309 impacts maximal oxygen consumption (VO_2max) in a sex-dependent manner in young healthy men, while not significantly impacting it in women.

Abstract: Maximal oxygen consumption (VOmax), the predominant index of cardiorespiratory fitness (CRF), is a predictor of whole-body function and longevity in humans. The central cardiac function and the skeletal muscle's capacity to use oxygen are key determinants of VOmax. Murine Double Minute 2 (MDM2), mainly known as an oncogene, could regulate myocardial hypertrophy, skeletal muscle angiogenesis, and oxidative phosphorylation. A prevalent single nucleotide polymorphism in the MDM2 promoter (SNP309) substitutes a T for a G, supporting a greater transcriptional activity. We aim to assess whether SNP309 impacts intrinsic CRF. 82 young healthy nonathletic male and female adults aged 23 ± 2 years performed cardiorespiratory exercise testing to determine their VOmax (mL kg min). The genomic DNAs isolated from saliva were genotyped using Taqman-based qPCR. A one-way ANOVA showed that SNP309 influenced relative VOmax in the whole cohort (p = 0.044) and in men (p = 0.009), remaining non-significant in women (p = 0.133). VOmax was higher in TT homozygotes than in GT heterozygotes (whole cohort, 47 ± 12 vs. 42 ± 6 mL kg min, p = 0.030; men, 53 ± 8 vs. 45 ± 6 mL kg min, p = 0.011). A contingency analysis revealed a positive association between SNP309 in men in which the TT genotype was more frequent in the high VOmax group (p = 0.006). When considering G as the dominant allele, men bearing a G allele had lower relative VOmax than TT homozygotes (47 ± 7 vs. 53 ± 8, GG/GT vs. TT, p = 0.010). Conversely, women bearing a G allele had a higher relative VOmax than TT homozygotes (39 ± 5 vs. 34 ± 7, GG/GT vs. TT, p = 0.047). SNP309 impacts VOmax in a sex-dependent manner in our cohort.

Novel Transcriptomic Predictors of Exercise Training‐Induced VO2max Improvements

Type of study: non-rct experimental

Number of citations: 0

Year: 2021

Authors: Meghan E. Smith, Kaitlin A. Freeberg, Daniel H. Craighead, Angela Bryan, D. Seals, T. LaRocca

Journal: The FASEB Journal

Journal ranking: Q1

Key takeaways: Gene expression changes in blood samples can predict the VO2max response to aerobic exercise training, with robust improvements occurring in individuals with higher levels of inflammatory signaling and reduced metabolism/mitochondrial function.

Abstract: Aerobic exercise is universally recommended for reducing chronic disease risk, and maximal aerobic exercise capacity (VO2max) is one of the strongest predictors of healthspan and lifespan. However, VO2maximprovements in response to exercise training vary remarkably between individuals. The mechanisms driving this variability are heavily studied, but while genome‐wide association studies have estimated the heritability of VO2max trainability, accessible transcriptomic predictors of this response have not been elucidated. Therefore, we determined if circulating transcriptomic predictors of VO2max trainability could be identified by studying gene expression signatures that: 1) differ between individuals who respond to aerobic exercise training with robust vs. little/no increases in VO2max; and 2) change in a dose‐dependent fashion with exercise volume/intensity. We first identified 15 subjects with robust VO2max improvements (ΔVO2max 19 ± 1.2%) and 15 with minimal improvements (ΔVO2max 0 ± 1.0%) in a 16‐week trial consisting of four supervised aerobic exercise training interventions (permutations of high/low volume and high/low intensity). Then, we performed total transcriptomics (RNA‐seq) on blood samples (PaxGene RNA tubes) collected before and after the interventions, as well as gene ontology analyses to identify differences in biological processes associated with exercise and VO2max responses. All subjects were healthy, sedentary women aged 38 ± 0.9 years, and at baseline were phenotypically similar (i.e., no differences in basic clinical variables). However, in subjects with robust VO2max improvements, we found greater levels of ~1800 genes/transcripts and lower levels of ~2900 transcripts before training (vs. subjects with minimal VO2max improvements). Enriched biological processes (gene ontology terms) in VO2max responders at baseline included inflammatory signaling and other adverse pathways, while reduced signatures were related to metabolism/mitochondrial function. Strikingly, these baseline gene expression differences were normalized by exercise interventions in a dose‐dependent manner in the entire group (i.e., most normalized by high volume/high intensity exercise and least normalized by low volume/low intensity exercise). These data suggest it may be possible to predict the VO2max response to aerobic exercise training using whole blood‐based transcriptomics/RNA‐seq approaches.

The Association between Cardiorespiratory Fitness and Gut Microbiota Composition in Premenopausal Women

Type of study: non-rct observational study

Number of citations: 70

Year: 2017

Authors: Yifan Yang, Yi Shi, P. Wiklund, Xiao Tan, Na Wu, Xiaobo Zhang, Olli Tikkanen, Chenhong Zhang, E. Munukka, Sulin Cheng

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Higher cardiorespiratory fitness is associated with better gut microbiota composition in premenopausal women, while the association between VO2max and EreC is mediated by body fatness.

Abstract: The aim of this study was to investigate the association between cardiorespiratory fitness and gut microbiota composition in premenopausal women. The participants consisted of 71 premenopausal Finnish women (aged 19–49 years). Gut microbiota were analyzed using flow cytometry, 16S rRNA gene hybridization and DNA-staining. Maximum oxygen uptake (VO2max) was assessed by respiratory gas analyzer and body composition by Bioimpdance. We found that participants with low VO2max had lower Bacteroides, but higher Eubacterium rectale-Clostridium coccoides than the high VO2max group (p < 0.05 for all). VO2max was inversely associated with EreC (r = −0.309, p = 0.01) but not with other bacteria. VO2max also negatively correlated with fat% (r = −0.755, p < 0.001), triglycerides (r = −0.274, p = 0.021) and leptin (r = −0.574, p < 0.001). By contrast, EreC was positively associated with fat% (r = 0.382, p = 0.002), dietary fat intake (r = 0.258, p = 0.034), triglycerides (r = 0.390, p = 0.002) and leptin (r = 0.424, p = 0.001), but negatively with carbohydrate intake (r = −0.252, p = 0.034) and HDL (r = −0.26, p = 0.028). After adjusting for age and dietary intake, all the significant associations remained. However, after adjusting for fat%, the associations between VO2max and EreC disappeared. Our results suggest that cardiorespiratory fitness is associated with gut microbiota composition, independent of age and carbohydrate or fat intake. The association between VO2max and EreC, however, appears to be mediated by body fatness.

Sex- and age-specific associations between cardiorespiratory fitness, CVD morbidity and all-cause mortality in in 266.109 adults.

Type of study: non-rct observational study

Number of citations: 60

Year: 2019

Authors: E. Ekblom-Bak, B. Ekblom, Jonas Söderling, M. Börjesson, V. Blom, Lena V. Kallings, E. Hemmingsson, Gunnar Andersson, Peter Wallin, Ö. Ekblom

Journal: Preventive medicine

Journal ranking: Q1

Key takeaways: Increasing cardiorespiratory fitness reduces the risk of cardiovascular disease morbidity and all-cause mortality in both men and women across all age groups.