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September 6, 2026European Journal of Preventive Cardiology

Low cardiorespiratory fitness is linked to a ~77% increase in mortality.

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Why the study?

The relative contributions of low cardiorespiratory fitness and traditional cardiovascular risk factors to mortality, and the independent association of cardiorespiratory fitness, remain incompletely understood.

Population

580,290 Veterans Administration patients undergoing maximal exercise testing (mean age 65.1±9.7 years)

Comparison

Low cardiorespiratory fitness vs other major cardiovascular risk factors

Design

Cohort study

Follow-up

10.2±5.1 years

Key result

Low cardiorespiratory fitness was independently associated with increased mortality (RR 1.77; 95% CI 1.75-1.79) and accounted for a population attributable risk of 14.7%.

Authors

JMJonathan MyersPKPeter KokkinosKCKhin Chan

Discussion

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Overview

Low fitness showed strongest independent mortality link; extends observational data but leaves open whether improving CRF reduces deaths.

Key Points

  • To determine the independent association of cardiorespiratory fitness with mortality and compare its population-level impact against traditional cardiovascular risk factors.
  • Analyzed a cohort of 580,290 veterans (mean age 65.1 ± 9.7 years) undergoing maximal exercise testing with 10.2 ± 5.1 years of follow-up.
  • Calculated relative risks for mortality via Poisson regression with robust (HC3) standard errors, adjusting for age, sex, BMI, diabetes, smoking, and statin therapy.
  • Estimated population attributable risks (PARs) and exposure impact numbers (EINs) for low fitness and traditional risk factors.
  • Individuals in the highest fitness quintile had ~74% lower mortality compared to the lowest quintile (<5 METs), with low fitness exhibiting the strongest independent mortality association (RR 1.77; 95% CI 1.75–1.79) versus hypertension (RR 1.33; 95% CI 1.32–1.35).
  • Hypertension contributed the highest population-level risk (PAR 21.8%; 95% CI 15.2–28.0), followed closely by low cardiorespiratory fitness (PAR 14.7%; 95% CI 8.1–21.1).
  • Low fitness yielded the lowest absolute exposure impact number (2.36), indicating approximately 24 fewer deaths per 100 individuals who improve fitness over follow-up.

Study Design

Type

Cohort (n=580,290)

PICO

P
Population
580,290 individuals from a Veterans Administration cohort undergoing maximal exercise testing, followed for a mean of 10.2 years.
E
Exposure / Comparator
Low cardiorespiratory fitness vs Higher cardiorespiratory fitness
O
Primary Outcome
Mortality — RR 1.77 (1.75-1.79)

Main Result

Relative Risk: 1.77 (95% CI 1.75–1.79)

Cite This Study

Myers et al. (2026) reported a cohort. Low cardiorespiratory fitness vs. Higher cardiorespiratory fitness was evaluated on Mortality (RR 1.77, 95% CI 1.75-1.79). Low cardiorespiratory fitness was independently associated with increased mortality (RR 1.77; 95% CI 1.75-1.79) and accounted for a population attributable risk of 14.7%.

synapsesocial.com/papers/6a9d1ee128139818eab22165https://doi.org/10.1093/eurjpc/zwag471
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