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Dose-response associations of cardiorespiratory fitness with all-cause mortality and incidence and mortality of cancer and cardiovascular and respiratory diseases: the UK Biobank cohort study
  1. Lewis Steell1,
  2. Frederick K Ho2,3,
  3. Anne Sillars1,
  4. Fanny Petermann-Rocha1,3,
  5. Hiu Li1,
  6. Donald M Lyall3,
  7. Stamatina Iliodromiti1,
  8. Paul Welsh1,
  9. Jana Anderson3,
  10. Daniel F MacKay3,
  11. Jill P Pell3,
  12. Naveed Sattar1,
  13. Jason MR Gill1,
  14. Stuart Robert Gray1,
  15. Carlos A Celis-Morales1,4
  1. 1 British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  2. 2 Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Island, Hong Kong
  3. 3 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  4. 4 Centro de Investigación en Fisiología del Ejercicio(CIFE), Universidad Mayor, Santiago, Chile
  1. Correspondence to Dr Carlos A Celis-Morales, BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK; carlos.celis{at}


Objective To investigate the association of cardiorespiratory fitness with all-cause mortality, and cardiovascular disease (CVD), respiratory disease, chronic obstructive pulmonary disease (COPD) and cancer mortality and incidence.

Design Prospective population-based study.

Setting UK Biobank.

Participants Of the 5 02 628 (5.5% response rate) participants recruited by UK Biobank, we included 73 259 (14.6%) participants with available data in this analysis. Of these, 1374 participants died and 4210 developed circulatory diseases, 1293 respiratory diseases and 4281 cancer, over a median of 5.0 years (IQR 4.3–5.7) follow-up.

Main outcome measures All-cause mortality and circulatory disease, respiratory disease, COPD and cancer (such as colorectal, lung, breast and prostate) mortality/incidence. Fitness was estimated using a submaximal cycle ergometer test.

Results The HR for all-cause mortality for each metabolic equivalent of task (MET) higher fitness was 0.96 (95% CI 0.93 to 0.98). Similar results were observed for incident circulatory disease (HR 0.96 [0.95 to 0.97]), respiratory disease (HR 0.96 [0.94 to 0.98]), COPD (HR 0.90 [0.86 to 0.95) and colorectal cancer (HR 0.96 [0.92 to 1.00]). Nonlinear analysis revealed that a high level of fitness (>10METs) was associated with a greater incidence of atrial fibrillation (HR 1.24 [1.07 to 1.44]) and prostate cancer (HR 1.16 [1.02 to 1.32]) compared with average fitness. All results were adjusted for sociodemographic, lifestyle and dietary factors, body composition, and morbidity at baseline and excluded events in the first 2 years of follow-up.

Conclusions Higher cardiorespiratory fitness was associated with lower risk of premature mortality and incidence of CVD, respiratory disease and colorectal cancer.

  • fitness
  • cardiovascular
  • cancer
  • respiratory
  • epidemiology

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  • 36 SRG and CAC-M contributed equally and are joint senior authors.

  • LS and FKH contributed equally.

  • Contributors CACM, LS, JPP, JMRG and NS contributed to the conception and design of the study, advised on all statistical aspects and interpreted the data. LS, FP, HL, SG and CACM performed the statistical analysis. LS, SG, FP and CACM drafted the manuscript. LS, SG, SI, DLM, FP, HL, PW, JA, DM, JPP, NS, JMRG and CACM reviewed the manuscript and approved the final version to be published. CACM, LS, JPP, JMRG and NS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The UK Biobank was supported by the Wellcome Trust, Medical Research Council, Department of Health, Scottish government and Northwest Regional Development Agency. It has also had funding from the Welsh Assembly government and British Heart Foundation. The research was designed, conducted, analysed and interpreted by the authors entirely independently of the funding sources.

  • Competing interests None declared.

  • Ethics approval UK Biobank received ethical approval from the North West Multi-centre Research Ethics Committee (REC reference: 11/NW/03820). All participants gave written informed consent before enrolment in the study, which was conducted in accord with the principles of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Researchers can apply to use the UK Biobank resource and access the data used. No additional data are available.

  • Patient consent for publication Not required.