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Cardiorespiratory fitness and mortality from all causes, cardiovascular disease and cancer: dose–response meta-analysis of cohort studies
  1. Minghui Han1,
  2. Ranran Qie1,
  3. Xuezhong Shi1,
  4. Yongli Yang1,
  5. Jie Lu1,
  6. Fulan Hu2,
  7. Ming Zhang2,
  8. Zhenzhong Zhang3,
  9. Dongsheng Hu1,
  10. Yang Zhao1
  1. 1Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
  2. 2Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
  3. 3School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
  1. Correspondence to Dr Yang Zhao, Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China; yzhao20{at}zzu.edu.cn

Abstract

Objective Current evidence of the associations between cardiorespiratory fitness (CRF) and mortality is limited. We performed a meta-analysis to assess the dose–response association of CRF with mortality from all causes, cardiovascular disease (CVD) and cancer in healthy population.

Methods PubMed, EMBASE and Web of Science were searched up to 26 December 2019 for reports of cohort studies giving risk estimates for all-cause, CVD and cancer mortality by level of CRF. Cohort studies were included if CRF was assessed by an exercise stress test and reported as at least three levels or per incremental increase, and the association of CRF with all-cause, CVD and cancer mortality was evaluated. Generalised least-squares regression models were used to assess the quantitative relation of CRF with all-cause, CVD and cancer mortality.

Results 34 cohort studies were eligible for the meta-analysis. The pooled relative risks (RRs) for all-cause, CVD and cancer mortality per one-metabolic equivalent increase in CRF were 0.88 (95% CI 0.83 to 0.93), 0.87 (95% CI0.83 to 0.91) and 0.93 (95% CI 0.91 to 0.96), respectively. As compared with lowest CRF, with intermediate CRF, the summary RRs for all-cause, CVD and cancer mortality were 0.67 (95% CI 0.61 to 0.74), 0.60 (95% CI 0.51 to 0.69) and 0.76 (95% CI 0.69 to 0.84), respectively, and with highest CRF were 0.47 (95% CI 0.39 to 0.56), 0.49 (95% CI 0.42 to 0.56) and 0.57 (95% CI 0.46 to 0.70), respectively.

Conclusion Our analysis showed inverse dose–response associations of CRF with all-cause, CVD and cancer mortality, which provides evidence for public health recommendations for preventing all-cause, CVD and cancer mortality.

PROSPERO registration number CRD42020208883.

  • meta-analysis
  • death

Data availability statement

Data are available on reasonable request. Not applicable.

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Data availability statement

Data are available on reasonable request. Not applicable.

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Footnotes

  • Contributors YZ, DH and MH conceived, designed and performed the work; YZ, MH and RQ drafted the initial search strategy, screened the studies and analysed the data; XS, YY, JL, FH, MZ, ZZ and DH revised the manuscript. YZ and MH had full access to the cohort-specific data and take full responsibility for the integrity of the data and the accuracy of the meta-analyses. YZ is the study guarantor.

  • Funding This study was supported by the National Natural Science Foundation of China (grant no. 82073646), the Natural Science Foundation of Guangdong Province (grant no. 2019A1515011183), and the Natural Science Foundation of Shenzhen of China (grant no. JCYJ20190808145805515).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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