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.
Data availability statement
Data are available on reasonable request. Not applicable.
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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.
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