Elsevier

Progress in Cardiovascular Diseases

Volume 56, Issue 4, January–February 2014, Pages 382-390
Progress in Cardiovascular Diseases

Fitness vs. Fatness on All-Cause Mortality: A Meta-Analysis

https://doi.org/10.1016/j.pcad.2013.09.002Get rights and content

Abstract

The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.

Section snippets

Literature review

The data collection and reporting process were completed following the Meta-analysis of Observational Studies in Epidemiology43 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements.44 The review of the literature was performed through Pubmed, EBSCOhost, and ProQuest searches by the first author using keywords related to the joint association between CRF and BMI on mortality from all-causes ((“Cardiorespiratory fitness” OR “physical fitness” OR “fitness” OR

Results

Fig 1 shows the literature selection process. A total of 891 articles were retrieved from Pubmed, Ebscohost, and ProQuest searches. Sixty-six potentially relevant articles were further examined using abstract and full article assessments. Following this assessment, ten articles remained eligible for the current meta-analysis. When assessing for publication bias, however, there were no significant results. Fig. 2, Fig. 3, Fig. 4 present the findings from the meta-analysis comparing the joint

Discussion

After completing the meta-analysis on the joint association between CRF and BMI on mortality from all causes, the results indicate that the risk of death was dependent upon CRF level and not BMI. Therefore, fit individuals who are overweight or obese are not automatically at a higher risk for all-cause mortality. These findings are promising for all individuals, including those unable to lose weight or maintain weight loss, as all can experience significant health benefits by developing and

Statement of Conflict of Interest

All authors declare that there are no conflicts of interest.

Acknowledgments

This article was supported by the RWJ grant from the Positive Psychology Center, Martin Seligman, PI, University of Pennsylvania.

References (54)

  • S.N. Blair et al.

    Physical fitness and all-cause mortality. A prospective study of healthy men and women

    J Am Med Assoc

    (1989)
  • L.G. Ekelund et al.

    Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study

    N Engl J Med

    (1988)
  • K.R. Evenson et al.

    Effect of cardiorespiratory fitness on mortality among hypertensive and normotensive women and men

    Epidemiology

    (2004)
  • P. Kokkinos et al.

    Exercise capacity and mortality in black and white men

    Circulation

    (2008)
  • A.M. Thompson et al.

    Cardiorespiratory fitness as a predictor of cancer mortality among men with pre-diabetes and diabetes

    Diabetes Care

    (2008)
  • J. Stevens et al.

    The effect of age on the association between body-mass index and mortality

    N Engl J Med

    (1998)
  • J. Stevens et al.

    The body mass index-mortality relationship in white and African American women

    Obes Res

    (1998)
  • S.H. Jee et al.

    Body-mass index and mortality in Korean men and women

    N Engl J Med

    (2006)
  • P. Diehr et al.

    Body mass index and mortality in nonsmoking older adults: the Cardiovascular Health Study

    Am J Public Health

    (1998)
  • R.P. Gelber et al.

    Body mass index and mortality in men: evaluating the shape of the association

    Int J Obes (Lond)

    (2007)
  • S. Kodama et al.

    Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis

    JAMA

    (2009)
  • V. Hainer et al.

    Fat or fit: what is more important?

    Diabetes Care

    (2009)
  • M. Fogelholm

    Physical activity, fitness and fatness: relations to mortality, morbidity and disease risk factors. A systematic review

    Obes Rev

    (2010)
  • B.K. Pedersen

    Body mass index-independent effect of fitness and physical activity for all-cause mortality

    Scand J Med Sci Sports

    (2007)
  • J. Woo et al.

    Fitness, fatness and survival in elderly populations

    Age

    (2013)
  • T.S. Church et al.

    Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes

    Arch Intern Med

    (2005)
  • C. Faselis et al.

    Body mass index, exercise capacity, and mortality risk in male veterans with hypertension

    Am J Hypertens

    (2012)
  • Cited by (487)

    View all citing articles on Scopus

    Statement of Conflict of Interest: see page 389.

    View full text