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Sex- and age-specific associations between cardiorespiratory fitness, CVD morbidity and all-cause mortality in 266.109 adults

Journal article
Authors E. Ekblom-Bak
B. Ekblom
J. Soderling
Mats Börjesson
V. Blom
L. V. Kallings
E. Hemmingsson
G. Andersson
P. Wallin
O. Ekblom
Published in Preventive Medicine
Volume 127
ISSN 0091-7435
Publication year 2019
Published at Institute of Neuroscience and Physiology
Department of Food and Nutrition, and Sport Science
Language en
Keywords Cardiovascular disease, Cancer, Aerobic capacity, VO(2)max, Population, Risk, physical-activity, healthy-men, follow-up, cardiovascular health, heart-failure, exercise, risk, modalities, predictor, events, Public, Environmental & Occupational Health, General & Internal Medicine
Subject categories Environmental Health and Occupational Health


The aim was to investigate sex- and age-specific associations between cardiorespiratory fitness, all-cause and cause-specific mortality, and cardiovascular disease (CVD) morbidity. 266.109 participants (47% women, 18-74 years) free from CVD, participating in occupational health service screenings in 1995-2015 were included. CRF was assessed as estimated maximal oxygen consumption (estVO(2)max) using a submaximal cycle test. Incident cases of first-time CVD event and death from any cause were ascertained through national registers. There were 4244 CVD events and 2750 cases of all-cause mortality during mean 7.6 years follow-up. Male gender, higher age and lower estVO(2)max were associated with higher all-cause mortality and CVD morbidity incidence rates. Risk reductions with increasing estVO(2)max were present in all age-groups of men and women. No obvious levelling off in risk was identified in the total cohort. However, women and older age-groups showed no further reduction in higher aggregated estVO(2)max levels. CVD specific mortality was more associated with estVO(2)max compared to tumor specific mortality. The risk for all-cause mortality and CVD morbidity decreased by 2.3% and 2.6% per increase in 1 ml.min(-) (1).kg(-1) with no significant sex-differences but more pronounced in the three lower estVO(2)max categories for all-cause mortality (9.1%, 3.8% and 3.3%, respectively). High compared to lower levels of estVO(2)max was not related to a significantly elevated mortality or morbidity. In this large cohort study, CVD morbidity and all-cause mortality were inversely related to estVO(2)max in both men and women of all age-groups. Increasing cardiorespiratory fitness is a clear public health priority.

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