Cardiorespiratory Fitness and Coronary Heart
Disease Risk Factors
The LDS Hospital Fitness Institute Cohort
Michael J. LaMonte, PhD; Patricia A. Eisenman, PhD; Ted D. Adams, PhD, MPH;
Barry B. Shultz, PhD; Barbara E. Ainsworth, PhD, MPH; Frank G. Yanowitz, MD
Downloaded from http://circ.ahajournals.org/ by guest on June 16, 2017
Background—Cardiorespiratory fitness is favorably associated with most modifiable coronary heart disease (CHD) risk
factors. Findings are limited, however, by few data for women, persons with existing CHD, and low-risk populations.
In the present study, we described cross-sectional associations between cardiorespiratory fitness and CHD risk factors
in a large cohort of middle-aged men and women, of whom the majority were LDS Church members (Mormons), with
and without existing CHD.
Methods and Results—Comprehensive health examinations were performed on 3232 men (age 45.9⫾10.8 years) and 1128
women (age 43.8⫾12.8 years) between 1975 and 1997. Maximal treadmill exercise testing was used to categorize those
with (12% of the men and 10% of the women) and those without CHD into age- and sex-specific cardiorespiratory
fitness quintiles. After adjustments for age, body fat, smoking status, and family history of CHD, favorable associations
were observed between fitness and most CHD risk factors among men and women, regardless of CHD status.
Conclusions—These data indicate that enhanced levels of cardiorespiratory fitness may confer resistance to elevations in
CHD risk factors even in a low-risk sample of middle-aged men and women. Furthermore, these findings reinforce
current public health recommendations that advocate increased national levels of physical activity and cardiorespiratory
fitness for primary and secondary CHD prevention. (Circulation. 2000;102:1623-1628.)
Key Words: cardiovascular disease 䡲 risk factors 䡲 exercise 䡲 women
R
ecent reports document a large national health burden of
chronic disease with significant proportions due to
behavioral dimensions such as physical inactivity and low
levels of cardiorespiratory fitness.1,2 Physical inactivity confers a relative3 and attributable4 risk for death due to coronary
heart disease (CHD) that is similar to that of other major
modifiable risk factors. With the high prevalence of physical
inactivity,1 increasing population physical activity levels may
confer substantial reductions in incident CHD.
A current understanding of the relationship between sedentary lifestyles and CHD has emerged from pioneering
works that used self-reported physical activity to represent
the degree of exposure.1 Cardiorespiratory fitness assessed
with maximal exercise testing is a more precise and reliable
measure than self-reported physical activity. This may in part
explain the larger risk estimates for death due to CHD
associated with low levels of measured fitness compared with
self-reported physical inactivity.1 Correlations between carefully aggregated habitual activity levels and cardiorespiratory
fitness measured with maximal exercise testing have been
large (r⫽0.50 to 0.83).5 The objective measure of cardiore-
spiratory fitness might therefore more accurately reflect the
consequences of a sedentary or irregularly active lifestyle.
Compared with physical activity,1,3 fewer reports are available on the association between cardiorespiratory fitness and
CHD.6 –10 Existing studies have often had modest sample
sizes with relatively small percentages of women. Cardiorespiratory fitness has frequently been extrapolated from submaximal exercise, few reports have included participants with
existing CHD, and there is a paucity of data from low-risk
populations. In the present investigation, we described the
association between measured cardiorespiratory fitness and
coronary risk factors in a large low-risk sample of middleaged men and women with and without CHD.
Methods
Study Design and Participants
Cross-sectional analyses were performed on 3232 men and 1128
women who underwent a comprehensive health assessment at the
LDS Hospital Fitness Institute (Salt Lake City, Utah) between 1975
and 1997. Participants were mostly white-collar executives who had
the health evaluation performed for employment reasons or for
personal interest. The majority of participants were residents of Utah
Received November 16, 1999; revision received May 8, 2000; accepted May 11, 2000.
From Department of Exercise and Sport Science (M.J.L., P.A.E., B.B.S.), University of Utah, Salt Lake City; LDS Hospital Fitness Institute (T.D.A.,
F.G.Y.), Salt Lake City, Utah; and Department of Epidemiology and Biostatistics (B.E.A.), University of South Carolina, Columbia.
Correspondence to Michael J. LaMonte, PhD, Prevention Research Center, School of Public Health, University of South Carolina, Columbia, SC
29208. E-mail [email protected]
© 2000 American Heart Association, Inc.
Circulation is available at http://www.circulationaha.org
1623
1624
Circulation
TABLE 1.
Participant Characteristics
Age, y
Weight, kg
Body mass index,
kg/m2
Body fat, %
October 3, 2000
All
(n⫽4360)
Men
(n⫽3232)
Women
(n⫽1128)
45.4⫾11.4
45.9⫾10.8
43.8⫾12.8
(45.1–45.7)
(45.5–46.3)
(43.1–44.6)
81.0⫾16.6
85.9⫾14.4
66.7⫾14.1
(80.5–81.5)
(85.5–86.5)
(65.9–67.5)
26.2⫾4.5
(26.1–26.3)
26.7⫾4.1
(26.6–26.9)
24.6⫾5.3
(24.3–24.9)
23.3⫾7.4
21.8⫾6.6
27.6⫾8.0
(23.1–23.6)
(21.6–22.1)
(27.1–28.1)
35.7⫾8.5
(35.5–36.0)
37.6⫾7.9
(37.3–37.8)
30.5⫾7.9
(30.1–30.9)
4.4
4.6
3.9
CHD,* %
11.35
11.94
9.7
Family history of
CHD, %
18.5
19.2
16.4
Low
1.2
0.7
Fair
7.4
5.5
12.7
Average
33.9
31.7
40.3
Good
45.6
48.2
38.2
High
11.9
13.8
6.3
V̇O2max,
mL 䡠 kg⫺1 䡠 min⫺1
Smoker, %
Fitness level, %
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2.39
Values are mean⫾SD (95% CI).
*Known or suspected CHD.
and members of the LDS Church (Mormons). Written informed
consent was recorded at LDS Hospital.
A detailed health-fitness evaluation was performed by a licensed
physician and qualified technician. Personal and familial health
histories were obtained through interview procedures. Clinical measurements included resting and exercise ECG and blood pressure,
fasting blood glucose and lipids, pulmonary function, body composition, and cardiorespiratory fitness. Body mass index (in kg/m2) was
calculated on the basis of standing weight and height, and percent
body fat11 was determined hydrodensitometrically.12
intolerance. Exercise intolerance was defined as (1) failure to
achieve ⱖ85% of age-predicted maximal heart rate or (2) premature
termination of the exercise stress test for reasons other than
exhaustion.
Statistical Analyses
Glucose and triglyceride values were log (base 10) transformed to
better approach normality. Other variables demonstrated small
amounts of skewness due to outlying values, but these outliers were
retained in the analyses because of their possible association with
fitness. Linear regression was used to adjust mean risk factor values
for age, percent body fat, smoking status, and family history of CHD
to better assess the independent effect of fitness. Polynomial trend
modeling was used to describe the shape of the association between
risk factors and cardiorespiratory fitness. The highest-order polynomial term that was significant and the percent linear variation19 are
reported. Logistic regression models were constructed to evaluate the
clinical relevance of the association between fitness and CHD risk
factors. Sample size limited logistic analyses to men and women
without CHD. Fitness tertiles were formed according to MET levels
of maximal exercise performance20 to enable a comparison with
existing data. CHD risk factors associated with the insulin-resistance
metabolic syndrome were dichotomized as10 Systolic blood pressure
(SBP; ⱖ140 mm Hg or not), glucose (ⱖ6.1 mmol/L or not),
triglycerides (ⱖ1.7 mmol/L or not), and LDL (ⱖ3.4 mmol/L or not).
Statistical significance was evaluated with point estimates and the
reported 2-tailed probability or the 95% CI. All analyses were
performed with SPSS-PC⫹ (Version 6.1).
Results
The majority of participants in the present study were whites
from middle and upper socioeconomic levels and members of
the LDS Church. Participants were middle aged and marginally overweight and displayed average levels of cardiorespiratory fitness (Table 1). The prevalence of smoking, CHD,
and family history of heart disease was low. Except for
marginally elevated LDL levels, the cohort risk factor profile
was clinically acceptable (Table 2).
TABLE 2.
CHD Risk Factor Profiles
All
(n⫽4360)
Cardiorespiratory Fitness Test
Most participants (⬎97%) completed a maximal treadmill exercise
test. Treadmill test time was used to predict maximal oxygen
consumption (V̇O2 max) according to Bruce et al.13 The age-adjusted
correlation between predicted and measured V̇O2max was 0.92 (SEE
⫾1.9 mL 䡠 kg⫺1 䡠 min⫺1) for men13,14 and 0.92 (SEE ⫾2.2 mL 䡠 kg⫺1 䡠
min⫺1) for women.13,15
Participants (⬍3.0%) with ambulatory or other contraindications
to maximal treadmill testing completed an Astrand-Ryhming submaximal cycle ergometry test,16 from which age-corrected17 V̇O2 max
was estimated. The correlation between the predicted age- and
sex-corrected V̇O2 max and that measured during maximal cycle
ergometry was 0.94 (SEE 0.248 L/min).17
For the treadmill tests, a 12-lead ECG and blood pressure were
recorded at rest, during exercise, and during recovery. After an
appropriate warm-up, participants exercised to a volitional end point
or until specific criteria16 to terminate the test were observed.
Maximal effort was seen as achievement of ⱖ85% age-predicted
maximal heart rate and perceived exertion of ⬎16 on a 20-point Borg
scale.16 During the Astrand-Ryhming tests, heart rate was obtained
from a bipolar CM-5 ECG. Age- and sex-specific cardiorespiratory
fitness quintiles were developed according to published standards.18
Participants were classified as those with and those without known
or suspected heart disease based on the following criteria:
(1) indication of existing CHD on the medical history questionnaire,
(2) a positive resting or exercise ECG, or (3) demonstrated exercise
SBP, mm Hg
Glucose, mmol/L
Triglycerides, mmol/L
Total cholesterol, mmol/L
LDL cholesterol, mmol/L
HDL cholesterol, mmol/L
TC/HDL*
Men
(n⫽3232)
Women
(n⫽1128)
122.9⫾16.3
124.7⫾15.8
118.2⫾17.1
(122.5–123.5)
(124.1–125.2)
(117.2–119.2)
5.34⫾1.04
5.44⫾1.0
5.07⫾1.11
(5.32–5.38)
(5.41–5.48)
(5.0–5.13)
1.63⫾1.52
1.75⫾1.68
1.34⫾0.84
(1.59–1.68)
(1.69–1.81)
(1.25–1.35)
5.33⫾1.07
5.37⫾1.05
5.19⫾1.10
(5.29–5.36)
(5.33–5.41)
(5.13–5.26)
3.39⫾0.98
3.49⫾0.97
3.11⫾0.98
(3.37–3.42)
(3.46–3.53)
(3.05–3.17)
1.21⫾0.39
1.11⫾0.33
1.49⫾0.42
(1.19–1.22)
(1.10–1.12)
(1.47–1.52)
4.8⫾1.9
5.2⫾1.9
3.7⫾1.3
(4.8–4.9)
(5.1–5.3)
(3.6–3.8)
Values are mean⫾SD (95% CI).
*TC/HDL, ratio of total to HDL cholesterol, is calculated from mg/dL values.
Approximate conversions: total, LDL, and HDL cholesterol are 38.6 mg/dL
per mmol/L; triglycerides, 88.5 mg/dL per mmol/L; and glucose, 18 mg/dL
per mmol/L.
LaMonte et al
TABLE 3.
Fitness
Level
Low
Average
SBP,
mm Hg
Glucose,
mmol/L
Triglycerides,
mmol/L
Total Cholesterol,
mmol/L
LDL Cholesterol,
mmol/L
HDL Cholesterol,
mmol/L
TC/HDL*
128.8⫾5.8
5.61⫾0.24
1.74⫾0.33
5.67⫾0.33
3.68⫾0.28
1.20⫾0.03
5.2⫾0.37
(125.5–132.4)
(5.45–5.76)
(1.53–1.95)
(5.46–5.88)
(3.50–3.85)
(1.18–1.23)
(4.9–5.4)
n⫽11
n⫽11
n⫽11
n⫽11
n⫽11
High
5.41⫾0.25
1.84⫾0.23
5.43⫾0.34
3.44⫾0.29
1.19⫾0.03
5.0⫾0.36
(123.5–125.4)
(5.36–5.44)
(1.80–1.88)
(5.37–5.49)
(3.38–3.48)
(1.18–1.196)
(4.9–5.1)
n⫽144
n⫽131
n⫽139
n⫽141
n⫽129
n⫽139
n⫽139
123.6⫾4.5
5.37⫾0.21
1.69⫾0.21
5.37⫾0.28
3.42⫾0.23
1.21⫾0.02
4.9⫾0.31
(123.2–123.9)
(5.35–5.38)
(1.68–1.71)
(5.35–5.38)
(3.40–3.43)
(1.20–1.212)
(4.8–4.95)
n⫽806
n⫽823
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P
Linear, %‡
n⫽828
n⫽791
n⫽823
n⫽822
121.7⫾4.5
5.29⫾0.20
1.53⫾0.19
5.24⫾0.27
3.35⫾0.23
1.22 ⫾0.02
4.74⫾0.30
(121.5–121.9)
(5.28–5.31)
(1.52–1.54)
(5.23–5.26)
(3.34–3.36)
(1.21–1.22)
(4.7–4.75)
n⫽1407
n⫽1346
n⫽1379
n⫽1382
n⫽1355
n⫽1380
n⫽1380
119.7⫾3.9
5.21⫾0.16
1.36⫾0.18
5.12⫾0.23
3.28⫾0.18
1.23⫾0.02
4.56⫾0.30
(119.3–120.1)
(5.18–5.22)
(1.34–1.38)
(5.1–5.13)
(3.26–3.29)
(1.22–1.233)
(4.5–4.58)
n⫽396
n⫽414
n⫽414
n⫽411
n⫽424
Trend†
n⫽11
124.5⫾5.8
n⫽845
Good
1625
CHD Risk Factors According to Cardiorespiratory Fitness Level Among Men Without CHD
n⫽16
Fair
Coronary Heart Disease and Fitness
n⫽414
n⫽414
Linear
Linear
Quadratic
Linear
Linear
Quadratic
Linear
0.00001
0.00001
0.00001
0.00001
0.00001
0.01
0.00001
97.5
96.9
97.9
98
93.3
96
99
Values are mean⫾SD (95% CI). n⫽2846. Mean values are adjusted for age, percent body fat, smoking, and family history of heart disease.
*TC/HDL, ratio of total to HDL cholesterol, is calculated from mg/dL values. See Table 2 for conversions.
†Weighted polynomial trend term.
‡Percent linear variation in polynomial model.
Glucose and triglycerides were log transformed before trend analyses.
Risk Factors Across Fitness Levels
Men
Cardiorespiratory fitness was indirectly associated with all
CHD risk factors among men without CHD (Table 3).
Significant linear trends were seen for SBP, glucose, total
cholesterol (TC), LDL, and TC/HDL, with ⬎90% linear
variation in these risk factors across fitness levels. Triglycerides and HDL demonstrated significant higher-order associations with fitness, although the largest proportion of variation in these trends was linear (97.9% and 96%, respectively).
Among men with CHD (data not shown), significant linear
inverse associations were observed between fitness and all
CHD risk factors except HDL.
Women
Cardiorespiratory fitness was inversely associated with all
CHD risk factors in women without CHD (Table 4). However, only HDL demonstrated a significant linear association
with fitness. Among the risk factors that demonstrated higherorder associations with fitness, triglycerides and TC/HDL
showed large proportions of linear variation (90% and 67%,
respectively) across levels of fitness. Risk factor values
generally improved with higher levels of fitness among
women with CHD (data not shown), among whom significant
linear trends were observed for triglycerides, HDL, and
TC/HDL.
Logistic Regression Models
The prevalence of clinically relevant risk factor values was
higher among men than women: SBP (15.4% versus 10.9%),
glucose (8.6% versus 3.1%), triglycerides (35.2% versus
20.3%), and LDL (50.4% versus 33.9%). After adjustment for
potential confounders, significant inverse associations persisted between fitness and all risk factors except glucose
among men (Figure 1) and between fitness and SBP and
triglycerides among women (Figure 2).
Discussion
CHD, the leading cause of death among US adults,21 is a
multifactorial process with cultural and behavioral origins.22
Recent reports have described the cardiovascular benefits of
physical activity and cardiorespiratory fitness.1,2 The current
study showed significant favorable associations between
fitness and most CHD risk factors among men and women,
regardless of CHD status. Higher fitness significantly reduced
the odds of clinically relevant risk factor values among men
and women without CHD.
Cardiorespiratory fitness was favorably associated with CHD
risk factors despite a relatively homogeneous cohort and after
statistical adjustment for age, percent body fat, smoking status,
and family history of heart disease. Our findings are consistent
with cross-sectional reports on Aerobics Center Longitudinal
Study (ACLS) men6 and women,7 as well as other observational
data.8 –10 Furthermore, associations between fitness and CHD
risk factors similar to those seen in the current data have been
reported at baseline in prospective studies that have subsequently demonstrated reduced coronary mortality rates in fit
versus unfit men and women.23
Extensive reviews have summarized observational and experimental data that show desirable effects of exercise on glyce-
1626
Circulation
TABLE 4.
CHD Risk Factors According to Cardiorespiratory Fitness Level Among Women Without CHD (nⴝ1019)
Fitness
Level
Low
SBP,
mm Hg
Glucose,
mmol/L
Triglycerides,
mmol/L
Total Cholesterol,
mmol/L
LDL Cholesterol,
mmol/L
HDL Cholesterol,
mmol/L
123.2⫾5.2
5.34⫾0.21
2.05⫾0.15
5.36⫾0.28
3.31⫾0.25
1.17⫾0.01
5.1⫾0.27
(120.9–125.5)
(5.25–5.43)
(1.99–2.12)
(5.24–5.49)
(3.19–3.42)
(1.16–1.18)
(4.9–5.2)
n⫽23
Fair
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Trend†
P
Linear, %‡
n⫽21
n⫽21
n⫽21
n⫽21
1.86⫾0.29
5.31⫾0.34
3.31⫾0.27
1.18⫾0.03
4.9⫾0.38
(121.2–123.3)
(5.27–5.36)
(1.80–1.91)
(5.24–5.37)
(3.26–3.36)
(1.17–1.19)
(4.8–4.99)
n⫽111
n⫽124
n⫽126
n⫽121
n⫽124
n⫽124
124.1⫾6.1
5.38⫾0.26
1.83⫾0.26
5.39⫾0.35
3.41⫾0.28
1.19⫾0.02
4.98⫾0.39
(123.4–124.7)
(5.36–5.41)
(1.80–1.85)
(5.36–5.34)
(3.38–3.44)
(1.18–1.194)
(4.95–5.0)
n⫽391
n⫽402
n⫽401
n⫽399
n⫽401
n⫽399
122.4⫾5.9
5.32⫾0.25
1.65⫾0.25
5.29⫾0.34
3.35⫾0.27
1.21⫾0.02
4.8⫾0.38
(113.6–116.8)
(5.29–5.34)
(1.62–1.68)
(5.26–5.32)
(3.33–3.38)
(1.20–1.218)
(4.7–4.86)
n⫽384
High
n⫽21
5.31⫾0.25
n⫽403
Good
n⫽15
TC/HDL*
122.3⫾5.9
n⫽130
Average
October 3, 2000
n⫽371
n⫽376
n⫽380
n⫽374
n⫽375
n⫽375
120.0⫾5.9
5.22⫾0.24
1.52⫾0.24
5.15⫾0.34
3.26⫾0.27
1.22⫾0.02
4.6⫾0.40
(118.5–121.5)
(5.16–5.28)
(1.46–1.58)
(5.06–5.24)
(3.19–3.32)
(1.21–1.23)
(4.5–4.7)
n⫽67
n⫽63
n⫽63
n⫽63
n⫽63
n⫽63
Quadratic
Quadratic
Quadratic
Quadratic
Quadratic
Linear
Quadratic
n⫽63
0.0001
0.0001
0.04
0.0001
0.0001
0.001
0.0003
27
30
90
37
4
94
67
See Table 3 for legend.
mia24 and resting blood pressure.25 We observed fitness to be
strongly and inversely associated with fasting glucose and
resting SBP levels even after adjustment for influential variables.
This observation has clinical significance because elevated
fasting glucose and resting SBP have been suggested as markers
for insulin resistance,26 which is known to increase CHD risk by
clustering adverse conditions of hyperglycemia, hypertension,
and dyslipidemia.27,28 Because skeletal muscle is a large and
robust substrate depot for active and fit persons,24 it is not
surprising that enhanced fitness appears to protect against
elevated blood pressure, glucose, and lipid values.
The extent to which blood lipids were associated with
cardiorespiratory fitness among the current cohort is contrary
to some studies29,30 but similar to others.6 –10 We observed
significant inverse linear trends for TC and LDL across
fitness levels among men regardless of CHD status. Fitness
was favorably and significantly associated with HDL and
TC/HDL among women even after adjustment for age and
body fat and despite no association between fitness and TC.
Among men and women with CHD (data not shown), percent
differences in lipid levels between the lowest and highest
fitness groups (eg, triglycerides 25% decrease, LDL 12%
decrease) were similar to the expected effect of low-dose
fibric acid derivatives and HMG-CoA reductase inhibitors.31
Exercise, which is essentially an anabolic agent, is one of few
dose-response agents with proven therapeutic effects for
many chronic diseases that is not regulated by the Food and
Drug Administration.32 Because risk factors synergistically
multiply the individual risk of CHD,28 even small risk factor
reductions associated with increased fitness could substantially lower the probability of incident CHD.
The homogeneity of the cohort may have resulted in underrepresentation of the influence of fitness on the coronary risk
profile; therefore, we looked at the relationship from a clinical
perspective. Recent ACLS reports have shown fitness to be
inversely associated with the prevalence10 and associated mortality risk33 of CHD risk factor clustering. By applying the
criteria used by ACLS investigators, we observed that low-fit
men (Figure 1) and women (Figure 2) were 3 to 6 times more
likely to have clinically relevant risk factor levels than their
high-fit counterparts. The associations remained significant even
after adjustment for body fat. Our hydrostatic estimate of total
body fat does not precisely quantify the more atherogenic central
fat depot.34 Nonetheless, the current observations support previous data6 –10,24,34 that show enhanced cardiorespiratory fitness
levels confer protection against elevated CHD risk independent
of the influence of body fat.
Recommendations that promote the cardiovascular benefits
of physical activity and cardiorespiratory fitness1,2 are potentially limited by little data from low-risk populations.35
Significant inverse associations were reported between baseline self-reported physical activity and fatal coronary events
among 27 658 adults after a 6-year follow-up in the Adventist
Health Study.35 Potential misclassification on exposure and
selection bias reduces the generalizability of these data until
other studies confirm the health benefits of physical activity
in low-risk populations. Low coronary mortality rates have
been reported among Mormons,36,37 including men with
lethal genetic predisposition.38 Between 1993 and 1995, Utah
ranked first and third nationally for the lowest cardiovascular
and CHD death rates, respectively.21 Our cross-sectional
findings showed that a large cohort of middle-aged men and
women, the majority of whom are Mormon, demonstrated
(1) average levels of cardiorespiratory fitness, (2) clinically
acceptable values for most CHD risk factors, and (3) inverse
associations between fitness and CHD risk factors, regardless
LaMonte et al
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Figure 1. Unadjusted (A) and adjusted (B) odds ratios of clinical
threshold values for risk factors across low, moderate, and high
levels of cardiorespiratory fitness (CRF) in 2715 LDS Hospital
Fitness Institute men. Number on columns indicates cases at or
above clinical threshold value; High CRF, referent. Adjusted
odds ratios were controlled for age, percent body fat, smoking,
and family history of heart disease.
of CHD status. These observations are consistent with crosssectional data from other cohorts,6,7 among whom prospective studies subsequently showed that fitness independently
protected against coronary mortality.23 It is therefore plausible that fitness contributes to the low CHD incidence and
mortality rates previously described for Utah Mormons.36 –38
Our findings and those from the Adventist Health Study
suggest that physical activity and cardiorespiratory fitness
confer substantial cardiovascular benefits, even in low-risk
populations of men and women.
The present study has potential limitations that deserve
consideration. Although cardiorespiratory fitness (V̇O2 max)
was predicted from time during a maximal treadmill test as
opposed to measured aerobic power, correlations between
predicted and measured V̇O2 max are large.14,15 Recent evidence
of only modest genetic contributions to cardiorespiratory
fitness,39 reported training gains of up to 30%,16 and rapid
detraining-related losses40 illustrate the plasticity of cardiorespiratory fitness and should temper genetic arguments against
targeting fitness enhancement for CHD prevention. A recent
randomized trial showed that sedentary or irregularly active
Coronary Heart Disease and Fitness
1627
Figure 2. Unadjusted (A) and adjusted (B) odds ratios for clinical threshold values for risk factors common to insulinresistance metabolic syndrome across low, moderate, and high
levels of cardiorespiratory fitness (CRF) in 980 LDS Hospital Fitness Institute women. Number on columns indicates cases at or
above clinical threshold value; High CRF, referent.
individuals can achieve health-related levels of cardiorespiratory fitness through regular moderate-intensity lifestyle
activities such as brisk walking.41 Our data lack more precise
indices of coronary risk (eg, regional adiposity, insulin,
lipoprotein subfractions)34 that may have resulted in stronger
associations with fitness. Attempts to control for medications
and diet were not made. Our analyses lacked an index of
habitual physical activity. With some of the variation in
cardiorespiratory fitness not accounted for by genetic or
environmental transmission,39 the level of habitual physical
activity may indeed account for the remainder. Furthermore,
differences in risk estimates for CHD mortality between
fitness and physical activity1 may reflect different mechanisms through which fitness and activity confer cardiovascular health benefits.8,32 Last, we see a large need for data on
ethnic minorities and persons with lower socioeconomic
status for whom different levels of physical activity and CHD
rates have been described.1,42
We conclude that cardiorespiratory fitness was significantly and favorably associated with CHD risk factors independent of age, percent body fat, and family history of CHD,
and regardless of CHD status, in a low-risk population of
middle-aged men and women. These findings support public
health recommendations for increased physical activity and
1628
Circulation
October 3, 2000
cardiorespiratory fitness to prevent the morbidity and mortality associated with CHD.
Acknowledgments
This work was supported by the Union Pacific Foundation and the
Deseret Foundation, LDS Hospital.
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Cardiorespiratory Fitness and Coronary Heart Disease Risk Factors: The LDS Hospital
Fitness Institute Cohort
Michael J. LaMonte, Patricia A. Eisenman, Ted D. Adams, Barry B. Shultz, Barbara E.
Ainsworth and Frank G. Yanowitz
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Circulation. 2000;102:1623-1628
doi: 10.1161/01.CIR.102.14.1623
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