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September 6, 2026European Journal of Preventive Cardiology

Low cardiorespiratory fitness is linked to a ~77% increase in mortality.

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Key result

Low cardiorespiratory fitness was independently associated with increased mortality (RR 1.77; 95% CI 1.75-1.79) and accounted for a population attributable risk of 14.7%.

Authors

JMJonathan MyersPKPeter KokkinosKCKhin Chan

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Overview

Low fitness showed strongest independent mortality link; extends observational data but leaves open whether improving CRF reduces deaths.

Key Points

  • To determine the independent association of cardiorespiratory fitness with mortality and compare its population-level impact against traditional cardiovascular risk factors.
  • Analyzed a cohort of 580,290 veterans (mean age 65.1 ± 9.7 years) undergoing maximal exercise testing with 10.2 ± 5.1 years of follow-up.
  • Calculated relative risks for mortality via Poisson regression with robust (HC3) standard errors, adjusting for age, sex, BMI, diabetes, smoking, and statin therapy.
  • Estimated population attributable risks (PARs) and exposure impact numbers (EINs) for low fitness and traditional risk factors.
  • Individuals in the highest fitness quintile had ~74% lower mortality compared to the lowest quintile (<5 METs), with low fitness exhibiting the strongest independent mortality association (RR 1.77; 95% CI 1.75–1.79) versus hypertension (RR 1.33; 95% CI 1.32–1.35).
  • Hypertension contributed the highest population-level risk (PAR 21.8%; 95% CI 15.2–28.0), followed closely by low cardiorespiratory fitness (PAR 14.7%; 95% CI 8.1–21.1).
  • Low fitness yielded the lowest absolute exposure impact number (2.36), indicating approximately 24 fewer deaths per 100 individuals who improve fitness over follow-up.

Study Design

Type

Cohort (n=580,290)

PICO

P
Population
580,290 individuals from a Veterans Administration cohort undergoing maximal exercise testing, followed for a mean of 10.2 years.
E
Exposure / Comparator
Low cardiorespiratory fitness vs Higher cardiorespiratory fitness
O
Primary Outcome
Mortality — RR 1.77 (1.75-1.79)

Main Result

Relative Risk: 1.77 (95% CI 1.75–1.79)

Cite This Study

Myers et al. (2026) reported a cohort. Low cardiorespiratory fitness vs. Higher cardiorespiratory fitness was evaluated on Mortality (RR 1.77, 95% CI 1.75-1.79). Low cardiorespiratory fitness was independently associated with increased mortality (RR 1.77; 95% CI 1.75-1.79) and accounted for a population attributable risk of 14.7%.

synapsesocial.com/papers/6a9d1ee128139818eab22165https://doi.org/10.1093/eurjpc/zwag471
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiorespiratory Fitness, Multimorbidity Risk, and 15-Year Trajectories in Chronic Disease Accumulation2025 · 4 citations
  2. 2Metabolomic and Proteomic Signatures of Cardiorespiratory Fitness for Predicting All-Cause Mortality and Non-Communicable Disease Risk: A Prospective Study in the UK Biobank2026
  3. 3Associations of Fitness, Fatness Indices and Fit–Fat Index Variants With Cardiovascular and All‐Cause Mortality in Men2026 · 1 citations
  4. 4Adolescent Cardiorespiratory Fitness and the Trade-Off Between Atrial Fibrillation Risk and Cardiovascular Benefits: A Nationwide Sibling-Controlled Cohort Study2026
  5. 5Using Time-Varying Effect Modeling to Examine the Association Between Cardiorespiratory Fitness and Global Cognition in Older Adults: A Nationwide Sample2025