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Joint Associations Between Cardiorespiratory Fitness, Adiposity, and Mortality in Cardiac Outpatients Within a

Andrea Raisi1, Tommaso Piva, Jonathan Myers

  • 1Author Affiliations: Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Drs Raisi,Piva, Zerbini, Masotti, Grazzi, and Mandini); Division of Cardiology, VA, Palo Alto, California (Dr Myers); Stanford University School of Medicine, Stanford, California (Dr Myers); Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois (Dr Grazzi); Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy (Dr Menegatti); and Public Health Department, AUSL Ferrara, Ferrara, Italy (Drs Grazzi and Mazzoni).

Journal of Cardiopulmonary Rehabilitation and Prevention
|April 21, 2025
PubMed

Insights

High cardiorespiratory fitness (CRF) significantly lowers mortality risk in cardiac patients, even those who are overweight or obese. Maintaining CRF is crucial for secondary prevention programs.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Public Health

Background:

  • Cardiorespiratory fitness (CRF) and obesity are established predictors of cardiometabolic risk and mortality.
  • Stable cardiovascular disease (CVD) patients require effective secondary prevention strategies.

Purpose of the Study:

  • To investigate the combined association of CRF and adiposity with all-cause and CVD mortality.
  • To analyze these associations in patients undergoing exercise-based secondary prevention.

Main Methods:

  • Utilized data from the ITER registry, including 2860 cardiac patients (1997-2023).
  • Assessed CRF via the 1-km treadmill walking test.
  • Measured body mass index (BMI) and predicted body fat percentage (pBF%).
  • Employed Cox proportional hazard models, adjusting for confounders.

Main Results:

  • Over 11 years, 1034 deaths (463 CVD) occurred.
  • All fitness-fatness combinations showed increased mortality risk compared to fit, normal-weight individuals.
  • Overweight-unfit and obese-unfit patients had significantly higher mortality risks (HRs ranging from 1.63 to 1.93).
  • Elevated risks were also observed for moderate and high pBF%-unfit groups (HRs ranging from 2.07 to 2.47).
  • Similar patterns were noted for CVD-specific mortality.

Conclusions:

  • Overweight and obesity increase mortality risk, but adequate CRF can mitigate this.
  • CRF is a critical factor in exercise assessment and prescription for cardiac secondary prevention programs.
Abstract

Keywords:
body compositioncardiorespiratory fitnesscardiovascular diseaseepidemiologymortalitysecondary prevention

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