Data from the 1999-2004 National Health and Nutrition Examination Survey were used to describe the distribution of cardiorespiratory fitness and its association with obesity and leisure-time physical activity (LTPA) for adults 20-49 years of age without physical limitations or indications of cardiovascular disease. A sample of 7,437 adults aged 20-49 years were examined at a mobile examination center. Of 4,860 eligible for a submaximal treadmill test, 3,250 completed the test and were included in the analysis. The mean maximal oxygen uptake ( max) was estimated as 44.5, 42.8, and 42.2 mL/kg/minute for men 20-29, 30-39, and 40-49 years of age, respectively. For women, it was 36.5, 35.4, and 34.4 mL/kg/minute for the corresponding age groups. Non-Hispanic black women had lower fitness levels than did non-Hispanic white and Mexican-American women. Regardless of gender or race/ethnicity, people who were obese had a significantly lower estimated maximal oxygen uptake than did nonobese adults. Furthermore, a positive association between fitness level and LTPA participation was observed for both men and women. These results can be used to track future population assessments and to evaluate interventions. The differences in fitness status among population subgroups and by obesity status or LTPA can also be used to develop health policies and targeted educational campaigns.

Importance Cardiorespiratory fitness (CRF) as assessed by formalized incremental exercise testing is a strong independent predictor of numerous chronic diseases but has received little attention as a predictor of incident cancer or survival following a diagnosis of cancer. Objective To assess the association between midlife CRF and incident cancer and survival following a cancer diagnosis. Design Prospective, observational cohort study. Setting Preventive medicine clinic Participants and Exposures The prospective, observational cohort study included 13,949 community-dwelling men who had a baseline fitness examination. All men completed a comprehensive medical examination, a cardiovascular risk factor assessment, and incremental treadmill exercise test to evaluate CRF. We utilized age-sex specific distribution of treadmill duration from the overall CCLS population to define fitness groups as low (lowest 20%), moderate (middle 40%), and high (upper 40%) fit groups. The adjusted multivariable model included: age, exam year, body mass index, smoking, total cholesterol, systolic blood pressure, diabetes, fasting glucose. Main Outcome Measures (1) Incident prostate, lung, and colorectal cancer, and (2) all-cause mortality and cause-specific mortality among men who developed cancer are Medicare age (on or after age 65 years). Results Compared to low CRF, the adjusted hazard ratio (HR) for incident lung, colorectal, and prostate cancer among men with high CRF was 0.45 (95% CI: 0.29-0.68), 0.56 (95% CI: 0.36-0.87), 1.22 (95% CI: 1.02-1.46), respectively. Among those diagnosed with cancer at Medicare age (65 years), high CRF in mid-life was associated with an adjusted 36% (HR 0.64, 95% CI: 0.45-0.93) risk reduction in all cancer related deaths and a 69% reduction in cardiovascular disease mortality following a cancer diagnosis (HR 0.31, 95% CI: 0.15-0.62) compared to low fit men in mid-life. Conclusions and Relevance There is a strong inverse relationship between midlife CRF and incident lung and colorectal cancer but not prostate cancer. High mid-life CRF is also protective against the risk of cause-specific mortality in those diagnosed with cancer at Medicare age.

IMPORTANCE Few data are available to guide clinical recommendations for individuals with high levels of physical activity in the presence of clinically significant coronary artery calcification (CAC). OBJECTIVE To assess the association among high levels of physical activity, prevalent CAC, and subsequent mortality risk. DESIGN, SETTING, AND PARTICIPANTS The Cooper Center Longitudinal Study is a prospective observational study of patients from the Cooper Clinic, a preventive medicine facility. The present study included participants seen from January 13, 1998, through December 30, 2013, with mortality follow-up through December 31, 2014. A total of 21 758 generally healthy men without prevalent cardiovascular disease (CVD) were included if they reported their physical activity level and underwent CAC scanning. Data were analyzed from September 26, 2017, through May 2, 2018. EXPOSURES Self-reported physical activity was categorized into at least 3000 (n = 1561), 1500 to 2999 (n = 3750), and less than 1500 (n = 16 447) metabolic equivalent of task (MET)-minutes/week (min/wk). The CAC scores were categorized into at least 100 (n = 5314) and less than 100 (n = 16 444) Agatston units (AU). MAIN OUTCOMES AND MEASURES All-cause and CVD mortality collected from the National Death Index Plus. RESULTS Among the 21 758 male participants, baseline mean (SD) age was 51.7 (8.4) years. Men with at least 3000 MET-min/wk were more likely to have prevalent CAC of at least 100 AU (relative risk, 1.11; 95% CI, 1.03-1.20) compared with those accumulating less physical activity. In the group with physical activity of at least 3000 MET-min/wk and CAC of at least 100 AU, mean (SD) CAC level was 807 (1120) AU. After a mean (SD) follow-up of 10.4 (4.3) years, 759 all-cause and 180 CVD deaths occurred, including 40 all-cause and 10 CVD deaths among those with physical activity of at least 3000 MET-min/wk. Men with CAC of less than 100 AU and physical activity of at least 3000 MET-min/wk were about half as likely to die compared with men with less than 1500 MET-min/wk (hazard ratio [HR], 0.52; 95% CI, 0.29-0.91). In the group with CAC of at least 100 AU, men with at least 3000 MET-min/wk did not have a significant increase in all-cause mortality (HR, 0.77; 95% CI, 0.52-1.15) when compared with men with physical activity of less than 1500 MET-min/wk. In the least active men, those with CAC of at least 100 AU were twice as likely to die of CVD compared with those with CAC of less than 100 AU (HR, 1.93; 95% CI, 1.34-2.78). CONCLUSIONS AND RELEVANCE This study suggests there is evidence that high levels of physical activity (Ն3000 MET-min/wk) are associated with prevalent CAC but are not associated with increased all-cause or CVD mortality after a decade of follow-up, even in the presence of clinically significant CAC levels.

The relation of body mass index, cardiorespiratory fitness, and all-cause mortality in women. Obes Res. 2002;10:417-423. Objective: To examine the relation of body mass index (BMI), cardiorespiratory fitness (CRF), and all-cause mortality in women. Research Methods and Procedures:A cohort of women (42.9 Ϯ 10.4 years) was assessed for CRF, height, and weight. Participants were divided into three BMI categories (normal, overweight, and obese) and three CRF categories (low, moderate, and high). After adjustment for age, smoking, and baseline health status, the relative risk (RR) of all-cause mortality was determined for each group. Further multivariate analyses were performed to examine the contribution of each predictor (e.g., age, BMI, CRF, smoking status, and baseline health status) on all-cause mortality while controlling for all other predictors. Results: During follow-up (113,145 woman-years), 195 deaths from all causes occurred. Compared with normal weight (RR ϭ 1.0), overweight (RR ϭ 0.92) and obesity (RR ϭ 1.58) did not significantly increase all-cause mortality risk. Compared with low CRF (RR ϭ 1.0), moderate (RR ϭ 0.48) and high (RR ϭ 0.57) CRF were associated significantly with lower mortality risk (p ϭ 0.002). In multivariate analyses, moderate (RR ϭ 0.49) and high (RR ϭ 0.57) CRF were strongly associated with decreased mortality relative to low CRF (p ϭ 0.003). Compared with normal weight (RR ϭ 1.0), overweight (RR ϭ 0.84) and obesity (RR ϭ 1.21) were not significantly associated with all-cause mortality. Discussion: Low CRF in women was an important predictor of all-cause mortality. BMI, as a predictor of all-cause mortality risk in women, may be misleading unless CRF is also considered.

This study suggests that GOR-related aspiration plays a role in chronic cough in children with known GOR. Detecting pepsin in BAL fluid may therefore become an important adjunct in patient selection for antireflux surgery.

In US youth, cardiorespiratory fitness is lower in males and females who are overweight than in those of normal weight, but fitness is not related to race/ethnicity. Youth who have low levels of physical activity and high levels of sedentary behavior are also more likely to have lower cardiorespiratory fitness.

FARRELL, STEPHEN W., YILING J. CHENG, AND STEVEN N. BLAIR. Prevalence of the metabolic syndrome across age strata and cardiorespiratory fitness levels in women. Obes Res. 2004;12:824 -830. Objective: To determine the prevalence of the metabolic syndrome across age strata and cardiorespiratory fitness (CRF) levels in women. Research Methods and Procedures: 7104 women underwent a physical examination, including a maximal treadmill exercise test. Participants were divided into CRF quintiles according to age. The metabolic syndrome was identified using Adult Treatment Panel-III Guidelines. Tests for trend were performed on demographic variables across CRF quintiles, as well as prevalence of the metabolic syndrome across CRF quintiles, age strata, and maximal workload achieved [maximal metabolic equivalent (MET) level]. Results: The overall prevalence of the metabolic syndrome was 6.5%. Age-and smoking-adjusted prevalence was lower across quintiles of CRF (19.0%, 6.7%, 6.0%, 3.6%, and 2.3% for quintiles I to V, respectively, p for trend ϭ 0.001). Smoking-adjusted prevalence of the metabolic syndrome was higher across age strata (2.4%, 2.7%, 6.4%, 8.7%, 15.3%, and 16.1% for ages 20 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 to 80, respectively, p for trend ϭ 0.001). Prevalence of the metabolic syndrome in the different age groups for women who achieved a maximal MET level of 11 or higher was one-third to one-fourth that of women who achieved lower maximal MET levels. Discussion: Prevalence of the metabolic syndrome was markedly lower across progressively higher levels of CRF in women of different age strata. Because regular physical activity improves components of the metabolic syndrome, modest increases in CRF among low fit women may ameliorate the metabolic syndrome in some instances.

Results: During a mean follow-up period of 17.2 Ϯ 7.9 years, 1037 cancer deaths occurred. Adjusted hazard ratios across incremental BMI quintiles were 1.0, 1.23, 1.15, 1.39, and 1.72; those of WC were 1.0, 1.05, 1.03, 1.31, and 1.64; those of percent body fat were 1.0, 1.24, 1.17, 1.23, and 1.50; and those of CRF were 1.0, 0.70, 0.67, 0.70, and 0.49 (trend p Ͻ 0.01 for each). Further adjustment for CRF eliminated the significant trend in mortality risk across percent body fat groups and attenuated the trend in risk across BMI and WC groups. Adjustment of CRF for adiposity measures had little effect on mortality risk. When grouped into categories of fit and unfit (upper 80% and lower 20% of CRF distribution, respectively), mortality rates (per 10,000 man-years) were significantly lower in fit compared with unfit men within each stratum of BMI, WC, and percent body fat. Discussion: Higher levels of CRF are associated with lower cancer mortality risk in men, independently of several adiposity measures.