Cardiorespiratory fitness assessment using risk-stratified exercise testing and dose–response relationships with disease outcomes

Tomas I. Gonzales, Kate Westgate, Tessa Strain, Stefanie Hollidge, Justin Jeon, Dirk L. Christensen, Jorgen Jensen, Nicholas J. Wareham, Søren Brage

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Cardiorespiratory fitness (CRF) is associated with mortality and cardiovascular disease, but assessing CRF in the population is challenging. Here we develop and validate a novel framework to estimate CRF (as maximal oxygen consumption, VO2max) from heart rate response to low-risk personalised exercise tests. We apply the method to examine associations between CRF and health outcomes in the UK Biobank study, one of the world’s largest and most inclusive studies of CRF, showing that risk of all-cause mortality is 8% lower (95%CI 5–11%, 2670 deaths among 79,981 participants) and cardiovascular mortality is 9% lower (95%CI 4–14%, 854 deaths) per 1-metabolic equivalent difference in CRF. Associations obtained with the novel validated CRF estimation method are stronger than those obtained using previous methodology, suggesting previous methods may have underestimated the importance of fitness for human health.

Original languageEnglish
Article number15315
JournalScientific reports
Issue number1
Publication statusPublished - 2021 Dec

Bibliographical note

Funding Information:
We thank the participants of both the validation study and the UK Biobank study for their time. We are also grateful to all members of the MRC Epidemiology Unit functional groups, including field epidemiology, physical activity technical team, IT and data management for their contribution to the validation study, as well as the UK Biobank principal investigators and study teams. We thank Youngwon Kim for early discussions around the design of the validation study and Thomas White for implementation of the heart beat detection algorithms from Physionet. The present analyses of UK Biobank data use application #408. This work was funded by the UK Medical Research Council (MC_UU_12015/3 and MC_UU_00006/4) and the NIHR Biomedical Research Centre in Cambridge (IS-BRC-1215-20014). UK Biobank is acknowledged for contributing to the costs of the validation fieldwork. The funders had no role in the design, conduct, analysis, and decision to publish results from this study.

Publisher Copyright:
© 2021, The Author(s).

All Science Journal Classification (ASJC) codes

  • General


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