A claim you hear on longevity podcasts
The claim checked: Below-average vs above-average VO2 max for age carries a 1.41 hazard ratio, the same as smoking Hear it at 9:33
All ten studies linked lower fitness to a higher risk of death, in men and women and in older adults. Each one observed people rather than testing fitness.
Computed from 10 studies that test this point, each judged by two readers, in full. 10 more studies are waiting for a full read and do not count yet.
“the hazard ratio is 1.41 in other words you are 41% more likely to die in the coming year than somebody who is that much fitter than you and by the way it's not it's not lost on anybody that that's the exact same Hazard ratio of a smoker to a non-smoker”
other primary study · 1999 · landmark
“Unfit men had a higher risk of all-cause and CVD mortality than did fit men in all fat and fat-free mass categories.”
Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr
Who: 21,925 US men aged 30-83 y (Cooper Clinic, Aerobics Center Longitudinal Study), mostly white, middle/upper socioeconomic status, no history of MI, stroke or cancer
PMID 10075319
other primary study · 2007 · landmark
“In conclusion, our prospective findings in adults ages 60 and over show that low fitness predicted higher all-cause mortality risk after adjustment for potential confounding factors including adiposity.”
Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA
Who: 2,603 adults aged 60+ (mean 64.4 y, 19.8% women) examined at the Cooper Clinic, Dallas (Aerobics Center Longitudinal Study), mostly white, well-educated, middle to upper socioeconomic status
PMID 18056904
other primary study · 2018 · landmark · cited on tape
“Increased CRF was associated with reduced long-term mortality with no observed upper limit of benefit.”
Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open
Who: consecutive adults (mean age 53.4, 59.2% male) undergoing symptom-limited exercise treadmill testing at a tertiary care center, 1991-2014
PMID 30646252
other primary study · 2022 · landmark
“The adjusted association of CRF and mortality risk was inverse and graded across the age spectrum, sex, and race.”
Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex. J Am Coll Cardiol
Who: US veterans aged 30-95 (mean 61.3) who completed a Bruce-protocol exercise treadmill test, 94% men
PMID 35926933
pooled analysis · 2024 · landmark
“This overview of systematic reviews demonstrated that CRF is a strong and consistent predictor of risk across many mortality outcomes in the adult general population.”
Cardiorespiratory fitness is a strong and consistent predictor of morbidity and mortality among adults: an overview of meta-analyses representing over 20.9 million observations from 199 unique cohort studies. Br J Sports Med
Who: Adults 18+ (apparently healthy and with chronic conditions) in cohort studies pooled by systematic reviews; predominantly male samples
PMID 38599681
pooled analysis · 2022 · landmark
“In the most updated comprehensive meta-analysis, high levels of objectively assessed CRF were strongly and independently associated with reduced risk of all-cause mortality.”
Objectively Assessed Cardiorespiratory Fitness and All-Cause Mortality Risk: An Updated Meta-analysis of 37 Cohort Studies Involving 2,258,029 Participants. Mayo Clin Proc
Who: general-population adults (mean age about 48) in 37 observational cohorts with exercise-test-assessed cardiorespiratory fitness
PMID 35562197
pooled analysis · 2025 · landmark
“Importantly, individuals who were unfit had a ~2-fold increase in the risk of all-cause mortality and a ~2–3-fold increase in the risk of CVD mortality.”
Cardiorespiratory fitness, body mass index and mortality: a systematic review and meta-analysis. Br J Sports Med
Who: adults in prospective cohorts (mean age 42.4-64.4 years, 67% male, mostly US, some with CVD, diabetes or hypertension) with CRF measured by maximal or VO2peak exercise test and clinic-measured BMI
PMID 39537313
other primary study · 2018
“CRF was significantly related to longevity over the course of 4 decades in middle-aged, employed men free of CVD.”
Midlife Cardiorespiratory Fitness and the Long-Term Risk of Mortality: 46 Years of Follow-Up. J Am Coll Cardiol
Who: 5,107 employed Copenhagen men aged 40-59 (mean 48.8) free of cardiovascular disease at baseline (Copenhagen Male Study, 1970-71)
PMID 30139444
other primary study · 2016
“Fitness was inversely associated with mortality in both men (hazard ratio [HR], 0.84 per 1 MET; 95% CI, 0.83-0.85) and women (HR, 0.83 per 1 MET; 95% CI, 0.81-0.84).”
Sex Differences in Cardiorespiratory Fitness and All-Cause Mortality: The Henry Ford ExercIse Testing (FIT) Project. Mayo Clin Proc
Who: 57,284 patients (29,470 men, 27,814 women; mean age 53-54) without coronary artery disease or heart failure referred for treadmill stress testing at Henry Ford Health System, Detroit, 1991-2009
PMID 27161032
other primary study · 2022
“Higher NEE-CRF was independently associated with lower risk of death from all-causes, cardiovascular disease and cancer.”
Non-exercise estimated cardiorespiratory fitness and mortality from all-causes, cardiovascular disease, and cancer in the NIH-AARP diet and health study. Eur J Prev Cardiol
Who: NIH-AARP Diet and Health Study members aged 50-71 years in six US states and two metropolitan areas, free of cancer, CVD, stroke and end-stage kidney disease at baseline (>90% non-Hispanic white)
PMID 33624091
None.
None.
One cohort reports the same 1.41 hazard ratio for below- vs above-average fitness. Four others found risk rising step by step but grouped fitness differently.
Computed from 5 studies that test this point, each judged by two readers, in full. 5 more studies are waiting for a full read and do not count yet.
other primary study · 2018 · landmark · cited on tape
“The increase in all-cause mortality associated with reduced CRF (low vs elite: adjusted HR, 5.04; 95% CI, 4.10-6.20; P < .001; below average vs above average: adjusted HR, 1.41; 95% CI, 1.34-1.49; P < .001) was comparable to or greater than traditional clinical risk factors.”
Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open
Who: adult patients referred for exercise treadmill testing at Cleveland Clinic, 1991-2014 (mean age 53.4, 59.2% male)
PMID 30646252
other primary study · 2022 · landmark
“The risk for least fit individuals (20th percentile) was 4-fold higher (HR: 4.09; 95% CI: 3.90-4.20) compared with extremely fit individuals.”
Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex. J Am Coll Cardiol
Who: US veterans aged 30-95 (mean 61.3) who completed a Bruce-protocol exercise treadmill test, 94% men
PMID 35926933
other primary study · 2022
“Compared to the lowest quartile of NEE-CRF, the hazard ratios and 95% confidence interval for all-cause mortality in the second, third, and fourth quartiles were: 0.82 (0.79-0.84), 0.74 (0.72-0.77), and 0.70 (0.67-0.73) for men, and 0.84 (0.81-0.88), 0.78 (0.75-0.82), and 0.72 (0.68-0.77) for women (P trend <0.001 for all).”
Non-exercise estimated cardiorespiratory fitness and mortality from all-causes, cardiovascular disease, and cancer in the NIH-AARP diet and health study. Eur J Prev Cardiol
Who: 330,769 US adults aged 50-71 (NIH-AARP Diet and Health Study) without baseline cancer or CVD
PMID 33624091
other primary study · 2022
“More specifically, within WBC Quartile 1, HR were 1.0 (referent), 1.29 (95%CI: 1.06‒1.57), and 2.03 (95%CI: 1.42‒2.92) for high, moderate, and low CRF categories, respectively.”
Cardiorespiratory fitness, white blood cell count, and mortality in men and women. J Sport Health Sci
Who: apparently healthy adults (mean age 45.2) completing a maximal treadmill test at the Cooper Clinic, Dallas, 1978-2015 (Cooper Center Longitudinal Study)
PMID 34740872
other primary study · 2011
“After adjusting for age and examination year (model 1), the age-specific CRF had a significant inverse association with all-cause mortality (p for trend <0.0001), with men in the Q2 to Q4 having significantly lower all-cause mortality compared to men in Q1.”
Usefulness of serum bilirubin and cardiorespiratory fitness as predictors of mortality in men. Am J Cardiol
Who: 1,279 men aged 30-82, Cooper Clinic (ACLS), mostly white, middle-upper class
PMID 21864819
None.
The Precis Weekly
One email a week with the claims and episodes we checked, what the studies found and the minute each claim was said.
Free. Unsubscribe anytime.