The Joint Association of Fitness and Fatness on Cardiovascular Disease Mortality: A Meta-Analysis.

The joint association of cardiorespiratory fitness (CRF) and body mass index (BMI) on cardiovascular disease (CVD) mortality was determined. PubMed and CINAHL were searched following PRISMA guidelines. Included studies were prospective, had objective assessments of maximal CRF and BMI, and compared the joint impact of CRF and BMI on CVD mortality risk to normal weight, fit referents. Pooled hazard ratios and 95% confidence intervals were calculated from eight articles with nine independent groups using a random effects model. Unfit individuals had two to three times the risk of mortality across all levels of BMI. Overweight and obese-fit individuals had 25% and 42% increased mortality risk, respectively, compared to normal weight-fit individuals. However, for the obese-fit group, a one study removed analysis for five studies resulted in non-significant changes in mortality risk. Researchers, clinicians, and public health officials are encouraged to employ CRF interventions to reduce CDV mortality risk.