Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Cardiorespiratory Fitness Change & Mortality Risk

Am J Med; 2017 Oct; Ehrman, Brawner, et al

Among both black and white patients, change in cardiorespiratory fitness from low to intermediate/high fitness is associated with a substantially lower risk of all-cause mortality, a recent study found. The Henry Ford Exercise Testing (FIT) Project is a retrospective, longitudinal, observational study that included 13,345 patients (median age 55±11 years; 39% women, 26% black) who completed 2 exercise tests at least 12 months apart. All-cause mortality was identified through April 2013. Mean time between tests was 3.4 years. Researchers found:

  • During 9.1 years of follow-up, there were 1,931 deaths (16.5% black, 13.7% white).
  • Among both black and white patients, change in cardiorespiratory fitness from low to intermediate/high fitness was associated with a 35% and 59% lower risk of all-cause mortality, respectively.
  • Each 1-metabolic-equivalent-of-task increase was associated with a reduced mortality risk in black (HR, 0.84) and white (HR, 0.87) patients.


Ehrman JK, Brawner CA, Al-Mallah MH, Qureshi WT, Blaha MJ, Keteyian SJ. Cardiorespiratory fitness change and mortality risk among black and white patients: Henry Ford Exercise Testing (FIT) Project. Am J Med. doi:10.1016/j.amjmed.2017.02.036.


Low cardiorespiratory fitness is a risk factor for all-cause as well as cardiovascular-specific death.1 This relationship exists in tandem with the effect of traditional CV risk factors including hypertension, hyperlipidemia, and diabetes.2 Many studies have shown that improvement in CV fitness in middle age leads to lower CV mortality over the subsequent 1 to 2 decades. Studies have also shown that individuals who are black have higher CV risk than white individuals. The current study further supports this existent data on the benefits of fitness during middle age on CV outcomes and expands the data to show that the improvement in fitness is true for both black and white individuals. The evidence is clear that the assessment and promotion of fitness with a goal of CV risk modification is an important part of our preventive health approach. —Neil Skolnik, MD

  1. Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301:2024-2035. doi:10.1001/jama.2009.681.
  2. Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: A case for fitness as a clinical vital sign: A scientific statement from the American Heart Association. Circulation. 2016;134:e653-e699. doi:10.1161/CIR.0000000000000461.

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